18
Nov
2020
BMS ep 164: Arguments on Mask Mandates
This starts with broccoli but ends with ice cream. Specifically, I point out that one of Biden’s Transition Team covid-19 experts back in June came out with stern warnings about mask mandates.
Bob, I feel your pain. For people who believe masks are a bad idea they will see any evidence as supporting it. Many find it difficult to support the position that mandates are bad even if masks reduce infections and universal wearing will lead to fewer deaths. Therefore they have to claim that masks do not work, masksare actually harmful, there is no problem to begin with or that mandates will lead to reduced mask wearing.
As you say, it is perfectly possible to support the claim that masks work but they should not be mandated because people’s freedom to not wear masks is more important than saving lives.
The other claim is more difficult, I would say impossible now that it has become politicised. If you don’t want to wear a mask you must either not think they work or not care about others to the extent you will not do this simple thing. Few will admit to the latter, so we are still left with the belief they do not work or that there is no problem to begin with. Most of those that don’t think masks work are also less concerned about Covid-19 generally, in part because someone kept telling them it was like a flu and it would go away. These people will not wear a mask without a mandate. It seems probable that some of them will with a mandate. It is also possible that more will refuse, but that is a sad indictment that people are prepared for others to die for their small freedom to be maskless.
Small point, but surgeons generally do not wear N95 masks, but surgical masks.
I often appeal to evidence and data, but it has very little effect. People just pick the sources that back up what they want to believe. This will often require a deep suspicion of certain sources, such a media or peer reviewed journals so they can be avoided. For example, the CDC will be treated as unreliable, so I can point to CDC reports showing that masks work, but this evidence will be dismissed.. You can’t believe anything they say.
It is very difficult to get someone to make an argument for not wearing masks that does not rely on highly selective sources. Since reliable sources are rejected all that is left is “I saw it on blog or video”, which is also seen as somehow not too convincing. All that is left is the non sequitur, as you describe.
“Risks of N95 Face Mask Use in Subjects With COPD”
Sun Young Kyung, Yujin Kim, Hyunjoong Hwang, Jeong-Woong Park and Sung Hwan Jeong
Respiratory Care May 2020, 65 (5) 658-664; DOI: https://doi.org/10.4187/respcare.06713
http://rc.rcjournal.com/content/65/5/658
Definitely more than a blog or a video.
The final sentence of the conclusion reads, “Also, patients should be warned to remove the N95s immediately on the onset of dyspnea, headache, or dizziness.”
The text of the study mentions that, “Most of the subjects (n = 6) in the mask failure group removed the mask during the 6MWT due to low SpO2 or CO2 retention. All the subjects exhibited decreased SpO2, increased PETCO2, and dyspnea.”
SpO2 is oxygen saturation. And, according to Hamilton Medical, “In general, PetCO2 value represents a reliable index of CO2 partial pressure in the arterial blood (PaCO2) (measured using blood gas analysis (BGA)). To get the most accurate approximation of PaCO2, the second highest PetCO2 value out of 8 breaths is used.” So if I am correctly understanding the article, the N95s reduced oxygen saturation and increased carbon dioxide partial pressure in arterial blood even in the COPD patients who succeeded in wearing the N95 masks, just not to the extreme that they felt they had to take them off. However, in a few patients, the effect was severe enough that they felt they had to remove the masks.
Obviously, this one study doesn’t prove that no one should ever wear N95s, and certainly not that no one should ever wear other types of masks. The study even encourages cautious mask-wearing. But it also comes with a rather huge disclaimer. “Also, patients should be warned to remove the N95s immediately on the onset of dyspnea, headache, or dizziness.” In other words, wearers of N95 masks should monitor their symptoms and remove their masks if certain symptoms appear.
Now, the study doesn’t test cloth masks, but there are people with asthma and other breathing conditions who have alleged that they have trouble breathing with such masks on, and I don’t think we should disbelieve them, just because their reports are anecdotal, any more than we should disbelieve reports of food allergy reactions, just because they are anecdotal, and this study does at least lend credence to such claims.
It’s fairly standard for medicine and medical equipment to carry such disclaimers. Discontinue use if you experience any potentially serious side effects, such as [whatever the list of potentially serious side effects is]. It seems obvious, to me at least, that mandating people take a medicine or use a particular piece of medical equipment regardless of the symptoms they experience crosses the boundary from responsible medicine to medical tyranny.
And it does raise questions. If N95s can cause such side effects in some COPD patients, could N95s or other types of masks also have less noticeable, but still undesirable, effects in people with healthier lungs? (Which I suppose is a question to be answered by other studies.)
“Risks of N95 Face Mask Use in Subjects With COPD”
Sun Young Kyung, Yujin Kim, Hyunjoong Hwang, Jeong-Woong Park and Sung Hwan Jeong
Respiratory Care May 2020, 65 (5) 658-664; DOI: doi [dot ] org [slash] 10.4187/respcare.06713
http://rc.rcjournal.com/content/65/5/658
Definitely more than a blog or a video.
The final sentence of the conclusion reads, “Also, patients should be warned to remove the N95s immediately on the onset of dyspnea, headache, or dizziness.”
The text of the study mentions that, “Most of the subjects (n = 6) in the mask failure group removed the mask during the 6MWT due to low SpO2 or CO2 retention. All the subjects exhibited decreased SpO2, increased PETCO2, and dyspnea.”
SpO2 is oxygen saturation. And, according to Hamilton Medical, “In general, PetCO2 value represents a reliable index of CO2 partial pressure in the arterial blood (PaCO2) (measured using blood gas analysis (BGA)). To get the most accurate approximation of PaCO2, the second highest PetCO2 value out of 8 breaths is used.” So if I am correctly understanding the article, the N95s reduced oxygen saturation and increased carbon dioxide partial pressure in arterial blood even in the COPD patients who succeeded in wearing the N95 masks, just not to the extreme that they felt they had to take them off. However, in a few patients, the effect was severe enough that they felt they had to remove the masks.
Obviously, this one study doesn’t prove that no one should ever wear N95s, and certainly not that no one should ever wear other types of masks. The study even encourages cautious mask-wearing. But it also comes with a rather huge disclaimer. “Also, patients should be warned to remove the N95s immediately on the onset of dyspnea, headache, or dizziness.” In other words, wearers of N95 masks should monitor their symptoms and remove their masks if certain symptoms appear.
Now, the study doesn’t test cloth masks, but there are people with asthma and other breathing conditions who have alleged that they have trouble breathing with such masks on, and I don’t think we should disbelieve them, just because their reports are anecdotal, any more than we should disbelieve reports of food allergy reactions, just because they are anecdotal, and this study does at least lend credence to such claims.
It’s fairly standard for medicine and medical equipment to carry such disclaimers. Discontinue use if you experience any potentially serious side effects, such as [whatever the list of potentially serious side effects is]. It seems obvious, to me at least, that mandating people take a medicine or use a particular piece of medical equipment regardless of the symptoms they experience crosses the boundary from responsible medicine to medical tyranny.
And it does raise questions. If N95s can cause such side effects in some COPD patients, could N95s or other types of masks also have less noticeable, but still undesirable, effects in people with healthier lungs? (Which I suppose is a question to be answered by other studies.)
Interestingly, some Standford engineers have been attempting to redesign N95s to include oxygen concentrators to help counteract reported side effects from N95 usage.
https://news.stanford.edu/2020/04/14/stanford-researchers-reengineer-covid-19-face-masks/
Another thing is that, even if we assume for the sake of argument that masks are helpful when used properly, for some definition of properly, it’s not reasonable to assume that people who are compelled to wear masks by a mandate will all be wearing them properly.
For example, I have had multiple people confess to me that, on occasions when they couldn’t find their mask or had lost it, they picked up a used mask off the sidewalk or ground and used that. Some of the people who confessed this were homeless, and a few were not homeless. None of them seemed to think it was a particularly good idea to use masks that had been discarded by others, except in so far as it brought them into compliance with mask mandates. One homeless man said that he prayed the mask he picked up off the sidewalk wasn’t contaminated with COVID or anything, but decided that it was less risky to take a mask off the sidewalk than to miss lunch because he wasn’t wearing a mask.
A number of homeless people I spoke to also complained that it was literally impossible for them to wash their masks properly, especially since a number of charities which previously offered laundry services to the homeless have apparently stopped providing laundry services.
If masks were voluntary and not mandated, we might expect that a person who had misplaced or lost their mask would simply not wear one until able to obtain a new, sanitary one (or find their old one), rather than resorting to picking up a used mask off the sidewalk. One might also expect that, if masks were voluntary and not mandated, homeless people without access to laundry facilities to wash their masks properly would only wear masks temporarily after someone had offered them a fresh, disposable mask, and would forgo repeated re-use of unwashed masks.
“Bob, I feel your pain. For people who believe masks are a bad idea they will see any evidence as supporting it. Many find it difficult to support the position that mandates are bad even if masks reduce infections and universal wearing will lead to fewer deaths. Therefore they have to claim that masks do not work …”
Uh oh:
WHO stands by recommendation to not wear masks if you are not sick or not caring for someone who is sick
[www]https://www.cnn.com/2020/03/30/world/coronavirus-who-masks-recommendation-trnd/index.html
“There is no specific evidence to suggest that the wearing of masks by the mass population has any potential benefit. In fact, there’s some evidence to suggest the opposite in the misuse of wearing a mask properly or fitting it properly,” Dr. Mike Ryan, executive director of the WHO health emergencies program, said at a media briefing in Geneva, Switzerland, on Monday.”
Somewhere in there, you mention that some people suggesting just protecting the elderly and the vulnerable by just isolating them, and you point out people would still need to bring food and stuff to the elderly and the vulnerable (I can’t recall exactly how you worded it, but anyway), and I would like to point out that in a number of nursing homes, people have taken the idea of “protecting” the elderly and the vulnerable from COVID-19 has been taken to the extreme of not bringing them food.
For example, when the Spanish army went into Spanish nursing homes on a disinfection mission, they found out some elderly residents “completely abandoned” and even “dead in their beds”.
https://www.npr.org/sections/coronavirus-live-updates/2020/03/24/820711855/spanish-military-finds-dead-bodies-and-seniors-completely-abandoned-in-care-home
Propublica published the story of one Natasha Roland of New York who rescued her 82-year-old father from a “care” home where he hadn’t been given food for a week, wasn’t being given is his medication, and had apparently come down with coronavirus, even after the care home administrator had repeatedly lied to her and told her he was fine.
www [dot] propublica [dot] org/video/rescuing-her-father-from-an-assisted-living-facility-in-the-coronavirus-epicenter
It’s worth pointing out that, according to an article published back in June, nearly half the COVID-19 deaths in the United States were, in one way or another, linked to nursing homes.
nypost [dot] com/2020/06/27/almost-half-of-us-covid-19-deaths-are-linked-to-nursing-homes/
Although it looks like more recent statistics bring the percent of US COVID-19 deaths linked to nursing homes down to 38%.
www [dot] nytimes [dot] com/interactive/2020/us/coronavirus-nursing-homes.html?action=click&module=Spotlight&pgtype=Homepage
The article also mentions that, “In 17 states, at least half of deaths are linked to nursing homes.”
In Sweden, the idea of “protecting” the ederly from COVID-19 has gone to the extreme of involuntarily euthanizing COVID-19 patients, and, according to PBS, the instructions regarding this came from the very top.
www [dot] pbs [dot] org/newshour/show/denmark-and-sweden-responded-differently-to-the-pandemic-how-did-they-fare
This article is quite explicit about the method of euthanasia used in Sweden.
mercatornet [dot] com/did-covid-19-open-the-door-to-euthanasia-in-sweden/63962/
To quote that article:
To contextualize this problem, consider the large number of law firms specializing in the area of nursing home abuse and neglect.
Also consider allegations of what some call “stealth euthanasia” by people like Ron Panzer.
https://web.archive.org/web/20201102054807/http://www.hospicepatients.org/this-thing-called-hospice.html
So, if nursing home abuse and neglect was already enough of a problem to attract the attention of a significant number of law firms pre-lockdown, and bad enough to draw allegations of stealth euthanasia from some people such as Ron Panzer, it’s not surprising that lockdowns – in particular, the aspect of not allowing family and other visitors into nursing homes (which was done even in Sweden) – have apparently exacerbated the situation in some nursing homes.
Also of interest, respiratory illnesses in general are more deadly in the nursing home context, see for example:
“Paramyxovirus Outbreak in a Long-Term Care Facility: The Challenges of Implementing Infection Control Practices in a Congregate Setting”
https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/paramyxovirus-outbreak-in-a-longterm-care-facility-the-challenges-of-implementing-infection-control-practices-in-a-congregate-setting/6B8A94211F5CA02FE72A1F06ED164440/core-reader
For a summary, see:
“Common viruses prove dangerous in long-term care facility”
https://medicalxpress.com/news/2017-01-common-viruses-dangerous-long-term-facility.html
Just came across this, while I was actually searching for something else, but anyway.
It’s titled, “Millions of Americans can’t stay home with the flu, so it spreads: In America, paid sick leave is not guaranteed.” It’s dated February 13, 2018.
https://www.popsci.com/flu-season-paid-sick-leave/
It’s a reminder that, not long ago, not only were people not required to stay home when sick (usually, I’m sure there were exceptions), but many were not in a position where they could afford to. Some of the arguments in the article, regarding the flu, are similar to present day arguments regarding COVID-19. For example, the author writes, “A healthy young adult isn’t likely to die from influenza. But that person’s grandmother is, and she’d be at a lower risk of contracting the virus in the first place if we all stayed home when we felt ill.”
But the recommendations the author makes are far more moderate than present day recommendations about lockdowns and whatnot. Mostly the author recommends paid sick leave.
For example,
Today, many still aren’t in a position to afford to be able stay home when sick, and yet many are required to stay home even if they aren’t sick and even if they can’t afford it. I’ve met panhandlers who say they became homeless because of the lockdowns and describe lockdown policies in ways like, “Stay home until you lose your home.”
It really makes me wonder why our culture couldn’t have tried more moderate interventions, like paying people to stay home when sick instead of demanding they stay home even when not sick and even if they aren’t able to financially make ends meet while staying home.
“Somewhere in there, you mention that some people suggesting just protecting the elderly and the vulnerable by just isolating them, and you point out people would still need to bring food and stuff to the elderly and the vulnerable (I can’t recall exactly how you worded it, but anyway),”
i don’t know what comment specifically, but I have have said that separating the old from the young would be a way to mitigate the worst problems of Covid, but that I could not see a way to do it. The Great Barrington Declaration suggests this, but offers absolutely no way to achieve it. It is like saying we could stop all Covid spread if we could stop people breathing. True but useless. It is very easy to point out the easy part, but unless you adress the hard part your contribution is useless.
i think this is where the attenton shoud be focused -how could we construct a society where the old are separated from the young. It is not easy. I have hope that now a vaccine is imminemt we don’t need to solve this problem, Just keep cases low for a while and the vaccine will solve it for us. I hope I am not being too optimistic.
Regarding paid sick leave, this is something that can claerly benefit everyone. Mostly in Europe this is accepted. Sure, there is probably some abuse, but the benefits are clear.
On masks, we all know that wearing a 2 layer cloth or surgical mask is not a problem for the vast majority of people.. Don’t make the exception the rule.
Apologies, just then, I mean “you” as in Bob Murphy. He said something to that effect in his episode. However, I realize that you (as in Harold) have also expressed similar sentiments at times. Sorry for the confusion. I should have been more explicit.
That’s actually a good analogy. If people stopped breathing, they would stop spreading COVID-19, but have worse problems, like all being dead within 5 minutes or so. If we separated the old from the young, it would stop the young from spreading COVID-19 to the old, but soon many of the old would have worse problems, like dehydration, starvation, and lack of help with sanitation.
I think it’s the wrong direction to go in. It’s not even what many of the elderly want. Even if they could somehow be cared for by robots, many elderly fear loneliness more than they fear death.
See for example,
“Covid-19 has terminally ill in Victoria fearing dying alone if they go into palliative care: Cancer Council says people nearing death want to be with those they love rather than be isolated and lonely”
by Melissa Davey
www [dot] theguardian [dot] com/australia-news/2020/sep/21/covid-19-has-terminally-ill-in-victoria-fearing-dying-alone-if-they-go-into-palliative-care
I think Zeynep Tufekci has the right idea about ventilation.
“We Need to Talk About Ventilation: How is it that six months into a respiratory pandemic, we are still doing so little to mitigate airborne transmission?”
https://www.theatlantic.com/health/archive/2020/07/why-arent-we-talking-more-about-airborne-transmission/614737/
Zeynep Tufekci writes,
Apparently, there was a case of a tuberculosis outbreak that was solved by improving ventilation.
“Effect of ventilation improvement during a tuberculosis outbreak in underventilated university buildings”
onlinelibrary [dot] wiley [dot] com/doi/full/10.1111/ina.12639
I agree. I long felt it was a cultural peculiarity of the United States (and perhaps so many other places too) that so many employers were so reluctant to offer sick leave, and so many customers didn’t seem to care. It seems to me that, for example in the food service industry, I should expect that people should feel more comfortable buying food from restaurants that gave their employees sick leave. However, Puritan values about hard work and just pushing through it seemed to override common sense, as a cultural matter. But one thing that really struck me when reading that article was that, although radical by 2018 standards, it was incredibly moderate by 2020 standards.
I’m not exactly sure how the concept of paid sick leave could be extended to people such as day laborers and buskers. Perhaps this indicates a lack of creativity on my part. I recall reading something about Ivorian farm workers pooling money together to go to the pharmacy when someone got sick, but I don’t think that’s quite the same thing as paid sick leave. However, even if it was only applied to people working for large companies that are presumably able to afford it, that would still have been a substantial improvement relative to what the status quo was back in 2018
Harold wrote,
It’s true that the exception isn’t the rule, but, arguably, an exception is a good reason not to leave the enforcement of the rule up to either police or vigilantes. Also, an exception may also be reason for further investigation. If some people with severe asthma react adversely to even short term mask usage, what might the effect be on someone who doesn’t have severe asthma, but has to work 12 hour shifts under stressful conditions?
Arguably, the Canadian health authorities have a more balanced approach, advising the use of masks, while also reminding people that there are exceptions, and that people should therefore refrain from being judgmental and not “assume that someone who isn’t wearing a mask or is wearing something different doesn’t have an actual reason for it.”
www [dot] ctvnews [dot] ca/health/coronavirus/masks-problematic-for-asthmatic-autistic-deaf-and-hard-of-hearing-health-advocates-1.4948802
It’s also worth pointing out that while homeless people are a minority (at least in the United States), they represent a disproportionate percent of the people who are not at home at any given point in time (since, by definition, a homeless person doesn’t have a home to be at), and are therefore subject to mask mandates which apply whenever a person is not at home.
Here’s another article about the benefits of ventilation, although it involves a “computational fluid dynamics (CFD) simulation of airflow field and virus dispersion” rather than a real world study.
“Ventilation of general hospital wards for mitigating infection risks of three kinds of viruses including Middle East respiratory syndrome coronavirus”
https://journals.sagepub.com/doi/10.1177/1420326X16631596
The idea of reccommending masks for all but being tolerant of the few who cannot do so for reasonable reasons works very well in society that has certain shared basic values. Unfortunarely, the USA is not such a societry and hence these reasonable and basic principles cannot work.
These principles give some adavantges in a cut and thrust capitalist environment. USA has done very well from them. but it has left a lot of people behind, and in a pandemic it has left a lot of people dead.
Just on masks, say the scientists are right, and if eveyone wore masks we would reduce transmission by some factor and those getting th dsisease woud likely have a milder version of it,. Then if everyone did wear a mask, we woud reduce transmission by that factor, and that many feweer people would have contracted Covid-19., and that many fewer people would have died.
The evidence is not 100% so there is a chance the scientists are wrong. That chance is quite small, but possible.
It seems obvious that a sensible societywould adopt mask wearing. That assumes that the society has shared vales,values other members of the society and will act accordingly.
This provides gret strength for that society, but also a great vulnerabilty to coersion from a dictaotor.
it seems to me that USA has fetishised the individual beyond the point where it is providinng useful defense against tyranny and is just counter productive in collecive action againsts a problem like a pandemic.
The big problem is that those arguing for the individual are not accepting eviednce. You could make a case for letting covid run rampant and accepting the deaths. Nobody made that case. Tney made an imaginaru cae that covid was not a problem. If someone genuinely made the case that we should carry on with no social distancing and accept over 1 million deaths then we could argue the plusses and mnuses. What has happened is that we have argued about facts. Arguing about facts is pointless because facts are true and reality willl prevail. Nonetheless, it may be a short term benefit for some people to deny this.
Despite the denialists, 1/4 of a million Americams have died of Covid-19. This pandemic is a tragedy and there is no point in denying it. Alll that really matters is plotting a best course to minimise the impact. People are going to continue to die of thiis, but plausibly a vaccine will stop in its tracks early next year. Until then, we have a choice to make about how many poeple will die.
At least with respect to mask wearing, I would say that Canada is much more individualistic than the USA.
In US political discourse, I’ve often gotten the sense that “individualism” is often promoted by people who don’t really believe in it. For example, it seems that some people proclaiming to be individualists, seem less interested in considering their opponents as individuals, than in simply smearing their opponents as “collectivists”.
Ayn Rand comes to my mind as one of the more blatant examples of this, who alleged that the native Americans did not have “respect for individual rights” at the same time as she defended the genocide of native Americans.
https://www.salon.com/2015/10/14/libertarian_superstar_ayn_rand_defended_genocide_of_savage_native_americans/
While Ayn Rand is a rather blatant example, I don’t think the United States suffers from too much individualism, I think the United States suffers from too much fake individualism where alleged proponents of individualism only grant the mantle of “individual” to favored peoples.
Respecting exemptions has less to do with distorted ideas about individualism in the United States, and more to do with medical ideals such as “Do no harm.” Perhaps an absolutely literal interpretation of “do no harm” is impossible, because mistakes happen, but reasonable efforts to “do no harm” include warning lists of potential side effects, including some which are serious enough to discontinue use of a drug, device, or other intervention. Reasonable efforts to “do no harm” also include warning labels for common food allergens like peanuts. Forcing a patient to continue use of a drug, device, or other intervention, even after the patient has stated that they experienced a potentially severe side effect, seems, in my opinion, an obvious violation of the Hippocratic Oath.
Yeah well strangely flu deaths have gone away and one of the major co-morbidities for COVID is Alzheimer’s which does kill people anyhow (although they die fast with both COVID and Alzheimer’s). I suspect there might be some “Cobra effect” happening in the statistics where, then COVID deaths are worth a lot more money to the hospitals than flu deaths.
https://realclimatescience.com/2020/08/covd-19-retroactively-cures-the-flu/
This is the first time in human history we have had widespread testing … therefore the science of looking under the lamp post has become slightly larger because a new lamp post just lit up. Don’t conclude too much … people die every year.
https://straight2point.info/22-falsities-you-probably-still-believe/#Falsity15
There’s some fairly good stats from Ivor Cummins and Michael Levitt showing that COVID-19 has been only slightly worse than a typical flu season (e.g. 2017-2018). Obviously that’s no comfort to the people who died of COVID, but then again plenty of people also died of flu a few years back and no one freaked out then.
At some stage, modern people need to come to grips with mortality … because it ain’t going away any time soon.
I assume you are familiar with the term “playing God”? It is sometimes used to refer to acts of choosing who will live and who will die, in cases where not everyone can be saved.
If in order to save some people from COVID (at least for a particular method of saving, such as a lockdown), we have to let other people die of child abuse, domestic violence, nursing home abuse and neglect, and invountary euthanasia, this is, in my view at least, is “playing God”.
Yes, people are dying of COVID-19, just as in the past people have died of other respiratory illnesses, but people are also dying of lockdown-induced child abuse, domestic violence, nursing home abuse and neglect, and involuntary euthanasia. It’s true that deaths from child abuse, domestic violence, nursing home abuse and neglect, and involuntary euthanasia predate lockdowns, but it’s also true that lockdowns have caused these problems to increase, due to the loss of oversight which in the past served to mitigate these problems. In the case of nursing home abuse and neglect and involuntary euthanasia, I think it’s safe to say that these deaths overlap with COVID-19 deaths. I don’t think it takes a genius to recognize that someone who receives proper hydration, nutrition, and other care, and it’s overdosed on morphine, is more likely to survive COVID-19 and other respiratory illnesses than someone who is severely dehydrated, not receiving food, not receiving other necessary care, and in some cases, is being overdosed on morphine.
There’s a number of ways to look at playing God. Some might argue that playing God is okay, provided the total number of lives saved is greater than the total number of lives sacrificed. Some might use a weighted system where they care more about certain lives than others, whereby it’s okay to kill a lot of people to save a few, so long as the few are the people you care about the most For example, rich people might care about other rich people more than they care about poor people. I believe lockdowns primarily benefit rich people who can afford to stay home, and are not at risk of abuse or neglect. A lockdown involves sacrificing people who are poor enough to, say, lose their home as a result of the lockdown, as well as people who experience increased abuse, neglect, or involuntary euthanasia as the result of the lockdown (regardless of whether they are poor or not), in order to save those who are rich enough to self-isolate anyway, but want to reduce the risk of those poor people, abuse and neglect victims, and involuntary euthanasia victims spreading the virus to them, the cost to those people be d****ed.
Others might argue that it is never acceptable to kill one person to save another, or even one hundred others. This of course involves making some distinction between what counts as killing and what counts as merely allowing someone to do. In my view, deaths from violent interventions such as mandatory lockdowns count as people who have been killed, whereas allowing the virus to spread naturally (but not under forceful conditions, like holding people in various institutions against their will) is allowing people to die, but not actually killing them.
Others might ask, well, are there any ways we can save lives that don’t rise to the level of playing God (i.e. sacrificing some people to save other people). For example, allowing people who can afford to voluntarily self-isolate and do not feel themselves at undue risk of abuse or neglect to do so, but not forcing people who can’t afford to self-isolate, or do feel themselves to be at undue risk of abuse or neglect, to also self-isolate against their will. Or simple things like opening windows and improving ventilation.
Sorry for typo.
“it’s overdosed” -> “isn’t overdosed”
Note that I recognize that there are some people who die as a result of abuse and neglect, and others who do not die (at least not immediately), but do experienced increased suffering (and will probably have a shorter lifespan in the long run as a result of the increased stress).
Arguably both matter. The ones who are killed by their abusers, or neglected to death, may be easier to tally, but human suffering also matters, even if it can’t easily be quantified.
Likewise with poor people losing their homes. I realize that, in most cases, homelessness is not equivalent to an immediate death sentence. But it probably will shorten their lifespan, and increase their suffering. For people who are so poor they lose the ability to afford food, death is likely to come much sooner. (Although I realize there’s a lot of grey, e.g. poor people who can still afford some food, but perhaps have to go down from two meals a day to one meal a day.)
Harold wrote (typos corrected),
“They” is a bit vague. It is true that some people have argued that Covid is not a problem, or at least not a sufficiently severe problem that they wished to concern themselves with it. Arguably all problems are relative anyway, so someone who feels more threatened by the prospect of starvation, homelessness, or abuse or neglect, is not necessarily making an “imaginary” case, merely a relative case.
But another point is that just because someone is critical of one or more recommendations made by the WHO or CDC or society in general, does not mean that they don’t think COVID-19 is a problem.
https://www.propublica.org/video/rescuing-her-father-from-an-assisted-living-facility-in-the-coronavirus-epicenter
Natasha Roland is an excellent example of this. If you listen to her interview with Propublica, she very clearly was taking COVID-19 seriously. But she was also very critical of the specific part of the lockdown most relevant to her: the prohibition of visiting relatives in nursing homes. She describes how in her case, this lead to her father being neglected nearly to death. How it made it possible for the nursing home administrator to lie to her. How she regrets believing him for as long as she did. How she took nonviolent direct action by rescuing her father from the nursing home in spite of the lockdown, by taking her chance when no one was at the front desk to stop her. Natasha Roland argues, “These residents need to go somewhere where people care about them.”
The specific lockdown policy Natasha Roland is opposing is one that is, unfortunately, being advocated, perhaps out of ignorance, even by supporters of so-called “minimal” lockdowns.
And her case is not isolated. Nursing home abuse and neglect has clearly risen as a result of lockdowns, included so-called “minimal” lockdowns. Sweden apparently went so far as to involuntarily euthanize a lot of nursing home residents.
“Apologies, just then, I mean “you” as in Bob Murphy. ”
It is I who should apologise. It is very presumptuous of me to assume that you were directing that comment to me on Bob’s blog. Sorry.
Nah, it wasn’t presumptuous, especially considering we talk to each other a lot more than either of us talk to Bob, presumably because he is busy with other matters.
I went to Nuclear, Biological, and Nuclear Warfare School in the Marine Corps. Pretty much everything we are doing and they are recommending is of minimal or completely ineffective. The COVID virus is smaller than a tear gas particle. The idea that you can wear a scarf or bandana, as they suggest here in CA, and have any level of protection is silly.
On top of that, if they believe the virus is on the surface of everything (and I believe this to be true), when you exit the store, or wherever you have gone and enter your car, it is contaminated. It is on your clothes, it is on your skin, it is in your hair. You need to remain protected until you enter a decontamination site. This means you should disrobe in a particular manner outside your home, be sprayed down in some manner, prior to entering your home. It means your clothing needs to be handled by someone in the proper PPE to clean your clothes in a proper manner to not spread the virus further. Better yet, your clothes should probably be burned.
Of course none of this is practical in the normal course. Bottom line, we are going to be exposed. It is probably better to get it over with rather than destroy the economy trying to avoid the inevitable. Trying to quarantine indefinitely is going to harm our immunity from other illnesses. The, if it saves one life mentality, is akin to the, we had to destroy the village to save it mentality.
JimS, you are so full of shit In my extensive delve into the darkside I have never come in contact with someone with so little understanding of things. That is because I generally avoid the deepest rescesses, but you are demonstarting a deep ignorance I don’t usually encounter here.
just in cae you are genuine and misguided, the aim is not to avoid all transmission, as you suggest with your decontaminations fantasy. the aim is to reduce transmission so that the R value is less tha 1. This doe not require disrobing outside your home, but does require social distancing, habd washing and wearing a mask in public.
See “This Overlooked Variable Is the Key to the Pandemic: It’s not R”
by Zeynep Tufekci
https://www.theatlantic.com/health/archive/2020/09/k-overlooked-variable-driving-pandemic/616548/
Zeynep Tufekci is also the author of the “We Need to Talk About Ventilation: How is it that six months into a respiratory pandemic, we are still doing so little to mitigate airborne transmission?” article I mentioned earlier.
My understanding is that R0 is the initial “wild” spread without countermeasures. This will be different for different societies and different for different populations within societies. The R value we are trying to et reduced is the actual spread at any time. It is a crude figure and not the whole story. Heterogenicity does need to be taken into account.
Nonetheless, R is the average number of infections per infected person and if R is reduced below one the disease will start to die out. This may be better achieved by tackiing a few superspreaders than the majority of normal spreaders.
I agree that ventilation is much under discussed. I hope that for example supermarkets have been instructed to turn their ventilation to maximum airflow, but I have no idea if this has been done. Other simple and cheap ameliorations such as vitamin D are also not promoted sufficiently. The UK Govt recently announced that they will provide free Vit D to those at particuar risk, claiming “new infromation”, but the information has been available for months at least. With this measure, even if you are wrong it will have almost no downside and have other benefits as well.
These are not silver bullets, but incremental benefits that all add up. If we implement them, we can have greater social mixing without increasing deaths.
Good to hear that the UK government has finally admitted that vitamin D can be beneficial.
Yeah, Zeynep talks about the difference between R0 and R.
And also…
So, based on that, COVID-19 doesn’t seem to be particularly infectious under ordinary circumstances, and it’s really the exceptions, what Zeynep calls the superspreader effects, that should draw our attention.
Anyway, I think ventilation is potentially a huge factor, not just for COVID-19, but for respiratory illnesses in general. I mentioned earlier a study titled, “Effect of ventilation improvement during a tuberculosis outbreak in underventilated university buildings.” The results just from improving ventilation were astounding. Improving ventilation stopped the outbreak. And tuberculosis is caused by a bacterium, not a virus. If a bacterium can be spread by aerosol transmission, I think it’s reasonable to suspect most respiratory viruses can too. Furthermore, what Zeynep Tufekci writes in “We Need to Talk About Ventilation: How is it that six months into a respiratory pandemic, we are still doing so little to mitigate airborne transmission?” basically confirms that yes, COVID-19 is spread by aerosol transmission, but primarily in situations where what Zeynep calls the three Vs are present.
To quote that article by Zeynep again,
Additionally, indoor air quality has been found to be significant for non-contagious respiratory issues as well, such as asthma. Of course, it depends on what an individual person’s asthma triggers are, but for at least some asthmatics, indoor air pollution is a major issue.
The only significant downsides would be the cost of redesigning buildings to allow for better ventilation, and the increased difficultly in keeping a good indoor temperature. However, ventilation renovations and spending a bit more on heating/cooling would probably still be far cheaper than the lockdowns. Ventilation renovations and opening up more windows would also not increase the risks of abuse, neglect, and involuntary euthanasia, unlike lockdowns.
I guess there could also be issues for asthmatics who are very allergic to pollen. I’ve never heard of anyone who had a life-threatening pollen allergy, but that doesn’t mean it’s never happened. But I suppose such a person would probably have already had to move to a place that didn’t have the type of pollen they were deadly allergic too.
I think (hope) we will incorporate the learnig from this pandemic into future building design. It takes something like this to get enough attention. Meanwhile, given the buildings we have with the ventilation they have, at the very least we should be ensuring that they are operating at maximum air exchange, even if this is not very efficient for heating/cooling.
This will likely benefit asthmatics, and everyone from future flu and other infectious diseases.
This is not an alternative to lockdowns, but part of the armory. If we can reduce the spread in offices, then we can allow children to go to school, or groups of 6 to meet indoors. It is about getting the biggest benefit for the least cost, not just in money.
My view is that we should take whatever measures are required to allow children to go to school. We get more spread from schools, so we have to restrict somewhere else. Turning up the ventilation in buildings seems like one of the easiest and least costly things we can do. Wearing masks when we go out is another very low cost thing we can do. None of these prevent infections, but these measures reduce infections, and that is enough.
In the case of the tuberculosis outbreak at the university, they were able to use ventilation engineering to improve the ventilation of the existing buildings. We don’t necessarily have to wait until we are ready to demolish current buildings and construct new ones. We can modify them now. Sure, it would cost economic resources (materials and labor power), but the economic cost would probably be far less than the economic cost of the lockdowns, and, I suspect, would be far more effective.
https://onlinelibrary.wiley.com/doi/full/10.1111/ina.12639
The study authors point out that other interventions were tried first, and that people had resorted to ventilation engineering after those other interventions proved far less effective than hoped for.
random, we have disagreed on many things and agreed on others, but here I think we are complete agreement. Ventilation is not the cure for the pandemic, but is a significant factor and should be given much more prominence. A bit of re-engineering is much less costly than lockdowns. If we can reduce transmittion in buildings, we can relax restrictions elsewhere.
We are in agreement about ventilation. We are still not in agreement about lockdowns, but ventilation, yes. Ventilation is good.
Incidentally, I recently helped someone install basement fans. The basement was not fully underground, and had windows at like, the top of the basement, so it was fairly simple, and has already significantly improved the air in that particular basement, which I suppose will indirectly help that house as a whole. Hurrah for do-it-yourself ventilation engineering. \o/
Additionally, the need for re-engineering might be mitigated, to some degree, by simply hosting more events outdoors. (This isn’t to say that we should skip ventilation engineering, merely that hosting more events outdoors could supplement ventilation engineering, especially if demand for ventilation engineers excepts their availability, or they do not always manage to achieve desired results.) Granted, this may depend on the weather. But, weather permitting, I’m sure, for example, that there are plenty of lectures that students could listen to just as well outdoors as indoors.
Interestingly, holding classes outdoors has been shown to have other benefits as well.
“The Surprising Benefits of Teaching a Class Outside: A new study finds that a class in nature helps kids be more attentive and focused once they return indoors.”
by Jill Suttie
https://greatergood.berkeley.edu/article/item/the_surprising_benefits_of_teaching_a_class_outside
This discussion went to ventilation, but the other important thing was focusing on superspreaders. Is there a way to identify and isolate these individuals, rather than everyone? Is it their physiology, their disease or their behavior? That would seem to be a productive route to go.
Harold wrote,
It’s not that there are people who are innately superspreaders, it’s that there are superspreader events, which are overwhelmingly indoors, generally in poorly ventilated settings that are crowded and have a lot of people vocalizing (talking or singing). The people merely happen to show up to these events while having a respiratory illness. If they avoided indoor, poorly ventilated settings as much as possible, especially crowded ones, or at least avoided talking while in such places, they would be much less likely to spread COVID to anyone, let alone to loads of people.
Widespread adoption of ventilation engineering would make it easier for people to avoid poorly ventilated settings.
See, read this article again.
“We Need to Talk About Ventilation: How is it that six months into a respiratory pandemic, we are still doing so little to mitigate airborne transmission?”
https://www.theatlantic.com/health/archive/2020/07/why-arent-we-talking-more-about-airborne-transmission/614737/
Zeynep Tufekci writes,
This cannot be the whole story. In the UK, large meetings were prohibited. No more than 6 people could meet indoors. Many areas had more stringent restrictions. Yet still the number of infections, hospitalisations and deaths rose dramatically. The sort of superspreader event you describe was not possible, yet still the numbers rose apparently exponentially. Basically, if Ris above 1, infections will rise exponentially. The doubling period will be different, but the end result seems inevitable.
Were hospitals, nursing homes, and all other businesses prohibited from having more than six people inside (including customers, staff, and residents) at any given time? And, even ignoring hospitals, nursing homes, and other business, to what extent was the prohibition of large indoor gatherings enforced?
Zeynep’s article even specifically mentions hospitals in the UK.
https://www.theatlantic.com/health/archive/2020/07/why-arent-we-talking-more-about-airborne-transmission/614737/
There’s a big difference between a scarf or bandana and a proper N95 mask.
Even if you do have an N95 mask that still allows 5% of particles through, and for a surgical mask (what most people wear) it’s more like 30% gets through. I found this link with test charts.
https://www.tandfonline.com/doi/full/10.1080/02786826.2013.829209
Regarding tear gas, there are various types … Australian cops typically use capsaicin and it’s mildly water soluble and also fat soluble so a wet cloth offers some protection … but since eyes are also vulnerable, some kind of goggles would be required. I think CN tear gas is outlawed in most countries, while CS is not strictly speaking gas, it’s more of a dust and thus the mask might help … unless you go for the full moon suit, eyes remain vulnerable.
Aerosol coronavirus can also land in the eyes, and not many people protect themselves against that. I have no idea how many catch it through their eyes, there’s really no data available on this … must be more than zero.
You can’t buy full N95 masks anywhere around here (i.e. the ones that are semi-rigid and have the full strap around the back of the head) but you can buy what they call KN95 masks that are soft and sit against the face with an ear loop. These are slightly better than surgical masks but I’ve worn them a few times and they get damp very quickly, so I would suggest they are OK to go into a shop, buy a few things and leave again. They get uncomfortable if worn for a long time, not sure how much they lose effectiveness.
If you look at Japan … where they all wear surgical masks (no eye protection) and started wearing masks very early this year … the total infections and deaths has been growing but slower than most countries. Similar results for Taiwan and Hong Kong, which is strongly suggestive that the mask helps but does not stop the infection. Some protection is better than nothing.
Personally, I’m not worried about what I catch, I’m pretty healthy and I hardly ever visit my mum. If I get sick I’ll just get over it. I wear a mask if the shop requires it, and I keep a few of the KN95 masks in the dashboard of the car … they are mostly to cheer other people up. My opinion is that it’s better for the strong people to catch the thing and get it over with rather than waste another year of our lives … that’s a personal cost benefit judgement. I can understand Bob wanting to protect his wife, and each healthy person who recovers and builds immunity also ends up protecting Bob’s wife as well.
I am happy to take a vaccine, providing Bill Gates has never had his grubby fingers anywhere near it. Other than that I’m fine.
https://qualitymedicalsupplies.com.au/collections/face-masks/products/kn95-masks-5-pack-in-stock-buy-now
That’s the sort of masks you can buy in Australia, they are about $3 each and they are soft with the ear loops but shaped to closely conform to the face.
They are comfortable for a while, until they get damp.
My understanding is that infection via eyes is possible, but the evidence suggests it is a minor route of infection. It makes a lot of sense for a health worker in a Covid ward to wear eye protection, but for the general public it will make little difference.
“My opinion is that it’s better for the strong people to catch the thing and get it over with rather than waste another year of our lives … ”
I agree in principle, but we have no way so far to saparate the vulnerable from the fit and healthy. If we had a policy that said young people could mix unrestricted, the incidence of Covid would then rise in that population exponentially, I don’t see how we could prevent that from getting to the vulnerable. If you have a suggestion of how that could be done I would love to hear it.
This is what th Great Barrington Declaration suggested, but they offered no way to prevent the huge increae in infected young people from then infecting the vulnerable. I totally agree that this would be a great solution, now we know reasonably well that it is not too dangerous for these people, but there is no mechanism to prevent this from spreading. At least, none I have seen.
I am hopeful that a vaccine will make this moot, but without a vaccine, the way to minimise deaths is to infect everybody in low risk groups and nobody in high risk groups. Then we can get herd immunity with minimum deaths. I don’t see how this is possible without massive coercion of who people are allowed to mix with. I would love to hear possible solutions, as this is where we will probably have to go if the vaccines fail, or we get another pandemic.
What evidence though? With something like capsicum spray, it’s very easy to figure out if it got in your eyes.
Show me equivalent tests for a coronavirus. How many people did catch it through their eyes? What sort of statistic confirms this?
Right through the start of this they were going around telling everyone “Don’t touch your face!” and that turned out to be mostly rubbish. We had people confined to their cabins on the Diamond Princess cruise ship and they still came down with it one after another. No one thought masks were a good idea for the people on the ship. None of that was based on scientific evidence, it was simply the first idea that came to people at the time.
How can I confirm the mechanism by which any given sick person got sick in the first place? Show me the test data.
The conclusion from one paper published 11 August in British Journal of Opthalmology.
“we conclude that the likelihood of the ocular surface being an infection gateway is low, but SARS-CoV-2 infection or transmission through the ocular surface may be a potential infection route, especially in hospitals. Therefore, good eye protection is an essential safeguard procedure, especially for medical staff.”
https://bjo.bmj.com/content/early/2020/08/25/bjophthalmol-2020-316263
Another from April 24 in frontiers in Public Health.
“This suggests that the eye is neither a preferred organ for human CoV infection nor a preferred gateway of entry that enables human CoVs to infect the respiratory tract.”
There is a problem in confirming how an individual got infected. The eye appears to be a possible but minor route, and if caring for someone with Covid-19 wearing eye protection would seem to be a sensible precaution.
This is mostly for Harold.
“Not just COVID: Nursing home neglect deaths surge in shadows”
By Matt Sedensky and Bernard Condon, November 19, 2020
https://apnews.com/article/nursing-homes-neglect-death-surge-3b74a2202140c5a6b5cf05cdf0ea4f32
and later in the article…
Wording of paragraph is a bit unclear, but if I understand correctly, for every two excess deaths attributed to COVID-19, another one has occurred to “other causes”, but presumably increased nursing home abuse and neglect. In theory, if at least half of the COVID-19 deaths were from a combination of nursing home and neglect as well as COVID-19, the increased deaths in nursing homes since March due to abuse and neglect could possibly exceed the deaths from COVID-19 (if deaths from both are counted in both categories). I guess further research would be needed on the numbers, but there’s clearly a bunch of people dying from abuse and neglect but not COVID-19, and I don’t think it’s a stretch to say that someone who isn’t being abused/neglected would be more likely to survive COVID-19 that someone who is being abused/neglected.
Have you heard about the Youth In Asia?
Sometimes you look, and you look again … and it’s right there in plain sight but still quite difficult to see. If anyone was looking around for a cover story, doesn’t get a whole lot better than a global pandemic … just putting that out there.
Nice to see 80’s anarcho-punk making something of a comeback
https://www.youtube.com/watch?v=IxA27AEECys
However, I think you may be talking of something else, perhaps the unemployment crisis.
The responses have had large costs. probabl less in much of Asia than outside Asia, but many of the impacts are due to global rather than local factors.
That is the problem with a global pandemic. there are no cost-free answers.
Collectively we have failed to come up with a smart solution, maybe there are none to be found. Except the vaccine, which could end this.
The choice is between restrictions, fewer deaths and economic harm, or no restrictions, more deaths and possibly just as great economic harm. We seem to have failed to come up with smart restrictions.
The problem is that with no restrictions, the infection spreads exponentially. We have seen this in the second waves in Europe, which unlike the USA had reduced infections to a relatively low level.
I did not see arguments accepting the high fatalities that would follow easing or dropping restrictions, but arguing we should do it anyway. They may exists, but most of the arguments I saw in favor of easing or dropping restrictions did not tackle the death rates that would follow, and offered no mechanism to avoid it.
You mean euthanasia?
Sweden was rather blatant about it.
From PBS,
https://www.pbs.org/newshour/show/denmark-and-sweden-responded-differently-to-the-pandemic-how-did-they-fare
This article is quite explicit about the method of euthanasia used in Sweden.
mercatornet [dot] com/did-covid-19-open-the-door-to-euthanasia-in-sweden/63962/
To quote that article:
And Ron Panzer has been alleging stealth euthanasia in the United States for some time now.
https://web.archive.org/web/20201102054807/http://www.hospicepatients.org/this-thing-called-hospice.html
And there’s certainly historical precedent for epidemics being created by subjecting people to horrible conditions. One of the more well known historical examples being typhus outbreaks in concentration camps during World War II.
Do you mean euthanasia?
Sweden was rather blatant about it.
From PBS,
https://www.pbs.org/newshour/show/denmark-and-sweden-responded-differently-to-the-pandemic-how-did-they-fare
This article is quite explicit about the method of euthanasia used in Sweden.
mercatornet [dot] com/did-covid-19-open-the-door-to-euthanasia-in-sweden/63962/
To quote that article:
And Ron Panzer has been alleging stealth euthanasia in the United States for some time now.
web [dot] archive [dot] org/web/20201102054807/http://www.hospicepatients.org/this-thing-called-hospice.html
And there’s certainly historical precedent for epidemics being created by subjecting people to horrible conditions. One of the more well known historical examples would be typhus outbreaks in concentration camps during World War II.
The care home disaster is a tragedy, and with hindsight could have been avoided. In Hong Kong, as soon as the infection was recognized, care homes implemented a prepared plan. They had a dedicated infection control officer, stocks of PPE, they banned visitors and new admissions had to be tested. This was out in place after the SARS outbreak. They have had 108 deaths in total. The message is clear – if you want to minimise deaths you have to keep care homes protected.
In USA and Europe, the approach was vastly different. Infected patients were released from hospital to care homes, there was little PPE, staff work more than one job, so bring infection in, there is general under-staffing. The result was a tragedy.
The problem did not start with Covid. There is a reason “I am going to put you in a care home” is used as a threat, often with comedic intent. Somewhat like references to rape in prisons is seen as something of a joke rather than an indictment of the system. The tragedy was in part a result of general neglect in elderly care. This is one problem we have not really addressed given the aging population.
The excess deaths in care homes from non-covid causes are a foretaste of what would happen in the general population if infection rates rose exponentially. The staff were not able to care for covid patients and provide the general care one could reasonably expect. This would happen in the community and in hospitals.
There are two ways to keep Covid out of care homes. Reduce the infection rates in the general population, or have very strict restrictions on who can go in.
On July 22, The Trump administration announced $5 billion funding for care homes. Whilst welcome, it was really too little, too late.
This was a reply to Random’s “This is mostly for Harold.”
Harold wrote,
It is absolutely true that the problem in care homes didn’t start with Covid (or the lockdowns). But the lockdowns did exacerbate the issue.
I mentioned up here that the abuse and neglect problem in care homes, along with some allegations of stealth euthanasia, and problems with people dying from a variety of respiratory illnesses, predates any concerns about COVID-19.
https://consultingbyrpm.com/blog/2020/11/bms-ep-164-arguments-on-mask-mandates.html#comment-1997850
Harold wrote,
You rightly point out understaffing, but you also mention, “The staff were not able to care for covid patients and provide the general care one could reasonably expect.”
I think it could be more than that. Natasha Roland’s father did test positive for coronavirus, and he still wasn’t being provided with proper care. Natasha Roland says that by the time she got in to get him, he hadn’t eating for a week, and he wasn’t being given his medication, even though he had diabetes.
I don’t think it’s unreasonable to suppose that some nurses might be afraid of getting sick themselves and might therefore be reluctant to provide care to someone who shows symptoms that could possibly be attributed to COVID-19, especially since so much of the propaganda has focused on avoiding contact with people who may have COVID-19, and not on measures such as opening windows. Another possible interpretation is that they were simply too understaffed to provide care for patients whether they had COVID-19 or not. Associated Press noted that a substantial amount of care, pre-lockdown, was being provided by visitors – family, friends, and other volunteers. The loss of volunteer care services may have been too much for staff to be able to pick up the slack, in some and perhaps many nursing homes, even aside from increased strain from COVID-19 and other respiratory illnesses.
Harold wrote,
Imagining that we can reasonably expect to keep COVID-19 or any other respiratory illness out of care homes indefinitely is perhaps rather unrealistic. In theory, you could achieve it by having no one at all go into the care home, but then the residents (or at least ones who are too weak to get themselves a glass of water) will horrible deaths of dehydration. The ventilation approach, however, does not depend on being able to keep COVID-19 out forever. Instead, the idea of ventilation is to flush any airborne illnesses out quickly, before they can concentrate enough to infect someone else. Bear in mind that a single, solitary viral entity is unlikely to overwhelm someone’s immune system by itself. Viruses need strength in numbers. Poor ventilation gives airborne viruses a chance to accumulate strength in numbers.
But even if nursing homes, for whatever reason, can’t be bothered to ventilate properly, I still think that someone has a better chance of surviving COVID-19, or any other respiratory illness, than of surviving prolonged dehydration. I believe the maximum I’ve heard that a bedridden person can last without water is a couple weeks? But most probably won’t last that long. Against a respiratory illness, a person at least has a chance.
It’s worth pointing out that consent is a major issue in medical ethics (and in ethics in general) and that a number of elderly people clearly do not consent to these lockdowns. For example, there was a survey here, in which many elderly people were allowed to express their views. A number make it clear they do not consent to the lockdown.
Experiences of Nursing Home Residents During the Pandemic: What we learned from residents about life under Covid-19 restrictions and what we can do about it
https://altarum.org/sites/default/files/uploaded-publication-files/Nursing-Home-Resident-Survey_Altarum-Special-Report_FINAL.pdf
To give just one example.
Stating that one would rather be homeless under a bridge, than under lockdown, is a fairly strong statement.
Harold wrote,
Recent Congolese history, especially with regard to the Rwandan refugee situation, shows that throwing money at a problem isn’t necessarily the same as solving it. There’s a lot of detail in “Dancing in the Glory of Monsters: The Collapse of the Congo and the Great War of Africa” by Jason Stearns, but basically, international aid organizations threw a bunch of money at Rwandan refugees in the Congo, providing food and medical care, but failed to do something that was probably more important: having some sort of judicial hearings to separate the genocidaire refugees from the civilian refugees. The result was an absolute catastrophe, and people are still dying over it to this day. Rwanda and Uganda invaded to kill the Rwandan refugees, civilians and genocidaires alike, and while they were at it, helped overthrow Mobutu. Mobutu was a brutal dictator who had been ruling, with CIA help, for about 30 years, after the CIA removed democratically elected prime minister Lumumba from power, and a Belgian plot succeeded in assassinating Lumumba, because the CIA was apparently too stupid to tell the difference between a communist risk and an anti-forced-labor leader. (Unless we choose to define people who oppose forced labor as communists. This seems rather excessive. If anything, merely opposing forced labor is only enough to make one a socialist.) Thus, Mobutu’s overthrow was only a tragedy in the sense that what followed was even worse than he was. Rwanda and Uganda started fighting each other on Congolese soil, and this devolved into a bunch of armed groups fighting each other for control of Congolese resources, killing, raping, and subjecting the locals to forced labor.
While that is an extreme example, it’s important to remember that spending funds wisely is often more important than the actual amount of the funds. I believe that hiring more staff, providing more paid sick leave to staff, and improving ventilation (while not subjecting residents to extreme cold or extreme heat) would be good uses of the funds. However, hiring more security guards to enforce the failed lockdown measures would be a bad use of funds.
Harold wrote,
I do not agree with this prediction. Nursing homes are in a particularly precarious situation. Common viruses, which are not deadly to the general population, were already deadly in the nursing home context, even prior to COVID-19, as I mentioned earlier. Nursing homes also frequently have poor ventilation, a significant amount of crowding, and a lot of people coming in and out (whether they are staff or visitors). The community in general often doesn’t face this combination of risks, especially on a 24 hours per day basis.. (One obvious exception would be prisons. Another might be crowded apartment buildings, especially ones with indoor hallways.)
Nor was the understaffing situation totally unavoidable. It was, in part, perhaps in large part, created by prohibiting family, friends, and others who had been providing volunteer services from continuing to do so. They could have done the opposite and called for more volunteers, rather than barring volunteers from entering.
I can’t recall which book I originally read about it in, but USA Today confirms that a number of black volunteer nurses helped save lives during a yellow fever outbreak in 1793. (See “Fact check: Black nurses helped save Philadelphia during a 1793 epidemic” by Melissa Badamo on USA Today.) I am unclear whether the nurses were professional or amateur, but given the state of medical knowledge in 1793, the answer is probably irrelevant with respect to the question of whether modern volunteers need be professional or amateur. A person doesn’t have to go to medical school to be able to hand a glass of water to a sick person. I am sure the black nurses did much more than provide water to sick people, but my point is that there are many potentially life-saving tasks a person can perform without ever having been to medical school. This frees up people who have actually been to medical school to focus on providing more specialized types of care, and, even if there are a shortage of actual trained doctors, at least makes it less likely that people will die of things that are comparatively easy to prevent, such as dehydration.
“I do not agree with this prediction.”
We saw it in NY and Italy. Hospitals get overwhelmed and in housholds it would be hard for famiy to care for the sick. If we do not restrict socialcontact, this is what happens.
Since I don’t speak Italian, it’s hard to find comprehensive information about what went wrong in Italy, but the information might well end up showing that Italy suffered from a lockdown-inflicted tragedy.
In the United States, even accepting the official COVID-19 numbers, we saw nearly 1 nursing home resident die from abuse or neglect (while COVID-negative) for every 2 who died from COVID-19. And the fact that abuse and neglect has apparently been so widespread is cause to question the official numbers. How many were from a combination of both COVID-19 and abuse or neglect? How many of those might have survived COVID-19 if only it weren’t for the abuse or neglect? How many abuse or neglect deaths were outright misattributed to COVID? Surely we do not think that all the staff who are dishonest enough to engage in abuse or neglect, without whistleblowing on it, are nonetheless impeccably honest when it comes to attributing death to a particular cause?
I don’t think Italians are fundamentally different from Americans or Spanish, or people in other places where lockdown-related elder abuse and neglect have been documented. I doubt Italian nursing home staff are inherently less likely to engage in abuse or neglect when given the opportunity to do so without the family watching, or inherently more likely to at least whistleblow, or inherently less susceptible to the effects of understaffing.
However, while it was difficult to find more Italian-specific information, I was eventually able to find something, published in English. The information strongly suggests that families do a better job of taking care of their elderly (when they choose to do so) than nursing homes do.
See
“Is social connectedness a risk factor for the spreading of COVID-19 among older adults? The Italian paradox”
Giuseppe Liotta, Maria Cristina Marazzi, Stefano Orlando, Leonardo Palombi
https://doi.org/10.1371/journal.pone.0233329
According to the abstract,
and the conclusion…
So, it may be “hard” for family to care for the sick (or people considered more vulnerable), but in spite of the hardness, they nevertheless apparently do a better job (statistically speaking) than nursing homes.
From AP, Nov 12.
““We are very close to not keeping up. I cannot say when we will reach the limit, but that day is not far off,” said Cabrini, who runs the intensive care ward at Varese’s Circolo hospital, the largest in the province of 1 million people northwest of Milan….
“The region’s hospitals are responding by reorganizing wards in a bid to avoid shutting down ordinary care, as happened spontaneously during Italy’s first deadly coronavirus spike. Still, hospitals in Lombardy and neighboring Piedmont — designated red zones by the government last week — have closed surgical, pediatric and geriatric wards to make room for COVID patients.”
Already the hospitals are struggling to provide the care expected for non-covid cases. If the hospitals are filled with Covid patients they of necessity neglect other patients. Those not cared for in hospitals will need to be cared for at home, which will increased pressure in the community.
It is blindness not to see it.
If the pandemic rages, the hospitals get overwhelmed. The evidence is there, from the early outbreaks and more recent ones. It is not reasonable to argue that this will not happen when it is actually happening.
Alright, I found the Associated Press article you quote. “Italian hospitals face breaking point in fall virus surge” by Colleen Barry.
I find myself reminded of Chapter 25 of Machiavelli’s the Prince, in which Machiavelli writes,
(Or at least, Machiavelli wrote something in Italian, which someone else translated as above.)
Alright, so, nature makes floods, fair enough, but it is insufficient to say that a bunch of buildings were destroyed by the flood, if there was something people could have done to prevent the flood from destroying the buildings, like building a canal. If people could have built a canal to stop the flood from destroying the buildings, then the destruction happened not only as a result of the flood, but also as a result of people’s negligence in failing to build a canal, and, seeing as how floods don’t have free will, but people do, we should put the blame on the people’s negligence. (At least, assuming the canal could have been constructed without committing any atrocities.)
Likewise, sure, there’s a “virus surge” overwhelming Italian hospitals, according to the Associated Press, but this is insufficient explanation, if there is something people could to prevent the virus surge from overwhelming the hospitals (without committing any atrocities). In other words, what human negligence lead to this, or was it truly out of human control?
Harold wrote,
Well, let me check back to your original prediction that I disagreed with.
It was,
In my interpretation at least, this is a bit different from what you are arguing now. (I realize it may seem perfectly consistent to you, but to me, it seems a little different.) The situation in the nursing homes has gotten so bad that people have been neglected to the point of being dehydrated to death or even being involuntarily euthanized with morphine and other drugs (in the case of Sweden).
Preventing lethal dehydration doesn’t require any sort of professional expertise in medicine. It requires a basic level of paying attention to the patient. I believe that, given the opportunity and motivation, the vast majority of families and communities can handle not letting their sick dehydrate to death, even if they don’t have a single doctor among them. The reason things got so bad in nursing homes was because people were prohibited from coming in to help or rescue their loves ones and take them home.
This, in my mind at least, is a bit different from your current claims, which is that services which (presumably) require some sort of professional expertise might get overwhelmed. Providing people with basic hydration (and other very basic services) does not require professional expertise.
I still maintain that COVID-19 by itself shouldn’t be able to overwhelm our society’s ability to care for people to the extent that some people get dehydrated to death. It was the lockdown that did that. But since the question of more professional services being overwhelmed is important to you, let’s talk about that.
As I was mentioning earlier in this comment, a “virus surge” seems insufficient to explain why hospitals are being overwhelmed, just as a flood seems insufficient to explain building destruction, if there was some human negligence that played a role in allowing these things to happen. (I.e. if there was something people could have done to prevent the hospitals being overwhelmed, without resorting to atrocities.)
To try to answer this, let’s turn to, “A plea from doctors in Italy: To avoid Covid-19 disaster, treat more patients at home” by Sharon Begley, found on statnews dot com.
and later in the article…
So, apparently, a big part of why the hospitals in Italy are being overwhelmed is because the hospitals themselves are spreading COVID-19.
This sounds like bad hospital design. Perhaps, the hospitals could have been better-ventilated. Perhaps, as the article suggests, more patients could be treated at home, or at least in more decentralized facilities. Perhaps both.
An Associated Press article titled “Europe’s hospitals among the best but can’t handle pandemic”, by Maria Cheng, also covers this angle.
The Associated Press article mentions,
So apparently the style healthcare used in many poorer countries, where fewer people are treated in hospitals and more people are treated in more decentralized settings, and where they have armies of health workers with far less training than doctors but with specialization in epidemic control, is better for these sorts of situations.
Italy is richer than these poorer countries, so if they can manage it, there’s no reason Italy shouldn’t have been able too. The problem appears to be human negligence.
We could build massive flood defenses around every city. It would be wasted resources, because we only need to build defenses around cities that will actually flood. Which ones will actually flood? We don’t know! So we build flood defenses where we think they will do most good.
We could have prevented Covid patients overwhelming hospitals by designing and running hospitals to cope with massive influx, run them all at 50% capacity, just in case. We have not done this, for obvious reasons, but that means when we suddenly get many more patients, we do not have capacity to treat them.
We cannot easily increase capacity, so the solution chosen is to reduce patients. That means restricting social contact.
However, a pandemic has been predicted for decades. It was one of WHO’s major threats. Little was done to actually put in place ways to deal with it. We are now scrabbling to minimize damage.
Antibiotic resistance is another of the major threats identified. Little is being done to deal with that. We hope it will not happen, but we are not really doing anything to prevent it. If it does happen, we will have a similar situation. Pharma companies will be paid massive amounts to come up with new antibiotics quickly, and we will all be so grateful if they do. This is a predictable problem – since it has acually been predicted – and could be dealt with much more cheaply by non-commercial research. The big companies do not seem interested, and why should they, because if it becomes a crisis they will the ones we call on to provide the solution.
My interpretation of Machiavelli’s discussion on flood defenses was that one should take past floods as warning that future floods may also occur, and plan accordingly.
Harold wrote,
Except hospitals have already been shown to be fertile grounds for super spreader events. Part of why Italy’s hospitals are overwhelmed is because the hospitals themselves are spreading respiratory illness.
If you look above, one of my quotes notes that “One such step reflects the finding that hospitals might be “the main” source of Covid-19 transmission, the Bergamo doctors warned.”
So, bigger hospitals might not be the answer, and might allow for even bigger superspreader events.
An alternative suggested by the doctors was that Italy and other countries should have focused more on “community care”. In other words, actually make the hospitals smaller, but increase capacity in other things, such as doctors who make house calls and more decentralized medical facilities. Also, train medical workers who have far less training than doctors but who specialize in epidemic control. Since these methods are used in many poorer countries, they clearly aren’t so expensive that a comparatively rich country like Italy shouldn’t be able to manage them.
Improved hospital ventilation would have been another option. This would pair well with the community care model, since smaller, more decentralized facilities are easier to supply with plenty of windows. However, ventilation engineering could also be used to install vents in existing buildings.
Some older hospitals apparently have superior ventilation to newer hospitals, so we’re talking old technology here. Newer isn’t always better.
See for example,
“A Breath of Fresh Air: To Fight Tuberculosis, Open a Window: Higher ceilings and bigger windows might be simple fixes for fighting tuberculosis in hospitals strapped for cash”
by JR Minkel
www [dot] scientificamerican [dot] com/article/a-breath-of-fresh-air-to/
Also see:
“When Fresh Air Went Out of Fashion at Hospitals: How the hospital went from luxury resort to windowless box”
by Jeanne Kisacky
https://www.smithsonianmag.com/history/when-fresh-air-went-out-fashion-hospitals-180963710/
Harold wrote,
One wonders when people will start losing faith in mainstream medicine in large numbers. Note that this isn’t to say that all these scientific studies are bad, just that the results from many of the good scientific studies are often ignored by mainstream medicine. Not to mention the lessons from history. This ought to be cause for losing faith in mainstream medicine. The level of propaganda that is used to prevent large numbers of people form doing so in quite an interesting topic in itself.
“Except hospitals have already been shown to be fertile grounds for super spreader events.”
This does present a problem in a pandemic and has contributed to reduced uptake of treatment apart from Covid. . I suppose we could have implemented an infrastructure to treat people at home, but we did not know what sort of treatment would be needed. A distributed system is likely t be less efficient at treating than consolidated treatment. One doctor or nurse can only be in one place at a time, and if the number of medical staff is not enough in a hospital it seems unlikely there will be enough in the community. Nevertheless, this is the sort of solution we should be looking into to find out if these problems can be overcome. .
Well, efficient can mean many things. You can call a shark an efficient killer, and I guess there is truth in that, but it’s not exactly a good thing from the perspective of a seal trying to avoid being eaten.
So efficiency in a hospital really depends on what units of measurement you are looking at.
Number of patients the hospital can fit divided by money spent building the hospital is one type of efficiency.
Number of patients successfully treated (for some definition of “successfully”) divided by total number of doctor-hours spent treating patients is another type of efficiency.
Number of patients murdered divided by total number of patients is the sort of efficiency a so-called “angel of mercy” (read: murderer who is deluded into thinking their victims want to die) might be interested in.
So really, whether a hospital is efficient or not depends a lot on what sorts of variables we are focusing on.
I do get that centralized, poorly ventilated hospitals are cheaper to build. But are we willing to accept the downsides, the poorer patient outcomes, the increased spread of respiratory illnesses, etc just for cheaper buildings?
Part of what gets me is, if it’s so expensive to decentralize medicine (which doesn’t necessarily mean treating people at home, it could also mean more numerous but smaller medical facilities, although I guess treating people at home would be the gold standard of decentralized medicine), why are poorer countries like Sierra Leone able to manage it.
“Covid-19: What Africa Can Learn from Africa – Community Care Centres”
https://africanarguments.org/2020/04/17/covid-19-what-africa-can-learn-from-africa-community-care-centres/
Ah, yes, tents. And makeshift huts. Decentralized, well ventilated, and quite cheap.
Also of interest is this article from the American Academy of Home Care Physicians.
“Costs and Cost-effectiveness of Home Medical Care”
http://go.nationalpartnership.org/site/DocServer/Costs_and_Cost_effectiveness_of_home_medical_care.pdf?docID=6850
Here’s a good one.
“The open-air factor and infection control”
https://doi.org/10.1016/j.jhin.2019.04.003
efficiency is not really a very good term here, I agree. unpicking my intention, the number of patients mdical staff could see would be much lower, which would be a efficincy thing. Since the number of medical staff is limited, this will result in fewer patients seen, which would be an effectiveness thing. This could possibly be reduced by training many less qualified people to treat Covid patients only.
Harold wrote,
Yes yes yes, one of the Associated Press articles I quoted suggests something similar.
“Europe’s hospitals among the best but can’t handle pandemic”
by Maria Cheng
https://apnews.com/article/10d4e6220bda4d237066477b40805cf3
Harold wrote,
Well, even aside from the suggestion of training people who are less qualified in medicine overall, but trained to handle an epidemic specifically, I should think that providing unsafe work conditions which make it easy for staff to become sick (or at least contagious) also reduces effectiveness, for a variety of reasons.
* Sick staff may stay home, thus not caring for anyone while at home.
* Other staff may stay home for fear of getting sick, and thus also not care for anyone while at home.
* Some people may decide they don’t want to work in healthcare because of the job hazards.
* Asymptomatic but infected staff may stay home for fear of spreading illness.
* Asymptomatic but infected staff may spread illness to their patients, reducing the effectiveness of the care they provide.
While providing safer, better ventilated working conditions can’t be expected to eliminate these problems, it could mitigate them.
Note that staff also includes people in roles that don’t require years of medical training, such as the cleaning staff.
See for example:
“NHS cleaners and porters were coronavirus ‘super-spreaders’ in hospitals, data reveal: Domiciliary workers in some hospitals found to have ‘sky-high’ levels of antibodies compared to intensive care doctors”
by Bill Gardner
The Telegraph
As discussed earlier, the poor ventilation of the hospitals should probably be blamed far more than the workers themselves.
Harold wrote,
It is absolutely true that the problem in care homes didn’t start with Covid (or the lockdowns). But the lockdowns did exacerbate the issue.
I mentioned up here that the abuse and neglect problem in care homes, along with some allegations of stealth euthanasia, and problems with people dying from a variety of respiratory illnesses, predates any concerns about COVID-19.
consultingbyrpm [dot] com/blog/2020/11/bms-ep-164-arguments-on-mask-mandates.html#comment-1997850
Harold wrote,
You rightly point out understaffing, but you also mention, “The staff were not able to care for covid patients and provide the general care one could reasonably expect.”
I think it could be more than that. Natasha Roland’s father did test positive for coronavirus, and he still wasn’t being provided with proper care. Natasha Roland says that by the time she got in to get him, he hadn’t eating for a week, and he wasn’t being given his medication, even though he had diabetes.
I don’t think it’s unreasonable to suppose that some nurses might be afraid of getting sick themselves and might therefore be reluctant to provide care to someone who shows symptoms that could possibly be attributed to COVID-19, especially since so much of the propaganda has focused on avoiding contact with people who may have COVID-19, and not on measures such as opening windows. Another possible interpretation is that they were simply too understaffed to provide care for patients whether they had COVID-19 or not. Associated Press noted that a substantial amount of care, pre-lockdown, was being provided by visitors – family, friends, and other volunteers. The loss of volunteer care services may have been too much for staff to be able to pick up the slack, in some and perhaps many nursing homes, even aside from increased strain from COVID-19 and other respiratory illnesses.
Harold wrote,
Imagining that we can reasonably expect to keep COVID-19 or any other respiratory illness out of care homes indefinitely is perhaps rather unrealistic. In theory, you could achieve it by having no one at all go into the care home, but then the residents (or at least ones who are too weak to get themselves a glass of water) will horrible deaths of dehydration. The ventilation approach, however, does not depend on being able to keep COVID-19 out forever. Instead, the idea of ventilation is to flush any airborne illnesses out quickly, before they can concentrate enough to infect someone else. Bear in mind that a single, solitary viral entity is unlikely to overwhelm someone’s immune system by itself. Viruses need strength in numbers. Poor ventilation gives airborne viruses a chance to accumulate strength in numbers.
But even if nursing homes, for whatever reason, can’t be bothered to ventilate properly, I still think that someone has a better chance of surviving COVID-19, or any other respiratory illness, than of surviving prolonged dehydration. I believe the maximum I’ve heard that a bedridden person can last without water is a couple weeks? But most probably won’t last that long. Against a respiratory illness, a person at least has a chance.
It’s worth pointing out that consent is a major issue in medical ethics (and in ethics in general) and that a number of elderly people clearly do not consent to these lockdowns. For example, there was a survey here, in which many elderly people were allowed to express their views. A number make it clear they do not consent to the lockdown.
Experiences of Nursing Home Residents During the Pandemic: What we learned from residents about life under Covid-19 restrictions and what we can do about it
https://altarum.org/sites/default/files/uploaded-publication-files/Nursing-Home-Resident-Survey_Altarum-Special-Report_FINAL.pdf
To give just one example.
Stating that one would rather be homeless under a bridge, than under lockdown, is a fairly strong statement.
Harold wrote,
Recent Congolese history, especially with regard to the Rwandan refugee situation, shows that throwing money at a problem isn’t necessarily the same as solving it. There’s a lot of detail in “Dancing in the Glory of Monsters: The Collapse of the Congo and the Great War of Africa” by Jason Stearns, but basically, international aid organizations threw a bunch of money at Rwandan refugees in the Congo, providing food and medical care, but failed to do something that was probably more important: having some sort of judicial hearings to separate the genocidaire refugees from the civilian refugees. The result was an absolute catastrophe, and people are still dying over it to this day. Rwanda and Uganda invaded to kill the Rwandan refugees, civilians and genocidaires alike, and while they were at it, helped overthrow Mobutu. Mobutu was a brutal dictator who had been ruling, with CIA help, for about 30 years, after the CIA removed democratically elected prime minister Lumumba from power, and a Belgian plot succeeded in assassinating Lumumba, because the CIA was apparently too stupid to tell the difference between a communist risk and an anti-forced-labor leader. (Unless we choose to define people who oppose forced labor as communists. This seems rather excessive. If anything, merely opposing forced labor is only enough to make one a socialist.) Thus, Mobutu’s overthrow was only a tragedy in the sense that what followed was even worse than he was. Rwanda and Uganda started fighting each other on Congolese soil, and this devolved into a bunch of armed groups fighting each other for control of Congolese resources, killing, raping, and subjecting the locals to forced labor.
While that is an extreme example, it’s important to remember that spending funds wisely is often more important than the actual amount of the funds. I believe that hiring more staff, providing more paid sick leave to staff, and improving ventilation (while not subjecting residents to extreme cold or extreme heat) would be good uses of the funds. However, hiring more security guards to enforce the failed lockdown measures would be a bad use of funds.
Harold wrote,
I do not agree with this prediction. Nursing homes are in a particularly precarious situation. Common viruses, which are not deadly to the general population, were already deadly in the nursing home context, even prior to COVID-19, as I mentioned earlier. Nursing homes also frequently have poor ventilation, a significant amount of crowding, and a lot of people coming in and out (whether they are staff or visitors). The community in general often doesn’t face this combination of risks, especially on a 24 hours per day basis.. (One obvious exception would be prisons. Another might be crowded apartment buildings, especially ones with indoor hallways.)
Nor was the understaffing situation totally unavoidable. It was, in part, perhaps in large part, created by prohibiting family, friends, and others who had been providing volunteer services from continuing to do so. They could have done the opposite and called for more volunteers, rather than barring volunteers from entering.
I can’t recall which book I originally read about it in, but USA Today confirms that a number of black volunteer nurses helped save lives during a yellow fever outbreak in 1793. (See “Fact check: Black nurses helped save Philadelphia during a 1793 epidemic” by Melissa Badamo on USA Today.) I am unclear whether the nurses were professional or amateur, but given the state of medical knowledge in 1793, the answer is probably irrelevant with respect to the question of whether modern volunteers need be professional or amateur. A person doesn’t have to go to medical school to be able to hand a glass of water to a sick person. I am sure the black nurses did much more than provide water to sick people, but my point is that there are many potentially life-saving tasks a person can perform without ever having been to medical school. This frees up people who have actually been to medical school to focus on providing more specialized types of care, and, even if there are a shortage of actual trained doctors, at least makes it less likely that people will die of things that are comparatively easy to prevent, such as dehydration.
Continuing discussion with Harold regarding superspreading events in the UK.
It may also be useful to look at the database Zeynep cites.
https://docs.google.com/spreadsheets/d/1c9jwMyT1lw2P0d6SDTno6nHLGMtpheO9xJyGHgdBoco/edit#gid=1812932356
According to the database, venues for superspreading events in the UK include:
* Nursing home (Dumbarton, West Dunbartonshire, Scotland)
* Nursing home (North Lanarkshire, Scotland)
* Nursing home (East Lothian, Scotland)
* Nursing home (Luton, England, United Kingdom)
* Various hospitals (Scotland, United Kingdom)
* Nursing home (Desborough, United kingdom)
* Meat processing (Kepak meat processing plant, Merthyr Tydfil, Wales, United Kingdom)
* Meat processing (Rowan foods meet processing plant, Wrexham, Wales, United Kingdom)
* Meat processing (2 Sisters Food Group meat processing plant, Llangefni on Anglesey, Wales, United Kingdom)
* Meat processing (Asda owned Kober meat, Cleckheaton, United Kingdom)
* Call center (contact tracing call center, Motherwell, North Lanarkshire, United Kingdom
* Bar (Hawthorn bar, Aberdeen, Scotland, United Kingdom)
* Food processing (Greencore factory, Northampton, United Kingdom)
* Ship: Fishing (Orkney-register boat Aalskere, Orkney Islands, United kingdom)
* Food processing (Fyffes banana supplier, Walsgrave, Coventry, United Kingdom)
* School (special needs school, Dundee, United Kingdom)
* Hospital (Weston General Hospital, Weston-Super-Mare, United Kingdom)
* Hospital (Cragavon Area Hospital, Cragavon, United Kingdom)
* University dormitory (University of Glasgow student accommodations, Glasgow, Scotland, United Kingdom)
* Nursing home (Redmill Care Home, West Lothian, Scotland, United Kingdom)
* Nursing home (Milford House Care Home, Edinburgh, Scotland, United Kingdom)
* Meat processing (2 Sister Food Group poultry processing plant, Coupar Angus, Scotland, United Kingdom)
* Meat processing (Karro Food Group pork processing plant, Scunthorp, United Kingdom)
* Meat processing (Pilgrim’s Pride meat processing plant, Pool, Cornwall, United Kingdom)
* Meat processing (Millers of Speyside abbatoir, Grantown-on-Spey, Scotland, United Kingdom)
* Meat processing (Banham Poultry processing plant, Norfolk, United Kingdom)
* Meat processing (Cranswick County Foods meat processing plant, Cullybackey, County Antrim, Northern Ireland, United Kingdom)
Many of the venues on that list, though not all of them, would probably be exempt from prohibitions of indoor gatherings of more than six people. Unless the United Kingdom has decided to take enforcement of that prohibition to the extent of closing down all hospitals, nursing homes, and meat processing facilities, in which case, many of them apparently continued operating anyway.
If we don’t consider closing down such facilities to be realistic, then perhaps improving the ventilation inside such facilities might be a better idea?
This is a continuation of the discussion up here:
https://consultingbyrpm.com/blog/2020/11/bms-ep-164-arguments-on-mask-mandates.html#comment-1998135
Bob –
You are conflating disparate arguments. In the first instance, there was no claim about the efficacy of masks. It is purely a statement that a mandate with no cases is bad policy. The second instance is a claim about mask efficacy. However, based on what you recited on the podcast, you read too much into the first statement.