Mask Morons and Rio Blanco County #COVID19Colorado

by Guerin Lee Green

Last week, we motorcycled through northwest Colorado, and in a day traveled the width and breadth of Rio Blanco County and back, probably close to 200 miles, on our way from Glenwood Springs to Dinosaur National Monument.

We enjoyed our travels, mostly along the White River and then Piceance Creek, stopping and spending money in Meeker and Rangely.
We wore masks, ’cause, hey, we aren’t idiots, aware of the science and risks. The same reason we wore helmets, gloves and protective gear on the bike. And checked the condition of the bike and its tires everyday. It’s why I practice panic stops and high and low-speed maneuvers. All the time. It’s basic risk mitigation. It’s not risk aversion— we rarely followed the speed limits, and at times touched 100 mph on the county’s deserted two-lane roads. And considering we had a pretty close elk encounter in Dinosaur, this travel has real risk.

We stopped in Meeker for coffee – a place called Wendll’s. We had lunch at the Main Street Coffee House in Rangely. We looked, but couldn’t find comfortable outdoor dining in Rangely. In neither establishment were employees or customers wearing masks— a clear violation of the State of Colorado’s public health order. Given Rio Blanco’s current COVID19 case count, (Rio Blanco has 6 confirmed cases to date) this wasn’t outlandish. But it was akin to riding in Colorado’s mountains without a helmet. A bit stupid. And on the wrong day, at the wrong time, in the wrong place, deadly stupid. And we wore masks, knowing that we were the most likely vector of the disease in Meeker and Rangely. We were the most likely killers.

Upon our return, we’ve seen the Sheriff of Rio Blanco County with this bit of non-sense: “The order from Governor Polis “statewide mask order” will not change the way Rio Blanco County Sheriff’s Office conducts business. We will continue to stand by our mission and safeguard the lives and property of the people of Rio Blanco County. We will not be “patrolling” for people who are out without a mask. Rio Blanco County Sheriff’s Office will step up to the challenge, as now is the time to protect and serve our citizens. We will continue to be vigilant to protect our citizens’ lives and property.” The County Sheriff, a gentleman named Anthony Mazzola, doesn’t seem to think COVID19 is a threat to lives of Rio Blanco County.  Frankly, he is either an idiot or participating in a political stunt. The Rio Blanco County Commission, with an outsized vision of their own authority, went on record opposing enforcement of the mask mandate and reviewing their (narrow) options to oppose it. 

With nearly 150,000 dead Americans, the noble elected officials of Rio Blanco County stand opposed to science, common sense, and their duty to the law and their citizens. It’s frankly a bit unbelievable, but hey, it’s 2020. Idiocy is in ascendancy. 

We won’t be spending money in Rio Blanco County in the future, and will do our utmost to alert others of the public health stupidity of the county’s elected officials. It’s a beautiful part of our nation. It’s a shame it’s led by morons.

In our travels— people seem to chat up motorcyclists— multiple people seemed eager to opine without foundation upon the efficacy of wearing masks. I felt bad that they were laboring under misinformation, or worse yet, embracing dangerous conspiracy theories. I feel like the media and community leaders failed them, and I suppose that includes me.

Here’s a great rundown of some of the science of masks and the coronavirus:

Jeremy Howard

Last week I presented to the WHO Guidelines Development Group. It was targeted towards infectious disease epidemiologists, but many folks have asked me to share the presentation.

So, here’s a video discussion. Read the thread below to see each slide.

The evidence that WHO relies on for its mask guidelines has many problems. For instance, the meta-analysis they sponsored only has 3 non-healthcare studies, 1 of which is wrongly categorized, and one of which is under-powered. None studied COVID-19.

The review had three studies of SARS-CoV-2 in healthcare, but largely ignored them, by using inappropriate statistical techniques. (See the tiny weights in the right-most column.)

There has been a study of mask wearing in households for reducing COVID-19 transmission, which showed around 80% reduction in transmission.

Classic epidemiological studies can never really tell us if masks reduce community transmission, because if I (for instance) wear a mask, how do you know which people I contact avoided getting sick because of me?

So we have to broaden our evidence base.

We put together a multi-disciplinary team to examine a broad evidence base.

Our review of the evidence for masks, from 155 references, is the most viewed paper ever on preprints.org. It is now being reviewed at PNAS.

>80% of the world now lives in regions that require masks, plus most of the US. These means there are many natural experiments we can analyze.

Sometime epidemiologists assume that’s not useful, due to the “ecological fallacy”, but there’s decades of research on good approaches

Leffler (@ChrisLefflerMD) et al looked at nearly 200 countries, adjusted for dozens of confounders. Mask use was associated in a 5-10x decrease in transmission rate.

Lyu and Wehby observed the effect of mask mandates across US states

We also have great lab evidence, including videos and images directly showing a simple piece of kitchen paper towel blocking nearly all speech droplets, which are believed to be responsible for a lot of transmission

Since people with symptoms stay home (hopefully!), we focus on speech droplets

It is easier to block particles on the way out (“source control”), than on the way in (“PPE”)

Even if breathing does cause infection, cloth masks may be the best at blocking breath droplets too

The droplet cloud stays airborne for many minutes after speaking

Fluid dynamics analysis supports the finding that cloth masks decrease the radius of the droplet cloud

The impact of droplet cloud radius depends on construction

Masks can improve the effectiveness of distancing, both due to the smaller droplet cloud, and though social signaling

Masks should be used at schools for children >5 (at least)

WHO’s June advice includes a number of inappropriate “likely harms”

WHO’s advice uses worst case *PPE* assumptions, not *source control*

Even for PPE, WHO’s table is missing the highest quality materials, such as these:

WHO’s guidelines also fail to discuss the most effective DIY mask designs

We are only now rediscovering the designs developed a hundred years ago

For references to the papers, and more details, please see the full video.

Huge thanks too all my great co-authors, @arimoin, @larrychu, @zeynep, @lexfridman, @austinvhuang, @hernandez_danny, @arnedelft, @HeleneMarivdW, @AmyPricePhD, @reshamas, Z. Li, C. Ramirez, L. Tang, V. Zdimal, C. Bax, G. Watson & V. Tang.
& to @VincentRK @trishgreenhalgh & more!