Should You Be Wearing a Mask?
S1: I called up Aaron Carroll, a doctor and writer in Indianapolis, because I was trying to figure out how to feel about masks and I knew he’d have opinions and it’s now recording.
S2: OK. You have to be clear.
S1: I wasn’t sure if I was going to agree with Aaron’s opinions. OK. So, Aaron Carroll, you’re a doctor. I’m going to ask you a question. And I want you to be honest. How many masks do you have in your house? Literally zero.
S3: Really, literally zero.
S4: When Aaron told me this, I was surprised in the last few days, there have been multiple reports that the Centers for Disease Control is about to issue new guidelines, saying the general public. All of us should consider wearing masks when we go outside.
S5: Back in February, you tweeted masks are mostly to protect others from you when you are sick. Correct. Not the other way around. Correct. Please don’t waste them. Correct. Leave them for those who have a real need. I’m still consistent in that. I think that that is utterly true.
S4: This is the part where I should tell you that in my front hall I’ve got masks, just four of them, surgical masks, not those and ninety fives they need in hospitals, but I’ve got them.
S6: The thing about Aaron Carroll is that he’s the kind of guy who lives and dies by data, thinks it’s fun to question the conventional wisdom. So as the conventional wisdom on masks seemed to be changing, I wanted him to poke holes in my arguments, see if we could agree on anything.
S7: If we’re talking about the CDC is changing its guidance, then when and if it does. I would really like to see the evidence behind with behind the reason they’re doing that.
S1: Well, I mean, there is reporting that the CDC might be changing its guidelines this week.
S7: I know I’m I’m curious to see how and why they do so, because what I do fear is that there will just be a statement of you do this because it’s safer and there’s a lot of wiggle words in there, safer. You know, the safest thing to do is never, ever, ever leave your house. And then different actions that we take increased our risk. But it’s not just the binary increase or decrease, it’s how much.
S5: And I’m not sure that that message ever gets across today on the show. What the data says about whether or not you should be wearing a mask from two people who don’t necessarily agree on the answer. I’m Mary Harris. You’re listening to what next. Stick with us.
S6: There is this chart that’s been making the rounds among people who think the public should be wearing more masks. It shows that pandemic curve we’re all trying to flatten, separated out by country. And in three of those countries, Japan, South Korea and Singapore, the curve gets flatter way faster. Coincidentally, these are countries that have embraced masks. So I asked Aaron to start out by telling me whether this chart should change anyone’s mind.
S8: If you look at the responses of those three countries and what you can only take home from it is masks. I mean, that’s the truly I mean, just such an association versus causation thing. Let’s also start with the fact that that those three were Asian countries that had been through the SARS epidemic and therefore had already built facilities and resources and procedures and plans in place for what to do when a pandemic like this shows up. Secondly, they engaged in massive, massive secondary distancing measures, keeping everybody at home engaging in huge levels of testing.
S7: They were able to do things. We are still not able to do what someone even dreaming of doing in the United States. So it’s impossible to tease it out. Yeah, it’s like I mean, to say that masks were the difference is is like saying, oh, well, you know what it is? You know, they’re in the Eastern Hemisphere. We’re in the Western Hemisphere. That’s the difference. Like, no, that’s not that is not the difference.
S6: Aaron’s main argument against the general public wearing masks is that he doesn’t want to take them away from health care workers. After all, the CDC is already telling doctors and nurses that if they can’t find masks, they should be making their own bandanas and scarves. But this isn’t Aaron’s only argument.
S8: So the other arguments that I would make in calmer times would be that I worry that putting on a mask gives people a false sense of security. What do you mean when you say that that that I mean that if you put the mask on, then you won’t be you know, you’ll you’ll think like, OK, I’m protected and you won’t wash hands as vigorously. You won’t be careful not to touch your face. Or worse, you’ll keep touching your face because you keep adjusting the mask, which is terrible, or that, you know, you might just start to be lax in your distancing or the other practices that we would recommend that you do to keep yourself from getting infected. So if you’re asking me my theoretical, you know, concerns about wearing a mask, I’d say, well, these are the potential upsides. These are the potential downsides. I think that this is how it would weigh out for the public. I think this is how it would weigh out for me. And I would make a decision. And I would also say, like, if you want to put on Scorpion’s Catholic.
S7: Go ahead. Look, no one’s telling you not to. It’s it’s that I think people somehow feel like they can’t do this because the CDC didn’t tell them to. It’s like if you want to wear a scarf, wear a scarf.
S1: Well, I don’t know that it’s that people don’t want to do it because the CDC didn’t tell them to. I think there’s a little bit of creating a common thing that you’re doing together. When people go out wearing masks now, it’s a little bit more of a symbol of like it’s me and I might be sick.
S2: Baila even. See? I don’t. I think people are doing what people are doing.
S8: I know people who are hoarding masks who are perfectly fine if you’re wearing a mask in public. I’m assuming you’re well, because if you’re out in public in your city, you’ve ignored all advice. And I don’t even know what we could do with that point. Like we should be sheltering in place, period. We should be sheltering in place if we are. Well, if you’re sick. By God, you should not be leaving your home. Anyone you see wearing a mask, I’d assume they’re well right now, because if they’re sick, they’re really not listening. And I know I even got just a little bit heated there. But like, that’s like that’s just a void. You know, where I’m at is not where I’m at. Clearly, anything we tell you isn’t going to matter.
S1: Do you ever worry that scientists and physicians sort of thinking about this fast moving virus are so use to having time to figure things out? Like being able to point to the evidence when we’re living in a situation where the evidence is coming two weeks late. And so you’re making the decisions blind.
S8: I don’t know that that’s I mean. OK. First of all, like, I I don’t know that it’s that it’s taking us a long time to figure out what to do. It’s taking us a long time to do the things that we’ve figured out.
S9: Singapore, they engaged in amazing guidelines and restrictions and isolation. We do none of that. For us to look at that massive amount of manpower resources policy and take home. Well, they wore masks and we didn’t. That’s missing the forest for the trees. Yes. They also are much more engaged and wearing masks than we are. But masks are likely not what made the difference. It’s everything else they’re doing. And we’re not talking about it at all. We’re talking about masks.
S10: Yeah. I mean, I just think about stuff like from the beginning. The W.H.O. saying this is not airborne. This is why we don’t need masks. Like this is not floating in the air. And it’s true that this coronavirus is not like measles, where it will sit in a room without a human attached to it and float around to infect someone a half an hour later. That’s very true.
S1: But that is not the same thing as it is not in droplets of spit.
S10: They can wander around the air for a couple minutes.
S2: Here’s the problem. You and I are having, you know, a half hour conversation, which is phenomenal. And I swear to you, if you if you look back over what I have said, I have a YouTube show. And every time I and I we’ve been doing Q&A is for the last few weeks. And every time I answer this question, it takes me minutes to answer this question because I go into the detail you just said. And if people are willing to sit and listen to someone talk for half an hour, an hour, they can get a very consistent answer for what I mean by. Is this airborne or not in the same way we say it? You know, we think the virus survives for like four hours to a day. And then the news says, oh, my God, it was on the princess ship 17 days later and everybody freaks out and there’s no time for me to explain. OK. On the princess ship, they could detect RNA, but that doesn’t mean it was a live virus. It was a fragment of a virus. A fragment. It’s not a lot. It couldn’t infect you. And they can still be. The New England Journal Medicine study said that they could detect virus for days later on on a table. And I could say there’s a difference between being able to detect some virus and having enough there to be infectious.
S1: The problem is that our community, our communication suck, right? That it’s job in our communication suck. Great. Our communication, our communication systems have been trained for the last few decades to take the Dateline NBC approach.
S10: Sprayed this on the comforter at the hotel and check it out. It looks really dirty, but can it actually hurt you? Right. And so I feel like in some way his our understanding, our ability to understand has been a little bit eroded.
S8: Well, it’s also it’s also we have to start we don’t we talk in absolutes. We say it’s gone in four days. And what I would say are like gone in a day. And what I would say is like at one day the amount of virus left is so low that it is a very, very, very low chance that you would you would catch the virus and you could probably start to relax. Is it zero? Nothing in life is zero in the same way. Masks and masks provide a very, very low benefit. And for most people, they’re probably not worth it. The rationale behind wearing the mask was we’re having sick people wear them to prevent healthy people from getting sick. Not necessarily that healthy people should be wearing masks to prevent them from getting the virus.
S6: Well, I also think some of this debate over masks is that we just don’t know who is healthy and who’s sick.
S8: That’s not true. That is true with coronavirus. There are other viruses where that is not necessarily as true, which is why I think also you’re seeing the rationale change is we have a new virus where it turns out there are a lot of asymptomatic carriers who might not know they’re sick and therefore there might be an increased benefit to having a lot of people wear masks now because this is a virus where, yeah, it’s much more possible that people who think they’re healthy could still spread it. When you give me that new data, then yes, the calculus changes in telling people, yes, even people who are asymptomatic should wear masks.
S1: Aaron, in his soul, he’s a data guy. And him, the numbers are clear. Stay home. But I look out my window every day and I see people who can’t or won’t follow that advice. There’s the guy next door. He’s an acentral worker, leaves every day to work on the trains. There are jogger’s and delivery guys. I don’t want to take protective equipment away from a health care worker. But those surgical masks I have sitting in my front hall, I’ll probably wear one the next time I go to the grocery store. I do think part of the reason we disagree, too, is just based on where we physically are in the world. Like I’m talking to you from a closet in Brooklyn. Yeah. So I’m in the hot spot of the country. Right. The hottest hot spot. And not just that, but it’s very, very dense here. Right. And you’re speaking to me from a place that’s much less dense and is not as hot of a hot spot. And so what might make sense for me in New York City might not make sense to someone in Indianapolis.
S7: I mean, that’s. I mean, look, first of all, like everyone weighs their own risk benefit calculation and it makes a decision. But but I would also say that what are you going out for?
S1: Only groceries at this point.
S7: So select the first thing I would say is, you know, as much as you can be delivered because that would be safe or not. They get a lot of this also comes out to like I give I give, you know, when I’m talking, I’m like, dude, for the people that can do this, like we have not yet built a society where we have given everybody the freedom and the ability to make the choices, I’m about to say. And I fully recognize that. Right.
S1: Because when you say get groceries delivered. I go to this ethical calculus in my head where I’m like, then I’m making like the Amazon guy, go to the store again, like we can make out.
S8: Like in a perfect world, we can make calculations and protect the Amazon guy up the wazoo and totally make sure he’s the safest part. Again, I know that these are for a perfect world. So if you’re going out like if I’m going out to the grocery store. Because if I or my wife have to go to the grocery store, to be honest with you, we don’t wear a mask. We stay away as far away from other people’s possible.
S7: And I can I would say, like, if it’s because you read about someone coughing in your mouth, like the people who are sick have got to stay home, like that’s the only way that we’re going to halt this.
S1: I live in New York City. I don’t trust any of these people.
S7: That’s fair. And so, look, if you look again, I get it. And so I’m saying to you, like, if you want to wear a mask, that’s fine. Like, I’m not I’m not trying to talk you out of wearing a mask. I’m saying that when we give population level, God, this is you know, it’s funny because I spend my non-covered time often writing about guidelines and things like nutrition and stuff like that when I’m ready at The New York Times. And and it’s, um, I think I’m being very consistent here is like guidelines are supposed to be what we sort of tell everyone and give people reasons why. And we explain who fits the guidelines and who does not. So if we can follow the other guy’s hands that we’re putting out of social distancing and how we’re supposed to doing it. I think masks provide minimal, you know, a small if possibly greater than zero, but small amount of additional benefit if we are doing the other things that we should be doing big. If that’s the problem. If we’re not doing it, then yes, this other guideline clearly doesn’t apply in this guideline can apply. And then just make the decisions that you need to make because people aren’t doing what they’re supposed to be doing. But those are the first guidelines. The social distancing stuff is so much more important than the masks. And that’s what drives me a little bit crazy, is like to think that the masks are an equivalent Band-Aid to this sucking the wound over here. It’s not going to be enough if we aren’t doing the massive social distancing, contact tracing and isolation dusting of the population, you know, all the quarantine, all the other things we need to be doing. Masks are not going to get the job done.
S1: So you’re saying the political leaders just need to crack down more in a place like New York?
S2: I think. Yeah. I mean, and and and let me backed up news. I provide everything you possibly would need to make this social distancing work. Open the spigot. Figure it out. Spend the money. And we are not doing that, which is why I’m not angry at people who, you know, can’t get the job done in their house and have to wear a mask and go out and get food. I get it. That’s you have not been supported correctly, but knowing that the social isolation is the tool, we’ve got to flatten the curve and we’ve got to then take the next step of supporting people in being able to do that social distancing. And we’re not doing that.
S1: Mm hmm. So by the time this airs, there could be a new recommendation from the CDC advising the general public to wear masks. And I think. This evolution is interesting because I worry about something else, which is this like degradation of trust, because when I’m talking to you as a scientist and someone who’s so rigorous with the data, I feel like you’re really comfortable with this unknowing place with. Yes. Changing your viewpoint as you go evolving your thinking. And people look to the government for just firm, reassuring, clear messages.
S7: It may be impossible to give those right now the number of things in health that we know for sure is so small it would blow your mind. This. This is like I just this is I swear to God, if there were like three themes of all the columns I’ve written at The New York Times in the last six years, that would be one of them. There are a number of things that we know because we have done enough double-blind randomized controlled trials that we’re like, this is the way to go. But even when you’re just in the doctor’s office, like everything is probabilities, and when you get a lab test, it doesn’t say sick or not sick. There’s a pre-test probability of how sick we think you are. And then based on a lab test and its characteristics. If we truly ran the math, it should change our prelim process probabilities. Maybe we were 55 percent sure you had something to begin with and after the test were 70 percent sure. But that means we’re 30 percent not sure. Like we could be wrong and we don’t ever speak like that. We just say you’ve got it or you don’t have it. And we make these blanket statements all the time. And that’s what I think is harmful.
S11: Aaron Carroll, thank you so much for joining me. Thank you.
S12: Aaron Carroll is a professor of pediatrics at Indiana University School of Medicine. He blogs at a Web site called The Incidental Economist. He’ll also answer your coronavirus questions on YouTube. His channel is called Health Care Triage.
S13: That’s the show we have been listening to, all the voicemails folks are sending us from around the country. We know you’ve got a lot going on. So then to us, it might become a story.
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