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Mask-wearing and COVID-19 is complicated.
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And not just because it's become politically fraught, not just because there are many different
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kinds of masks of varying levels of effectiveness, not just because there's been a shortage
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of medical grade masks so authorities were trying to convince the public not to buy them,
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not just because there's tons of malicious or simply misguided misinformation flying
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around, not just because our understanding of how COVID spreads has been changing, and
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not just because countries in the West ignored the lessons learned by Asian countries that
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faced SARS (though all of these things are true).
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In addition to all this, masks are also complicated because they fly in the face of our mathematical
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intuition.
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The good news is that when you do the math (and we're going to), you find that masks
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are much more effective than you might think.
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Say you have a mask that cuts in half the chance a contagious person will infect a nearby
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susceptible person.
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In other words, this mask is 50% effective.
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Except, this mask is way more than 50% effective because as we'll see, when many people wear
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even just a 50% effective mask, you end up with way more than 50% protection (both to
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the wearer and to society at large).
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It seems obvious that if no one wears a mask, then no one gets any benefit - and that's
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true.
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And you might assume that if everyone wears a 50% effective mask, there'd be a 50% benefit
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- that is, a 50% drop in disease transmission.
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But that's not how the math of masks works!
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When everyone wears a 50% effective mask, disease transmission actually drops by 75%
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-- much better than 50%.
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Masks break our intuition because we're used to thinking about masks as single-directional,
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only protecting the wearer.
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But masks can protect in both directions, when you breath in through them, and when
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you breath out.
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This means that when everyone is wearing masks, there are in fact two masks between any two
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people.
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If we assume for simplicity that masks are equally effective in either direction – and
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if this assumption bothers you, stick around till the end of the video – if masks are
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equally effective in either direction, then the first mask cuts disease transmission in
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half, and the second mask cuts it in half again.
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So overall, you end up with a 75% drop in disease transmission, not 50%.
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In this scenario, masks do double duty!
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But in reality, not everyone will wear a mask.
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So when a contagious person encounters a susceptible person, there are in fact FOUR possible routes
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of infection.
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In the first route neither person is wearing a mask, which means there's no reduction
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in disease transmission.
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In the second route, only the contagious person is wearing a mask, and so for a 50% effective
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mask, disease transmission drops by 50%.
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In the third route, only the susceptible person is wearing a mask, and again disease transmission
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drops by 50%.
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And in the final route where both the contagious person and the susceptible person are wearing
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masks, disease transmission gets cut in half twice – aka it drops by 75%.
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What does this mean for society overall?
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Well, it depends on what fraction of people wear masks.
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As we've seen, if no one wears masks then no interactions involve any masks and the
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overall drop in disease transmission is 0%.
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And if 100% of people wear masks, then all interactions involve two masks and the overall
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drop in disease transmission is 75%.
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But if 50% of people wear masks?
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Then on average – assuming that people interact randomly – a quarter of all interactions
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will involve no masks, a quarter will have the contagious person masked, a quarter will
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have the susceptible person masked, and a quarter will have two masks.
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So even when just half of people wear masks, three-quarters of interactions involve masks
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(and a significant portion of those involve two masks).
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Do you see the magic math of masks yet?
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Your first guess might have been that if 50% of people wore 50% effective masks, you'd
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get a 25% drop in disease transmission because 50% of 50% is 25%.
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In fact, this intuition would be true if masks were only effective one-way (like on exhalation
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only) - then there'd just be two routes: either the contagious person wears a mask,
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or they don't, and these average to 25%.
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BUT when we take into account the two-way nature of masks and average over all four
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possible mask combinations, the overall drop in disease transmission becomes almost twice
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as good!
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Masks Work Better Than You'd Think.
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And this is true in general - no matter what numbers you choose for mask effectiveness
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and usage, the overall drop in disease transmission is always better than the intuitive guess
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from just multiplying those numbers together.
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So what does this mean for the 2020 pandemic?
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Well, for COVID-19, epidemiology suggests that each contagious person infects on average
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2.5 other people.
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If you could drop that number to below one, a drop of just over 60%, then each contagious
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person would infect fewer than one other person on average, which would be enough to swiftly
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halt the spread of COVID-19.
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So what would it take to drop disease transmission by 60%?
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Well, there are many options, but a particularly cost effective and arithmetically satisfying
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one is this -- if 60% of people wore 60% effective masks, disease transmission would drop by
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60%!
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And if we did that, we would beat COVID - the mask math shows us how.
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Specifically, it shows us that masks are more effective than you'd think for two reasons:
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first, they do double duty when both people wear them, and second, the fraction of interactions
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involving masks is always much more than the fraction of people who wear masks.
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This is the magic multiplicative power of masks –– even partially effective masks,
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partially adopted, can extinguish an epidemic, as long as enough people wear them.
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Ok, some caveats to all this: We've been pretty vague about what it actually
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means for a mask to be X% effective --- for the purposes of the math in this video, all
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that matters is that disease transmission drops by X%, irrespective of how the mask
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actually achieves this drop.
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In reality, masks reduce disease transmission through a combination of filtering and redirecting
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air, and they vary a lot in effectiveness depending on their filtration, how tightly
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they fit, if they have an exhalation valve, etc.
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So it's hard to give exact numbers; a 50% effective mask could be something like an
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N95 worn poorly (or incorrectly decontaminated) or a cloth mask worn well.
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We've assumed that masks provide equivalent protection upon inhalation and exhalation.
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Aatish put together an interactive essay where you can see what happens when inhalation and
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exhalation effectivenesses differ, what happens when more (or less) of the population uses
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masks, and more.
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For simplicity we've assumed that contagious people are just as likely to wear masks as
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non-contagious people.
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We also assumed that people mix randomly, which isn't necessarily true.
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For various reasons, people who wear masks may be more likely to interact with other
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mask wearers, and less likely to interact with those who don't wear masks (and vice
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versa).
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Clustering non-mask users together diminishes the overall protective power of masks and
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means you need more people to wear masks to achieve the same drop in transmission.
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Again, if you're interested in more details and references, definitely check out the interactive
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companion essay at aatishb.com/howmaskswork.
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This video was made with the generous support of the Heising-Simons Foundation, which normally
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works with MinutePhysics to help communicate about fundamental physics research, but this
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year they're providing additional funding to focus on the response to COVID-19.
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That means they've supported research – including some of the N95 mask decontamination work
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I mentioned in my video on the physics of N95s – they've supported hospitals and
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remote learning, they've helped low-income households maintain access to utilities, and
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they're funding COVID science communication like this video!
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A big thanks to Heising-Simons for their support of science – both fundamental and applied
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– as well as science communication.