Oh how little we know, yet so much we must do. A policy review of #COVID19

What we know about #COVID19, aka the China Virus, the Wuhan Wanderer, or the Bat Soup Hangover: is a) it is a virus, b) people get it, c) some people very badly, and d) it kills some of them. 

Beyond that, we don't "know" much at all. And by “know” I mean we are not as sure as we hold other things to be true. We will know more in the future, thanks to scientific process, more time to compare its impact and spread in different locations. 

Right now we aren't even into the opening set, past the first quarter of this game, and anyone who says they know for sure anything is being imprecise with their words. When someone says we know for sure where it came from, how people have got it, how the infection path is going to play out in each country, what treatments are best, what best preventative measures and so on, they should be adding something on the spectrum from "to the best of our current knowledge" to "we made that guess this morning at the meeting." 

What this means is that public policy — each government's plans plus the multi-stakeholder organisations, such as the UN through its World Health Organisation — have to adjust with all new relevant information. For policy makers this is horrible, because you sound like you are contradicting yourself. Example 1, the British "Herd Immunity" strategy that was misunderstood by most and ended up taking giving its top bull a case of the Wet Market Blues. 

The UK Government was rather sophisticated in its communication, but the media sound bites didn’t always pick up the prefaces and caveats of “based on what we know, and if the models prove us wrong we will change.” 

We’ve lived in a world where we’d been taught that all words that fall from the lips of politicians are to some degree weasel words; only now we live in an age where a different type of communication is needed. 

This needs to sometimes come with an openness we are also not used to. We need leaders who are prepared to say “we had said X, now we are going to say Y, not because we are stupid or lied, but because we have new data or have changed the way we are looking at that data.” 

Politicians are not used to changing positions, so we usually change our politicians instead. The Vietnam War or invasion of Iraq, privatization of railroads, bathroom general alignment and so on.

With something as fast moving, in terms of its growth and our understanding of it, like a pandemic, we don’t have the luxury of changing our leadership. It’s them that got to be a’changing. 

Which brings me to the debate to Mask or not to Mask and #Masks4All, a global, grassroots, non-governmental initiative, that is in conflict with WHO guidelines and the US Surgeon General’s recommendations, that seeks to change the public policy recommendation for #COVID19 response in a major way. 

First the history: wearing masks was outright shunned as a strategy early on, for some combination of concern they wouldn’t work, would create a false sense of security, and wealthy citizens would buy them up and medical professionals would have to work without them. 

Holding those two issues (effectiveness and supply of professional masks) aside for a moment, should you wear a mask?

The answer is, unhelpfully, yes for some people, no for others and potentially yes for the middle group. 

If you feel sick, if you are coughing, have a temperature and have to be in contact with any other human being, then yes. 

If you are around someone or caring for someone with COVID-19 or are a health care professional, then absolutely yes. Nobody debates that (which should have been a clue, but more on that later.)

Now, the easy no’s. 

If the mask you are planning on buying or wearing denies a health care professional a mask, then no. 

If you are a politician or other public leader and you are about to go on TV or the internet to talk about this issue, and, by wearing a mask you would scare others into blindly wearing a mask, then no. 

How about everyone else? The ninety to ninety nine per cent of society? The answer is not so clear. But there is increasing support for the proposition that wearing masks will reduce the speed at which the virus spreads. 

Essentially, a mask on you means that if you have COVID-19, you’ll send less aerosol particles of it out into the world, and if you don’t have it, you are likely to suck (or place into your own mouth) particles of the virus.

How much less in each case? We don’t know, but we don’t know much anyway, so all policy is being done in the dark. 

We do know that some countries with a habit of wearing masks (because of previous virus outbreaks or pollution concerns) have lower rates of infection than we’ve seen in mask adverse countries. We can’t be sure this is a mask issue of course. 

We also know some public health responses (such as in the Czech Republic, in normal times a mask adverse country) included masks in the mix of social distancing strategies and we know these countries had lower rates of infection. 

Are we sure that masks are what made the difference? No. Could it have been? Possibly. 

Is there a draw back? 

Again, if you are buying a mask that prevents a professional getting one, then yes, that’s a big issue as a professional might save ten lives to you no matter how important you see yourself, you are only one. 

Two, it might result in you touching your face more—an early concern that led to some no mask policies—but now people are taking this seriously, perhaps it’s not so much of an issue. 

Three, cost. Yes, this is an issue in a large part of the world, call it the sixty per cent who live under two dollars a day or less, for whom a mask is out of the question. 

Fortunately, there is a simple option, a cloth across the mouth and nose, that is anything from a repurposed T-shirt, or a locally mask from available materials. 

It just may be that this solution, shunned in developing countries, is right for African nations where the virus is only now catching hold. 

Note: I stopped here because both the WHO and the US Surgeon General are reported to be revisiting their position. Will update as we get news.