I don't just mean "lay people", I mean the relatively well-educated HN crowd and even some medical professionals misunderstood what was said. Across the entire group, literally every part of what was publicly said by government agencies was misinterpreted in some way and turned into an argument.
For example, the "We don't recommend the general public wear masks at this time" was consistently misinterpreted to mean "Masks don't work", which is not what was said at all. The more nuanced and complex statement has too many parts to it, and just like Dan Luu said, the second you have an AND or an OR, (or IF, THEN, BUT, etc...) people will just blank and see some random subset of the logical statement.
The full nuanced statement was: "The CURRENT scientific evidence that is available does not support (OR deny!) that mask wearing by (specifically) the general public is (cost) effective enough to legally mandate. ALSO, at THIS TIME there is insufficient supply of masks, AND UNTIL supply can be increased the masks should be prioritised for health workers (that are trained to wear them properly)."
(This of course implies that once evidence is available to support the efficacy of public mask wearing AND the supply problems are solved, the recommendation may change.)
Something like 50% of the people listening to that misunderstood it. And then when the recommendation changed, they lost their minds. "I don't even know what to believe any more! They keep saying different things!" was a common response.
People got especially confused by the "current scientific evidence does not support", because to them that sounds like "scientists say it doesn't work". That's not what that says at all, it's just a statement to say that not enough studies have been done at all to say anything one way or another confidently.
This kind of precise speech as heard from scientists is ironically less effective than simpler but technically incorrect statements!
For developers: One issue I've had with Agile techniques is that that same people that just can't wrap their heads around government agencies changing their recommendations to fit the changing scenarios of an unfolding event like a pandemic also work in large enterprises and are unable to comprehend a plan changing. Ever. Not even once. Everything has to be known ahead, forever, and be set in stone and never change in any way. It's "just too confusing", a sentence I've heard verbatim more than once.
Speaking down from a moral high ground obviously does not motivate everyone to do what we want, but it does motivate everyone ... a) it makes those who agree feel good for following the agreed rules b) it makes those who disagree feel like their human experience is invalid and motivates them to find a counter argument that feels just as strong (I HAVE to fight to protect my RIGHTS)
Obviously this is not the only thing that's going on. Every crisis is someone's opportunity.
Anthony Fauci literally said that "there's no reason for the general public to be walking around with a mask". On television. I'll link to this version, since hilariously, facebook has "fact checked" it:
https://www.facebook.com/DeannaForCongress/videos/3682499312...
(note that I have no idea who "Deanna for Congress" is. This is the first version of the video I could find -- linked from a reuters article also claiming to "fact check" it [1] -- because google has gone out of its way to bury the video.)
It's pretty darned ironic that this is your preferred example of people "not understanding" messaging. If you search for this, you will find hundreds of other articles "fact-checking" this, even though he said it, it's not debatable, and the various walk-backs and fact-checks and whatnot simply make the issue look ridiculously farcical.
Just to underscore the point here, the Reuters "fact check" admits he said it (since, to be fair, he said it), and the only "fact checking" involved is that the official government position has changed. It wasn't taken out of context. It wasn't a misquote. It wasn't "misinterpreted". He said masks don't work other than blocking "the occasional droplet", and that there's no reason for the public to wear them. This was March 2020.
While it's true (and obvious to anyone) that the government position has changed, it doesn't change the "fact" of what was said in the past. And yet, people persist in trying to do this absurd stuff.
Let's be honest with ourselves: if this leads to doubt amongst the public, is this the fault of a dense public not understanding sophisticated, super-nuanced messaging, or simply that the messaging was muddled and has wavered over time, and that some parties are engaged in blatant attempts to re-write the factual record?
[1] https://www.reuters.com/article/uk-factcheck-fauci-outdated-...
Early in the pandemic, virtually all the major health orgs spread the message "masks for the public don't work". Of course, the real issue was that there was a valid fear that there would be a run on masks and not enough for healthcare workers. There was never any significant evidence masks for the public don't work, on the contrary there was at least some flu-based evidenced that they were beneficial, but at best you could say "we don't know".
So I'm very sympathetic to the authorities trying to give simple messages, but in the end the original guidance really bit them in the ass and made a lot of people lose trust. I wonder if the simpler message could have been "don't use a mask, because it means nobody will be left to treat you when your nurse/doctor needs a mask".
We aren't supposed to make decisions on medical interventions based on "evidence that X doesn't work". Otherwise, we'd default to just doing stuff until we had evidence that it was worse than doing nothing at all. Literally every failed drug ever tested had a biologically plausible reason for starting the test, and yet we know that most drugs don't work when you take them out of the lab!
Saying that there were some papers out there recommending masks is beside the point, because you can find papers recommending lots of things that don't work. Pretty much anything, in fact. We can see the double-standard at play directly with the Ivermectin debate. Public masks and Ivermectin both have an evidence base of low-quality data, with weak effect sizes and huge error bars overall, and a clear bias of the strongest reported effect toward the lowest-quality evidence. But one is evil and the other is magic, depending on your politics.
To take it back to the subject of the OP, here we have two issues that are fundamentally nuanced (the evidence bases are ambigious, at best), and collapsing the range of allowable communication to "you must do X!" leads to obviously wrong outcomes no matter what you do. So maybe we shouldn't be doing anything at all? Or maybe...maybe...we could try to get answers with experiments, instead of just making things up and asserting that we're right?
For whatever it's worth, I recommend this paper as a balanced, comprehensive review of mask literature (not just cloth, though that is the title). You will not find a more complete treatment of the data for public masking:
https://www.cato.org/sites/cato.org/files/2021-11/working-pa...
Science doesn’t tell anybody what to do. People can completely understand the science if something but still feel a given course of action is inappropriate. And that is just fine.
> What I am saying is their adamant declarations of "masks don't work for the public", which note is an affirmative declaration, were false, and never had any supporting evidence.
There's no such thing as an affirmative declaration of the null hypothesis. You either have proof that something works, or you do not. If you do not have evidence that X works, or the evidence is ambiguous, your conclusion is the null hypothesis (that X doesn't work)...but that doesn't mean that you have to scream it from the rooftops. You can just say "we don't know; the evidence is poor."
The only accurate thing you can say in the "mask debate" is that strong declarations both ways are wrong. The original declarations were wrong, and the declarations now are also wrong. If you look at the data you can't judge either way (with the exception of cloth masks, which are looking quite poor), and so we must equivocate.
The only way you can possibly go on this issue and still be correct is to use nuance. And if you do that, then it's a question of how you use medical evidence to advocate for interventions.
> The full nuanced statement was: "The CURRENT scientific evidence that is available does not support (OR deny!) that mask wearing by (specifically) the general public is (cost) effective enough to legally mandate. ALSO, at THIS TIME there is insufficient supply of masks, AND UNTIL supply can be increased the masks should be prioritised for health workers (that are trained to wear them properly)."
100% false. The statements were about what individuals should do. Not what governments would mandate. And some authorities said masks don't work expressly. "Seriously people- STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus"[1]
> People got especially confused by the "current scientific evidence does not support", because to them that sounds like "scientists say it doesn't work". That's not what that says at all, it's just a statement to say that not enough studies have been done at all to say anything one way or another confidently.
Current scientific evidence showed masks were effective for closely related coronaviruses. Do you doubt they would have recommended masks without a shortage?
[1] http://web.archive.org/web/20200301144229/https://twitter.co...
But this is Dan Luu's point exactly. When forced to communicate at scale -- such as public health directive messaging -- there's no choice. Nuance doesn't work, only the simplest, blunt messages "get through".
Fauci, like many others, were concerned about panic-buying of masks. It's not that they don't work at all, they obviously do, and Fauci knew this. However, they don't work anywhere near as effectively in the hands of the untrained public (chin straps! pulling masks aside to sneeze! INCREASED touching of the face to adjust masks!), so it's taking masks away from people that can use them effectively.
Option 1) Tell the full message, mention that masks do work to a degree.
Outcome 1) People panic buy, and the overall effect is to make the pandemic worse because health professionals can't get enough PPE.
Option 2) Straight up tell people not to buy masks.
Outcome 2) People shrug their shoulders, don't buy masks, and the overall outcome is better, especially for the overburdened health system.
Which would you choose?
Nuance -- resulting in dead doctors and nurses, crippling the health system OR the clear but inaccurate statement -- that saves the country?
This is why it cracks me up to see responses precisely like yours, foaming at the mouth in anger.
You're angry at people that did what you would have done, if sitting in their position and faced with the same choices.
I strongly disagree, epistemologically speaking. You can run repeated tests and then conclude an intervention is successful. You can also run repeated tests and conclude an intervention is not successful - as you put it, no better than the null hypothesis. Or, finally, you can have just not run tests at all. There is a difference between the second and third states, and health authorities implied the second state when the third state was far more accurate.
Some countries were able to issue effective mask wearing guidance - without lying to people, or causing mass mask hoarding. So let's not pretend that wasn't achievable.
Let's also not act like we tried other outcomes first; incentives to mask production, disincentives to mask hoarding, etc.
Multiple trusted organisations lied to Americans, not just for practical purposes but also for political and personal reasons. "Trust the science" now means, obey the science that we didn't censor / fail to investigate / lock behind data protection. It's really not justified, however thick you take people for, and however limited your imagination.
What choice did they have? They were talking to Americans!
"there's no reason for the general public to be walking around with a mask".
Nothing in that statement says that masks don't work. It also doesn't say there will never be a reason for the general public to walk around wearing masks. It is in the present tense and a single sentence.
In a shortage, you want the masks focused where the infections are coming in, the hospitals. The virus was not widespread at that point, so you are wasting resources by spreading your mask supply so thin.
His statement seems like an acceptable balance of simplicity and the truth. I also remember him couching it with "at this time" though I don't know if that was a common thing he said.
No??? This is what having a prior is for. In this case, the prior was the mechanistic model which told you with reasonable confidence that masks would work in the slices of worlds where the primary mode of transmission was one mitigated by mask-wearing. We do not in fact live in a state of helplessness absent a double-blind peer-reviewed RCT; you will actively come to incorrect conclusions if you refuse to use your existing models & knowledge of the world to draw conclusions about the likelihoods of various outcomes.
Our institutions need to be both truthful, and also accountable. This means being able to freely debate the facts without censorship. And for the decisions and communications of our organisations and leaders to be examined, debated, and judged. We cannot have a society where people are knowingly and deliberately misinformed, and debate of the matters is suppressed. That's 1930s Germany levels of gaslighting and suppression. The West is supposed to be Free, and this is not free or democratic.
The implication seems pretty clear. We don't live in a world where statements only mean their narrowest and most literal reading.
pseudalopex linked to Fauci's tweet plainly stating that masks are ineffective for the general public.
Yes. I'm incorporating a prior. Read what I wrote at the top of the thread: every medical intervention that has ever failed a trial has had a biologically plausible justification for doing the trial. Nearly all trials fail.
In the history of medicine, literally every failed medication, surgery, treatment or intervention has had an explanation that seemed plausible at the time. Just as we're seeing with masks, the vast majority of interventions have little to no effect. Many make things worse. From bloodletting to thalidomide to failed cancer drugs, medicine is littered with examples of people who "knew" that their preferred treatment would work based on "priors" or "plausible mechanisms", and ended up doing great harm.
As a bayesian and someone who is knowledgable of science and medicine, my prior probability of any medical intervention working is almost zero.
I don't disagree. You test to reject the null hypothesis. If you do not reject, you must accept. Eventually, hopefully, you give up on the failed alternative hypothesis and move on.
> Or, finally, you can have just not run tests at all. There is a difference between the second and third states, and health authorities implied the second state when the third state was far more accurate.
We agree completely here.
Yes, this is reasonable, in the general case, absent a specific example to examine. However, masks do in fact work to prevent the spread of certain kinds of disease, based on both obvious mechanistic reasoning and on actual experimental evidence to that effect. Making the affirmative claim that masks would not work against covid (at the time) would have been ignoring or denying the non-trivial possibility that they would work quite well (or work poorly, but working poorly is still working on the margin).
* https://www.nytimes.com/2020/02/29/health/coronavirus-n95-fa...
* https://edition.cnn.com/2020/02/29/health/face-masks-coronav...