An ongoing dialogue on HIV/AIDS, infectious diseases,
April 19th, 2021
Is It Time to Eliminate Outdoor Mask Mandates?
Louie checks out our local town policies.
I do the morning dog walk in our house. And every day, I put on a mask before going out, just as I have since March of last year.
As the data accumulate on the dynamics of SARS-CoV-2 transmission, it’s definitely time to ask this question — why am I still doing this? After all, it’s just Louie and me — and even he’s wondering.
It’s generated some interesting dialogue between the two of us:
Why are you doing that? he asks me each morning. Who are you protecting?
Good questions, Louie!
It’s true, I’ll briefly pass an occasional person on the street or sidewalk. But they’re not going to get COVID from me, or the reverse. That’s not how this works.
Even if I, as a fully vaccinated person, were asymptomatically carrying SARS-CoV-2 — already exceedingly unlikely on any given day — the virus would be rapidly diluted by the extraordinary ventilation conferred by just being outside.
And while the vaccines aren’t 100% protective of me — nothing is, sports fans — they are amazingly good. Got to love these recent CDC data, interpreted by indefatigable COVID-19 optimist Dr. Monica Gandhi:
When CDC says <1% vaccine breakthroughs, let's be specific & say 0.008%. And in terms of severe disease, 0.0005% and in terms of deaths, 0.0001%. And Dr. Fauci said severe disease in elderly with other health problems to NPR. Reduce hesitancy by optimismhttps://t.co/mYLQ7G8psi https://t.co/MsQJwGPtkT
— Monica Gandhi MD, MPH (@MonicaGandhi9) April 17, 2021
With COVID-19, the most intensely studied viral respiratory tract infection in over a century, it’s worth emphasizing that clear documentation of outdoor transmission has been a challenge — and it’s not for lack of trying. In such rare cases, it’s often impossible to disentangle the indoor activities accompanying the outdoor events as contributing to the risk.
Or the people were crowded together outside, facing each other and interacting. Or exercising together and breathing heavily.
Transmissions do not take place between solitary individuals going for a walk, transiently passing each other on the street, a hiking trail, or a jogging track. That biker who whizzes by without a mask poses no danger to us, at least from a resipiratory virus perspective. Read more about the safety of being outside in this excellent piece by Shannon Palus, which also questions the need for masking outside — generating quite the heated commentary, as I anticipate this post will also.
But what about the community solidarity engendered by wearing a mask outside in public? Isn’t this worth something? A way of showing that I’m 100% part of Team Mask?
Maybe — certainly there’s a strong component of this messaging among the highly adherent mask wearers here in Boston. But this performative aspect of outdoor mask-wearing has a downside, too.
You might think you need to wear a mask while walking me in the morning to set a good example for others, said Louie the other day.
But really you might be misleading people about how the virus is transmitted.
Wise words, dog of mine! (He’s very articulate.)
Here’s a bold proposal — let’s make public policy based on our best understanding of the science of SARS-CoV-2 transmission:
Dangerous — crowded indoor spaces with poor ventilation, in particular with unmasked individuals talking, shouting, singing. Wear a well-fitted mask until case numbers are down and more people are vaccinated.
Safe — outdoors, especially while distanced. Masks only needed for lengthy interactions with others at close distance.
Some might wonder if this is too nuanced a message — the “people will get confused” argument.
Give them more credit than that, says Louie. If I can understand it — and I’m a dog — so can they.
He’s got a point, it’s not that hard. We’ve learned so much since the terrifying days early in the pandemic — why not share what we’ve learned and eliminate mandates that no longer make sense?
To wrap up, Zeynep Tufekci kindly shared her thoughts on this issue. She’s been fighting something she’s called “beach scolding” for over a year now. It’s when public health officials and the media shame people or even worse prohibit outdoor activities — when they should be encouraging them since they’re so much safer. Examples — the dreaded yellow police tape outside the park or on the benches, the swings removed from the playground, the beaches and lakeside trails closed.
In a way, it relates to outdoor mask mandates:
Sometimes people invoke the precautionary principle or what’s the downside argument to argue for universal masking outdoors. However, the precautionary principle is not necessarily appropriate after a whole year of epidemiological data showing little to no transmission outdoors outside of sustained close contact: precaution is what we do when we don’t know the answer, not something we invoke to continue doing things on autopilot.
Plus, there is a very important downside that’s not being considered sufficiently: by mandating or normalizing masks outdoors at all times, we are miscommunicating about the real risk factors—indoors, especially if they are crowded and poorly-ventilated—which means that even a full year after the pandemic, people are not being properly informed about where and how they should increase their vigilance.
It’s fine to tell people to continue wearing masks outside especially if they are unvaccinated and are about to engage in a sustained interaction at close distance, especially if it involves higher aerosol emitting activities like talking, yelling or singing, but it’s time for the excessive masking outdoors, and especially mandates, to go.
Bravo. Looking forward to seeing more outdoor faces soon.
69 Responses to “Is It Time to Eliminate Outdoor Mask Mandates?”
Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases
Biography | Disclosures | Summaries
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Agree completely with the science, but would add one thing to the “performative aspect” of mask wearing. I think it’s really important that we remain in compliance with local mandates and guidelines. I am all for lobbying for local/state/federal guidelines and mandates to change, but we need to be visibly complying with them while they last.
Great post Dr Sax.
I struggle to understand how anyone could make the case for wearing a mask outdoors. As you say, like much of what we’ve done (or been told to do) over the last year it is mostly a performance. The risk of outdoor transmission has always been negligible and religiously wearing a mask outdoors has always been more about political identification than anything else. The N-95 masked runners and cyclists who scowl at me every morning say it all…
Public health people should focus on reducing risks that actually exist. Telling noble lies to engineer pro-social behaviour – for example telling people to mask outdoors to ‘show solidarity’ with someone or other – has been a huge mistake over the last year and I’m glad you’re drawing attention to it here.
Dear Dr Sax:
I respect your opinion, but I most strongly disagree. As we have seen nationally and globally, the public has difficulty reacting to changes in directives – changes that the anti-vaccine community seizes on and feeds back as opposition when facts on the ground change.
The facts on the ground are most certainly going to change. You practice and live in a near-hermetically sealed bubble here in MA. We as a community believe in science. Yet nationally the picture is very different, as demonstrated by https://surgoventures.org/newsroom-all/analysis-surgo-projects-us-covid-19-vaccination-rates-will-plateau-in-late-april.
We are not going to hit national herd immunity from this research/forecast. Vaccine hesitancy predicted that BEFORE the J&J “pause”, and that resistance will likely be invigorated by FDA advisory community discussions if/when AstraZeneca/Oxford submit their vaccine for EUA – and the belief by some politicians that ANY masking is a massive infringement on their rights.
As the objective of herd immunity becomes more and more delayed, and more and more variants are free to continue to emerge, it’s very likely that much of America will be a high risk for Michigan-style resurgence. Pulling back on outdoor masking will result in less indoor masking.
And keeping outdoor mask mandates isn’t going to convert any of the hesitant people to start wearing a mask or get vaccinated. It only confirms their bias that people want masks forever — and it’s not an unreasonable assumption from that perspective.
As a doctor I see on MSNBC a lot tweeted, “It’s illogical to watch people wearing a mask on the sidewalk walk into a restaurant or bar, immediately take it off and keep it off for 1-2 hours.”
The risk calculations are screwed up.
If they’re wearing N95s while they run/cycle, how can you tell they’re scowling at you?
Sure, its safer outside, but not everyone is as enlightened (or blessed with xray vision) like you. We need to stay vigilant until the danger has passed for everyone. Calling public health people liars and judging people for staying safe does nothing to end the pandemic..
We need to row together or we go nowhere together.
In normal times, we try worry about things in proportion to their risk. I’d be much more worried about sharing a swimming pool with a shark than sharing an ocean.
The risk of outdoor transmission is orders of magnitude lower than the risk of indoor transmission. The proportion of total transmission events that occur outside is low enough to be a rounding error, as Dr Sax outlines above. This data is clear and has been for months, and anybody who claims otherwise is lying, no matter their motification.
If anyone is so innumerate to still worry about ourdoor transmission then they’re free to keep wearing a mask, and presumably also forgo all human contact forevermore in accordance with their zero tolerance for personal risk.
We can all stay vigilant by doing things that actually matter, like wearing masks in crowded indoor spaces and testing & isolating when infectious. I want this pandemic to end as much as anyone else, but I am not remotely interested in performative gestures to ‘show solidarity’ and help us all ‘row together’ – the only relevant question is whether outside masking does anything or not.
We said, Patrick, well said. I couldn’t agree more.
You sir are a wise man, just like Dr. Sax
Thank you for saying what needs to be said. This solidarity nonsense has to end.
Paul,
Where you say, “Masks only needed for lengthy interactions with others at close distance”, what would you think about replacing “lengthy” with “continuous or continual”?
I’m thinking about the difference between the hikes I take in the woods in Maryland, versus a crowded sidewalk in New York City. Is a latter really safe if one is never distanced from others, even though the others vary?
I agree with your post overall, and acknowledge lack of evidence that crowded outdoor exposures are risky, so I honestly am not certain of the right answer to my question.
Agree that outdoor COVID-19 risk is <<<<indoor risk. Outdoor crowds may pose some risk, especially with variants, eg see: https://www.cbc.ca/news/canada/saskatoon/covid-19-coronavirus-variant-outdoor-gatherings-southwest-sask-1.5987813. (Epi investigation is needed to determine if indoor exposures also occurred)
I 100% agree with Dr. Sax. The entire mask wearing mandate has no basis. I went to the restaurant Saturday night, while walking I had to have my mask on, when sitting down I took the mask off. Why, is the virus smart enough to know if I was liking or sitting down? While I agree that COVID-19 is a serious disease and very infectious, wearing these so called masks or face covering does not do anything to protect yourself. Why, because the paper mask that we put on our face does not filter the small particles of this various and the mask is not sealed against your face. Even it was, these toilet paper masks cannot filter COVID virus. Just think about it, what happens when you put your mask and your reading glasses on, the glasses fog up. Why, because you are breathing around the mask. So these masks have no filtration capability, and it is foolish to tell people to wear these paper masks or a face covering to protect you from others and others from you. In fact, in my assessment, telling people to wear these masks is giving them a false sense of security and protection. People think that by wearing a mask they become immune to this virus, and those who have COVID cannot transmit this virus to them, from from the truth. I know for fact that people who wore masks visiting relatives who had COVID, sadly, they all got infected and some died. Working with nuclear power plants, I know the importance of wearing masks to protect you from small particles. And as I said, I do not underestimate the seriousness of this disease, but please, don’t tell the public that masks save lives, they actually kill lives. Vaccination is the key, the only way we can stop the spread of this virus.
[1] Some masks on the continuum of filter-paper plainly do protect. Do you believe that the doctors and nurses wearing *their* masks are merely engaging in superstitious performance?
[2] “the particles” and “the toilet paper filters”. The the billiard ball analogy is not operative at the scale in question. Look up: [a] brownian motion; in the presence of [b] electrostatic potential lattice.
Yes, doctors were masks, and they were mask that seals around their face, and they know how to were them, this gives them some protection, not full protection. In fact, doctors do get COVID from their patients and I know some who sadly died from it. Again, even the good N95 masks are only effective to some point, not 100% not even 50%, maybe 20%, with face shield and mask, you are protected a lot better. But again, the average public wearing these masks lose on their face have big zero protection against this sneaky virus. If you want adequate protection, then you need to wear a mask with right filters. These masks have rubber face piece that fully covers your face and you only breath in through the filters. But even these masks you breath out through an exhaust port. So, you are protected from someone who has COVID, but even these masks will transmit COVID if the person wearing it is infected. And no mask will work if you have facial hair.
Okay so name all the doctors you know who caught covid from their patients, including the ones who died.
Next please show the source(s) you reference stating that N95s are effective not even 50%.
This is like claiming that airbags kill, because you know a couple of people who decided that airbags negated the need for seatbelts. It doesn’t work that way.
It both misattributes the cause of death, and neglects to look at the big picture. Even with some people wearing masks improperly and/or failing to socially distance, masks are a huge public health win. As someone who works in a nuclear power plant, surely you can appreciate the difference between “I know a few people this happened to” and “our industry did ACTUAL RESEARCH with data and statistics and peer review”.
Besides, vaccines are not a perfect solution to the problem of humans who can’t follow directions, either. If people get their first shot and then immediately jump in a mosh pit, they could well have a superspreader event. That doesn’t mean vaccines kill. It means there is no technology in the world that is so foolproof that it will work perfectly even when misused. Again, as a nuclear power plant worker, you must be well aware of this.
Masks save lives. Vaccines save lives. Education and science are key. What’s killing us are those who see a couple exceptions to a general rule, and use that to try to fight against the rule itself. This is the recipe for anti-vaxxers, too. Please, remove your own experience and emotions from the equation and look at the data. Then remind your friends and family that the same scientists telling you to wear masks are telling you to keep your distance and don’t visit relatives right now!
You must go to a crowded beach in Rio de Janeiro to think about distance and transmission. There’s a virtual distance between people. How can you control how mutch people can go to the beach until it’s considered crowded?
Mask wearing while on bike trails, walking/running trails has become a series of mask “yanking up” when passing fellow trail users. And instantly “yanking down” when passing. This becomes laughable at its face and virtue signaling at its best. To think that yanking up a mask for the split second interaction between passing on a trail is preventative is down right hysterical. The only reason to have a mask outdoors is if it is really cold, or if you need to come into close contact for greater than 15 minutes with people you do not live with. So go for a run, keep the mask or gaiter on the neck, or in a pocket. If you have a long conversation with someone put the mask on. Otherwise stop with the “YANK”.
I applaud your science-based analysis. One other comment and a suggestion. Is it possible that a coronavirus only knows to stick to the mask and not anywhere else on the face? One might argue this may be true because a person is inhaling via the nose and mouth and the virus may be drawn in with inhaled air. But this presents a dangerous false sense of security that somehow a mask protects one from infection; mask wearing alone falls well short of proper infection control. The virus can also enter via other mucosa like the eyes of if the virus is also on a person’s face this also presents a more dangerous risk to the person who feels they are somehow protected with a mask. People constantly touch their face, remember the famous press conference when the health care official was constantly touching her face while admonishing others on infection control? We tell people to wash their hands but we should be telling them to wash their hands AND FACE. I wonder how many infections could have been prevented and could still be prevented if our health care leaders told people to wash their hands and face. After all, if you wash your face you also wash your hands, for much longer and to much greater infection control effect than a quick hand rinse.
A comment on the Lillian Brown’s statistics. For all the experts and general public pontificating about scary dangers of Covid I wish some of our health care leaders or mathematics professionals would use the attention to the pandemic to provide the general public with some simple education about probability and statistics. The following does not attempt to describe all the moments and descriptive statistics of the probability distributions referred to but consider the following.
Per Lillian Brown’s statistics, for a vaccinated person to:
become infected: 5800 / 77 million = .0075% or 1 in 13,275
become hospitalized 396 / 77 million = .00051% or 1 in 194,444
Now let’s compare those chances with the probability of being hit by lightning in your lifetime which according to Erie Insurance is 1 in 15,300 = .0065%
So you should be about as worried about being hit by lightning in your entire life as being infected after vaccinated and you should be far more worried about getting hit by lightning in your lifetime than being hospitalized from Covid after being vaccinated, at least according to the statistics up to the present time.
lightning strike reference: https://www.erieinsurance.com/blog/struck-by-lightning
Anticipating being slammed for being insensitive, please know the writer understands the seriousness of Covid and is not making light of the impact on human lives in the pandemic nor being struck by lightning to be fair to both life threatening risks.
It makes no sense to compare lifetime risk of lightning strike to a two-month risk of post-vaccination COVID exposure. the rate of lightning storms is relatively stationary, the risk of COVID is nonstationary in a statistical sense (both because of antibody persistence declining over time and because of the relative base rate of COVID around you and the mix of variants in circulation). It’s a facile observation. This cuts both ways, by the way, because it’s also the case the people involved in the sample population for the post-vaccination infects are not a random sample of the population, they are disproportionately older people in semi-congregate populations and/or medical professionals (because, again, this is a dataset based on ~2 months of post-vaccine exposure among the very earliest vaccinated)
The vaccines work and people should get vaccinated and post-vaccine they should feel less worried about the risk of COVID. People should maintain the measures that are most likely to continue reducing risk, but not take for granted the additional safety that they’ve bought by being vaccinated. There’s no need to engage in theatrics to prove that point, and that’s precisely what the lightning comparison is.
I disagree for now. I am not a doctor, much less an infectious disease specialist, but I do understand human nature. Give them a finger and they will take the hand. If we lighten up restrictions in one area people will become complacent and feel safe. We are not out of the woods yet. Not everyone is vaccinated yet. Look how covid rates are going up instead of down in many areas. Is it really a good time to relax mandates? I do not think so. Let’s keep the masks on, even outside, until most of the adult population has been vaccinated. Let play it safe, because with Covid it could be life or death and why risk anyone’s life? We can see the light at the end of the tunnel, no need to crash before we get to the end of the tunnel. Let’s take it safely and slowly. Again I have no credentials, so just my opinion as a educated Cambridge resident.
Again, wearing mask gives the public’s a false sense of protection. The masks we wear are absolutely garbage, they provide no protection. I would not doubt if people with COVID wear masks and go out, they are not supposed to, but they think wearing a mask they won’t transmit their disease to someone else. That Apis what we are told, wear a mask to protect you from others and others from you. It does not do anything, it kills people.
This is not how harm reduction works. You don’t tell people not to have sex; you teach them about condoms.
If we really think so little of society, then we deserve to live in a dictatorship.
I’m not inclined to wear a mask outdoors while I’m hiking, biking, walking, playing pickleball, etc. Massachusetts is mask obsessed which is why I’m now a Florida resident! The Massachusetts virus numbers are no better than Florida here Governor DeSantis let’s adults make their own decisions.
So glad I live in the world of common sense.
Most people walking on my somewhat rural road are not wearing masks. There’s a mask mandate in the center of town, and I would certainly wear one there at least for social solidarity as well as to follow the rules.
It’s probably irrelevant, but, although it’s clear that Louie is very intelligent, he should have said, “Whom are you protecting.” I guess he can be forgiven this once, as he is a dog.
My country Thailand was the first in the world to report Covid infection outside of China. We braced for a fire storm of infection and went into early lockdown. Mask wearing in urban areas was already common before Covid due to air pollution and quickly became the new norm. People were compliant with government requests for anti-Covid measures. As a result, for a year after the beginning of the pandemic, Thailand had only about 3000 cases up until March 2021, and only 90 deaths. People were wearing masks indoors, outdoors, some people even while driving! It has literally become the new normal.
Thailand is now in the midst of a new surge of cases, with clusters originating in venues where masks are removed such as clubs and bars. After a year of economic pain, the Thai government is now prioritizing the economy and has stated there will be no new lockdown. The message of wearing masks has been reinforced. It remains to be seen how well this surge can be suppressed. The new normal of mask wearing can only help to limit Covid spread and for us Thais, we feel it’s not even a big ask and we simply do not understand why it has become a civil liberty issue in other countries.
I agree with the science, it is difficult to find a case of Covid that was contracted from an isolated contact that occured only outside. However we are dealing not just with science. Football, soccer and NASCAR, all occur “outside” and there have not been studies that look at 50,000 to 100,000 people in a stadium or grandstand without masks. Political rallies held outside in India seem to have been super spreader events. People who are tired or just resistant to mask wearing will take take the no masks outside as license to not wear them at all. With the increasing incidence of variants and the unknown duration of immunity to the current vaccines, wearing a mask outside your “pod” seems like a minimal inconvenience.
Your point is very valid. The level of precaution has to be commensurate with the level of risk. Under or over enthusiasm and precautions could be counter productive.
In a developing country like Nepal, we use common sense. We always carry a mask. Apply it on mouth and NOSE while indoors whether it is a store, an office, a cafe or any other place where there is someone else than I.
While on a street or a park for a stroll, we are always on the look out and guard. We cover mouth and NOSE if we encounter anyone closer than 6 feet irrespective whether the other person has mask or no mask. If there is none within our “Personal sphere” of 6 feet radius, we may take off the mask.
I wonder why such explicit instructions can not be give, advocated, communicated and followed? It needs nothing more than common sense. But perhaps Common sense is uncommonly prevalent.
While I respect and agree with Dr. Sax that it is scientifically and logically unnecessary to put on a mask while walking a dog in an open uncrowded environment, may I add one more suggestion. Do not reuse the same mask, but put on a new mask every time. In Hong Kong we were hit badly by the first corona virus epidemic 18 years ago. Many health workers came down with the infection and at least two doctors in public hospitals died in the prime of their lives. One of the many causes for the heavy casualties in public hospital personnel was the policy of false economy and reuse of masks, caps and gowns, not only for the same day but even over a number of days. I have talked to the chief of a respiratory unit who had a successful record of keep the infection statistics low in her hospital, and she said one of the major cause of infection lies in the way of putting on and off protective gears. So if you have taken a mask off for some time better not use it again unless you can be sure it is virus-free.
Ever since the pandemic started I only wear a mask when I’m interacting indoors like in a grocery store. I walk my dog 2-3 times a day and go for solo walks for another hour or so and only wear a mask as a courtesy to others if I interact with them other than passing them on the sidewalk. I’m now fully vaccinated and there are even fewer reasons to wear a mask except when interacting with unvaccinated people indoors.
Dr. Sax,
I am interested on the results of the ivermectine trials. The ones that you talked about some weeks ago and gave us some hope. Any of them was good news? Thank you.
I am so glad to see that I am not the only one who has conversations with his dog. Mine too is very wise. The problem is that, like my wife on the dancefloor, he likes to lead. I can’t get him to understand that I am the boss. We have watched multiple episodes of Cesar Milan and he inevitably says “you see, it is always the humans who are the problem”. He asked me to let you know that he completely agrees with you in terms of mask wearing.
I applaud Dr. Sax’s Frank honesty and freedom of speech here!
Add an ICU nurse, the dangers of the pandemic are very real to me, but the autopilot approach public officials are taking in regards to masking mandates is getting nonsensical. Masking mandates should be seen as emergency measures, not new norms. We need to see each other’s faces, there’s a legitimate psychological toll masking imposes – especially on our developing children.
I think for many people it is simply easier to wear a mask at all times rather than sorting through a complicated set of what if’s every time they walk out their front door.
And let’s be clear that it’s a different decision when you live in the suburbs with spacious, empty streets as opposed to a crowded urban setting.
And if you’re out hiking in the Maine woods it’s a completely different discussion.
I want to ditch the mask as much as anyone. I really miss seeing faces. However, if the worse thing that ever happens to me is having to wear a mask during a pandemic I’m a pretty lucky fellow and I’ll deal with it.
Guess what? Your opinion doesn’t matter here. Science does. Whether you agree or not? Beside the point. Each of us have all sorts of opinions throughout our lives that are factually inaccurate, wrong, biased, lacking insight, etc.
So our opinions mean nothing with regards to wearing masks outside.
What does matter? Science.
Here are two articles that compile a lot of research about how wearing masks outside is does almost nothing to prevent spreading or getting COVID:
https://link.medium.com/b3XG12R6Bfb
https://link.medium.com/kae18206Bfb
Masking mandates anywhere at this juncture is senseless. In the past year we’ve learned who is most vulnerable and those folks should be protecting themselves by staying isolated untill vaccinated. The airline industry packs their planes, no distancing when boarding or deplaning, checking luggage, in line at the counter. Airports themselves are very crowded with no distancing. Allowing one industry to circumvent the ” science” is unfair to everyone and financially motivated. Covering the mouth and nose without the eyes helps no one. Billions of chlorox wipes were used for no benefit. Individuals need to know if they’re vulnerable and decide what risks to take. The inconsistent message and information helps no one. Instead of a Mask for All mandate, the vulnerable should be wearing ppe that prevents them for acquiring the virus and free the vaccinated, healthy, young, and previously infected to live normally.
Another article, of many, regarding the SCIENCE (not mere personal opinions) of why mask mandates outdoors and largely ineffective, silly, and overkill. This piece is newly published in The Atlantic.
https://link.medium.com/IjRM3FHgCfb
No, it’s not time to stop wearing masks anywhere. Seriously, there’s no argument that is convincing otherwise. And as for your opinion, only scientific FACT matters. Real scientific fact. People are still dying from Covid-19. Many people refuse to get bloody vaccinated! These are appropriate topics to discuss. And, this sort of nonsense leads other scientifically illiterate people to stop wearing masks in general.
I would explain with more eloquence, but I am an ICU Nurse Practitioner with Covid-19 patients to attend to right now. I work 12 hours a day with 2 days a month off. I live in a hotel so my family is safe. You may be sheltering yourself from the truth and/or reading like-minded material. Educate yourself on what’s really happening.
Thank you Paul.
Agree and on a similar note, isn’t it time to recommend that – in those who have had symptomatic COVID-19 – one dose of vaccine is enough? Several good studies point in this direction but still we cannot recommend it to people outright!
Monica Gandhi’s & Lillian Brown’s numbers do not measure covid breakthrough among vaccinated people. To measure breakthrough, the 5800 covid cases among 77 million vaccinated people must be compared to a comparable cohort of unvaccinated people. We can instead look at the frequency of new infections in the whole US population (350 million) during the same interval, i.e., ~11 million new cases in the period January-March*, since vaccinations began, thus a frequency of 1/30. This number is to be compared to the frequency among vaccinated people, namely 5800/77 million, thus 1/13,000. The breakthrough frequency is therefore the ration of these two frequencies = 30/13000 = 0.0023 = 0.23% — less than 1%, but much more than 0.008%. Expressed otherwise, the vaccine provides 99.77% protection. I do not understand why this protection is so much better than the 90% that was estimated following the initial trials that validated the vaccines for public use.
The same CDC report** included the information that of the 5800 covid cases, 65 people died from covid, thus a death rate of 65/5800 = 1.1%. The death rate among non-vaccinated people has been variously estimated to be ~2%. As noted in the CDC report, this difference suggests that vaccination provides some additional protection against severe covid.
*https://www.statista.com/statistics/1103185/cumulative-coronavirus-covid19-cases-number-us-by-day/
**https://www.cdc.gov/vaccines/covid-19/health-departments/breakthrough-cases.html
Marc
As you stated, coming two set of numbers and thier relationship to each other does give you the ratio, but that’s all. The “frequency” or the “rate” of re-infection was correct as stated.
Comparing the rates of people re-infected with or without the vaccine will give you a % of increase or decrease. But the point is: once vaccinated, or recovered or otherwise immune, the “variants” are just fascinating differences for immunologists to study, but they do not represent an “all new danger” putting us all back to last March!!
When this all started, I remember very clearly the guidelines: “maintain 6ft of social distance -OR- if not able to, than wear a face covering”
Wearing a mask while walking down the street at 6am, alone, is just ludicrous!!!
Even if I sneezed 3 times on the sidewalk, is the person that is walking 25 years behind me going to stop and lick the sidewalk where I just sneezed???
We cannot continue to give into this non-stop sense of FEAR!!!
Some people will always be afraid to cross the street and won’t drive on the highway.
So let the people who are still living in fear wear a mask, a face shield or a hazmat suit if it makes them happy! (Just not while they are in school teaching my kids, THATS fear mongering at its worst!!)
Let the rest of us go back to living.
@gretchen “I am all for lobbying for local/state/federal guidelines and mandates to change, but we need to be visibly complying with them while they last.”
The problem is with PEOPLE. The state of California ALREADY has a law, since last June by the way, that says you DON’T NEED A MASK WHEN OUTSIDE AND MORE THAN 6 FEET FROM OTHER PEOPLE. The problem is people don’t follow that. The fear is insane at this point. And half of it here in SF is to show other people how much you hate Trump, how much you watch CNN, and how you just can’t be too careful. And yet they are the ones not following logic and science. It makes my mind melt.
I have had Covid. I know it is real. I got it from people on a construction team in my building that all wore masks by the way. And I have always worn a mask in accordance with the law and common sense. The WHO has always recommending avoiding masks when exercising.
Here is the California law:
https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/COVID-19/Guidance-for-Face-Coverings_06-18-2020.pdf
Guidance from the WHO:
https://www.who.int/images/default-source/health-topics/coronavirus/myth-busters/mythbuster—masks-and-exercise.tmb-1920v.png?sfvrsn=2d51cd94_2
Consider that there is a 0.17% chance an asymptomatic positive will transmit to a household contact.it must be infinitesimally small to “catch” from someone on a park path that isn’t coughing or sneezing on us. Consider that wearing masks makes it difficult to understand and speak, therefore we lean in, we project more loudly,and the aerosols cling to the mask and get forcefully expelled around the weave of the cloth or disposable masks. Consider the children wearing masks and rebreathing cloth or paper fibers their developing respiratory systems are being stunted. Consider, the cases and hospitalizations for those who “were so careful” . Our immune systems, our lungs, need outside air! It’s madness that we have to argue or defend this. I think the paranoía and agoraphobia that has set in is a far deadlier comorbidity going forward. Public masking is a false comfort, a false theatrical show, and it makes me very sad that someone could even say “yay, I’m team mask”. This is moronic and absurd.To paraphrase my Governor, if You are vaccinated, act like it. Start living life! Talk, run, walk your dog outside without a face diaper! I’m in Florida and I thank God. It’s over people. Start pushing back on the petty tyrants or you will never be free. remember, when you are immunosuppressed, your own bacteria in your colon and urinary tract can kill you. Public masking has no bearing on the risk of sepsis for an immunosuppressed or elderly person.
And be free to show your canine teeth; your innate aggression must be expressed; life-or-death. That’s freedom. The Vikings had themselves buried in the glory of their Viking boats; and the Americans can think of nothing better than to be buried in the glorious opulence of their Denny’s and Applebie’s. The freedom! To be seen ordering food from waiters; to be seen in public commanding such respect. Glorious!
It would be an extraordinary jump for even someone with flaming covid to just walk by someone on an outdoor path and in the passing, give the passerby person Covid-19. Wearing a mask while walking dog is symbolic, not scientific. You see it the most in these ultra liberal communities. I think it’s really sad when public places like parks get roped off, but I think that’s behind us. Go without a mask on your walks, you’ve earned it!
It’s way past time to end blanket outdoor mask mandates. If you force people to continue to take unreasonable precautionary measures contrary to all the scientific evidence, they will become frustrated and cynical and will be less compliant the next time around when you really need them to be. The public’s patience with restrictive public health measures is a finite resource not to be squandered for “performative” or “community solidarity” purposes.
When mandates are based on concrete terms, not vague words like “distance” and lengthy, I’ll listen. In the meantime, I keep a mask handy, but not n, outdoors, in case someone comes close and then coughs or sneezes on me. We know too little about the variants, and too few people are vaccinated to know for sure where things stand. There is no downside to erring on the side of caution.
Simply passing one or two people outdoors, even if they are infected, will not carry the viral load to infect oneself. Yet if those people are sneezing and coughing, that spray carries 20-25 feet. The 6 feet rule is for people who are not sneezing/coughing. When people walk their dogs they always stop to talk with each other as their dogs play. They do not maintain distance. Once those numbers of people you pass/talk with/sneeze around grows, so does the viral load…it only took one person with covid-19 to spread it to many and there is disagreement as to where they were when it was spread initially.There is nothing wrong with putting our masks down when no one is around and putting it up when you get near another person. A person actually has no idea what will happen on a walk or whom one will encounter if there are numerous strangers around. Public health officials are smart to be cautious.
Here is a question. I’m a cyclist. I’m in a paceline with 10 other rides. We’re all breathing heavily and close behind each other, enjoying the benefit of being in the guy ahead’s slipstream. Aren’t I inhaling whatever they are exhaling? SHouldn’t we all be masked (except the lead cyclist)?
As I understand the MA facial masking order, it applies outdoors when you cannot maintain 6’ distance from persons who are not members of the same household. In practice that means if you’re walking your dog at 5:00 am and no one is around, you don’t need to wear a mask. If you’re walking your dog at 8:00 am and there are other dog walkers, then you must wear a mask.
Really, life is not so difficult that you have to go against nonexistent situations.
Mask or no mask, I remain surprised that there is little to no discussion in the press about mask hygiene. I see all sorts of variation and questionable practices in management of masks. Masks fall on the ground, are tucked in pockets and purses, “appear” unwashed. Makes me wonder just how protective these cotton coverings are when worn day after day after day.
From the beginning, I have followed the science, and the current science says that masks accomplish nothing outside unless you are in tight groups. Asking people to follow an unnecessary mandate will lead them to ignore future mandates.
Wear a mask outside if you wish, but don’t give the evil eye to others that follow the science.
Belosi, Franco, Marianna Conte, Vorne Gianelle, Gianni Santachiara, and Daniele Contini. “On the concentration of SARS-CoV-2 in outdoor air and the interaction with pre-existing atmospheric particles.” Environmental research 193 (2021): 110603.
In addition to pollutants and ambient particulates from traffic and such, there’s also the policy question of a small percent of the public, in the absence of mask-wearing mandates, insisting upon coming up to people and talking in their face from a foot and a half away. The existence of mandates at least gives the individual who objects to this behavior the social authority to demand it stop.
Personally, if someone did that, I would just run away from them. But not everyone can.
While the evidence is pretty compelling that most outdoor exposures pose little risk, I can think of at least one type that is likely to pose significantly more. In fact, it may pose greater risk than many indoor activities.
It is well established that people move more air per minute (“minute ventilation”) when exercising vigorously compared to rest – up to 10 times as much in trained athletes. Imagine a narrow trail where two runners are jogging for 15 minutes at an 8 minute per mile pace, with the second runner trailing the first by 10 feet. Now imagine the lead runner is infected and the trailing runner is not.
Let’s conservatively estimate the minute ventilation for both runners is 6 times their resting baseline. In this scenario, the trailing runner could inhale 36x the amount of virus as she would if both people were at rest. While cross winds likely reduce this number somewhat, it is still plausible the trailing runner could inhale more virions than she would if undistanced indoors, as less than 1 second elapses from the time the lead runner exhales until the trailing runner enters the exhaust plume – not enough time to dissipate most droplets.
At the level of viral prevalence currently experienced in most US communities, universal outdoor masking (which could reduce droplet exposure by up to 95%) while walking, hiking, or running on a trail continues to make sense. We can re-evaluate when our viral prevalence approaches the level in Israel or S. Korea.
How many people are killed or injured wearing mask outdoors . Ie unintended consequences
I’m really shocked at all the comments proclaiming that masks “*kill*!” What the hell? Whatever the level of protection (or lack thereof) a mask provides can be argued till we’re all blue in the face, but please, let’s stop the pearl-clutching urban legend than wearing a mask *kills* you. (Yes, I’m looking at you, Robert Kalantari.)
Whoever you are Tish Tash, I tried to explain it scientifically and logically why we should not rely too much on wearing masks, indoors or outdoors. It gives the public a false sense of protection. The paper masks we wear loose on our face may help a bit not to touch your mouth or nose, but it does not provide any protection against this, very small airborne virus when indoors. The virus travels in the air when inside and can enter your body through breathing around and through this mask. So if someone has COVID, wearing these paper masks provides nothing for stopping the virus getting into the air which can transmit to others when indoors, even when both wear masks. So please don’t wear these useless paper masks and go visit a person who has COVID thinking you are protected, stay away from them. I know for a fact that this is how some people got COVID from their relatives who had COVID, thinking their are protected and sadly died from it. That is the point I am trying to make. As I said before, I am not downplaying the seriousness of this virus, this is a very serious virus and very contagious. Hope most people will get vaccinated soon and have good protection against this virus. Be safe, and do whatever makes you feel safe.
Someone wrote:
“Your point is very valid. The level of precaution has to be commensurate with the level of risk. Under or over enthusiasm and precautions could be counter productive.”
Well, not complete, The level of precaution has to be commensurate with the level of risk (for getting infected) *and* the consequences of getting infected. Also, your own risk tolerance. Also, the chance that if you get infected, you will pass on the virus to a vulnerable person who might get very ill or die, or you may prolong the pandemic. None of this is simple.
Early on, I saw outdoor droplet spread studies from ordinary breathing, high rate breathing, cough and sneezes. Clouds of droplets were emitted. Doesn’t that create an infection risk? Can’t we just wear masks a little longer until the virus is really gone, as from large scale immunity and very low prevalence? Is wearing a mask really that bad? In the US, almost 600,000 people have died and look at the current still terrible rate of new infections and deaths. Some of us are such wusses and wimps they won’t wear a simple mask? Bet those aren’t surgeons! Do you advocates of easing of prematurely not get what 600,000 unnecessarily dead people mean? Disappointing if you are a physician or other health professional!
Speaking as a security professional and medic that has to do temp scans all day and remind people to wear a mask even in a building, people are getting to the point where they don’t want to wear a mask at all neither inside nor outside. Many of my fellow officers have gotten direct exposure to covid-19 because of this. To assume that people know the difference between wearing one outside and wearing one inside is off base at best. A lot of people see no difference. And with the resistant variance coming out now you really have to wonder if the vaccines are going to matter in the end. Even the vaccinated person can spread the virus. If you’re outside and you’re all alone I can see not wearing the mask if you’re on a public trail in the larger City we’re contact with multiple people as possible even people who are working out like jogging riding a bike that kind of stuff you’d be surprised how fast they can spread the particulates. You might want to make it a personal choice at least.
Masks outdoors are ridiculous. 396 hospitalizations out of 77 million people vaccinated. It’s safer than driving a car. If you think going for a run maskless is unsafe, how do you leave the house? You are totally ignorant of the data.
How about the fact that this virus is aerosolised and that anything short of a fresh N95 daily is is doing anyone any good in terms of transmission. Why isnt this a major topic? Ohhh I know why. Regardless social distancing among at risk groups is really where it’s at. New variants will perpetuate fear forever. In addition, Why does nobody bring up that TB, which is aerosolised, kills 1.9 million a year. Nobody in public is masking up for that. Never let a crisis go to waste.
Not enough nuance here to be reassuring. As an old (>70) retired physician, I’m frequently seeking reliable info re risk for my age group, and I fail to find it. Is this recommendation equally valid for variants of concern and for individuals with known risk factors regardless of age? Do we really know enough about prevalence and behavior of variants of concern to comment? It does not seem to me that we have adequate answers for many questions regarding risk. It does seem clear that with pleasant weather and optimistic messaging from the experts, the majority of Americans will discard their masks, leaving the cautious among us to feel further isolated. I guess it will be a sort of natural experiment.
The idea that the US is split between the community that believes in science and the community that doesn’t is false. There’s a community that believes in scientism and the credentialed experts, no matter how many times they change the message and/or are proven wrong or ineffective, and a community that takes its contempt for “so-called” experts to ridiculous lengths and will find any reason to believe the opposite no matter the available evidence.
Polls show that Democrats greatly overestimate the risk of severe illness by Covid infection – obviously not informed by science but by fear mongering triggering their own anxieties, while Republicans have often downplayed the risks far too much.
So we’re still stuck in a situation where one community has come to religiously believe in the paper and cloth shields Dr Fauci initially dismissed and that the WHO finds no good evidence for. They have become a tribal identity marker and often an excuse to forego the distancing that is the only effective method to reduce transmission. The other extreme end of the spectrum stopped listening and what the experts say have little to no impact on the choices made by this community.
It boils down to trust and the public health messaging during this pandemic has been nothing but catastrophic. It seems clear that these doctors and epidemiologists have no basic understanding of human psychology or even attempt to account for or predict the real-life impact of their advise. They’ve ensured that the virus has trumped all other considerations and have made no cost-benefit calculations before issuing blanket advise, resulting in deteriorating mental health and learning among children due to the virtual classrooms as one of the most egregious examples.
The fact that some people here believe we should wear masks outdoors is a great example of the failures of the messaging from the epidemiologists.
Does anyone commenting actually believe everyone wants to be vaccinated?