This Yahoo headline caught my eye:
Rand Paul’s Shockingly Bad Advice To Recovered COVID-19 Patients Fires Up Twitter
The story contained these competing claims:
The senator urged all those who have recovered from the coronavirus to throw out their masks and go out and enjoy public spaces because they are now “immune” to it. This is not true; there have been confirmed cases of reinfection both in the U.S. and abroad.
“We have 11 million people in our country who have already had COVID. We should tell them to celebrate. We should tell them to throw away their masks, go to restaurants, and live again, because these people are now immune,” he told Fox News host Martha MacCallum.
The Centers for Disease Control and Prevention has said that reinfection is possible and that all people should wear masks in public spaces, regardless of whether they have had COVID-19 or not.
It is certainly true that reinfection is possible, but that has almost no bearing on whether Rand Paul is correct when he tells those who have had the disease to throw away their masks. The question is whether the risk of re-infection is high enough to make mask wearing appropriate, not whether it’s zero. I don’t know the answer to that question, but this article suggests the risk of reinfection (before there is a vaccine) is very low:
Following the news this week of what appears to have been the first confirmed case of a Covid-19 reinfection, other researchers have been coming forward with their own reports. One in Belgium, another in the Netherlands. And now, one in Nevada.
That doesn’t sound like very many for a world with many tens of millions of recovered Covid victims.
You might think that I’m just quibbling over a minor point, but I have in mind something more serious. There’s a danger that people use measures appropriate for a very serious crisis even after the threat becomes far lower.
Consider this analogy. The 9/11 terrorist attack was a severe shock to the US, with nearly 3000 killed. After this event, we quickly took measures to prevent a repeat. But then we went much further, taking extremely costly steps to prevent far smaller terrorist attacks, where the costs almost certainly outweighed the benefits. My fear is that we’ll come out of this with mask wearing becoming somehow normalized, even for medical threats an order of magnitude lower than Covid-19. For “just the flu”.
People who early on claimed that this is “just the flu” were rightly criticized. But what is the actual risk for those who have already had the virus once? I don’t know, but I’m not able to find evidence that the risk is significant enough to require mask wearing.
There are other arguments for having everyone wear masks in crowded stores until we have a vaccine. It provides “social solidarity”, as customers might feel more comfortable if other shoppers have masks. They would not be aware that the person not wearing a mask had already recovered. But if that’s your actual objection to Rand Paul’s statement, then say so!
I’m a big fan of mask wearing and have no ax to grind on this issue. So if I’m wrong about reinfections, if those who have recovered are still highly likely to get the disease again, then let me know that I’m wrong about the facts and I’ll change my view.
READER COMMENTS
Ray
Nov 13 2020 at 3:38pm
The WHO estimates ~750 million cases worldwide so far. Of that there’s been on a handful of documented reinfections (vs. lengthy infections, false positives due to high PCR test thresholds detecting expired virus).
Antibodies of course fade, but recent studies show that they last at least six months, and possibly more. Beyond antibodies the body relies on other specialized cells to fight infection which can remember how to respond due to a previous bout. Resistance to SARS-CoV1 has been shown to last for 10 years. It’s not improbable that SARS-CoV1 is similar.
https://medicalxpress.com/news/2020-10-sars-cov-antibodies-immunity.html
robc
Nov 13 2020 at 3:46pm
I thought this was going to be about a different Rand Paul statement, as I saw an article earlier today showing that a recent study suggesting he was right with his argument with Fauci, as a number of people apparently have immunity from previous coronaviruses. The article (published in Science last week) says 5% of adults and 43% of children. Apparently the immunity fades over time but children get so many colds that they are likely to have had a coronavirus recently that provides immunity.
Scott Sumner
Nov 13 2020 at 5:12pm
Great news! I also get lots of colds. 🙂
Andrew T Gardner
Nov 13 2020 at 3:55pm
I agree that re-infection risks are low — but what keeps mask-deniers from just saying “I’ve already had COVID and recovered”. Given the low percentage of immune recovered people relative to the high percentage of mask-deniers, I wouldn’t be surprised if 9 out of 10 maskless folks would be deniers, not immune. The policy that Rand Paul is advocating displays a reckless disregard for the COVID-fatigue, hostility, and division that exists in this moment. The question isn’t “Is Rand Paul wrong?”, it should be “Is Rand Paul helpful?”
Scott Sumner
Nov 13 2020 at 5:13pm
That’s a very reasonable view.
Chris
Nov 13 2020 at 5:33pm
Right. It’s one thing to offer a qualified defense of that one claim Rand Paul made. But if you take his perspective on Covid in full there’s plenty to criticize.
MarkW
Nov 13 2020 at 6:01pm
Throw away the masks is probably bad advice for that reason, but throwing away excess caution is probably fine. I have an aunt and uncle in their 80s who are infected but seem to coming through it without much of a problem. My advice is to them is that when they’re through with the virus, they should go out to dinner as often as they like.
Mark Z
Nov 13 2020 at 9:00pm
I don’t think this criticism really makes sense. It has nothing to do with whether his advice to people who actually had covid is valid, and he doesn’t suggest here that people who haven’t had it should pretend to have had it. I also doubt that people who don’t like wearing masks haven’t thought of lying about being immune before. I don’t think there’s a good argument that telling people who’ve been infected in the last few months that they don’t need to wear masks is harmful, beyond that, inasmuch as they listen, they’ll scare people into avoiding them in public because no one will be able to tell if they are immune just by sight.
Alan Goldhammer
Nov 13 2020 at 5:10pm
From the reading I’ve done for my newsletter, reinfection is extremely low. Most papers tend to report 1-3 cases and given testing inaccuracies it is difficult to know for certain if these are true reinfections. Senator Paul overlooks the bigger issue of how we don’t know if a stranger that we see maskless on the street has had COVID-19 or not. Do stores with mask mandates (and almost all of them have them now) allow someone who claims the have had COVID-19 and don’t need to wear a mask in to shop?
I think Senator Paul’s statement was foolish but it’s what I’ve come to expect from him.
Gordon Inouye
Nov 13 2020 at 5:42pm
Scott, the very small number of confirmed reinfections has to do with the fact that you need the right circumstances to conclusively say it’s a reinfection vs. a past infection that has lain dormant. Researchers didn’t want to discount the latter possibility because this virus is so novel. And scientists say that other coronaviruses have shown only a limited time for immunity. So nobody really knows the reinfection risk and you can’t use the small handful of cases where it was possible to definitively say it was a reinfection to judge the probability of reinfection. Also, the notion that exposure to other coronaviruses in the past may confer immunity is highly speculative. For SARS, having some immunity to past coronavirus infections was correlated with worse symptoms. And the IHMS points out that some communities have seen 60 to 70% infection rates with SARS-COV-2 which also throws cold water on the notion that past coronavirus infections can confer immunity to SARS-COV-2.
Michael Sandifer
Nov 13 2020 at 8:21pm
How is it possible for people who run public spaces to know someone is immune? There might be ways to set up quick ways to check, but I’m not aware of any now in existence.
Also, would it be wrong to take the Flu more seriously? Would it be outrageous to aspire to universal vaccination each year, for example, which may save tens of thousands of lives just in the US some years?
Zeke5123
Nov 13 2020 at 10:17pm
Yes — wearing masks from now on would be awful. Mandatory vaccinations would also suck.
Scott Sumner
Nov 13 2020 at 10:33pm
Michael, You asked:
“Also, would it be wrong to take the Flu more seriously?”
It would be wrong to encourage society to wear masks to avoid getting the flu. I have no problem with voluntary flu shots, I get one each year.
Thomas Hutcheson
Nov 14 2020 at 7:36am
Considering the very low cost of wearing a mask, (and since no observer can know whether the non-wearer is “immune”) I’d think the value of preserving the mask-in-public norm would be enough to reject Sen Paul’s advice.
Zeke5123
Nov 14 2020 at 11:44am
Are you sure there is a low cost? Wearing a mask eliminates most non verbal communication which highly reduces interaction. Wearing a mask signals death is around.
There is a high social cost to wearing a mask.
Thomas Hutcheson
Nov 15 2020 at 10:42am
Yes, a mask reduces positive interactions with strangers, but if understood as itself a positive interaction, a desire to reduce the other;s risk of infection, I still hold that the cost is low. “Signaling” that there is an extant risk is not a net cost when there IS an extant risk.
Joe Kristan
Nov 14 2020 at 9:01am
We had an exchange student from Bangkok when the COVID epidemic broke out. She said mask wearing in Thailand is common every year; people who have colds, etc. generally go out only with masks.
I would like that sort of mask wearing culture to catch on here. I would be even happier if people coming to work with a cold or flu were considered a menace, rather than heroic.
As for Paul- I think he’s right to encourage convalescents to go back out and wrong about the masks. Recovered patients can help struggling businesses survive until this is over. But if you are a business owner trying to enforce mask discipline, you have no way to know if someone is a recovered patient or just a jerk.
ThatsNotAll
Nov 14 2020 at 6:42pm
The culture of colds is interesting. The American way has typically been to accept that colds happen. We admire people who work through colds. The Michael Jordan “flu game” is widely praised as a great feat of athletic determination. We applaud the worker who has never missed a day of work in ten or twenty years.
It will be interesting to see if this mindset changes. Many Americans are now saying that maybe they should stay home if they are not feeling well. Will they after the dust of Covid settles? I suspect this will only be the case if there is strong public messaging shaming those who bring a cold to work or school. If not, I expect the old mindset to return.
Sean
Nov 16 2020 at 10:39pm
I wouldn’t. Getting sick is part of developing a strong immune system. You catch viruses that your body can recover from and then are stronger at fighting other diseases.
same thing as going to the gym. You work out and train your body. And then you can run longer.
a few viruses are too dangerous to expose people to but the vast majority are viruses that train your immune system with only minor pain
BC
Nov 14 2020 at 11:01am
“There’s a danger that people use measures appropriate for a very serious crisis even after the threat becomes far lower.”
We are going to hear in a few weeks how even vaccinated people still need to wear masks because the vaccines may not necessarily be sterilizing, i.e., they may prevent Covid-19 symptoms but not infection. Of course, the sterilizing/non-sterilizing distinction is never brought up when the context is whether vaccines should be subsidized or even mandatory. If the context is mask-wearing, then the standard is: well, unless we are *absolutely sure* that the person *can’t* infect others, then he should have to wear a mask. If the context is subsidized/mandatory vaccination, then the standard quickly changes to: since it’s *possible* that the vaccine might be at least partially sterilizing, then it should be subsidized/mandatory since it *may* reduce spread. Notice the change in burden of proof?
Even better are some of the arguments above: even if the previously infected or vaccinated can’t infect others, then they still must wear masks because the mask nannies have no way of distinguishing them from the non-vaccinated. Funny to watch the goalposts move from (1) flatten the curve (remember that?) to (2) minimize spread to (3) make it easier to enforce measures to minimize spread. The facts, circumstances, and goalposts may change, but the conclusion is always the same: mandate, regulate, tax, and subsidize. I guess that’s how The Science (TM) works.
Thomas Hutcheson
Nov 15 2020 at 10:48am
The “goalposts” have remained the same, take cost effective measures to reduce transmission from (unknowingly) asymptomatic people. People differ in what seems cost effective as circumstances change. Some measures will err on the side of excess cost and other on the side of excess transmission,
robc
Nov 16 2020 at 9:23am
The measures take so far havent been cost effective and that was obvious back in March and April.
Dan M
Nov 17 2020 at 11:47pm
To me, those aren’t even goalposts, because we’re not actually making any claim to measure asymptomatic spread (and therefore set success/failure conditions). We’re measuring (and arguing about) the costs, but not the (claimed) benefits.
Luc Mennet
Nov 14 2020 at 1:27pm
I’m not sure about it being mandated, but after the time that I spent in Japan I felt that mask wearing was “appropriate” in all public spaces back in July of 2019, disregarding COVID as an issue. I believe that mask wearing is beneficial not just as a preventative to other future pandemics, or even public health in general, but even just on it’s various auxiliary merits. for example, it helps with bad breath; If you’re the type of person who worries about appearance but doesn’t want to have to do makeup for a short outing, then a mask can help with that sort of issue as well. I’m not sure if there’s some cost to societal mask wearing that I’m not seeing.
Zeke5123
Nov 16 2020 at 8:40am
Very large amount of human interaction is non verbal.
Sean
Nov 16 2020 at 10:40pm
Immune system is improved by interacting with normal viruses and bacteria
ThatsNotAll
Nov 14 2020 at 6:31pm
The argument that mask wearing mandates are to protect others has never made public health sense. This is because the risk of spread in general community settings is low and the prevalence of people who can spread Covid is low.
At any one time what is the prevalence of active Covid infections in general society? It seems to be fairly low, on the order of a few percent. If it were higher than after nine months of high prevalence the entire population would be exposed! So let’s go with at any one time 2% of the population is Covid contagious. This means out of every 100 people 2 will be infectious and 97 will not.
The mountain of evidence is that spread in community interaction is low – that most spread occurs in homes, hospitals and in crowded indoor environments. What this means is that in all those situations that do not involve indoor crowding, the risk of disease spread is low. Compound that low risk with the low prevalence of infectious people and there is a statistical conclusion:
Wearing masks in general community environments is a waste of time. Almost all people you encounter in the community are not infectious and even if they were the encounters you have will not transmit the infection!
But Covid rules are not about health. They are not based on science. They ignore the dispassionate calculations of math. Covid rules are about politics and putting government officials in a position to divide the citizenry, instill fear and elevate themselves.
Oh, and observe that government officials, even those in the high risk group such as 80 year old Nancy Pelosi, are willing to socialize, as long as their hypocrisy is not publicized. Believe what you want about Covid. Take whatever precautions you feel are necessary. But don’t for a second believe that government officials are truly interested in and able to impose policies that will enhance your health and well-being.
Scott Sumner
Nov 16 2020 at 2:52pm
You said:
“The mountain of evidence is that spread in community interaction is low – that most spread occurs in homes, hospitals and in crowded indoor environments.”
Obviously hospitals are not the main spreader, as most people visit hospitals only rarely. And while it spreads within homes, how does it get there in the first place? I’d say 90% of the problem is indoor social settings like bars, restaurants, stores, nursing homes, etc. That’s why I only wear masks when I’m indoors in a public setting.
Mark Brophy
Nov 14 2020 at 8:53pm
I’m not a big fan of wearing masks. About 10% of the population, including Joe Biden, has asthma or other respiratory disease. If your mask is tight and impedes your breathing, your health is in danger. If your mask is loose and doesn’t impede your breathing, it doesn’t prevent virus transmission. Masks also encourage people to stand closer together under the false idea that they’re protected.
Thomas Hutcheson
Nov 15 2020 at 10:51am
Even a “loose” mask reduces the outward spread of virus particles.
I cannot understand the animus against mask wearing.
Scott Sumner
Nov 16 2020 at 2:54pm
I don’t agree. I have mild asthma and I have no problem with even a N95 mask. Perhaps for severe asthma you are right, but that’s not 10% of the pop. And I only need a mask for about 15 minutes per week. It’s not a problem.
D.O.
Nov 16 2020 at 4:20pm
About the flu. Universal mask-wearing during the flu season is unreasonable. What is more reasonable is to get to a new public attitude of staying home with flu (especially if there is a possibility to work remotely) and wearing a mask if you have flu symptoms.
Mark Hill
Nov 19 2020 at 12:46pm
Another problem with that advice is that we don’t know how long the natural immunity lasts, and you have no knowledge of if or when that immunity wanes, it is highly unlikely to last a lifetime. So, if you follow Rand’s advice, it may be fine for a while, but you have no way of knowing when it is no longer fine to do so.
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