Train Americans to use masks the way that surgeons do or restructure the physical environment?

My Facebook feed is packed with the Masked Faithful expressing their outrage at fellow U.S. residents’ incompetence. Examples:

Ran into Meijer today – only about 1/2 the people were wearing masks, and maybe 25% of them weren’t wearing them correctly. A 12% success rate won’t help, folks. … [details on how stupid everyone else is] #communityspread #covidiots PLEASE PLEASE PLEASE send an emergency notification text to everybody’s cell phone. This is important.

[from a Manhattan elite] The last ten people I saw: every single one with his mask under his nose. One with his mask under his chin. Why bother?

I responded to the last one with “The dream of the technocrats encounters the real-world American.” One of her friends reasonably asked “So, how do we fix this? If people genuinely won’t follow directions about masks and distancing, etc. (and it does seem more and more likely that they either can’t or won’t), what’s the solution?”

My answer:

that is a great question! I think it is probably smarter to reconfigure stuff physically. Take out half the shelves in a Target for example, so that people are naturally farther apart. With so many other retailers shutting down, there is plenty of mall space.

switch small retail to more like it was in the 18th century. Customer enters spacious front part of shop and asks for item. Shopkeeper goes into jammed back part shelves to retrieve requested item.

make it illegal to sell the middle seat on an airliner except to a family group instead of relying on people to use masks properly (which includes never touching one’s mask) during a 6-hour flight.

in states with warmer weather, build a lot of big shade structures so that more things can be done outdoors rather than indoors. Add some warming lamps in the ceiling to extend the useful season.

The current situation seems a bit like observing that there are a lot of car accidents and planning to reduce them with more intensive driver training. In fact, the solution that has been found to work all over the world is re-engineering the road system so that the humans that we have are less likely to crash. (Dividing busy roads, for example, to eliminate the possibility of head-on collisions for most of the miles that people travel.)

Readers: What do you think? Re-engineer Americans or re-engineer the American physical environment so that people are naturally more separated? Besides the above, what else could we do?

[My own Karen moment: I was in a big box store on Saturday. It was jammed and there were long lines for anything requiring human assistance now that people have discovered they can earn more on unemployment than by working. The City of Waltham requires masks for everyone, said a sign at the carefully policed front door. Once inside, I observed an interaction between a store worker roughly age 60 who was wearing a mask…. around his neck, and a shopper in his 30s, nowhere near 6′ away, who was seeking help from him. The shopper had his hand on his mask to pull it away from his nose and mouth (leaving the nose completely uncovered) to make it easier to talk.]


33 thoughts on “Train Americans to use masks the way that surgeons do or restructure the physical environment?

  1. They have to call that Meijer and get those people fired, pronto! Seriously, why not just call the store and complain? The store staff is supposed to enforce the rules. Speaking of which —

    Real World Americans, at the Hospital: I went back to the hospital today for my CT scan. It was a morning appointment so I was literally the first (and from the looks of it, only) patient on the scene in a deserted hospital. The ED was still empty. Nobody was behind me. Upon arrival, three reception staff weren’t wearing their masks yet! They had them around their necks, and I caught them red-handed while they sipped their morning coffee. Two pulled them up in a little fit of embarrassment as I sauntered through the automatic doors. Mine was dangling from my left hand with a broken strap. I said to the nice lady:

    Me: “Good morning. Sorry, my mask strap broke, do you have another?”
    Nice Lady:”Sure, please sanitize your ha…OOPS! I don’t have mine on yet! I have to put mine on first! [Nervous laughter]”
    Me: “Well, make sure you sanitize your hands first!” [Laugh]

    Then she pulled out the thermometer gun and zapped my forehead:
    Nice Lady: “Your temperature is low!”
    Me: “I’m keeping my COVID cool. [Laugh]”
    Nice Lady: “Let me try again.” … “Normal! [Laugh]”

    To his credit the young fellow running the Phillips CT scanner in radiology was wearing his mask when he greeted me, and was very efficient and helpful. I quizzed him a little about the contrast agent and its attenuation and he gave me a good, non “just a button-pusher” answer including a little discussion of the excretion rate, etc. Just wanted to make sure he knew what he was doing.

    • “They have to call that Meijer and get those people fired, pronto! Seriously, why not just call the store and complain? The store staff is supposed to enforce the rules.”

      Alex: are you sure that your name isn’t really “Karen”?

    • I’m positive it’s not. But that sentiment is going around, I’m just reporting what I see. There was a fight this morning here in our town between two restaurants (again!) over their respective staff members not being masked up, with threats and counter-threats, calls to the Board of Health, etc. These two competing establishments have apparently enlisted friends to keep tabs on each other’s compliance and it’s escalating into a full-blown feud.

  2. Reducing the capacity of airplanes will increase the price of flying, but our government will issue more currency. Problem solved.

  3. Here in Northern California, per the county health regulations for Covid, masks are required inside stores. No mask, no entry. Seems to work pretty well.

    Use security to throw out anyone who won’t follow the rules, including not wearing the mask properly.

    We enforce behavioral rules all the time inside commercial establishments. Try rollerblading down the aisles of a Safeway and see how far you get, for example.

    Or check the list of rules inside an amusement park. The list requires an entire sign.

    This is not something new.

    • In Massachusetts, at least, there is an exception for people who have difficulty breathing, e.g., due to asthma, old age, whatever. They’re not required to carry and show documentation of their medical condition(s). If the store can throw out the old and/or sick who aren’t able to wear masks, that would seem to render useless the exception written in the governor’s order. What happens in California? Are those who have trouble breathing supposed to get an exemption or not?


      Effective Wednesday, May 6, 2020, any person over age two who is in a place open to
      the public in the Commonwealth, whether indoor or outdoor, and is unable to or does not
      maintain a distance of approximately six feet from every other person shall cover their mouth
      and nose with a mask or cloth face covering, except where a person is unable to wear a mask or face covering due to a medical condition or the person is otherwise exempted by Department of Public Health guidance. A person who declines to wear a mask or cloth face covering because of a medical condition shall not be required to produce documentation verifying the condition.

    • Here’s a fun part of the order: “All persons are strongly discouraged from using medical-grade masks to meet the requirements of this Order, as medical-grade masks should be reserved for healthcare workers and first responders.”

      So the saliva-soaked bandana is encouraged while the clean 2-cent disposable surgeon’s mask is discouraged because someone in our shut-down health care system might want one.

    • G C: Finally, even if people are wearings masks in stores, if the store hasn’t been decluttered and re-engineered, doesn’t that just mean people will be fairly close to each other while masked? I thought that one of the arguments against masks was that the result was people ignoring the 6′ rule because they don’t feel vulnerable anymore. I have noticed this in the local Costco. Before masks were conventional, people avoided each other within the store. Now they are elbow-to-elbow in the fruit section.

    • California has the same exemption for people “with health conditions”, according to my contacts in the OC.

    • In practice, the enforcers equate mask wearing with the 6′ separation at various public places. Of course, there is no conclusive evidence to what degree either is efficient. I personally think they are, just do not know how much (10% ? 50%? attenuation).

  4. Using Gunnison, Colorado response to the 1918 Spanish Flu as an example

    “Protective sequestration with barricades of roads; rail travel restricted; quarantine of arrivals to county; isolation of suspected cases; closure of schools; prohibition on public gatherings”

    Add contact tracing to the above and implement around every individual city and town and you would have everything under control very fast.

  5. This will all be over soon, in the US.

    See the last plot here:
    We are well on the downward slope.

    Some good tweets on infectiousness.

    40% or more of the population has preexisting immunity. The remaining 60% will catch it, sooner or later. Sooner in the US it seems, and later in many other countries. Of those who catch it, 80% are asymptomatic. Population-wide about 12 in 100 develop symptoms. About 1 in 100 are hospitalized. About 2-3 in 1000 die. 80% of those are over 65, a third are over 85:

    The US will “get back to normal” sooner than most other countries. Those countries will have to stay vigilant until a vaccine arrives. Which might happen relatively quickly, or never.

    • Brian: Thanks for that. The last CDC plot does look like a textbook epidemic curve! It is almost as though the shutdown had zero effect! My friends on Facebook would say that the plunging right side of the curve could be turned around at any moment, however, by the relaxed attitudes in the most rural areas of the U.S. CDC plot of pneumonia, flu, and Covid deaths

    • philg: I’m not sure how you’re drawing that conclusion. My friend kept pointing at the death numbers in Wuhan (which after seeing how poor the US response has been, he now insists are even more fake than the US numbers) and saying “obviously this will go away in a very short period of time and will only kill a few thousand people.” The part he missed (and I think you’re also missing) was that the shape of the “epidemic curve” is very much influenced by people’s behavior. China took much stronger measures than the US, so their curve did not get nearly as high. The US currently has about two orders of magnitude more coronavirus deaths than China. My friend infamously predicted, “the US will not do three orders of magnitude worse than China.” In some sense, we’re two-thirds of the way there!

    • We had a presentation at Google today about what our return to the office might look like. I don’t think there was really anything we hadn’t heard before, but hearing it all laid out was quite shocking. We are supposed to commute during off-peak times (noon to 3 PM? 3 PM to 9 PM?) and “socially distance” on public transit (on the NYC subway?). Then, when we get to the office, security will check our temperatures and verify it’s our designated day to show up to the office. We will probably have to wear masks all day long, and will receive boxed lunches instead of eating in the cafeterias. The gyms will stay closed and there will be no more free massages. The whole point of being in the office is to be around our coworkers, but we will have to space ourselves out as much as possible, and probably avoid crowding into conference rooms for meetings. Only a certain percentage of people will be in the office at each time. It’s not clear to be how we’ll schedule in-person meetings with people on other teams.

      After watching this presentation, I’m not even sure what the point is of having us try to go back to the office, since it will be such a miserable experience. Either we will all have to work from home for the foreseeable future, or Google will have to greatly expand headcount in countries with functioning public health systems (I’m sure this will go over like a lead balloon with the current presidential administration).

    • Ryan, as Phil said, the “lockdowns,” as instituted in the US, were ineffective. They might have been counter-productive, resulting in a larger spike, especially in NY, where the deaths are largely attributable to nursing homes. We may see a fat tail on this curve, but it is unlikely that we will see another spike like New York’s. Other states now know to prioritize nursing homes, and nowhere else in the US has NY’s population density. The NYT reports that 20% of people in NYC had antibodies as of May 2 ( And that about 60% is required to reach herd immunity. What they don’t say is that 40-60% of the population is either not susceptible in the first place, or has preexisting immunity via antibodies to *other* corona viruses which are not being measured by these tests ( – we just don’t know yet which other corona viruses may grant some immunity to this one. This is consistent with the numbers reported on the various cruise ships, aircraft carriers, etc. NYC may be close to herd immunity. Time will tell. Let’s hope for no bad mutations.

    • The US lockdowns were certainly not as effective as e.g. Wuhan’s lockdown, but I’m not aware of any evidence that they were “counter-productive.” I’m also not aware of any state with a plan to seriously protect their nursing homes from e.g. sick employees. We already knew that a significant percentage of people infected with coronavirus are asymptomatic, but that doesn’t mean they can’t still spread the virus, so I’m not sure what the relevance of this 40%–60% is.

    • > I’m not aware of any evidence that they were “counter-productive.”

      Putting an infected person into a nursing home is like inoculating a perti dish with a bacterium and putting it in an incubator. It is hard to imagine anything more counter-productive.

      > I’m also not aware of any state with a plan to seriously protect their nursing homes

      Not putting infected people in nursing homes is a very good start. I think most states are trying to avoid this.

      > We already knew that a significant percentage of people infected with coronavirus are asymptomatic, but that doesn’t mean they can’t still spread the virus

      10% or fewer of infections result in 80% or more of new infections – super-spreaders. Maybe these people are asymptomatic, but it seems unlikely, given what we know about how it spreads.

      > I’m not sure what the relevance of this 40%–60% is

      They are either not susceptible, so they are never infected and never infectious. Or they might get infected, but are able to fight it off with existing immunity, and are likely minimally (time-wise) or not infectious. That is, these people significantly reduce the R0 value.

    • Well, regarding whether or not states did enough to protect nursing home patients, Ryan is using a rather wide brush to paint the picture.

      E.g. Florida “advised nursing homes to deny admittance of suspected or confirmed coronavirus patients since March”. On the other hand, Gov. Cuomo did the opposite:

      “On March 25, New York officials ordered nursing homes to admit infected patients, if medically stable. Then, as deaths mounted inside the facilities, Gov. Andrew Cuomo reversed the policy on May 10 under pressure from advocates and relatives.”

      One can argue that Florida did not do enough, but somehow Cuomo is a progressive hero despite his decision to jeopardize lives of the most vulnerable segment of the population. Go figure.

    • Cuomo’s probably the worst governor in America right now, but there’s a pretty wide gap between trying to avoid something happening and actually preventing it from happening. The US tried to avoid >100,000 people dying of coronavirus.

    • “Cuomo’s probably the worst governor in America right now”

      Not according to New Yorkers:

      “90% of Democrats view him favorably.”

      “Cuomo’s overall favorability among New Yorkers at 77% while 71% approved of the job he is doing for the state”

      “they represent a stunning turnaround for Cuomo who, as recently as February, had an overall job approval of just 36%. Cuomo’s handling of the coronavirus has, without exaggeration, flipped public opinion about him in, roughly, six weeks. ”

      Truly amazing.

  6. How are we supposed to achieve herd immunity if we don’t spread covid in a slow, controlled manner? Wearing a mask properly will halt the spread, leaving millions of people vulnerable to catching it. Wearing a mask that is only partially effective will help us “flatten the curve”, isn’t that what Dr Fauci wanted?

    • @Nick: We’re not trying to achieve herd immunity, far from it. We’re trying to put the genie back in the bottle, or get the dog back on the leash it slipped, so to speak, while preventing the health care system from being overwhelmed. Then we hope to develop a vaccine to *confer* herd immunity – but without people getting sick.

      Wearing a mask in public is supposed to stop you – the untested, possibly infected person, the asymptomatic shedder — from aspirating the virus onto other, uninfected people. All the other measures we’ve done and are thinking of doing – including contact tracing – are there to slow the spread.
      Nowhere does the CDC mention herd immunity in its guidelines (AFAIK) – because that’s the opposite of what we’re trying to achieve.

      If we don’t get a vaccine that works, we will wind up with herd immunity in some form, until the virus runs out of hosts to infect.

  7. It’s those who think that the “failing” mask-wearers are ignorant of proper usage that are the truly foolish. They know full well that wearing the mask under their nose or chin doesn’t work – it’s simply that their goal is not to avoid COVID-19, but to avoid being hassled about not wearing a mask. If they can achieve their goal by pseudo-wearing a mask in the most comfortable way possible then they’re not foolish at all.

  8. A lot more people understand following basic rules than understand biology, physics, and complex systems. When the two understandings clash, the majority wins.

    My favourite stupidity is having a person at the entrance or directing lines getting close to everyone in line or as they enter. They are a perfect nexus for virus transmission, all in the name of stopping transmission.

    The September Eleventh attacks of 2001 brought us a vast new government bureaucracy and a bad war in Iraq. Imagine how much we can screw up the reaction to this crisis in 2020!

  9. Phil,
    Since this is all about science and you are sort of a scientist i thought you might be able to answer a few questions. I see lots of people in NYC wearing masks while they are running, cycling, just walking around and it seems that they think that the mask protects them from the corona virus, that the mesh kind of traps the virus like a net traps a fish. If that is the case, that the mask in some way protects you from some corona virus swooping down your throat do you also have to wear it in your home or is the idea that locking your door will keep the virus out? Also do you have to wear the mask when you sleep — or is the idea that the corona virus also sleeps at night and therefore doesn’t bother people?

    • If you live in NYC, to get outside safely, you probably live in a crowded building with an elevator, so you already have to put on a mask to get outside safely. You also need it to go back inside your building. So even if you don’t think you need it when you’re outside, you would still have to bring it with you. At that point, why not just keep wearing it? It’s also generally better to err on the side of caution than on the side of not wearing a mask when you should be wearing one.

  10. Mask wearing is the new religion and you will join or be slain on your knees. Show your devotion to truth, light, feelings based science and whatever BS we think of next and prove your faith by devoutly wearing your submission mask.
    Finally got challenged walking into a Walmart today, I said I’m medically exempt, and kept walking. No cops, Karens, or managers showed up.

  11. Life during COVID is WONDERFUL!
    Before COVID I was miserable.

    I had a job working $14.75/hr and hated waking up most days. I’ve since been laid off (obviously) but am one of those who is making much more by NOT working.

    I used to make $550-600 per week depending on my hours but since COVID began, I’m clearing just over $1000/week. My gf is in the same situation and she’s also clearing just over $1000.

    We are both loving life. Expenses are way down too. We wake up, have sex first thing, shower together, and then she makes the most fantastic breakfast. Afterwards, I make us a cappuccino (we splurged on a $400 machine) but it was so worth it. The rest of the day is ours. Today we plan to do some hiking since it’s going to be so nice out and I’ll be using my new grill to cook up some steak tonight. The gf is kind of a wine snob so she likes to splurge on really nice reds (which I’ll definitely be having later as well).

    I really don’t understand people who say they’re more stressed or are fighting with their gf/wife more than before. It makes absolutely no sense to me. These have been the best 2 months I’ve had in a while. I can’t imagine going back to my old life and way of doing things. NOT HAPPENING!

    The only thing that isn’t ideal right now is not being able to travel normally but I only vacationed once or twice a year before due to work/money issues. Now I’m able to save $800-1000/month with COVID stimulus and bonus so we’ll definitely be taking a nice vacation at some point this summer.

  12. If we had X95 masks, the incentive to wear them would be in alignment with the interests of the people wearing them instead of insisting that people wear them to benefit others. Once people can protect themselves instead of others, we can pretty much return to normal.

    What percentage of $2T would it take to manufacture enough masks to do this?

  13. I spent most of last night learning more about epidemic modeling than I’ve ever cared know, and I have to say that I’m impressed with Youyang Gu from MIT (Covid19Projections)

    This is one guy with a masters degree from MIT, he set up his initial model in what looks like 3 days, and in less than two months it performs as well or better than every other model including Los Alamos National Laboratory’s. With no public funding. He’s definitely going to have a job when all this is “over.” He also writes very clearly. Gifted man.

    I also learned a lot intuitively from Gabriel Goh’s (OpenAI) Epidemic Calculator at

    The interface is beautifully done. Adjusting the parameters you see the results clearly and instantly. I loved this:

    “At the time of writing, the coronavirus disease of 2019 remains a global health crisis of grave and uncertain magnitude. To the non-expert (such as myself), contextualizing the numbers, forecasts and epidemiological parameters described in the media and literature can be challenging. I created this calculator as an attempt to address this gap in understanding.”

    So he felt challenged trying to understand epidemics and just threw together that little calculator thingy to teach himself.

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