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Answer by FlorinOct 17, 202210

If current covid policies (lockdowns and tracing) are relaxed, millions of Chinese could die. China's CoronaVac vaccine doesn't appear to be nearly as effective as the Western alternatives at two doses. Why a third dose hasn't been more widely distributed yet is unclear. Respirators could also eliminate the need for current policies, but most experts still seem reluctant to recommend them for dumb reasons. There might also be "if it ain't broke, don't fix it" and "China is more effective and tougher than the rest of the world" attitudes floating around.

Here's another reason I forgot to mention:

  • Expert anti-valve bias: most elastomerics have exhalation valves

And to be clear, I don't think any of these reasons are enough (although, this somewhat depends on when in the pandemic these reasons were used) to justify not recommending the use of elastomerics.

It's mostly too late for intervention #1. Now, everyone knows about these issues. However, it may do some good to replace a lot of old experts with much better ones like Zeynep Tufekci. Tufekci wasn't perfect (never mentioned elastomerics), but she quickly got a lot of things right (even took lab leak seriously) and for the right reasons.

Intervention #2 has more merit, but I fear that the lack of urgency will take over and it will take too long to deploy elastomerics and/or PAPRs (which have certain advantages over elastomerics) at scale. This is starting to happen; I've seen a lot of talk about designing better respirators but nothing about deploying (or even recommending) the current generation of elastomerics to adults. The perfect is starting to become the enemy of the good.

If the current crop of experts can't be reasoned with in a timely manner, one potential solution is to set-up an independent pandemic risk reduction organization. This org would make recommendations (e.g., elastomerics should replace other PPE, cheap PAPRs should be developed to replace elastomerics), take action (e.g., quick studies, cheap PAPR development and distribution), and be advised by experts like Tufekci. A possible source of funding might be the EA community.

The one you suggested seems even better.

It might be a better alternative to surgical masks for children, but it's not necessarily better for adults. First, it's not independently certified (by NIOSH, for instance). And second, it lacks an exhaust valve which could make it significantly less comfortable to use for extended periods of time due to increased humidity.

A better alternative for adults is the 3M 6000 series with the optional 3M 604 exhalation valve filter, if you care about filtering the valve's exhaust.

N95 masks

KN95 masks

These aren't elastomeric respirators.

Answer by FlorinSep 17, 2022101

I can think of many reasons why elastomeric respirators haven't been widely used.

  • Slow expert opinion change: airborne transmission is not significant/only cause of infection
  • Bad assumptions: variants won't become significantly more contagious 
  • Unfamiliarity with elastomeric respirators: no/few studies, seem too uncomfortable, some advantages aren't obvious (e.g., better face seal and comfort)
  • Naive empiricism: China's lockdowns "worked," and other Asian countries (like Hong Kong, South Korea, Taiwan, and Japan) controlled covid well without respirators
  • Hope: a combination of cloth/surgical masks and vaccines is good enough (see "Naive empiricism")
  • Traditional expert training: contact tracing, vaccines, quarantine, social distancing
  • Low death rate: there's less pressure to use the most effective means of dealing with the pandemic
  • Complacency: most people that would die of covid have already died

I suspect that the main reason was that most experts thought that a combination of traditional masks, contact tracing, vaccines, quarantine, and social distancing would be good enough. Old school epidemiology and naive empiricism strongly suggested this: China's lockdowns "worked," and other Asian countries (like Hong Kong, South Korea, Taiwan, and Japan) controlled covid well with masks, contact tracing, and border restrictions but without respirators, hard lockdowns, or even vaccines.

However, in the rest of the world, these solutions weren't practical (due to the rise of more contagious variants) or available (vaccines).

#1 is a double-edged sword; it might help avoid #3 and #4 but might also avoid #2 (immortality). Although x-risk might be lower, billions will still suffer and die (assuming human-created medicine doesn't progress fast enough) in a present and future similar to #3. OTOH, future humanity might run resurrection sims to "rescue" us for our current #3 situation. However, I don't know if these sims are even possible for technical and philosophical reasons. From a self-preservation perspective, whether #1 is good or bad overall is not at all clear to me.

This is what happened:

Wrong expert opinion (no airborne transmission) → respirators not recommended → multiple lockdowns until vaccines became widely available → millions of dead people, massive economic and social disruption

This could have easily happened:

Fast expert opinion change (no airborne transmission → airborne transmission) → use first lockdown to manufacture respirators for everyone → use respirators until pandemic burns out or vaccines and therapeutics become widely available → thousands of dead people, only one lockdown, minimal economic and social disruption

The ideal scenario (everyone prepped with respirators for decades) could have also happened but expert opinion seemed to have been too stubborn to have considered airborne transmission as a real possibility before this pandemic, and even when sufficient evidence was acquired, this opinion was slow to change.

For similar pandemics (or future variants of the current virus that won't respond to available vaccines or therapeutics) the solution is obvious: use respirators until the pandemic burns out or effective vaccines and therapeutics become widely available. Strangely, there still has been no big push to send respirators to areas of the world where vaccines and therapeutics like Paxlovid are less available.

Another thing that expert opinion continues to get wrong is its focus on the not-that-great disposable respirators rather than the better-in-almost-every-way reusable respirators (including PAPRs). If this doesn't change and another pandemic (or nasty variant) develops, the disposables will run out again, a lot of them will fail (as they probably do today) to provide adequate protection (due to poor face seals), and the results will be similar to (or worse than) the current pandemic.

Just wear a respirator and be done with it.

Another factor to consider is how much outside air a ventilation system pulls in. This would help further dilute out the aerosols.

More worrisome are the 23.1% of people who wanted to take the flight while known to be positive. Thus, almost one in four people who follow a cautious doctor who writes frequently about Covid in the style above think that a known symptomatic Covid case should still go to a terminal and get on a flight. How many more of the general population must think the same way? That it’s fine to go around exposing people when you’re sick?

Well, maybe it’s not as clear cut as all that?

This is certainly a rather strong ‘planes are safe for Covid’ position, where it would be fine to put a known Covid-positive case on a plane (and more importantly, in the terminal to and from the plane) so long as everyone involved had masks, but without others wearing masks it turned into an unacceptable risk.

I notice my skepticism that things fit into these windows. A mask is a modest risk reduction. Even if we are super generous to both masks in general and mask use in practice and say 75% reduction between the two scenarios, a factor of four is actually rather unlikely to change the answer here. Which suggests that the masks are serving more of a symbolic ritual purpose, rather than anything else.


Bill Gates tests positive for Covid, properly treats it as an annoying need to isolate.

I don't see why this is worrisome. If a covid-positive person is wearing a ventless N95 (or better) respirator, the chance of them infecting other maskless people is miniscule. This is due to the fact that even if a small amount of aerosols leaked from the respirator's faceseal, it would be quickly diluted, especially in spaces (including terminals and flights) using any kind of ventilation system. Another thing to consider is that people that don't use respirators already accept the risk of becoming infected at any time.

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