The deadly virus (COVID-19) can not survive in the “grey zones”
20 million Americans will need ICU in next 40 days and possibility of 300m global deaths this year.
The current models suggest that the c19 virus doubles every 3 days. At the current stats it would consume the majority of population within 45 days.
For example in United States lets say of the infected 200 million, 10% will need critical care i.e. 20 million in next 45 days, while beds and doctors available for only 300k. That is 98.5% short.
False hope —
Flattening the curve diagrams typically show health care capacity at 50%
but actually it is only 2% (of what is needed by the 10% critical patients at peak). Even doubling the capacity by military is not helpful.
Quarantines in pandemics eventually fail
- Computer simulations show that as soon as you open the borders the virus comes back — https://www.washingtonpost.com/graphics/2020/world/corona-simulator/
- Even China is not immune to the virus coming back and therefore they have implemented 14 days quarantines.
- Lock-downs are not only ineffective but also risk banking failure leading to uncontrollable black swan events or financial collapse due to demand and supply chain shocks.
Globally 600 million people would need critical care in next 60 days with the current exponential rate.
What is a “grey zone”?
A grey zone is an a local area or a community where the R0 goes below 1. The virus cannot spread fast enough before the originating person gets cured as an average over the population. So the exponential turns negative or the R0 is below 1.
The grey zone is a place during a pandemic which is neither green (clean) or red (spreading).
For an example — a grey zone would be a place where social distancing is fully enforced. The infected people are free to enter the zone. A quarantine does not qualify as a grey zone.
Another example — would be where the population has acquired herd immunity.
How mandatory FACE MASKS in public can create instant grey zones?
First, debunking the interpretations of current studies on MASKS
The understanding today is that MASKS don’t help if warn by general public. But somehow it only magically helps the hospital staff. This advisory is built on TWO faulty assumptions.
- Anything below N95 masks or surgical masks does not help
- The masks have a limited supply — Advising public to not wear masks is necessary to secure market supply for health care workers.
Major Faulty assumption #1 — Cloth masks don’t help?
This view is valid only for hospital settings or in extremely high risk scenario where the health care workers ideally need 100% protection. Therefore the WHO recommends
- Change masks every day
- Use high quality filters
- Must not have gaps and needs proper fitting etc.
However, even in critical settings and in absence of supplies, homemade bandanas are now recommended and found useful.
- Studies show a single layer of cotton cloth stops 70% of particles that are 5 times smaller than the C19.
- In fact over 67 studies — We found no evidence that the more expensive, irritating and uncomfortable N95 respirators were superior to simple surgical masks.
- In detailed studies cotton blend t-shirt fabric were found to be 70% effective in stopping the virus as compared to 89% in case of surgical mask.
- Further findings suggest that a homemade mask should only be considered as a last resort to prevent droplet transmission from infected individuals, but it would be better than no protection. (Disaster Med Public Health Preparedness. 2013;0:1–6) — this article goes on to say that surgical masks are 3 times more effective than DIY masks.
1. The numbers can be misleading for example if surgical masks provide 99% reduction and the home made masks provide 97% then saying surgical masks are 3 times more effective is only sensationally correct but actually wrong.
2. Both these blockage figures are bound to be far higher and effective in case of C19 that is 5 times bigger.
3. The study measured only from the angle of the spreader that has high pressure near the mouth. And not from the angle of the receiver with no pressure to pass through the virus (in case of touching etc)
Further, the hospitals need N95s and not the general public— because the chances of virus exposure are 1000x more at any given time in health care settings. Even a small increase in effectiveness for health care workers matters. This no way rules out the benefit of less effective masks in lower risk scenarios.
To conclude — the effectiveness of DIY cotton-blend masks may be even far more effective than currently thought or the study suggests.
Major Faulty assumption #2 — are MASKS really in limited supply?
There are many ways to recycle the masks i.e.
- Soap-washing
- Boil in hot water
- Heat in oven at 70 degree for 30–60 minutes
- Reuse after x days
- UV disinfection
Cotton-blend masks are ideal because they are both soap-washable and can be soaked in HOT water. Further, the DIY model allows everyone to have enough quantities in an exponentially fast Pandemic.
Fabric mask disinfection is not an active research topic, but the standard wisdom of running it through a long, hot wash is supported by research showing that the SARS virus can be inactivated by high heat and detergent. UV light can also be used against SARS, but since the light needs to reach the virus in order to inactivate it, UV might not effectively sterilize porous fabric.
Faulty assumption #3 — can wearing masks could be harmful?
The earlier advice to not wear masks on WHO did not have any studies to back it up. It was purely based on preventing shortages for healthcare staff. It has now been withdrawn — https://www.who.int/csr/resources/publications/Adviceusemaskscommunityrevised.pdf (now taken down)
The issue was further exasperated with many faulty government announcements with faulty assumptions.
Can FACE-MASKS stop a pandemic ?
The core engine of pandemics is R0 (reproduction knots or virality spread index) which allows the virus to infect everyone. In case of C19 the R0 being 2.4 new infections per infected person. In the current pandemic the flattening required is 98% reduction from the peak, which is unrealistic.
Let’s assume the cotton-blend DIY masks only block 70% infection even for the 5 times bigger c19 cells (the actual figure likely over 90%).
Now, if all public is required to wear a mask — If a person A spreads 70% less infection while coughing and sneezing and the the receiver R pickups up only 70% less of the infection then the chances of virus particles being picked up are 10% (or 90% lower).
- This does not assume the benefit of the virus being 5 times bigger and also being attached to a droplet.
- It also does not account for the probability that the immune system may be able to handle the smaller dose of virus than a larger viral load and therefore may also get immune.
The actual benefit is not only the 90% risk reduction but actually reducing the virus spread coefficient R0 from 2.4 to below 1. This immediately halts the pandemic (like creating a grey zone).
Evidence suggests face masks can create grey zones
During SARS epidemic — It was found that consistently wearing a mask in public was associated with a 70% reduction in risk of catching SARS.
According to research on the SARS epidemic, face masks were the most consistently effective intervention for reducing the contraction and spread of SARS. In a Cochrane Review on the subject, 6 out of 7 studies showed that face masks (surgical and N95) offered significant protection against SARS. Hand washing was also very effective, supported by 4 out of 7 studies in a multivariate analysis.
Although most of the studies in the Cochrane Review were on medical workers in a hospital setting, one study followed community transmission of SARS in Beijing. It found that consistently wearing a mask in public was associated with a 70% reduction in risk of catching SARS. Additionally, the authors of the paper noted that most people in the community wore simple surgical masks, not N95 respirators. — https://medium.com/@adrien.burch/whats-the-evidence-on-face-masks-5f3c27a18cc
Different countries have shown the effectiveness of Masks in halting the pandemic.
Japan — Inspite of being one of the first countries with an out-break the country has been able to return to work as normal with no lock-downs. It has only a few more than 1000 cases despite having imposed no major lock downs.
China —Masks are required today for everyone in China. There are cases in China and Korea where one person with the virus was contact traced to others (40+ people) and they did not pass the virus off to anyone.
Czech — The whole Czech Republic is now required to wear procedure masks in public spaces and slow the growth without any lockdowns etc.
Taiwan — where face masks are nearly universal, isn’t even on this chart because it’s had so few cases. Taiwan is hard on wearing masks — didn’t even closed schools, no domestic spread inspite of being so close to China.
Hong Kong — inspite of large Chinese population and close proximity the region was able to fend off the pandemic.
Mongolia — They enforced mask wearing even before 1st case January and now only 4 cases and stopped to spread.
The western countries like USA and Europe — really underestimate the importance of Masks. The deadly consequences are apparent. This otherwise comes naturally to other eastern countries due their lessons learnt from SARS.
In video-recorded study related to C19 epidemic in China
Chinese government epidemiologists challenged the advice of health authorities and said — “It can be confirmed that in a closed environment with air-conditioning, the transmission distance of the new coronavirus will exceed the commonly recognized safe distance,” the researchers wrote in a paper published in peer-reviewed Chinese journal Practical Preventive Medicine.
The scientists said their research highlighted the importance of wearing face masks — since none of the passengers in both buses who were wearing masks became infected.
How DIY face-masks create a grey zone?
- The masks provide a barrier from respiratory droplets, which is predominantly how the C19 virus spreads.
Joseph Tsang, an infectious disease specialist who also worked as a consultant for the city’s Hospital Authority, says the purpose of wearing a mask is two-fold. “Wearing a mask is not just for protecting yourself from getting infected, but also minimizing the chance of potential infection harboring in your body from spreading to people around you,”
When a person coughs, the droplets are typically somewhere between 8,000–100,000 nanometers in diameter. Most of these droplets, especially the large ones, will quickly settle and end up on surfaces. The smaller droplets stay in the air longer.
Particularly in case of C19 various studies show that 50%-80% infected people remain asymptomatic and carry the virus over 29 days— https://t.co/ZgdQ6CXgJR?amp=1
Therefore beyond self-protection, one of the most compelling reasons that we should all wear face protection is to ensure that silent spreaders also cover their faces.
2. Masks prevent us from touching our faces with dirty hands — a study shows people touch their face usually 23 times an hour while it a common knowledge that C19 primarily transmits via dirty hands touching your own face.
3. The masks reduce the viral load — that a new person catches and allows the immune system to easily handle. Speculatively, it may also help build herd immunity and even faster recovery of patients.
4. Masks are visually enforceable — it is easier to enforce this hygiene in shared public places.
5. Automatic visual reminder — and activates natural averment to pecking or handshakes akin to creating a herd IQ to fight the spread.
6. Automate social distancing — makes everyone sensitive to people not wearing a mask. They automatically are perceived as dangerous and people maintain a distance (culture in japan).
7. Prevents spread from micro-droplets while talking— is the key for COVID-19 because its a droplet based infection.
8. Public Masks rapidly drop R0 — Wearing masks decreases the local R0 by a factor of 70% (spreader) x 70% (receiver) from 2.4 to say 0.20 and therefore C19 can not become an epidemic. Almost an equivalent benefit to a lockdown without the economic collateral damage.
Reduction in R0 brings the pandemic to a grinding halt. And thats why it is called a “Grey zone”.
7. It turns it into a locally manageable problem — The current infection models use a constant R0 for the virus and show that the virus would eventually break quarantines and infect everyone. So a lockdown does not help in long run. The face-masks create a local grey zone with continuous protection. This allows communities like Japan or Taiwan to continue working normally with no fear of viral import. It does not need closed borders.
Points to be considered for DIY masks
There is evidence to show
- A single layer cloth is almost as effective as multi-layers.
- Infact breath-ability with single layer is more important than a thick mask.
- Any cotton-blend fabric gives the best results.
Why it is critical to mandate it as public policy?
- Balance of perception — its important to shift the public opinion for proper social distancing form a person who is not wearing a mask. The non-compliant people in the culture get automatically marked. (culture in japan vs USA)
- Visual enforcement — Apart from being most effective this modality requires
- no budgets or equipment
- easy to visually enforce
- enables grass-root crowd participation
- restores sense of safety in public
3. Maintaining or restarting supply chains — it allows workers to return back to works faster and save the region from hyper-inflation.
4. Lock-downs are proven ineffective method in multiple pandemic simulations and eventually lead to catastrophic economic and bank failures. The virus is able to enter back into the system whenever travel restrictions are eased.
There is no evidence of harm in enforcing face-masks in public. On the contrary there is evidence that it halts pandemics by enabling open grey zones like in Japan, Taiwan and China.
New updates
- List all published papers with brief summaries — https://docs.google.com/document/d/1HLrm0pqBN_5bdyysOeoOBX4pt4oFDBhsC_jpblXpNtQ/edit#heading=h.9yzpxufkt5ow
