You still need to wear the damn mask

I know, it’s been a long pandemic. I’m tired, your tired, so, so many people are dead. It’s a lot, hell it’s a plot of dozens of horror movies, but it’s not over. So once again I am begging my lovely readers to wear the damned mask. I know there is a lot of confusing information out there. Some of it says don’t bother with the mask, some tells you wear one if you’re not vaccinated, it feels mixed signals sure sure. Well let me make it incredibly simple, wear the damn mask. You put on pants when you go outside, wear the damn mask.

When the pandemic was just starting I knew things were going to get bad quickly. A friend who was about to take a professorship position in his home country asked me what I thought he should do. Originally he was going to wait to leave, but I told him flat out to go while he could, it was only going to get worse. I hate it when I’m right, even though I didn’t expect it to be quite this bad.

If history has taught me anything, it’s that people are horrible at accurately assessing risk. The flu of 1918 ravaged the world and even then people fought against the science. This is not the flu of 1918, it’s far worse and it’s only going to get worse if we cannot all get on the same page. So today I want to remind everyone of two things, the first is obvious. Wear the damned mask. The second is polio, so let’s talk about how at the height of the polio pandemic, it was the most feared thing on the planet, even more than the A-bomb or H-bomb, polio was a threat to the world.

In a way, vaccines are a victim of their own success. There aren’t a lot of people around who lived through polio and we’ve almost eradicated it. It lingers despite our best efforts and here’s a scary thought, it may make a comeback (here). We’ve successfully eradicated smallpox, which is incredible and we’re on the verge (hopefully) of eliminating others as well (here’s a list)! Vaccines are an amazing thing, which is why we don’t hear about polio anymore, but since we’re living in a pandemic, it may be a good idea to revisit some history.

Poliomyelitis (polio for short) could be transferred through contaminated drinking water and a lot of the ways that COVID is transfered, contact with someone who has it (droplet transmission via coughing or just talking, exactly like COVID) or contact with their fecal matter (both polio and COVID). Yes, that’s poop and while there are no clearly documented cases of this happening, it’s always fun to mention a good poop fact (more crappy info).

The basic reproduction number (R0) of polio has been estimated at between 5-7 (here). The R0 value is an estimate of how many people will be infected by a single person. If the R0 number is small the disease will have a hard time spreading, if it’s less than 1 then it will be eliminated completely. It’s very difficult to calculate the R0 value because it changes depending on behaviors, for example if you were to say … wear a damn mask, the R0 value would be much lower than it would be for an unmasked person. So the R0 value is a very dynamic measurement, but when the pandemic ends (and do I hope it ends) we can back calculate the average R0 value and warn future generations to not be stupid about mask wearing (LOFUCKINGL).

With an R0 value of between 5 and 7, one person infected with polio becomes 5-7 people infected on average. Sometimes one person will be a total dick and infect dozens, maybe even hundreds, sometimes a person will be very responsible and infect no one, but on average 5-7 was the number. Now we can have my least favorite conversation on the planet exponential growth.

Humans don’t understand exponential growth, because why would we need to for our survival? There’s no benefit conferred to nature passing that kind of innate knowledge on to us. So if I were to suggest I would pay you to do some work for a month and I would start at one cent and double it every day to the end of the month, or I would pay you $150,000 for the whole month, you would probably look at me like I’m an idiot and take the $150,000. You would be making the worst mistake of your life, but that’s because if you don’t know the math beforehand $150,000 sounds like a lot more money than doubling one cent every day for 30 days. Don’t believe me? That’s fine, let’s do some math. The exponential growth/decay formula can be expressed as

Here our x0 is one, or one cent. the growth rate r is also one or 100% meaning we double that one cent every single day for, let’s say I double your pay for 30 days so in the end x0 = 1, r = 1, and t = 30. Fun fact, we could easily do the math by 2^t in this case, but I like using the full formula and you can see it collapses to 2^t in this case anyway. Now maybe you didn’t know the math, but thought something fishy was going on so you agreed to the one cent a day being doubled. Well if we wrote it out you would have 1 cent the first day, 2 cents the second day, 4 cents the third day 8 cents the fourth day, 16 cents the fifth day, 32 cents the sixth day, and 64 cents the seventh day. A this point you have a whopping $1.27 total, congrats you played yourself… or did you? If we keep going with this after 30 days you would have… $10,737,418.24.

Don’t believe me, do the math. $10,737,418.24 in the end, far more than $150,000 and that’s the power of exponential growth, the numbers are tiny, until they aren’t. Once the number gets larger, it blows up quick, so you have $1.27 at the end of the first week, but by the end of the month you have roughly 8,454,787x more. Now here’s where things get scary.

Let’s say instead of dollars we were talking polio infections. If our example above was polio and not pay, the R0 value would be 2. Remember the R value of polio was estimated between 5-7 and in a month with an R0 = 2, we already have 1,073,741,824 infections (remember we converted cents to dollars in our example above, the conversion doesn’t apply here). The good news is that roughly 99.9% of people who catch polio will be just fine! Yep, asymptomatic polio was a thing and it has to travel from the gut to the nervous system to cause a problem. So pandemic over! 0.1% of people are at risk so why vaccinate and why be afraid of polio?

Well that’s 0.1% of an incredibly large number, which I’ve got some bad news, is still a large number. Out of the people in our unfortunate example, if only 0.1% of them have serious polio symptoms (nervous system issues) in our month of polio spread, we have 1,073,741 people. In one month at 0.1% and an R0 = 2. That feels like 1,073,741 too many to me and it’s this math that made polio so fucking scary. It’s why the US had an incredibly aggressive vaccine program and it’s why since the vaccine effort, we’ve lived (almost completely) polio free here in the US. Of course, death from polio wasn’t all that high (here). It was the after effects of infection that made polio truly scary.

And for good reason, death shouldn’t be the only measure of how bad a disease is. It shouldn’t be the only measure for COVID-19 either, but for some people it’s a binary result only, death or life. In the US we average ~ 1.7% of COVID infections resulting in death or about 2 in 100 (source). That doesn’t include the number of people who have possibly life-long complications from COVID, things like shortness of breath, blood clots, brain, heart, or lung damage, things that you do not want (source). Maybe people will get better, maybe they won’t. One study suggests the chances of living with effects from COVID-19 (that aren’t death) are just a coinflip (here).

The original strain of COVID had an R0 value of “just” 3.38 (here). Which makes it less transmittable than polio, but that was the original strain and even with the “low” R0, it spread, killed, and injured. If the effects are life-long (and I have plenty of reason to assume they will be) you’re looking at a whole generation of people, old and young, that will be disabled. The delta variant of COVID has a R0 value of ~ 7 (here). It’s not exactly more deadly, but it’s more infectious meaning the number on both sides of the equation will ratchet up and we’ll end up with more infections and more deaths.

Then there’s the lambda variant, which I believe is the variant to watch (and I hope I’m wrong). It has mutations to its spike protein, the thing that the COVID vaccines targeted because it was believed to be conserved across strains (which it has thankfully, making vaccination your best option by far if you can get it). More specifically, the lambda variant is thought to be have mutations associated with higher transmissibility or possible increased resistance to neutralizing antibodies (IE the antibodies produced by vaccination). We’ve already seen it here in the US, it’s just not the dominant strain, yet (here). Of course, there’s no telling what the dominant strain will be. One thing is for sure, things will only get worse as the virus mutates, so I am not exactly looking forward to further variants and their implications.

All this to say that the more people a virus infects the more chances it has to mutate. The more chances it has to mutate the more likely a new strain will come. Which of course means a higher chance that the vaccine will become ineffective or that another vaccine will be needed. But there is hope, we have the capability to fight back and it’s super simple.

WEAR THE DAMN MASK.

Really, that’s all we need to do to slow and stop the spread of this thing. Really if you want to be a COVID fighting rockstar, get vaccinated and wear a mask that’s all you have to do and we could really stop this thing from spreading or getting far worse than it already has. 621,000+ deaths to date, that’s how many people have lost their lives to COVID and despite the absurd pro-virus propaganda, that number is likely a low count. That’s a lot of suffering and a whole lot of death, that’s like wiping out a whole city (the population of, as an example, portland, oregon is roughly 645,291 people). Could you imagine a whole city vanishing overnight? That’s the number of deaths from COVID. But it doesn’t have to be this way.

All you need to do is wear the damn mask.

How many people need to die before you do something differently? We’ve already seen America hoard toilet paper because of this (why?!), do something that really matters. We know masks work, we’ve studied it, over and over again (more),(more),(more),(still more),(even more),(oh and in case you think masks will keep you from breathing, which is outrageously incorrect). We wear masks at the hospital all the time and surgeons wear them for longer time periods than you would ever need to, we know they are safe. So really, just wear the damn mask. You put your pants on when you go out, you (hopefully) wear a seatbelt and follow traffic guidelines, all you have to do to help end the suffering is wear the damn mask.

Please.