Today let’s take a look at a Twitter thread by Trisha Greenhalgh, Professor of Primary Health Care at Oxford, posted on 4 March 2023. Note that Greenhalgh is in the UK, and the context for my comments and observations are from a U.S. perspective (e.g., references to CDC, etc.).
Let’s start off with Greenhalgh’s lead tweet that sets the stage:
Okay, so she DOES NOT BELIEVE (in booming all-caps) that everyone, including small children, should mask all the time. I would agree…with quite a number of qualifications that we’ll get to in a bit.
Then she gives a couple example logical fallacies:
I’m not going to comment on the fallacies, as those were just examples which, while certainly valid, to me seemed to muddle the thread a bit.
So let’s hop down to tweets 5 and 6 where we get to the meat of the matter:
I’d agree that if there weren’t any airborne pathogens in a given environment, you wouldn’t need to mask against them. But I’m really scratching my head over how you’d know if an environment had an “absence of any airborne pathogens.” You could reasonably assume the air in a highly filtered industrial clean room (at least to HEPA standards) might be effectively pathogen-free, but you sure as hell can’t assume that for any unfiltered volume of air into which people are exhaling these days. Schools? Airborne pathogens. Daycare centers? Airborne pathogens. Workplaces? Airborne pathogens. Hospitals? Airborne pathogens. Pick a place that has people, there are going to be airborne pathogens. The type, variants, density, etc., are going to vary, but these days if there are any number of people, it’s almost guaranteed that someone’s spreading something.
Even outdoors, airborne pathogens are circulating in abundance wherever people are, as the many folks who’ve been infected with COVID while outdoors can tell you. I mean, don’t get me wrong: it’d be GREAT if there was some sort of Airborne Pathogen Detector that would warn you – seriously, it would be! – but the last I checked such a gadget doesn’t exist. So, bouncing back to the precautionary principle, if there are people around, especially if they’re unmasked, assume there are airborne pathogens present.
In her second point, that masking decisions “should take account of RISK,” the first thing that comes to my mind is Dr. Bob Wachter’s long-winded threads loaded with computational contortions to justify whatever high risk behavior du jour he wants to engage in, all based on his assessment of RISK. When I see folks talking about RISK, the first thing that comes to mind is justifying high-risk behavior. Hold that thought for when we get to the last tweet of Greenhalgh’s thread.
Sure, there are typically some basic risk elements to consider. For example, if you’re going outside for a walk and no one else is around, the risk is extremely low and you’re probably fine without a mask (NOTE: if you do choose to wear a mask anyway, regardless of the reason, IMHO that’s 100% awesome).
But as soon as other people – especially folks who are unmasked – enter the scene, risk starts climbing quickly and we have absolutely no way to effectively assess it. All the percentages and whatnot that Wachter uses, for example, boils down to one thing: gambling. And you’re not just gambling with your health and life, you’re gambling with that of others you may infect or put in danger of infection. Just ask Bob Wachter’s wife, who’s reportedly been infected three times (at last count) and has long COVID. Thanks, Bob!
Of course, it would be nice to have some clear guidance from the CDC/public health organizations that was actually based on science as we know it going on four years into the pandemic instead of droplet dogma or giving fellatio to politicians and corporations. My own personal “risk assessment” (in fewer than 25 tweets – take THAT, Wachter!) is that if we’re outside and things get to the level of a backyard BBQ or farmer’s market – people density rising, people getting closer than maybe 10 feet or so, even if outside – my mask goes on. And it is always – ALWAYS – on indoors if we’re out and about or I’m at work, even if I’m sitting in an office alone, as someone else may have been breathing into it sometime earlier and aerosols can be very persistent without adequate filtration/ventilation (which our workplace, like most, doesn’t have). The only exception at work is if I hold my breath to drop my mask briefly for a sip of water at a drinking fountain at the end of the hall where nobody ventures. And when at work I eat lunch in my car. Always.
Sidebar: I’m not virtuous or virtue signaling or whatever. We’re dealing with a Biosafety Level-3 pathogen that’s killed millions and left millions more disabled and suffering and we need to act like it. I don’t want to catch this virus or give it to anyone else, and wearing a mask (well, let’s be proper and say respirator) is currently our best way to prevent that while still doing most of the things we want to do. And it’s easy: it’s just a part of my wardrobe now, and WAY easier to put on than pants.
Here Trisha makes some sense. Yes, “you do you” is morally (and scientifically) deficient and masks should absolutely be mandated on public transport. Kudos. But decisions about masking in PUBLIC should NEVER be purely individual. They are now because our governments and public health officials (so called) have thrown us under the bus. But the only way to ever get on top of this thing or any of the horrible diseases yet to come is to approach it from a concept of mutual community defense, everyone working together in common purpose. Sadly, we suck at that.
Here we have a mix of sensible and not so sensible arguments. The second tweet (11) is clearly sensible and very honorable. Again, kudos.
The third tweet (12) would also be sensible…IF we had science-driven PROTECTIONS in place, from daily testing from every wastewater shed to surveillance PCR testing, rapid PCRs for everyone, tracing and isolation (including guaranteed paid time off), mechanical filtration and ventilation requirements, and <add lots of other items here>. If we did, we could monitor viral spread at a very granular level through wastewater testing (which typically leads clinical cases by 1 to 2 weeks) to have the most current picture and we could react accordingly using our array of additional protective measures, only one of which would be masking. But, sadly, we do NOT have those things: we’ve just wound things back to near zero, regardless of how many are getting sick and dying.
Thus, when we hop back to the first tweet of this trio (9), we fall off the cliff into la-la land about decisions on masking in schools being taken “LOCALLY by the schools themselves.”
I’m sorry, but this assertion is simply ludicrous. Teachers, principals, school boards, school superintendents (or their equivalents in countries beyond the good ol’ US-of-A) — let’s even toss in the school nurses — as a general rule (always exceptions, of course) don’t have a flipping clue how to effectively assess risk for airborne pandemic pathogens. Hell, a huge chunk of the medical community – including many so-called infectious disease experts and public health officials from the WHO on down through the CDC, etc. – don’t. Educators are trained and experienced in RUNNING SCHOOLS. This is – or at least I used to think it was – why we have PUBLIC HEALTH ORGANIZATIONS, to provide guidance to government and society on how to deal with these things. Unfortunately, those organizations have become nothing but propaganda tools to drive political imperatives.
But the point remains: those in the education field are NOT qualified, at all, to make decisions like this, even if they had the authority to implement mandates in their schools (which many/most/all don’t, anyway).
Tweet 13: It’s good to know that she thought mask mandates made “some sense in some months in 2020.” Some sense. Some months. In 2020. I really have to wonder when people say things like this if they even remember how horrible that year, in particular, was for so many people in so many countries, and how many lives and how much suffering could’ve been saved and averted in all the time since then if people had just worn masks (not to mention all the other things we should be doing that would greatly reduce the time masking might be required).
And all I’ll say about tweet 14 is, hey, it’s good to see you’re an independent thinker, there, Trisha. Booyah.
Well, it’s good to see she’s blocking mask trolls, per tweet 15…although she only mentions that as a foil for pushing back on anyone saying she said everyone should be masking. Kudos on the logical contortions there — I wonder if she picked that up from Wachter?
The final tweet is what this is all truly about: “I just sat in a cafe maskless, having a coffee & croissant.” She may as well have added, “…while giving both middle fingers to everyone trying to avoid infection, especially the immunocompromised or otherwise vulnerable who can all fuck off and die for all I care. And so what if I get infected and then infect someone else? Not my problem. But did I mention this croissant is absolutely delish?”
Ironically, Greenhalgh tweeted this out later, presumably after some not so favorable feedback on the above thread (which she locked so people couldn’t further comment on it):
Nuance. That’s what they’re calling it these days. She reminds me a lot of Gregg Gonsalves, another “expert” who on the one hand has good things to say, but on the other is a minimizer who’s rationalized doing high risk activities and then had a huge tantrum for being called out on it. Eventually it caught up with him and – surprise! – he got infected.
It’s just my humble opinion, of course, but folks like Greenhalgh, Gonsalves, Wachter, and so many more are at heart — despite any truth-bearing messaging they may pump out — bad faith actors with monumental egos who have led countless people to infection and all that comes along with it.