Should you wear an n95/kn95/kf94?

Should kids in school?

If you are a hospital health care worker, and you are entering the room of a patient with known tuberculosis or covid19, then by all means, wear the n95 mask!*

If you are anyone outside of this, does it make sense to wear an n95 when you fly on airplanes or visit the grocery store or walk from the door of the restaurant to your table or walk around outside alone?

Does it make sense to mandate these masks (or smaller versions for school kids)?

The answer to all these questions is: no, it makes no sense. Let me make that case for you.

First, this post is for adults who have been vaccinated or have natural immunity. If you are an adult, particularly if you are older than 40, and have not have covid, nor been vaccinated, then I would advise you to get the shot, but let’s be honest: If you fit this bill, you sure as hell are not reading an article about whether you should wear an n95! The people who are most deeply considering wearing this type of mask, or wearing already, are those with 2 or 3 or 4 (improperly gotten) shots in the arm!

Second, this post is not for individuals or kids with immunocompromised status (e.g. post B cell depletion therapy), etc. You should seek the guidance of your physician. I think it might even make sense for individuals with resolving immuno-depletion to wear an n95 at certain times, but that is a far longer post.

Third, this post is for the current moment, not pre-vax 2020, where I would have made some changes.

Now, for the average healthy person with some immunity to COVID19 (vax or natural), here is why you should not wear this mask: the harms to benefits is a bad proposition.

Downsides:

First, these masks are uncomfortable, if fit and worn correctly, they can cause pain. I will attest to that, having worn them often at work recently, and here is Stef Baral,

Stefan Baral @sdbaral

My experience having to wear N95s in outbreak settings only reinforces my perspective that making kids wear them all day long in school is ridiculous.

Some people say they don’t always hurt. Ok (read on), but they are inconvenient and can cause subjective dyspnea, for instance if you wear them at the gym, or carry a heavy box of stairs, or (wrt kids) play, for e.g.

Second, if you wish to substantively lower the risk of exposure, you will have to wear them for long periods of time, and in many places. You cannot take them off to eat or drink. You will live a diminished life.

Third, you will have to do it forever. But you will not be able to do it forever. You will fail in month 2 or month 3 or year 2 or year 3. You will slip, and eventually exposure is guaranteed. This is a strategy to delay exposure; nothing can avert exposure as long as you are still a human being who plans on being around a while.

Fourth, why delay exposure? After vaccination (and losing weight), there is nothing more you can do to lower your risk of bad outcomes. The virus will never disappear. It will circulate in humans for a thousand years. And, exposure may even be best before vaccine immunity wanes appreciably. With some partial vaccine immunity, natural infection may be milder and solidify longer immunity. Even then, a few years later you will get covid19 again. That’s life, it was never zero risk.

Upsides:

Wearing the mask provides a short term benefit if done religiously. Remember back a few years ago. If you had an event you absolutely did not want to be sick for, you might not go out to nightclubs, or stay up late for a few days before. This made some sense.

Similarly, if you have some major life event you absolutely do not want to be sick for, or say you are visiting family abroad, and absolutely do not want to test positive so you can return to USA, and you were going to be in a high risk, time limited situation (crowded indoors meeting for an hour), then maybe you would wear one. This is similar to the logic of wearing one when you go visit a sick patient with known COVID19 (see * below).

Kids in school

It is ludicrous and delusional to impose these masks on healthy kids in school: indoors or outdoors. Whether or not one chooses to vaccinate a kid 5 to 18, how many doses, and how far apart is a personal medical choice in my opinion. But it is clear that many kids have either had vax or had natural immunity or both.

Seroprevalence estimates find that substantial numbers of kids have already had covid19 (40% at time of FDA vax adcom), and many may not have thought twice about it.

Kids will get exposed to this virus many times in their lifetime. Avoiding exposure with the discomfort and inconvenience of this mask is not worth it.

But more to point, there is zero credible data that the policy: Kids should wear this mask works. Kids will not wear the mask religiously. They must remove it to eat and drink. They will move it around when left alone. The seal will break.

So, it is not clear that the policy: you ought to wear it; will even slow spread among kids in the short term, even if that was a worthy goal (I don’t think it is). PS cloth masks, which many believed in, failed entirely in RCT.

The mask will surely impact kids’ speaking and communicating; it will impact their ability to run and play. It has downsides.

Some will argue that kids testing positive will halt school. First, let me re-state: you have no evidence that this mask policy will change the rate of positive results. It may not even impact the rate of absenteeism/ halting school.

Second, even if k94 kids masks did slow + results, that is only a benefit due to the foolish policies we have around kids. When human beings create bad policies around testing (overtesting asx kids) and pair them with prolonged quarantine periods (also unproven/ also not clear what the goal is), then of course avoidance of + results is important. But the answer is to fix our bad policies, not double down on them.

All kids will eventually get COVID19. That fact is inevitable. You would prefer they do so while they are still young (and thin), and if appropriate, vaccinated. But you should worry more about their mental health/ drugs and alcohol/ and other issues b/c the numerical risks to them are low.

What is going on here

COVID19 does damage the brain. But not primarily by binding to neurons. Instead it creates irrational anxiety among a certain class of social media user who continually escalates what is necessary to “keep us safe.” It has now reached an apogee with rising cases. In fact it tracks cases, lagging just 1 day behind.

The anxiety is irrational because it does not consider rates of events and contrast them with other risks we accept. It does not consider that policies (mask mandates for kiddos) are implemented in a messy world where people being people can erode any theoretical gain. It seldom conducts RCTs to test its delusions, so it can never course correct. It is irrational because it seldom considers harms or inconvenience. It is irrational because it doesn’t understand numerical risk. Many adults have proven themselves to be incapable of thinking about risk, and that was having attended schools; The next generation might fare worse with all the school closures.

Prosac is showing promising anti-covid19 results. In addition to treatment RCTs post exposure, we should randomly assign the most anxious op-ed writers and twitter users to it, and see if it improves outcomes for us all.

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*why wear it here? B/c in the case of tb you may avoid the exposure entirely, and in the case of active COVID19 pt you can avoid the certain exposure with a short, time limited use of mask (e.g. 20 mins), and you are less likely to miss work or spread covid19 in the next few days to your other patients with this very simple, short term act, and hospital policy mandates it.