Corona-Chan Didn’t Care Until I Put on the Mask
By Anatoly Karlin • Unz Review • April 2, 2020
For most of the past two months, Russian disinformation agents respectable Western Establishment voices such as the Surgeon-General of the US, the CDC, and the MSM (e.g. CNN, Vox) have churned out propaganda that masks are ineffective against containing the spread of the coronavirus. In perhaps the most “powerful” take, Forbes even claimed that they INCREASE infection risk.
This propaganda was bizarre on multiple levels. First, it violated common sense – even a T-shirt wrapped around your mouth and nose will ward off large droplets – there’s a massive amount of other evidence in favor of masks. Second, the conventional wisdom appears to be that this advice was given for a putative “greater good” – preventing runs on masks, so as to spare them for healthcare workers who are much more exposed to the virus. This, at least, made sense – though it had to be balanced against the negative impact on public trust towards “experts” and institutions. However, as Scott Alexander has noted, this explanation is likely false; in reality, the CDC and other American experts have been dismissing the efficacy of face masks for years, including during the H1N1 epidemic in 2009 and the MERS epidemic in 2015. So the real explanation is much less altruistic and far more banal than even reasoned critics gave them credit for – it was just sheer bureaucratic inertia and unwillingness to adapt East Asian best practice.
In any case, there is evidence of a turnaround. Global mask production has been revving up, though East Asia remains far in the lead – China alone produces almost half the world’s masks at ~100+ million units per day, and its capacity to supply them will enable it to acquire massive soft power in the coming months. Moreover, an official recommendation to wear masks in public in the US appears to be imminent. The process is more advanced in several European states, such as Czechia, where according to Twitter, face mask adaptation has become near as universal as in East Asia.
This is very good news, if long overdue. Had these policies been adopted at the very start, it is entirely possible that the West would not have seen the huge epidemics and morbid debates about whether to save the boomers or the GDP when a massive bunch of 5 cent face masks would have sufficed to keep r0 at close to 1. But this was left too late, and now there is no choice – POLITICALLY, at any rate – but to impose huge lockdowns that are going to crater the world economy (if only in the short-term… if we’re lucky).
The rest constitutes what I hope will be a useful reference on mask efficacy to convince people who insist that they are useless/won’t do anything/etc. Practical advice on face masks usage at my COVID-19 Survival Guide.
***
East Asian “Lived Experience”
Basic facts: No East Asian region outside Hubei, China – despite their FAR more intensive travel links with China – have experienced major COVID-19 epidemics as in Europe and the US. Not even South Korea, which experienced a freak occurrence thanks to Patient 31, a church-frequenting “superspreader.” Meanwhile, Japan has seen just a bit more than a thousand cases, despite adopting a very relaxed stance towards lockdowns, quarantines, and travel restrictions by global standards – there has not been a COVID-19 explosion as in Europe. Taiwanese cases capped out at 47, before Europeans started tilting their numbers modestly upwards again.
Science: Not wearing masks to protect against coronavirus is a ‘big mistake,’ top Chinese scientist says
Balaji S. Srinivasan: “… Asia shows it doesn’t have to be this way. And their playbooks are online. So it’s bizarre to watch Western leaders surrender to the idea of 40-80% infection rates AND extended lockdown. That’s not a manageable situation, it’s overnight impoverishment.”
***
Articles
* Scott Alexander: Face Masks: Much More Than You Wanted To Know. Does a large meta-analysis of different studies to conclude that surgical masks are effective.
Meanwhile, n95 masks are more effective than surgical masks, but only if you put them on properly – which is apparently not a trivial task:
I remember my respirator training, the last time I worked in a hospital. They gave the standard two minute explanation, made you put the respirator on, and then made you go underneath a hood where they squirted some aerosolized sugar solution. If you could smell the sugar, your respirator was leaky and you failed. I tried so hard and I failed so many times. It was embarrassing and I hated it.
I’m naturally clumsy and always bad at that kind of thing. Some people were able to listen to the two minute explanation and then pass right away. Those kinds of people could probably also listen to a two minute YouTube explanation and be fine. So I don’t want to claim it’s impossible or requires lots of specialized background knowledge. It’s just a slightly difficult physical skill you have to get right.
Bunyan et al, 2013, Respiratory And Facial Protection: A Critical Review Of Recent Literature, discusses this in more depth. They review some of the same studies we reviewed earlier, showing no benefit of N95 respirators over surgical masks for health care workers in most situations. This doesn’t make much theoretical sense – the respirators should win hands down.
The most likely explanation is: doctors aren’t much better at using respirators than anyone else. In a California study of tuberculosis precautions, 65% of health care workers used their respirators incorrectly. That’s little better than the general public, who have a 76% failure rate. …
Is a poorly-fitting N95 respirator better than nothing? The reviewed studies suggest that at that point it’s just a very fancy and expensive surgical mask.
* Dr. Sui Huang: COVID-19: Why We Should All Wear Masks — There Is New Scientific Rationale
The surgeon general tweeted: “STOP BUYING MASK, they are not effective…”. The Center for Disease Controls (CDC) states that surgical masks offer far less protection than the N95 respirator masks (which also must be perfectly fitted and only professionals can do it). The CDC recommends that healthy persons should not wear masks at all, only the sick ones. These guidelines are not rooted in scientific rationales but were motivated by the need to save the valuable masks for health professionals in view of a shortage. But they may have had unintended consequences: stigmatizing those that wear masks in the public (you are a hoarder, or you are contagious!)
Contrast this with the cultural habit, the encouragement, or even mandate to wear masks in Asian countries — which have now “flattened the curve” or even have had a flatter curve from the beginning.
* Less Wrong: Credibility of the CDC on SARS-CoV-2
***
Studies
* Yan, Jing, Suvajyoti Guha, Prasanna Hariharan, and Matthew Myers. 2019. “Modeling the Effectiveness of Respiratory Protective Devices in Reducing Influenza Outbreak.” Risk Analysis: An Official Publication of the Society for Risk Analysis 39 (3): 647–61.
It was found that a 50% compliance in donning the device resulted in a significant (at least 50% prevalence and 20% cumulative incidence) reduction in risk for fitted and unfitted N95 respirators, high-filtration surgical masks, and both low-filtration and high-filtration pediatric masks. An 80% compliance rate essentially eliminated the influenza outbreak.
* Davies, Anna, Katy-Anne Thompson, Karthika Giri, George Kafatos, Jimmy Walker, and Allan Bennett. 2013. “Testing the Efficacy of Homemade Masks: Would They Protect in an Influenza Pandemic?” Disaster Medicine and Public Health Preparedness 7 (4): 413–18.
The median-fit factor of the homemade masks was one-half that of the surgical masks. Both masks significantly reduced the number of microorganisms expelled by volunteers, although the surgical mask was 3 times more effective in blocking transmission than the homemade mask.
* Radonovich, Lewis J., Jr, Michael S. Simberkoff, Mary T. Bessesen, Alexandria C. Brown, Derek A. T. Cummings, Charlotte A. Gaydos, Jenna G. Los, et al. 2019. “N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical Trial.” JAMA: The Journal of the American Medical Association 322 (9): 824–33.
In this pragmatic, cluster randomized clinical trial involving 2862 health care personnel, there was no significant difference in the incidence of laboratory-confirmed influenza among health care personnel with the use of N95 respirators (8.2%) vs medical masks (7.2%).
* Leung, Nancy H. L., Daniel K. W. Chu, Eunice Y. C. Shiu, Kwok-Hung Chan, James J. McDevitt, Benien J. P. Hau, Hui-Ling Yen, et al. 2020. “Respiratory Virus Shedding in Exhaled Breath and Efficacy of Face Masks.” Nature Medicine, April.
Coronavirus: Virological findings from patients treated in a Munich hospital
Charité – Universitätsmedizin Berlin | April 3, 2020
In early February, research teams from Charité – Universitätsmedizin Berlin, München Klinik Schwabing and the Bundeswehr Institute of Microbiology published initial findings describing the efficient transmission of SARS-CoV-2. The researchers’ detailed report on the clinical course and treatment of Germany’s first group of COVID-19 patients has now been published in Nature*. Based on these findings, criteria may now be developed to determine the earliest point at which COVID-19 patients treated in hospitals with limited bed capacity can be safely discharged.
In late January, a group of patients in the Starnberg area near Munich became Germany’s first group of epidemiologically linked cases of COVID-19. Nine patients from this ‘Munich cluster’ subsequently received treatment at München Klinik Schwabing. “At that point time, we really knew very little about the novel coronavirus which we now refer to as SARS-CoV-2,” says one of the study’s lead authors, Prof. Dr. Christian Drosten, Director of the Institute of Virology on Campus Charité Mitte. He adds: “Our decision to study these nine cases very closely throughout the course of their illness resulted in the discovery of many important details about this new virus.”
“The patients treated at our hospital were all young to middle-aged. Their symptoms were generally mild and included flu-like symptoms like cough, fever and a loss of taste and smell,” explains the other lead author, Prof. Dr. Clemens Wendtner, Head of the Department of Infectious Diseases and Tropical Medicine at München Klinik Schwabing, a teaching hospital of LMU Munich. “In terms of scientific significance, our study benefited from the fact that all of the cases were linked to an index case, meaning they were not simply studied based on the presence of certain symptoms. In addition to getting a good picture of how this virus behaves, this also enabled us to gain other important insights, including on viral transmission.”
All nine patients underwent daily testing using both nasopharyngeal (nose and throat) swabs and sputum samples. Testing continued throughout the course of their illness and up to 28 days after the initial onset of symptoms. The researchers also collected stool, blood and urine samples whenever possible or practical. All of the samples collected were then tested for SARS-CoV-2 by two separate laboratories working independently of each other: the Institute of Virology on Campus Charité Mitte in Berlin and the Bundeswehr Institute of Microbiology, an institution which forms part of the German Center for Infection Research (DZIF).
According to the researchers’ observations, all COVID-19 patients showed a high rate of viral replication and shedding in the throat during the first week of symptoms. Sputum samples also showed high levels of viral RNA (genetic information). Infectious viral particles were isolated from both pharyngeal (throat) swabs and sputum samples. “This means that the novel coronavirus does not have to travel to the lungs to replicate. It can replicate while still in the throat, which means it is very easy to transmit,” explains Prof. Drosten, who is also affiliated with the DZIF, and is a professor at the Berlin Institute of Health (BIH). Due to genetic similarities between the new virus and the original SARS virus, the researchers initially assumed that, just like the SARS virus, the novel coronavirus would predominantly target the lungs – thus making human-to-human transmission more difficult. “However, our research involving the Munich cluster showed that the new SARS coronavirus differs quite considerably in terms of its preferential target tissue,” says the virologist, and adds: “Naturally, this has enormous consequences for both viral transmission and spread, which is why we decided to publish our initial findings in early February.”
In most cases, viral load decreased significantly during the first week of symptoms. While viral shedding in the lungs also decreased, this decline happened later than in the throat. The researchers were no longer able to obtain infectious virus particles from day 8 after the initial onset of symptoms. However, levels of viral RNA remained high in both the throat and lungs. The researchers found that samples with fewer than 100,000 copies of viral RNA no longer contained any infectious viral particles. This allowed the researchers to draw two conclusions: “A high viral load in the throat at the very onset of symptoms suggests that individuals with COVID-19 are infectious very early on, potentially before they are even aware of being ill,” explains Colonel PD Dr. Roman Wölfel, Director of the Bundeswehr Institute of Microbiology and one of the study’s first authors. “At the same time, the infectiousness of COVID-19 patients appears to be linked to viral load in the throat and lungs. In hospitals with limited bed capacity and the resultant pressure to expedite patient discharge, this is an important factor when it comes to deciding the earliest point at which a patient can be safely discharged.” Based on these data, the study’s authors suggest that COVID-19 patients with less than 100,000 viral RNA copies in their sputum sample on day 10 of symptoms could be discharged into home-based isolation.
The researchers’ work also suggests that SARS-CoV-2 replicates in the gastrointestinal tract. However, the researchers were unable to isolate any infectious virus from patients’ stool samples. None of the blood and urine samples tested positive for the virus. Serum samples were also tested for antibodies against SARS-CoV-2. Half of the patients tested had developed antibodies by day 7 following symptom onset; antibodies were detected in all patients after two weeks. The onset of antibody production coincided with a gradual decrease in viral load.
The Munich- and Berlin-based research groups plan to conduct additional research on the development of long-term immunity against SARS-CoV-2, both within the first German cluster and in other patients. This type of research will also play an important role in the development of vaccines.
*Comprehensive research data now published in Nature.
###
A joint press release by Charité, München Klinik Schwabing and the Bundeswehr Institute of Microbiology
Israel settlements turn Palestinian house into cage
The Gharibs’ house in Beit Ijza, caged by a fence and surrounded by the Israeli settlement of Givon Hahadasha, as seen here in a 2018 satellite image. [screen grab from Geomolg]
MEMO | April 4, 2020
Palestinian Saadat Sabri Gharib, 38, had never imagined that his house, which was built by his father in 1979, would be turned into a very narrow cage surrounded by barbed wire and surveillance cameras.
Gharib’s house is located in the Biet Ijza neighbourhood, west of occupied Jerusalem. It was surrounded by about 100 dunams of land owned by Gharib’s father. However, the Israeli settlers stole all of this land and kept the house, which is only 500-metres square.
Gharib told Anadolu Agency, that since 2008, his house has been turned into a very small cage surrounded with concrete walls and located in the middle of an Israeli settlement. It has only a very narrow passage with 12 cameras monitoring it.
Gharib, his mother, his wife and three children live in this house. “Our house is a real prison,” he explains, adding: “It is surrounded with wires from all sides. It was built in the middle of a wide area of land, but today it is a small prison in the middle of Giv’on Hahadasha settlement.”
“We are subjected to stone throwing, live bullet shooting, insulting and burning,” Gharib, who owns all the documents that prove the ownership of the land, revealed.
“However, we had seven demolition orders, but I fought in the Israeli courts and stopped them,” stating that 40 dunams were stolen by the Israeli occupation authorities in 1979 and 60 dunams were isolated from his house by the apartheid wall in 2007. “We do not access them except once a year with permission from the Israeli occupation,” Gharib explains, noting that his house is monitored 24/7.
In 1979, the settlers offered his father a large amount of money for the land, but he refused and said: “If you give me all of Israel’s money, I would never concede an inch of my land.”
Later on, the Israeli occupation stole it with its settlement power.
Putting pressure on Gharib in order to leave his house, the Israeli occupation prevents him from planting any trees near his house, from carrying out any renovation works or from making any repairs.
Gharib points out:
“A few months ago, the water tank was damaged and I wanted to change it, but Israel refused. They want to push us to leave our house. But if the house was demolished, I would live in a tent. I will never leave my family’s house to the settlers.
“We live a very difficult life. The gate of the passage leading to my house is controlled by the Israeli occupation and could be closed any time. In 2008, it was closed for three consecutive months, but we fought until it was opened 24 hours a day.”
Around 900 Palestinians live in Beit Ijza, which was part of Jerusalem before the 1967 Israeli occupation of the West Bank. Since the creation of the Palestinian Authority in 1993, Beit Ijza became part of the Palestinian Governorate of Jerusalem Suburbs.
This neighbourhood is one of many others which were isolated from Jerusalem by the apartheid wall, so they were connected with the occupied West Bank through tunnels or bridges.
According to the Palestinian Bureau of Statistics, more than 50,000 Palestinians holding Jerusalem’s ID cards were isolated by the apartheid wall and deprived from living in Jerusalem.
In 2002, Israel decided to build a 710-kilometre wall to separate the occupied West Bank from Israel and the illegal Israeli settlements in the depths of the occupied territories.
First COVID-19 Death Reported in Asia’s Largest Slum, Dharavi
teleSUR | April 3, 2020
Asia’s largest slum located in India’s financial capital of Mumbai has reported its first COVID-19 fatality, according to local reports.
The patient, a 56-year-old man, had no travel history and was admitted to a local hospital with a fever on Sunday and tested positive for the new coronavirus on Wednesday, an official of the Brihanmumbai Municipal Corporation (BMC) said, according to Al Jazeera.
The authorities have sealed the building where he lived, which is located in a redeveloped part of the Dharavi slum, local media reported.
Also, seven members of his family were quarantined and tested on Thursday for the virus that causes the COVID-19 disease, the Xinhua news agency said.
Mumbai authorities are concerned over the possible spread of the new coronavirus, as Dharavi is known as the most densely populated slum in Asia. At the same time, a doctor and a worker from a municipal corporation also tested positive.
An estimated 700,000 to 1 million people live crammed in Dharavi – a roughly five-square-kilometer maze of narrow lanes, dilapidated buildings, huts, and open sewers.
Public health experts say it would be difficult to contain the virus if it spread in a slum-like Dharavi where eight to 10 people often share a room.
The population density is about 270,000 per square kilometer, making social distancing almost impossible. Scores of people share water sources and sanitation facilities, Al Jazeera reported.
Dharavi’s cases have raised concern that India may be experiencing community transmission of the disease despite a countrywide lockdown since March 25, as well as exposing the harsh reality and problems of inequality in the country.
For his part, Prime Minister Narendra Modi insisted that “testing, isolation and quarantine” will remain priorities in the coming weeks, ignoring the situation of places like Dharavi, the problems of its population, as well as the needs that have arisen in the public health system in the country.
The death toll due to the COVID-19 in India stands at 62 as of Thursday, according to the latest data, while the number of confirmed cases in the country is around 2,547.
Bodies of Covid-19 victims pile up in streets of Ecuador as residents beg authorities for help
A vehicle carrying a coffin lined up to enter a cemetery, in Guayaquil, Ecuador April 2, 2020. © Reuters / Vicente Gaibor del Pino
RT | April 4, 2020
As the coronavirus pandemic rips through Ecuador, some cities are struggling to cope with a deluge of fatalities, pushing residents to make harrowing pleas for help as the bodies of loved ones accumulate in the streets.
The port city of Guayaquil, some 260 miles south of the capital of Quito, has been hit especially hard in the outbreak, leaving hospitals and morgues utterly overwhelmed in a flood of new patients and deaths. With local authorities unable to keep up with the influx of casualties, President Lenin Moreno has created a task force to tackle the problem, tapping Jorge Wated, board chairman at BanEcuador – a self-described “public development bank” – to lead the effort.
Seeking to ramp up the collection of bodies, Wated has allowed funeral homes to sidestep a nationwide curfew to work into the night to gather the deceased, and has dispatched teams of soldiers and police to pick up corpses from homes, hospitals and even streets around the city.
The efforts have still fallen short, however, sending countless citizens to social media to make desperate pleas for help, appealing directly to Wated through his Twitter account, where he shares frequent updates on the grim task at hand.
“Help me for the love of God,” one person said to Wated earlier this week, providing a home address and the name of a deceased man. “Nobody takes him … what do I do? I beg you.”
“Jorge. I have a case. Deceased going for 3 days. Already decomposed. Please … contact me,” another man wrote.
Left with few other options, social media appears to be the last recourse for many residents, with some of Wated’s tweets garnering dozens of similar urgent requests.
“On Monday my grandmother passed away, we do not know where else to call to remove the body and [need help] with the death certificate.”
Yet another appeal reads: “Dear Jorge Wated, a friend without Twitter asks for help, her brother died today 4 pm … and they still do not coordinate the removal of the corpse.”
Though Ecuador has reported only some 3,300 infections and 145 fatalities in its Covid-19 outbreak – over 100 of them in Guayaquil – the official disease and death tolls depend on the number of tests administered, and Ecuador has faced a shortage of test kits, leaving health officials unable to verify cases and add them to official tallies.
“The truth must be told. We know that both the number of infections and the official records fall short. Reality always exceeds the number of tests,” Ecuador’s president said in a recent address.
Well over 1 million cases of Covid-19 have been confirmed worldwide as of Friday, with the global death toll fast approaching 60,000. The United States remains the top hot spot for the illness, counting more than 266,000 cases – over twice that of the next largest outbreak, in Italy – and some 7,000 deaths. Still yet to reach the peak of its outbreak, the US has seen infections soar by the tens of thousands each day this week, breaking records for deaths and cases time and again.