Seems like the Reasonable Middle Ground™️ position on masks right now is to say they work for individuals but not for populations.

But all this really means is that masks work. Period. And that we need to increase access and education so they work for more people. Implicit in that framing is that some people have lower-quality masks or don’t wear them properly. Easy/free access to N95s or other respirators, education on how to wear, and improvements in design and comfort can help. It takes work but can be done. Think seat belts and condoms

1. Thank you to @BostonGlobe for continuing to shine a light on COVID and its impacts on mortality and morbidity. Since the shift in racial/ethnic patterns of deaths is perhaps a bit surprising, I want to walk through our findings and some hypotheses. 🧵

bostonglobe.com/2023/02/20/met… 2. First, the basics. @JacobBor and I looked at all deaths in Massachusetts in 2022 where COVID was on the death certificate as the immediate cause of death, underlying cause, or other significant condition contributing to cause of death. We only considered those age 20+.

A recent article ⬇️ has received a lot of attention for its estimate that 12.7% of childhood asthma in the US is attributable to gas stove use.

Without parsing through their calculations, the question is whether this is even plausible.

TL/DR - yep. 🧵

mdpi.com/1660-4601/20/1… I wrote on this topic this fall in @ConversationUS, and the article has a lot more detail (and references) than I can tweet.

But the essence is that we have known for a long time that gas stoves elevate indoor nitrogen dioxide, which affects asthma.

theconversation.com/amp/is-your-ga…

COVID hospitalizations in MA increasing quickly, highest since Omicron wave. But our CDC “community level” remains at medium.

Why? Because while hospitalizations have nearly doubled in the past month, case counts are flat. A metric based on data from 2021 doesn’t work in 2023. Basically, if you have < 200 cases per 100K people in past 7 days, you need > 20 hospitalizations per 100K to be “high”. If > 200 cases, you only need > 10 hospitalizations. Now that case ascertainment is way down, a metric that was already a lagging indicator lags even more.

Can we have a mature, honest, nuanced discussion about masks on Twitter in November 2022, where we acknowledge facts, shades of grey, and complex tradeoffs?

Well, I’m going to try anyway… First, we need to move past the “masks don’t work” “oh yes they do” argument. It’s tiresome and does not acknowledge that we are not talking about 0% or 100% here. And what the number is depends on who is wearing what mask, how they are wearing it, where they are, etc.

I recently published an invited perspective (ehp.niehs.nih.gov/doi/10.1289/EH…) where I argued that it is time to move beyond describing racial disparities in air pollution and focus on eliminating them. A wonderful new study by Wang and colleagues did just that. pnas.org/doi/10.1073/pn… They showed that location-specific strategies can help to eliminate racial/ethnic disparities in air pollution AND reduce overall averages as much or more than other strategies. This is consistent with the literature - smart strategies can be more efficient and more equitable.

Tweeted out 3 facts yesterday:
1) Ventilation/filtration reduce exposure
2) Masks reduce exposure
3) COVID infection risk is probabilistic function of exposure

Some requests to show data behind these facts. So here we go… 🧵 First, some ground rules. I will try to clearly define what I mean by each of the 3 facts, rely on first principles, and then provide some review articles or key primary literature to support the fact. I will also use too many gifs.

Back in the saddle - missed the tail end. But a few quick observations from the portion of the transcript I had, followed by some synthesis thoughts...first, @CorsIAQ brought up the Corsi-Rosenthal box, a great example that basic principles can trump fancy bells and whistles. They provide 7 additional air changes per hour for classrooms at a cost of $4.20 per student per year. Compare that to cost of educating a student of $13k/year. Literally pennies on the dollar.

Some periodic thoughts on today's White House Summit on Indoor Air Quality...

@AshishKJha46 kicks off by drawing parallel with water. Important that policy solution for water was NOT to put everything on people to boil own water, but to have institutionalized and systemic change Health care system can buckle under burden of flu+ COVID + other respiratory diseases. We can't solve this through health care capacity. Burden on health needs to come down through improvements in indoor air quality. Healthy buildings = healthy communities.

BA.5 is neither the sniffles nor the apocalypse. Doing nothing during this wave is a terrible idea, and so is telling people they are doomed if they leave home. There are sensible exposure and risk reduction measures, especially during the summer with more outdoor activities. We just took a family vacation. Very important for mental health. We rapid tested before seeing people and masked when sharing air for extended periods. No masks for swimming, mini-golf, boating, hiking, etc. Ate outdoors when with people. Lots of fun, returned home healthy.

1. I’ve been thinking a lot about the rationales given for various recent COVID policy decisions. Too often leaders use vague invocations of “The Tools” or “The Science” to avoid explaining hard decisions, and this ignores the values implicit in those decisions. 🧵 2. First, I *think* we can all agree that there are some good COVID prevention strategies and some bad ones.

Good: Keeping people with COVID from wandering around nursing homes

Bad: Permanent societal lockdown

Thurston High School.
Columbine High School.
Heritage High School.
Deming Middle School.
Fort Gibson Middle School.
Buell Elementary School.
Lake Worth Middle School.
University of Arkansas.
Junipero Serra High School.
Santana High School.
Bishop Neumann High School. Pacific Lutheran University.
Granite Hills High School.
Lew Wallace High School.
Martin Luther King, Jr. High School.
Appalachian School of Law.
Washington High School.
Conception Abbey.
Benjamin Tasker Middle School.
University of Arizona.
Lincoln High School.

1. So much hostility and confusion from people who saw me (on a Zoom) wearing a mask in my office this week! The question is: Am I crazy, am I virtue signaling, am I fear mongering, or is there some rationale to wear a mask in a private office? Let’s discuss! 🧵 2. Let’s start with the basics. Here’s a screenshot an angry critic took and shared. You can see I am wearing an N95. I work at a mask-optional university, so no one is making me do it. You can also see I need to clean up my office, but that’s a separate topic.

1. Yesterday’s @MassGovernor quote reacting to the “high” COVID designation of many MA counties by CDC isn’t just “spin” - it combines the obviously false, the vaguely misleading, the correct, and the correct but myopic. Let’s parse it! 🧵 2. First, background - every week on Thurs, @CDCgov updates its “Community Levels” designation by county. The methods, data, and designations are publicly available.

covid.cdc.gov/covid-data-tra…

1. When we officially record the millionth death from COVID in the US in the coming days, it should lead to collective introspection about our failures as a country and an articulation of lessons learned for future pandemic control. But it won’t. 2. Don’t get me wrong. There will be some great commentaries and excellent ideas put forward. But I used the word “collective” deliberately. I fear that many have learned one primary lesson from the pandemic - look away.

1. When I took logic in high school, my favorite logical fallacy (yes, I had one - don't judge) was "argument of the beard". I actually think it informs some of the current arguments about masks, airplanes/buses/trains, and other aspects of pandemic response. 🧵 2. First off, I know I'm not a philosopher or logician. My understanding of "argument of the beard" comes from a high school logic class in the 1980s. So don't dunk on me if I don't grasp the subtleties or misuse the fallacy a bit.

1. With the BA.2 wave here in MA, it is worth asking what the @CDCgov "community levels" tells us to do, when it will tell us to do something different, and what this means. I'll look at Suffolk County, which includes Boston. 🧵 2. Right now Suffolk County is "medium", because cases are > 200 per 100K. At that level, CDC says to talk to your health care provider if you are "at high risk for severe illness" to ask about wearing a mask. So, do nothing. It would be "high" using the old scheme.

1. Something interesting is happening with #COVID19 in MA, where case incidence appears much higher right now in wealthier suburbs. My guess is one of two things is happening, neither of which bodes well. 🧵 2. First, the data. We are seeing average daily rates > 20 per 100K in towns like Manchester, Sherborn, Wayland, Concord, and Wellesley. In contrast, it’s <= 5 in Chelsea, Lawrence, and Brockton. This isn’t a formal analysis and there are counterexamples, but you get the idea.

1. I’m trying to better understand the implications of the new @CDCgov Community Levels #COVID19 system. So I took a look at what it would have told us to do here in Boston during the Omicron wave.

TL/DR - looks ok if we live in the past, not good if we plan for the future

🧵 2. First off, I know you don’t evaluate a model on one data point. And this is based on the eyeball test, not formal analysis. And it’s hard to capture a counterfactual future scenario with historical data. But bear with me…

Leaders loosening #COVID19 restrictions now should be willing to answer the simple question - what conditions would lead you to reinstate restrictions? If there are none, we are unprepared for new waves or variants. If there are some, describe them, even generally. I know we don’t live in a technocracy and politics drive decisions. But if you are lifting restrictions because things are getting better, don’t you need some definition of “better”, so you know if things aren’t “better” any more?

1. FAQ for #BetterMasks in schools and colleges - a long 🧵

My goal is to provide information to parents, teachers, and students who want to protect themselves, but also to give sufficient background to allow people to advocate for policy changes. 2. Why am I doing this? Other than the fact that it is incredibly important given #Omicron, I have already prepared 3 versions of this for different schools this week. It is clear that many people don’t have the background needed to support mask upgrades.