This matches my understanding, but I think the conclusion is too strong. That is, I would agree that in most conditions this won’t materially affect transmission, but there are still reasons to think that in settings where people are properly masking, there should be a reasonably clear (or even large) effect on residual transmission. So I’ll strongly agree that it’s good further studies are underway, but I’m skeptical that they address the point I think i most likely to be relevant.
Does this matter in practice? Well, not when people are ignoring infection risks and can’t be bothered to mask, so perhaps not—unless we see an actually worst case pandemic, in which case I expect for behaviors to change and for this to have some non-trivial impact. How much is very uncertain, but I could imagine that conditional on masking, it would decrease transmission rate by more than 10%, which matters greatly if we’re talking about moving from, say, r=1.05 to r=0.95.
How likely is the case where it makes such a difference? It’s unlikely, but it’s exactly the class of case where making a difference matters; the infection rate is possible to reduce greatly, but not easy to actually reduce enough to stop spread using other interventions. (Also, as we saw during COVID, policy responses seem to get relaxed around r=1, and groups that want to push below that level will need something marginal to reduce transmission in their community.)
Given the above logic, clearly there are other methods we should prioritize more strongly, but I think it’s premature to claim the intervention isn’t going to work at all, even if we find trivially small or null impacts from newer studies. This mistake would be similar to, and related to, the mistake made during COVID, when many public health officials jumped from the observed and easy to notice fact that most transmission is via large droplets to the incorrect claim that there isn’t aerosol transmission. And if we slow large droplet based transmission, i.e. if people can keep their damn masks on, the residual infections plausibly get much more important.
This matches my understanding, but I think the conclusion is too strong. That is, I would agree that in most conditions this won’t materially affect transmission, but there are still reasons to think that in settings where people are properly masking, there should be a reasonably clear (or even large) effect on residual transmission. So I’ll strongly agree that it’s good further studies are underway, but I’m skeptical that they address the point I think i most likely to be relevant.
Does this matter in practice? Well, not when people are ignoring infection risks and can’t be bothered to mask, so perhaps not—unless we see an actually worst case pandemic, in which case I expect for behaviors to change and for this to have some non-trivial impact. How much is very uncertain, but I could imagine that conditional on masking, it would decrease transmission rate by more than 10%, which matters greatly if we’re talking about moving from, say, r=1.05 to r=0.95.
How likely is the case where it makes such a difference? It’s unlikely, but it’s exactly the class of case where making a difference matters; the infection rate is possible to reduce greatly, but not easy to actually reduce enough to stop spread using other interventions. (Also, as we saw during COVID, policy responses seem to get relaxed around r=1, and groups that want to push below that level will need something marginal to reduce transmission in their community.)
Given the above logic, clearly there are other methods we should prioritize more strongly, but I think it’s premature to claim the intervention isn’t going to work at all, even if we find trivially small or null impacts from newer studies. This mistake would be similar to, and related to, the mistake made during COVID, when many public health officials jumped from the observed and easy to notice fact that most transmission is via large droplets to the incorrect claim that there isn’t aerosol transmission. And if we slow large droplet based transmission, i.e. if people can keep their damn masks on, the residual infections plausibly get much more important.