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History Advocates for Wearing Masks during a Pandemic

Twitter surfaced a tweet to me which had some newspaper clippings during the 1918 flu pandemic (aka “Spanish Flu”):

The tweet didn’t cite the sources, but the clipping mentioning Portland jumped out at me since that’s my home. To find the source I googled for [“wearing masks in portland might save a life. it might save hundreds. if it would save just one, is there anybody who would object”] and I got back one result from Newspapers.com:

The source is The Oregon Daily Journal, a daily newspaper which ran from 1902 to 1982 in Portland, Oregon. The snippet comes from page 4 of the issue from Saturday, January 18, 1919. The full quote is illuminating:

FLU AND MASKS

More people have died from flu than were killed during the same period in the war.

The number of Americans who have died from flu is several times as large as the number of Americans killed in battle in France.

“I am satisfied that the universal use of the mask would cut the disease down to practically nothing in Portland in less than 10 days’ time,” is the statement from Dr. Sommer, director general of the anti-flu campaign. For the forenoon of yesterday the number of new cases and deaths reported was among the six highest days recorded since the epidemic struck Portland. Yesterday showed the largest number of deaths since November 4.

In San Francisco the average of deaths per day during October was over 40. The universal wearing of masks was then required, and within three weeks the average dropped to seven.

Wearing masks in Portland might save a life. It might save hundreds.

If it would save just one, is there anyone who would object?

That could have been written yesterday!

On the same page of the newspaper, I found yet another another striking reflection:

The painter knows best how to mix his paints. It is the lawyer, not the teamster that knows what is in the law books. Nobody studies flu so much as the doctors. If they say masks, on what authority can a street cleaner contradict them?

Listen to the experts!

The first quote comes from Dr. E. A. Sommer of the Portland School Board who also led the Consolidated Health Board (i.e. “director general of the anti-flu campaign”). In the Portland essay of The American Influenza Epidemic of 1918: A Digital Encyclopedia, I found another quote of his which is also cited as coming from The Oregon Daily Journal a couple weeks later:

The biggest thing we have had to fight in the influenza epidemic has been apathy, or perhaps the careless selfishness of the public.

“Carelessness Is Greatest Cause of Spread of Flu,” Oregon Daily Journal, 2 Feb. 1919, 15.

This is still true today, a century later.

Will we learn from those who came before us? Wear a mask. Save lives.

2 replies on “History Advocates for Wearing Masks during a Pandemic”

If you push the experience further, google-scholaring the matter, you will find very few studies on the actual efficiency of masks. In this set of very few studies, you will find that most of them are conducted in closed rooms in time frames of 10 to 20 min and only measure the particles filtering abilities of said masks at a short distance and usually only in front.

The problem is that the life cycle of a mask doesn’t last 10 min between putting it on and off cleanly. There is actually no study over the whole life cycle, including disposing of the mask, putting it on, off, and back on (you know, in restaurants…), repositioning it when it falls (usually when you have one grocery bag in each hand), and so on, not to mention the impact of improper use.

Also, there are psychological matters that get convoluted in the process, beyond particles filtering performance. Human beings, when they feel safe, tend to increase the amount of risk they take. For example, the 3-wheels BMW scooters, more stable than the 2-wheels generic ones, lead to a bit fewer accidents than the 2-wheels ones. However, the average gravity of the accidents is higher with 3 wheels, meaning the bikers probably pushed them harder. The same way, in FR, local governments shut down the lights at night on suburban highway sections after they noticed more accidents on them… That reduced accidents by up to 30% on the same sections.

All in all, if masks are better to filter viruses in outer breath but lead to more reckless conducts, the gross total of the operation could actually be a loss. Only a proper study can answer this, but I still don’t have seen any concluding on that topic.

So, while doctors might be the experts, in the absence of scientific studies following due-process of peer review, tests, P-values and so on, whatever they might say is nothing more than an opinion. This whole pandemic event has shown dozens of educated opinions proved wrong a couple of months later. Having a PhD doesn’t actually make everything you say true, moreover the clinician doctors might be biased by the sub-sample they see everyday in their office or at the emergency and might lack the scale of a proper statistical analysis, which is not the job of the people in the emergency room.

Thus I don’t think taking refuge in expert’s opinions is any more sound and sensible than going with your gut feeling. Opinions are still not knowledge, no matter who expresses them. Not to mention, experts take a guilty pleasure of disagreeing with each other, so you can build your confirmation/sample biases the way you want by listening to whomever you like. In the absence of proof, all we have is doubt.

Still, I will prefer to rely on the opinion of the majority of experts who have devoted their lives to the study of their area of expertise rather than trust my gut or the advice of others who have only recently become “experts” on a topic. Sure there is disagreement among actual experts, but there is more consensus than disagreement, as far as I have seen.

Nevertheless, the CDC actually just published a study that masking in schools limits the spread of COVID-19. If a school lacks mask requirements, it’s 3.5x more likely to have a COVID-19 obreak compared with schools that started the year with a mask mandate.

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