Thread by @trentyarwood

There's so much to unpack here, so I'm going to have a bit of a crack at it in a twitter thread.

I think the endless debate about masks is a symptom of a whole heap of COVID-induced but also more secular trends all coming together in a giant pandemic-flavoured mess.

https://twitter.com/deb_cohen/status/1282244768257499136

First up, pandemics are scary. There's lots of things from the Sandman model of risk communication that tilts them towards being high outrage.
- limited personal agency
- unseeable
- perceived as being imposed from outside
- "unnatural" (I dispute this)
- novel

This means that people are already wound up pretty tightly, and we know that this makes it even more difficult for people to process complex information properly.

Next up, there's been a trend in medicine and elsewhere to extreme intolerance of uncertainty.

Journalists love "gotchas" and saying "I don't know" or "the evidence is not clear" is seen as prevarication or waffle. People want answers and they want them right now, goddammit.

We also see this in medicine more generally. People aren't allowed to be under investigation anymore. They have to be empirically treated. This is a major challenge in antibiotic stewardship. People think I'm insane for saying "you could not treat them right now"

(Even though it's usually too late and people ring us after the first (four) doses of antibiotics have already gone in)

Who heard this interview on the radio (more than once)
"Should we wear masks?"
"The evidence is..."
"Yes or no?"
"Probably not very helpful and not as important as social distancing"
<EXPERT SAYS MASKS DON'T HELP>

It's also very difficult to transmit nuanced information in sound-bite media.

"But healthcare workers wear masks, why shouldn't I"?

- Because they are at a different level of risk than you

"But the CMO said yesterday that everyone is at risk, HCWs are a subset of everyone"

I've written previously at my blog about how we are very poorly served by the general state of scientific journalism at my blog (go check it out, I can't give you the direct link at the moment because """"security"""") blog.yarwood.id.au

You will have seen me in the last week calling out some egregious nonsense from the Health Report (don't snitch-tag you terrible people). I've said before that I think Norman is generally excellent, but good people can sometimes have bad ideas.

Especially when they're being fed incorrect information. Which brings me to the Prominent Public Health Expert who's practically got her own headphones on the Health Report - Raina McIntyre.

I was being diplomatic earlier in the pandemic when Raina (a public health physician) said in an interview on Health Report (lightly paraphrased) that "infection control people primarily care about protecting staff, not patients"

I was incandescently angry about this at the time to the point where I considered making a formal complaint about what is an egregious slur on all infection prevention professionals who - believe me - very definitely are interested in patient safety as well as staff health.

Which brings us to one of the other challenges with current communication - siloing.

Infectious diseases physicians (and nurses and all the rest) are not public health physicians (and nurses &c). We do the same sort of things, but with a slightly different focus.

This isn't wrong, or bad. It just is. But you need to remember that the advice that you are given is not and can never be completely impartial. It's like the relativity "no fixed frame of reference" thing.

For clarity - infectious diseases physicians are interested in the prevention, diagnosis, treatment of infections in patients. And that prevention includes an element of population health.

Public health physicians are interested in the prevention of disease at a population level

(and stacks of other stuff) and that this also includes preventing disease in individual patients.

We generally (but not always) agree. And there's always more than one side to the story

So, personally, here's my opinion (I'm an ID physician. Have done some public health, really should finish that one day). Others might have different ones.

That's fine, but I accept that this doesn't make it easy to know what to do. But this isn't because...

..."those doctors need to tell us what the right answer is". It's because there isn't one. It would be great if there was, but there's no rule that the universe needs to be fair.

What you need to do:
- Physicially distance. #staythefuckathome
- Wash your damn hands.
- Physicially distance
- Get tested if you're unwell.
- Don't go to work if you're unwell
- Wash your damn hands
- Physicially distance

Wear a mask if you want to, or if you're required
It might help. It might not.
Don't let using a mask replace physical distancing or hand washing.
Regardless of whether you wear a mask or not, don't touch your face. If you're wearing a mask be super cautious about this

Download COVIDSafe if you want to.
It almost certainly won't help and everyone who actually understood technology has been telling you this since March.
Don't feel like you can not physicially distance because you're "wearing sunscreen" because this is complete bullshit

Try to understand that there are no right answers.

The science is changing rapidly. This too is a problem because what was correct a week ago might not be anymore. That doesn't mean someone lied to you last week. It probably means the three second grab didn't summarise well.

Everybody is trying their best. But also remember that they're trying their best at doing the thing that they do.

Which isn't exactly the same thing that someone else is doing, so they might have a different perspective.

Conflicting information sucks. It's not a conspiracy.

Also try to be nice to each other. People who are trying their best probably don't deserve to be dog-piled on social media because what they said doesn't exactly agree with what you last read.

Especially the people who are trying really hard to get good information out there...

...in addition to actually working in the trenches.

<repost to thread properly>

I'm going to finish this with one of my favourite takes on the pandemic, from Randall Munroe.

xkcd.com/2287/

#StayTheFuckatHome
#WashYourDamnHands

</rant>

It's also worth pointing out here that the thing that modern journalism loves even more than a gotcha is a conflict.

"But <expert1>, <expert2> says <thing which disagrees with thing ex1 said>. How do you respond to that?"

#icemoonprison