He Said Six Weeks

A couple of days ago (it’s September 17th 2020) Dr. Robert Redfield, the director of The Center for Disease Control, testified to Congress that universal mask wearing in the US would bring Covid-19 under control in the US in six weeks. He’s has said this before but this time he said it under oath to Congress. Once again, didn’t make a ripple.

Dr. Redfield isn’t your drunk uncle Bob—the CDC is the deep duck in the epidemiology puddle and Redfield is their top guy. They have a budget twice as large as the NIAID (Dr. Fauci’s organization) and collectively know more about controlling infectious diseases than any other organization in the world.

His testimony barely made the papers. Control in six weeks with just masks that you can get for a buck a pop. Not masks plus economy-crippling isolation. Not masks plus vaccine. Not even masks plus elaborate social distancing. Just masks. Anything else you do is gravy. Redfield has made the same statements on camera before and it seems to have had no impact whatsoever. I’m at a loss to explain the lack of reaction. It’s a giant get-out-of-jail-free card for the whole country and the economy. It could save 250,000 more lives in the US this Winter for pocket change and make hundreds of millions of people less poor, bored, and anxious. Yet nobody is interested.

It’s not some pipe dream. His calculation is based on definitive research from a recent study on the efficacy of masks and backed up by practical experience around the world. The calculation is trivial, immediately obvious if you read the research. Moreover, the research would have to be wildly wrong to substantially change Dr. Redfield’s conclusion. Any plausible error would mean only that it wouldn’t be six-weeks, but eight, or twelve. The principle would hold up.

(I extracted this material from an earlier post where it was buried too deeply to be readily found so my apologies if some of it looks like I plagiarized myself.)

The Phrase “Slow The Spread” Kills People

Redfield didn’t say we could slow the spread. The ubiquitous phrase “slow the spread” is a strange holdover from last Spring when the goal was to “flatten the curve.” The assumption, reasonable at the time, was that sooner or later, regardless of what we did, most people would get Covid-19 but if we could just slow the spread we could keep the number who have it down to a level that the ICU’s and the existing mortuary capacity could handle.

“Slowing the spread” was the goal back when hospitals in NYC needed refrigerator trucks parked outside to accommodate the dead. It’s not a reasonable goal anymore, yet the zombie-like survival of the phrase still systematically warps our expectations and policy. It’s not just small town news anchors and frustrated bloggers who keep it alive. It’s the go-to phrase for politicians and even public health people.

It’s deadly because if all we can do is “slow the spread“, it makes sense to put our national hopes in a vaccine even if it is at best many months away. But that is demonstrably not the case; we have a more effective, safer, vastly cheaper,well understood and proven solution available right now, today. The correct expression would be something like “end Covid-19 forthwith.”

The vaccine isn’t even a real solution for this year, as Dr. Redfield also made clear in his testimony. When they talk about “getting the vaccine in November” they mean doses for a few of the most vulnerable. More doses are expected by January but general availability is not expected until the third quarter of 2021, i.e., nearly a year from now. And when we talk about an industrial-scale response, a healthy dose of skepticism is in order. We’re still experiencing shortages of simple mechanical devices like swabs, ventilator accessories, and sundry PPE. Organizing the manufacturing, distribution, and dispensing of hundreds of millions of doses of a new drug and persuading a jaded and cynical public to sit still for injections is hardly a risk free endeavor.

Our national failure to take this seriously is doubly bizarre because it is a conclusion that should be obvious to anyone who has even glanced at the study and we have many examples of Covid-19 having been brought under control in similar time frames. Control not some euphemism for the same approach. Control means that the disease is no longer everywhere in the community anymore; it means so few reported cases that all of them can be run to the ground and anyone who might have it can be tested and/or isolated immediately.

Six Weeks? That’s Crazy Talk!

Not a bit. All of the evidence is that the virus responds to what people do very predictably. It’s not transmitted by some intermediate vector animal like mosquitoes or fleas. People spread it in a well-understood way.

There’s actually nothing in Dr. Redfield’s conclusion that you can’t verify yourself. In the first place, you don’t need fancy science or statistics to infer that controlling it quickly is possible because many places have successfully done exactly that. Just read the papers.

Many Asian countries long ago got the situation in hand. New Zealand seems to have extirpated Covid-19 entirely. Canada is having days with zero Covid-19 deaths right now. In New York City, where it ran wild initially, you chance of dying of pneumonia now is less than in a normal year.

In fact, pretty much every country that has made a serious effort to suppress the virus has been successful. The converse is true too. The countries that have denied the seriousness of it (like the US and Brazil) have failed utterly and the countries that have backslid and ceased to make a serious effort have seen dire and rapid renewals of the epidemic.

What changed recently is that we now know rather precisely how effective masks in particular were/are in those efforts.

The Efficacy of Masks Is No Longer In Doubt

The US got off to a bad start with the whole mask thing. The authorities aways knew masks were at least somewhat effective for medical workers but it wasn’t clear how effective they’d be for the general public and they were understandably afraid that advocating them for the general public would lead to a run on the supply that would cause acute shortages for critical health care workers. Indeed, this is exactly what happened.  Tragically, the apparent about face left the public confused about whether the authorities knew what they were doing and the confusion was exploited for political ends.

The scientific literatures several months ago was neither complete nor consistent on the subject of the efficacy of masks for influenza-like illnesses, known in the business as ILI’s and for Covid-19 in particular (Covid-19 is an ILI.) Legitimate papers drew divergent conclusions with some even discounting the utility of masks entirely.

Today we know much more. First of all, the amount of protection masks supply varies widely with:

• The specific ILI
• Whether you’re talking about medical settings, a non-medical settings, use at home, etc.
• The type of mask–surgical, N-95, simple cloth coverings, etc.
• The nationality you’re talking about. (Asian countries do strikingly better at Covid-19 wrangling than Western countries for reasons that are not well understood.)
• What kind of protection you mean: masks are better at stopping an infected person from spreading Covid-19 than they are at preventing a specific uninfected person from catching Covid-19.

One big reason why the situation is clearer today is a type of analysis called a “meta study.” Meta-studies draw conclusions from large numbers of other studies. They use advanced statistical techniques to merge data and conclusions from multiple studies which are often not the same kinds of analysis, and can reach conclusions that are beyond any one contributing study. Statistics is a difficult field and meta-study techniques can be abstruse even for statisticians. Unless you’re a pro, you have to take their word for it but these boys and girls know what they’re doing. (I was once a semi-pro. Sort of. At any rate, I had at least enough graduate level statistics to be immunized against Dunning-Kruger.)

Readers who do not have some statistics background may find this report on a meta-study of mask effectiveness difficult to understand.  It is a complex analysis so any epitome is necessarily incomplete but I would summarize the conclusions as:

• The benefits for health-care workers (HCWs) are huge. At least an overall 80% reduction in infection rate for hospital personnel in high-risk environments. That’s protection of the worker.
• Masks worn by HCWs and visitors also have a very large protective effect for patients, particularly immune compromised people, the elderly, etc. This is protection from the workers.
• Masks worn by the general public appear to have an extraordinarily large effect. The risk from influenza, SARS, and COVID-19 transmission are reduced by 45%, 74%, and 96% respectively by wearing masks.

Wearing masks on trains and planes is a typical situation of concern (according to the article.) The authors mention a case study in which none of the flight attendants nor the 25 people closest to a masked person with active Covid-19 on an international flight tested positive later.

Bottom line: the data is in and masks are the unquestioned bomb for ILI’s, but particularly for Covid-19. If everyone wore masks routinely the vast majority of Covid-19 transmissions would not occur.

Why That Means You Can Crush Covid-19 Fast

The R value that you hear about for Covid-19 isn’t actually a direct property of the virus. It’s a measure of the number of people that a person with a disease will pass it to before they either recover or die. For a given disease the R varies with circumstances and indeed for Covid-19 it goes up and down significantly on a regular weekly cycle. You can introduce the most infectious disease on Earth to a nation of lonely shepherds and the R value will be near zero because the average shepherd never meets another person to give it to or catch it from. Whereas if you introduce the same disease into New York City or Hong Kong, the R will probably be quite high because you can’t swing a dead cat in either town without hitting someone you could infect.

I won’t bore you with a long explanation of exponential growth. Suffice it to say that R>1.0 means that a disease will propagate through an entire population faster and faster until it starts to run low on new people to infect.

The sunny side of exponential growth is that if R is less than one, the opposite happens. Some infected people don’t pass it on at all and the average number of people an infected person gives it to is less than one, so the disease dies out. The smaller the R, the faster it fades.

Masks reduce Covid-19 transmission by 96%. That means that if each infected person on average gives it to one person (which was approximately true for most of the Summer) with a 95% reduction each person gives it to only 0.04 people. Most people who don’t die get better in three weeks and the people will do die mostly go to the hospital where they are isolated and rarely infect anyone else after they get there. Simplifying somewhat, if everyone starts wearing a mask on day one, after three weeks the people who had originally had it will have only passed it to 0.04 people each. No matter how big an infected population you start with, you don’t have to multiply it by 0.04 many times to reduce it to a handful of cases. In three weeks, a million cases becomes 40,000 and in three more 40,000 becomes 1600. And with 1600 cases it’s basically under control because you can hunt down the contacts for all of them. Three weeks later 1600 would become 64 cases even without contact tracing, so in twelve weeks you could go from a million cases to a situation where Covid-19 researches would have to go to other countries to study the disease.

Why should this be hard to believe? Every country that tries to suppress it succeeds. The only real question was what specific actions were actually doing the work. Probably everything contributed something, but now we know that the simplest, cheapest, and least economically destructive technique is miraculously wildly effective.

By the way, masks also turn out to be so effective that you can quarantine an entire house and the infected person will rarely pass it to the uninfected even at close quarters.

Why Vaccination Is Iffy Even If We Get It

First of all, nobody with any sense believes a Covid-19 vaccine will be generally available this season. That’s the official opinion of the CDC as well as the opinion of almost all responsible analysts. We’ll probably get some doses this year but general availability won’t come before the coming ILI season is a distant memory.

Secondly, nobody knows how effective it will be when it arrives but it is very unlikely to be bulletproof. You shouldn’t think of it like say, birth control where the benefit to the person using it is the main consideration. If birth control were the model, it wouldn’t be like the pill; more realistically, we’re talking about rather worse than the rhythm method but probably better than prayer. Somewhere in that range. Vaccines for flu, for instance, tend to be between 40% to 60% effective at protecting the vaccinated party in good years. (In bad years the vaccine does almost nothing.)

In other words, personal protection is the motivation for a given person to be vaccinated but it isn’t really the main point of it from the public point of view. The real power of such a vaccine for Covid-19 is that either by itself or in combination with other measures, even a modestly effective vaccine can push the R value down below 1.0. If everyone takes a 50% effective vaccine and the R value is already 1-point-something, you don’t just get 50% fewer cases—you also push the R below 1.0 and therefore the entire disease fades away because the average sick person no longer replaces himself with one or more sick persons.

Thirdly, we don’t know what the R value for Covid-19 will be when Winter arrives so we don’t know how effective a vaccine must be to suppress it. It is under-appreciated that Covid-19 has never been around through an ILI season, so we don’t know. However, we can see that it did rather well for itself in the off season. Other ILI’s die down all Summer then erupt in the Fall but Covid just leveled off and then started back up again in mid Summer. That’s very virulent for a ILI so don’t bet on it remaining tame come Christmas or so.

Lastly, given the expected range of effectiveness, it would make a certain cynical sense for an individual who doubts the vaccine’s safety to hide behind others who are actually taking it. A large part of the public loses its mind when asked to wear a mask–will they all suddenly come to Jesus when the vaccine eventually becomes available? Maybe, but again, don’t bet the rent on it.

The Good News

A vaccine would be nice-to-have but even without it, dealing with Covid-19 need not be difficult or expensive if we presented a unified front. The person who in all the world is best equipped to know has said repeatedly that we have a faster, more powerful solution to the problem right now and all it would take is everyone acting like they are full grown responsible adults for a few weeks.

Bottom Line

Why this is being universally ignored is the mystery of the age. It seems to fly in the face of common sense on all sides. The President could pull his reelection campaign out of the fire and plausibly declare victory over the pandemic with weeks to crow before election day. He’d go from goat to hero overnight. Nobody would remember the false starts, only that he led the country back to normalcy. The economy would recover rapidly and he’d be golden.

It’s too cynical to imagine that the Democrats are keeping silent in order to assure the maximum embarrassment for the President. I can only imagine that it’s because they listen to the media like everyone else.

The media are the real mystery. They keep unthinkingly using the outdated language of last Spring and spreading a sense that there’s nothing to do but hold the line and wait for the cavalry. It’s flummoxing. Why? They don’t even need to think for themselves: Dr Redfield has thought it out for them. It’s as if Roosevelt’s response to Pearl Harbor had been to announce on December 8th that he would appoint a panel to look into the appropriate diplomatic response within 90 days.