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Facemasks (Listening to Experts)
Everybody's talking about 'em: facemasks. Which kind? Where can you buy them? How do you get your outsized ass to a hospital that needs them? Should you wear one? Should everybody? Which kind? In which situations? <h>The beleaguered CDC</h> The lynching party seems to be out in the States for the CDC, which is being blamed for trying to kill everyone by telling them that they don't need facemasks. This is the same advice being given the world over by anyone qualified to have an opinion. In the States, though, they've focused laser-like on the CDC's perfidy in <i>having the same opinion for the last ten years</i> and conjured up all sorts of conspiracy theories for why the CDC would be trying to eliminate the population of the United States. Apparently, it beats focusing on issues of import---which is kind of S.O.P. over there. <h>Could people be wrong?</h> But it makes sense that they would work, no? Why do doctors and nurses wear them? It's <i>common sense</i>. If it's common sense, then how can experts be telling us the opposite? Does that ever happen? That an expert in the field knows something that the unwashed masses can't intuit gastrically? It kind of happens all the time. LeBon first wrote <a href="https://en.wikipedia.org/wiki/The_Crowd:_A_Study_of_the_Popular_Mind" source="Wikipedia">The Crowd: A Study of the Popular Mind</a> in the century before last---and not a lot has changed since then. We still believe all kinds of outlandish shit. We knock on wood, we carry evil eyes, we pray to Jesus---hell we just had Easter, where a bunch of us celebrated a resurrection that a lot of people will swear on their mother's graves actually happened, just that one time, though. Or like that time the whole world drank water and called it medicine or ate sugar pills infused with the same water and called it medicine. Or the time a significantly large number of people stopped getting vaccines because they no longer believed in them. Or when a good part of America became materials and structural scientists and knew exactly how a building in NYC came down. People can believe in WMD. A majority of Americans believe they live in a great nation, better than everywhere else, with the best health care and the best intentions and the moral high ground. People can be super-wrong about things that seem right to them. They can believe in things that have extremely obvious and well-known incontrovertible evidence. They can believe in that shit even when their lives depend on what they believe <i>not</i> being true. Would I be surprised to hear that the scientific consensus is one thing and 99% of the rest of the world acts differently? Not at all. But people all over Asia wear them. They can't all be wrong, can they? Yeah, they could. Easily. They're not really harming themselves, so nobody stops them, but it's not a given that what they're doing is an overall positive for them. I bet there are some downsides to wearing a mask all the time. The discomfort, for one. <h>How do you choose a plan of action?</h> So I'm just saying "but everybody else is doing it" is not what got us where we are today as a species. We have the scientific method to thank for that. Could that have failed us, though? It doesn't hurt to ask, every once in a while. So, I'm open to opinions on this, but I'm not going to run out and buy masks just because most of Asia wears one. I'm going to listen to expert opinion. I'm going to find some experts and go with their opinion because, while I can make sound judgments based on evidence, I don't have enough evidence and I don't know enough. I feel that there's a good chance that a mask will help in some situations (e.g. close quarters, like mass transit), but that any of the situations in which I've found myself in the last six weeks wouldn't have been helped or hindered by a mask. That's <i>my</i> gut feeling. Is that going to bite me in the ass? Am I missing something? Am I being overly daring? Not cautious enough? Have I not considered the percentage confidence that those experts have in their opinions? At what percentage does it become more useful for me to just wear a mask anyway? 5%? 10%? 20%? 50%? It's not at all easy to make a choice, so I guess Rush's <i>Freewill</i> takes effect and I've chosen not to wear a mask by not choosing <i>to</i> wear a mask. I've listened to the experts. <h>How science decides</h> Medical science---pretty much science in general, but especially medical science---won't swear to anything until there's solid evidence. That's what makes it science. The studies to-date have either been ambivalent or have evinced negative results for efficacy or they've applied to specific and unrelated situations---i.e. many studies have been done on lab and hospital settings, but very few for the general population. The article <a href="https://slatestarcodex.com/2020/04/14/a-failure-but-not-of-prediction/" author="Scott Alexander" source="Slate Star Codex">A Failure, But Not Of Prediction</a> puts it very nicely: <bq>Doctors will not admit any treatment could possibly be good until it has a lot of randomized controlled trials behind it, common sense be damned. This didn’t come out of nowhere. They’ve been burned lots of times before by thinking they were applying common sense and getting things really wrong. And after your mistakes kill a few thousand people you start getting really paranoid and careful. And there are so many quacks who can spout off some “common sense” explanation for why their vitamin-infused bleach or colloidal silver should work that doctors have just become immune to that kind of bullshit. Multiple good RCTs or it didn’t happen. Given the history I think this is a defensible choice.</bq> We are basically stuck between believing everything about quack medicine that sounds good and trying to test things that we don't have ethical tests for. How do you test the efficacy of face-masks? Who wants to be in the control group? The article cites a "joke" study that compares some studies to verifying whether parachutes actually help: you'd have to get a control group that jumped without parachutes, just to be sure. <h>Which experts to you choose?</h> Again, from Alexander's article: <bq>But in terms of giant institutional failures that everyone is angry about, the face mask thing barely makes the top ten. [...] The role of science journalists is to primarily to relay, explain, give context to the opinions of experts, not to try to out-medicine the doctors. So I think this is a good excuse.</bq> I did the same thing: I listen to a daily podcast in German with the top virologist at the top clinic in Berlin, Germany, probably one of the most renowned experts in Europe. He said that you don't need a mask when you go outside. If you stay away from people (as you should), then a mask won't do a damned thing. He allowed as how you'd probably put your fingers in your face less (at the very least, your mouth). That probably helps, considering how many people I see touching their faces on the rare occasions when I go out. Alexander points out that a salient question (and one to keep in mind for the future) is: <iq>what was the experts’ percent confidence in their position?</iq> Experts are required to have an opinion, but how sure are they of it? I often joke to people when they ask me if I'm sure that, "I'm 100% certain. I might be wrong, but I'm 100% certain." Certainty isn't the same thing as being right. A lack of certainty (absolute or otherwise) is also no guarantee for being wrong. <h>Some shaky analogies</h> Not to harp on Alexander's otherwise good article, but I'm not quite sure about some of his analogies: I think they feel a bit pat and too convincing. They may be accurate, but now he's got me being suspicious of everyone---including him. For example, <bq>People were presented with a new idea: a global pandemic might arise and change everything. They waited for proof. The proof didn’t arise, at least at first. I remember hearing people say things like “there’s no reason for panic, there are currently only ten cases in the US”. This should sound like “there’s no reason to panic, the asteroid heading for Earth is still several weeks away”.</bq> The odds he cited earlier were that there was a 10% chance of a pandemic, which is significantly less than the 100% chance of an asteroid strike. Do you see what he did there? He conflated the possibility of a pandemic with the certainty of a strike to convince you that your lack of response to the risk of a pandemic was highly irrational. It might have been <i>lacking</i> but it wasn't the <i>active denialism</i> that ignoring an asteroid would be. The asteroid one analogy applies to "a potentially world-changing pandemic within the next few decades" more than "this specific pandemic". But its hard to act on something "in the next few decades", though some nations are better-prepared by having stockpiles and <i>plans of action</i> that they can just use instead of making shit up as they go along. The analogy definitely and tragically applies <i>perfectly</i> to climate change, worries about which have taken a backseat this year. <h>The uniqueness of the U.S. situation</h> Remember, too, that Alexander is writing from the States, specifically the Bay Area in California. The stumbling and belated response of the U.S. <i>combined with</i> the utter lack of preparation on the part of society in general there (no reserves, stripped hospitals, overextended staff, etc.) as well as having no policies in place---they have, instead, an ideology that is actively hostile to handling pandemics humanistically---makes Americans considerably more desperate and looking for a finger to point. His description below is a case in point. <bq>Gallant wouldn’t have waited for proof. He would have checked prediction markets and asked top experts for probabilistic judgments. If he heard numbers like 10 or 20 percent, he would have done a cost-benefit analysis and found that putting some tough measures into place, like quarantine and social distancing, would be worthwhile if they had a 10 or 20 percent chance of averting catastrophe.</bq> This is exactly <i>not</i> what the U.S. did because everyone responsible for running things or disseminating information---officially, via the press office of the executive branch, or via the mainstream media, or via the ad-hoc rumor mill of social media---ignored the pandemic until it was overwhelming them. There were three months of warnings. The description above is pretty much how the European governments reacted: Switzerland closed down early---it could have been a smidge earlier, but they were pretty on top of it. Now, several weeks later, we are benefitting from an obviously squashed curve. Switzerland is making plans for the next month. Things are going to relax a bit and we'll see where we go from here. Granted, we've only got 8 million people, but we're <i>organized</i> and <i>methodical</i> and <i>scientific</i> and <i>united</i>. There is every reason to believe that if there is a lower-impact way of getting past this pandemic, we will find it. <h>The Overton Window has shifted <i>considerably</i></h> Similarly, Alexander mentions later that the experts/media message should <iq>[...] have looked like 'We’re not sure how this will develop, so you should definitely stop large gatherings.'</iq>. This is exactly what we heard across the political spectrum in most of Europe. It didn't happen overnight, but definitely within a week, most if not all countries in the EU region had done this. However---and I cannot emphasize this enough---people are extremely cavalier about talking about "shutting down the economy for a few weeks" as if that was a policy thing before <i>the end of February 2020</i>. It went from <i>nearly completely inconceivable</i> to "why didn't we just do that earlier?" inside of a month. Hindsight truly is 20/20, but if you'd asked anyone how likely it would be for the OECD countries to drop their economies by 30-70% (Switzerland claims 30% reduction while the U.S. claims 70% reduction), you'd have been put into a straitjacket. I conclude from all of this that we have very little hope of handling similar, future catastrophes better than Europe and Asia already have. The U.S. is a special case and suffers from so many deficits that it's hard to even pinpoint which one contributed the most to the basket of extra problems that it's created for itself. For example, SARS, MERS, and Ebola all failed to circle the world, despite pretty dire warnings, failed to materialize (There were predictions of 1M Ebola victims worldwide with actual 30K in three west-coast African countries.) This predisposes people and governments to downplay the risk of the next prediction. This is natural and not necessarily a stupid reaction. Now that we have a new data point---that 20% of these pandemics actually materialize and total the economy---we will adjust our future behavior. At least some of us will. <h>Choosing Experts</h> Alexander gets a bit lost in the weeds, I think, when he says that <iq>[Zeynep Tufecki's] superpower is her ability to treat something as important even before she has incontrovertible evidence that it has to be.</iq> How do we tell the difference between a non-domain-expert but smart person like Zeynep (who was actually one of the ones who mis-predicted Ebola) and someone who's just predicting doom and gloom with other, but insufficient evidence that appeals to our gut? There are plenty of those out there---how do we ignore their noise? And how do we get the media to ignore them? I don't see the solution as simple as "listen to the right experts" that Alexander seems to be ending up at. It's what we all do with our information streams---I make conscious choices about who I follow and who I don't, who I trust in a byline, etc. Decades of experience reading about, studying, and thinking about an area is a huge plus. People can sound very credible and smart (case in point: Alexander himself ... or even yours truly, hopefully), but haven't actually done the work and are mostly working on intuition. We're certainly not always domain experts. Even for those who seem to be wide <i>and</i> deep in several areas, that's no guarantee of infallibility. We discern between these people based on <i>evidence</i>. <h>Examining SARS-CoV-2</h> But now we need to work without evidence because it isn't always available. Or it's not available <i>yet</i>. That's fair enough---that's reality. If hard decisions were easy...they wouldn't be hard. But we can't have adjusted our future behavior based on information that we didn't have yet. Though a lot of things went wrong, we can't kick ourselves for not having already shut down Europe at the end of January. Once I started researching COVID, I realized that there are facets of it that make it uniquely difficult to deal with and likely to cause more death than the flu. <ul> It's quite contagious We don't understand the transmission very well We don't have good predictive data We don't know who it affects (children less? Or just milder symptoms?) We don't know about re-infection rates We don't know the asymptomatic carrier rate We don't know the lead time for contagiousness before symptoms appear We know it causes severe respiratory issues We know that they can only be treated with ventilators We know that our medicine will not just let people go We know that people tend to be in ICU for weeks ICU staff is highly trained/expensive/rare </ul> From that, it made sense that we had to self-isolate/quarantine---reducing the spread with very prosaic means (the hammer)---to buy time to figure out a better plan. Through a confluence of luck and life choices (and those that I was able to make because I'm lucky): <ul> We have a good amount of supplies at home already We cook all the time and don't go out often We don't live in a city We spend time outside in nature We exercise outside My job can be done just as well from home as from an office (literally changed overnight with no reduction in productivity). We have enough books, movies and TV shows to keep us busy for years The Internet service is top-notch </ul> So, yeah, it's a bit easier for me to say "go ahead and shut it all down, just to be on the safe side" because this all barely affects me directly.<fn> The long-term effects of a starkly reduced economy will, of course, affect us all. <hr> <ft>It's mostly my summer travel and visitor plans that are up in the air.</ft>