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The Question That Nobody’s Asking

I’ve been scratching my head a lot lately, and I need to stop before I wear through my scalp. (My natural armor has been mostly gone for thirty-five years.) It’s a natural, nay obvious question, which I’m putting in bold and giving its own paragraph:

If masks prevent SARS-CoV-2 infections, where did the current explosion of cases and deaths come from?

Take a look at the screenshot below. This is from the Arizona Department of Health Services’ COVID-19 dashboard. The graph is deaths by date of death for the entire state of Arizona. The curve starts heading toward the sky during the last week in October.

AZCovidDeathsGraph-500 wide.png

Maricopa County, where we live, issued a mask mandate on June 19, 2020. That was right about when the first near-vertical slope in the graph began. It took a few weeks for the mandate to catch on, but by August 1, it was pretty much universal. That’s about when the curve started to fall. There was a certain amount of crowing that the mask mandate had brought the pandemic under control in the state.

Then the end of October happened.

Now, I’ve been watching not only whether people are wearing masks in retail outlets and offices (they are) but also what kinds of masks and how they’re being worn. Over time, the masks are getting better. I’m actually seeing KN95 masks with some frequency, and it’s been a couple of weeks since I’ve seen a useless “train robber” bandana mask anywhere. Mask adherence in the state is at 90%, which aligns with what I’ve seen, if perhaps on the low side. That’s a mighty high rate.

So again, my question: With mask adherence at 90%, why is the curve still so high? Note that the graph is of the days deaths happen, not when they are reported. Death reports are not all received by the state on the days deaths happen, and reports from rural areas can take a week or more to get to AzDHS. What looks like a falling curve at the right edge of the graph may simply be due to lag time in reporting.

There is certainly some inflation of death counts due to the problem of “with COVID but not of COVID.” Some. I don’t think that kind of confusion can cause the numbers we’re seeing here. And it’s inevitable that a certain amount of fraud happens; I’ve seen the news stories describing gunshot suicides, car accidents, and victims of alcohol poisoning described as COVID-19 deaths–some without a positive test for the virus. However, if there had been enough fraud to cause this explosion in deaths, somebody somewhere would have said something.

Wouldn’t they?

Ok. Although I’m open to other theories, I think it’s significant that something happened in the last week of October: Arizona temperatures crashed hard. We had a long, lingering summer here. Mid-October was still giving us 90+ degree days. That went down into the 60s and 70s in a big hurry.

It’s long been known that viral respiratory diseases become much more prevalent in cold weather. Why this should happen isn’t known with certainty. One theory is that influenza and corona viruses have a coating that becomes more rugged in colder temps, giving the virus a longer survival time in air and even in sun. Dry weather favors viruses for reasons that, again, are far from clear.

Well, in Arizona we have dry weather in spades, year-round. Cold, not so much. In fact, a typical winter’s day here is probably about the same temp as a typical summer’s day in North Dakota. Given the uncertainty about what causes viruses to infect more readily in winter, could it be a conjunction of cooler (than usual) temps and extreme dryness? Or (and I like this one better) is there something about the effect of a fall in temperatures (the delta, not the absolute temps) on the human body that gives the virus free rein?

That’s the only theory I have that I haven’t already shot down. It wasn’t Thanksgiving gatherings; the curve took off close to a month before Thanksgiving. And for all that, I consider it pretty thin gruel. It’s dry here probably 340 days a year. It’s even drier in summer than winter.

The theory that people spend more time indoors than outdoors in winter doesn’t apply in Arizona. The reverse is largely the case: When it’s 110 degrees outside, most people stay indoors, or maybe stand up to their necks in the pool. Winter is when people jog, bike, hike, and work outdoors, getting lots of fresh air and plenty of sun (and thus crucial Vitamin D) on their faces, arms, and legs.

Again, where the hell did that near-vertical runup in deaths come from?

I’ll tell you where it didn’t come from: People ditching their masks. The fact that mask compliance is at 90+% during an explosion in COVID-19 deaths screams out something a lot of people don’t want to hear: Masks don’t prevent infection. If they did, the increase would have been a lot more gradual, and probably a lot lower in magnitude.

Let me put it in short, simple words: Masks have been sold as a means of stopping the spread of SARS-CoV-2. They’ve been sold hard. Mask skeptics get called a whole lot of dirty words, even though we wear masks as a courtesy to the rule of law. Faced with a graph like the one the State of Arizona itself puts out, what are we supposed to think?

The graph says something else, perhaps a little more quietly: There are no COVID-19 experts. We still have very little understanding of how this thing spreads and (especially) why it hits some people so devastatingly hard, and others barely at all. When our (often self-appointed) experts told us to put on masks, we put on masks. And then the graph went through the roof.

I wish I had answers. I don’t. Why two peaks instead of one? What had been going on between the end of July and the end of September? Were we doing something right? If so, what? And what did we start doing wrong in late October?

Nobody knows. Read that again: Nobody knows.

If I figure it out, you’ll read about it here.

32 Comments

  1. Lee Hart says:

    Hi Jeff,
    I’m Susan Atamian, a (retired) physician, and married to Lee Hart. I’m the resident “expert” and keep up with the literature (though I agree we still don’t know nearly enough). I have data on what could be causing the spikes you are seeing. Contact me via Lee’s email if you’d like to discuss it further.

    1. Clint Wills says:

      Good afternoon, I live in Columbia, SC, where a friend shared this post. I think this is an important discussion, especially as the UK variant begins to affect the US in greater numbers. Dr. Atamian, I would be very interested in understanding your data about the cause of the spikes. The article, and the comments that followed it are both helpful and civil, a rare thing these days. Thank you in advance for any data you share.
      Clint Wills

  2. TRX says:

    There have been several labs caught simply marking every test “positivie”. And not all the tests are specific for COVID-19; they’ll pick up almost any coronavirus. And most tests will show positive if someone has had and recovered from the virus.

    Carl Bussjaeger has been keeping track of COVID reports, pointing out the large (in some cases, by an order of magnitude) disparities in numbers of cases according to which authority is making an announcement, and showing how some agencies “batch” reports in ways that distort things.

    Too many organizations, from the CDC to newspapers, have been caught in outright fabrication, for any reasonable person to put any trust in their announcements.

    So, “pick a number, any number…”

  3. Orvan Taurus says:

    Without saying exactly what I work at, I will say that I am in the “supply chain” and close enough to an end that I need to wear a mask for show at least some of the time. But when the show is NOT “on”, precious few bother. And I am one that does NOT bother. I have now had FIVE (5) co-workers come down with confirmed COVID19 (and a few more distant folks… and one more distant died [severe obesity…]) and meanwhile… I haven’t had ANY symptoms. I some *serious* supplementation (I suspect some minor itchiness will subside when I feel comfortable backing down. Right now? MINOR itchiness beats the alternatives). And I know one person who had a serious respiratory problem that was likely mask-induced.\

    And LONG before this, I had read of the 1918 flu… and all the masks and such.. and how it was realized later that they did NO good at all.

    Someone even once suggested I’d change my mind about my surgeon if s/he didn’t wear a mask – but even THAT study has been done. If the surgeon is NOT coughing/sneezing then the mask is purely for show. NO EFFECT. *NONE*. They got mighty quiet when I replied thus.

    1. Mapleton Reader says:

      Your comment about the 1918 flu surprised me and caused me to google “did masks help in 1918”. Of the articles that appeared one review article describes the failure but also why it failed. See https://www.healthaffairs.org/do/10.1377/hblog20200508.769108/full/ .

      There is another article about how one city avoided the 1918 flu without wearing masks.
      https://www.theguardian.com/world/2020/mar/01/gunnison-colorado-the-town-that-dodged-the-1918-spanish-flu-pandemic

      The first article goes along with your point that a mask really doesn’t help the wearer that much. But as the article points out in the conclusion, when apparently healthy people can carry and spread the virus without symptoms, your mask helps me, and my mask helps you.

      1. Heh. Gunnison sealed itself off from the outside world. Not an option today.

        As for the other article, nowhere does it present evidence that 1918 masks worn properly prevented the disease. The whole purpose of the article is to cajole us about mask mandates by blaming all failure in 1918 on a stubborn public. The possibility remains that aerosol H1N1 could get through cheap masks then–and most cheap masks today.

        Finally, the chestnut that masks are there to block exhaled virus-filled droplets (your mask protects me, my mask protects you) tacitly admits that wearing a mask does not prevent you from being infected. The public has been sold on masks as personal protection–for the person wearing the mask. If this isn’t true, it needs to be admitted up front and out loud.

        As I like to say, “Aerosols change everything.”

      2. In rereading my reply, I realize that I may have spoken a little too strongly. The Mask-Industrial Complex has not been honest with us, and that bothers me a great deal.

        The same people who wanted 372 peer-reviewed studies before admitting that HCQ can cure COVID-19 pretty much assume that masks work 100% and consider the subject closed. I find this attitude annoying. We don’t know that masks significantly reduce passage of aerosol viruses. Droplets, sure. Do we know how many cases are caused by inhaling aerosols? No. It may be impossible to know.

        My issues stem from two things: 1. Certainty where certainty is not warranted about the state of the science, and 2. Misrepresenting what we do know to the public. I’ve heard the argument that “We have to bend the truth some to get the public to comply.” Alas, lying to the public will not pass unnoticed, and when discovered will destroy what credibility the authorities have.

        I wear a mask when required. I am under no illusion that it will protect me or anyone else. If masks were effective, we wouldn’t be having a second surge, especially with mask compliance at 90% and the masks being used are much better than they were 7 or 8 months ago.

        1. WILLIAM H MEYER says:

          I have read some useful commentary on the issue of masks and the virus. The essence is that the particles of interest are sub-micron size, and clearly the masks will be useless against such things.

          An old friend who worked in workplace contamination used to say that masks only stop the basketballs.

  4. greatUnknown says:

    Consider Amazon deliveries of packages from China as a vector, and all becomes clear. Particularly the enormous spike starting in December.

    1. You mean those mystery packages of seeds? Huh. I forgot about that. I assume that at least a few of them were studied to see if they contained pathogens, though I consider it unlikely. Will sniff around a little. Thanks for reminding me.

      1. greatUnknown says:

        I actually meant almost every package containing products from China. I have seen no indication that those products are sterilized – or produced in clean environments – before entering the distribution chain.

        1. Jason Kaczor says:

          Current indications are that the virus only lasts 72-hours on a surface, so – chances of it actually coming from an Amazon package from China are slim. Any time I have had my Amazon/Prime orders accidentally fulfilled by a Chinese company, the delivery time was weeks, not days. (Typically not me, but the family would order something and not pay attention to the delivery date)

          Occam’s razor is more likely that your local/regional Amazon warehouses, and the associated delivery distribution chain.

  5. Roy Harvey says:

    “I’ll tell you where it didn’t come from: People ditching their masks.”

    Your observations about mask use pretty much agree with mine up here in Connecticut. BUT, what we are seeing is what people are doing out in public. We are not seeing what happens when the next door neighbor drops in, or at the Saturday night poker game, or the twelve people who come to little Debbie’s birthday party. People got tired of not socializing. Willing to mask while shopping or otherwise out in public, they became unwilling to remain sufficiently isolated from friends and family. That’s my theory anyway, with more confirmation from my own observation of friends and family than I am comfortable with.

    1. I’d consider this as a possibility if I were to observe a lot of people doing it. I haven’t. None of our friends are socializing indoors. Nobody had family Thanksgiving. All are complaining about isolation, which wouldn’t be happening if they weren’t isolating. The second surge came on very quickly and in huge numbers. This doesn’t align with what we’ve heard friends and family doing online. Although a certain amount of covert socializing may be happening, it’s in small numbers that can’t account for the observed explosion of cases and deaths. In AZ, 75% of deaths so far have been the 65+ demographic, which suggests we need to be paying more attention to the frail elderly. Nonetheless, the explosive rise in the graph continues to puzzle me.

      1. Roy Harvey says:

        Okay, that is what you get from friends and family. Were friends and family catching the virus? If the group was part of the surge then I would give weight to their correct behavior being unproductive. If they remain in the group that has not been infected, that sounds significant too. Working from a large enough and diverse enough sample size to matter is a problem for all of use working from our own observations.

        1. We have no family here in AZ, and I’m limiting the current discussion to AZ, because I have what I consider reliable stats from ADHS. However, among our local friends we’ve seen only one case, and just a few more (4?) outside AZ. In our extended family, an elderly woman in a nursing home caught it and threw it off without any apparent permanent damage. And that’s about it.

          They’re giving antibody tests (not PCR) at the local Kroger affiliate supermarket pharmacy, for $25. It requires a finger-stick blood draw, but it’s cheap and fast, and Carol and I may get the test as an experiment. The test is only 80% accurate, according to medical studies I’ve seen online. I wonder if the 20% of tests that failed were false positives or false negatives.

  6. John Rodman says:

    What else was on the upswing in September and October? Political gatherings, and one party in particular made aversion to masks a major part of their stance. So, large, dense gatherings of unmasked people, AKA “super spreader events”.

    1. Remember the rules here: No partisan politics.

      I’ve considered this and rejected it. There were plenty of political rallies in the summer, when the death count here dropped nearly to zero. In AZ, sunlight effectively kills viruses in just a few seconds, so outdoor activities seem very unlikely to generate huge numbers of cases, especially as quickly as they happened.

  7. RickH says:

    I’d be interested in the same data chart for prior years. Reporting on Covid might be more throrough, but do the incidence of flu cases in the past follow the same curve as the data you graphed?

    I’d also be interested in the ‘death’ curves of prior years compared to this year. Note that the comparison would not be to the actual numbers, but the ‘trending’ (maybe not the right term) curve for Covid and flu, and death rates, comparing this year to previous years.

    Maybe the numbers are larger with Covid, but is Covid x% higher over time compared to prior years of flu deaths?

    1. Ed says:

      Here are the “death curves” for previous years, courtesy W. Briggs:

      https://wmbriggs.com/post/34203/

  8. Orvan Taurus says:

    I once read (was it on Slashdot or in Science News when it wasn’t [fully] infiltrated by Klimate Kooks?) that a study was run about cold weather and viral(?) infection and such and there was an unexpected result: Temperature DID matter. But it was *nasal* temperature. As in, the old advice to breathe through the nose to avoid “freezing the lungs ” (WTH?!?) was exactly wrong. Now, I don’t know if this held or was debunk in the next (series of) study (-ies) or if mouth-inhale–nose-exhale helps, or if “mouth breathers” seem to be annoyingly unaffected by Winter Illnesses.

  9. Chris Rudek says:

    Lets look at how Singapore is handling this so well. They had a lot of practice already. They have an entire mitigation strategy for the entire country. Leaving politics out of this. Our country is greatly underestimating a real virus and we need to have an entire program to stop a major contagion. We can all say the numbers are ‘ not accurate ‘. What is accurate are major hospital organizations being work to death to try and save the most sick from COVID. I really feel bad for someone who just gets regular sick and goes to the hospital. Cancer patients with reduced immune systems etc. I’d say our management of this has been pretty disappointing. It will just “Go Away” was not a strategy that was appalling and locking down the entire working class is not the right way either. It’s unbelievable in 2020-2021 that we are in this situation. It is not 1918. Mask could be useless but it is so non invasive and easy and cheap that why not just try it ? Why all the vitriol towards mask. Just look on you tube at all the “anti-maskers”. They are as bad as the “anti-vaccines” people. All of a sudden everyone is a epidemiologist giving out advice. Our government better step up to the plate. Sadly the last time this country was united was after 9/11 and WW2. I have a 7 year old and I am very frustrated where we are. I am hopefully will we see a change in how we manage COVID soon. We need the National Guard to mobile and create Vaccine centers for people that “want” the vaccine. I want the vaccine. If a person feels they don’t want it that is fine. However going forward I will keep everyone at arms length. Signed Chris a USAF Vet.

    1. Masks can be health hazards. See this from the BMJ:

      https://www.bmj.com/content/369/bmj.m1435/rr-40

      I also have serious doubts that masks other than N95 (which I think should be reserved for front-line health workers) are effective in either direction against aerosols.

      The government is doing something important: It sped up the process of creating a vaccine, and is now rolling the vaccine out to the general public. I expect to get it later this week. (I’m 68.)

      The government went the distance to create the vaccine quickly. Destroying people’s livelihoods via lockdowns of dubious effectiveness has done nothing but stoke hatred for government generally and was a horrible mistake.

      We don’t need the National Guard. Pharmacies give flu shots. There’s no reason that pharmacies cannot give COVID-19 shots. All we have to do is supply them. As best I can tell, this is happening (at least in Arizona; no promises about New York) as quickly as practical.

      1. Chris Rudek says:

        Mask work. Look at Japan: https://www.japantimes.co.jp/news/2021/01/16/national/tokyo-covid-jan-16/

        They are a gigantic city with packed trains and buses and they have around 1000 cases a day.

        They locked down nothing. Their hospitals are not “overloaded” with patients either.

        The issues brought up against mask effect 1 out of 100,000 people. COPD, phenomena Etc.

        Sure I am all for “CVS” giving out vaccines so lets get it going. The fact is that is not happening, I have seen no plans to get that going.

        1. The Japanese have something else that most of us in the West don’t have: A very big tea habit. I observed it first-hand when I visited Japan in 1981. I was working in the local office of Xerox in Tokyo, in an open office, no cube walls. I could see everybody in the office. And every one of them had a cup of tea in front of them. All the time.

          A recent study by NARA University found that tea contains chemicals that interfere with virus activity:

          https://soranews24.com/2020/11/28/nara-university-study-finds-some-common-teas-can-neutralize-covid-19/

          This isn’t really news; I saw reports of this back in the spring. And while tea won’t cure a COVID-19 infection once it gets into second gear, there’s plenty of evidence that bingeing on tea could seriously reduce chances of infection from small viral load. So there is another reason for Japan’s success.

          Some of those chemicals in tea are zinc ionophores, which escort zinc into cells, where it stops viruses cold. Carol and I take quercetin, which is another zinc ionophore, along with zinc supplements to make sure our available zinc is topped off. (A zinc ionophore doesn’t accomplish anything without bioavailable zinc in the body.)

          Quercetin is a stronger ionophore than the chemicals in tea, if I’m reading the research correctly. And tea gives me kidney stones. So we’re sticking with quercetin. (Carol does drink tea, though nowhere near as much as the Japanese.)

  10. Mapleton Reader says:

    Looking only at the Arizona data and the first Gaussian like peak, I eyeball the following
    1) Mask mandate Jun 19 (from your text)
    2) Peak infections, shown by testing, ~Jun 29 (Arizona website – different page)
    3) Peak deaths, as reported ~Jul 15 (another eyeball estimate)

    This suggests a rough 10 to 14 days between “exposure”, “diagnosis”, and “death” for the unlucky ones.

    Assuming Thanksgiving was an exposure event, peak diagnosis would be during 6-10 December, with peak deaths between 16-24 Dec. This range should probably need to be broadened to account for early and late exposures if people were exposed a few days prior or after Thanksgiving by travel or shopping. (I am ignoring Christmas but that too should have an effect).

    To your point, it doesn’t appear likely that the uptick in deaths occurring the end of October is the effect of Thanksgiving exposures (unless time travel is assumed). Yet it does seem likely that the peak death data in December can be reasonably attributed to a Thanksgiving exposure (when masks and social distancing were presumably lacking).

    So, I see two main points: masks wearing/social distancing can 1) reasonably predict exposure/diagnosis/death peaks but 2) cannot iidentify all exposure events such as a rise in death rates as described in this post. I think the evidence so far suggests that I continue to wear a mask/social distance in my efforts to help stem the pandemic.

    1. Social distancing is a no-brainer. But most of the sound and fury is about masks, including insistence that they be worn outdoors, which seems absurd. The following article is old (April 1) but it does echo some of my misgivings about masks:

      https://www.cidrap.umn.edu/news-perspective/2020/04/commentary-masks-all-covid-19-not-based-sound-data

      In an ideal world, with ideal masks, masks would be effective. We do not live in an ideal world. Idealism, as I’ve said in other contexts, can be deadly.

      And I think almost everyone can agree that masks have been oversold relative to their effectiveness.

      I still think there’s a temperature factor that we don’t yet understand. I might agree that Thanksgiving was the cause, but the surge started long before Thanksgiving. It’s possible that the three holidays prolonged the surge, and now that we’re out of holidays we should be seeing the surge end soon. I’m thinking by February 1 that the curve should start to fall, unless other factors (like temperature) predominate.

      Complicating the equation is the fact that vaccination is now happening at a pretty good clip. Carol and I (being over 65) will be eligible for the vaccine this coming Tuesday. How soon we can actually get it is unclear, since our (sizeable) retiree population will all be trying to make reservations at once. I’m expecting a slow decay in the curve due to vaccination, and will be looking for a faster decay once temps in AZ get back up to what’s considered summer in colder climates.

      With any luck at all, the shape of the curve over the next couple of months will tell us a lot (or at least something useful) about what’s behind Arizona’s explosion in deaths.

      1. William Meyer says:

        Ah, but the Japanese have also determined that a social distance of three feet is effective.

        On the other hand, there have been studies showing that a sneeze plume may extend some 20 feet.

        The worst aspect of the pandemic is that reliable data are common as unicorns.

  11. james Fuerstenberg says:

    so…today I sat in on the Argonne National Lab townhall on vaccines. One thing that did come up by a presenting epidemiologist is that new strains of the virus cause the body to put out about twice the volume of virus as the original and the new version of the strain also requires something like 30% less for one to become infected. Even with significant usage of masks, that will result in a lot more infections.

    btw, also apparently those vaccinated have pretty strong immunity; more than one would get from having had the virus. they are hopeful that we can get a year out of that immunity. This is based on the early vaccinations during the trials.

  12. Rich Rostrom says:

    WRT to that right-edge-of-graph dip – can one accesss earlier reports for earlier dates?

    I.e. plot the data for 1 July to 15 August as reported on 15 August, and compare to the same date range as reported now. That would show whether there is a lag in some reports.

    1. I don’t think so. What’s there is what we get. I think the graphs are generated from the data when the page is refreshed, but I don’t see any way to get at the data.

  13. james Fuerstenberg says:

    despite the somewhat inflammatory title…the stats are interesting

    https://issuesinsights.com/2021/01/27/blue-states-covid-restrictions-are-killing-jobs-but-not-the-virus/

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