A Covid Mask Prediction

In speaking with several other covid conscious people I got a very nicely detailed prediction I wanted to record for posterity. They do not want to be credited with this out of concern for messenger-shooting. So I asked them if I could post it here anonymously and they agreed.

Anon:"We are going to have mask requirements. I've done the math on all the possible interventions, and masks are the only one which can get the Rt down below 1 and actually stop the pandemic. Without masks, you can't do it; the other tools put together just aren't good enough (the best one, air filtration, maxes out at 80% effective, and so does Far-UVC, and this simply isn't enough with the infectiousness of Covid -- short-range transmission, which neither intervention stops, will keep it going at pandemic levels). Therefore we're going to get masks. I don't know how many maskless people will die before we get masks. But the math is inescapable. We start using respirator masks. Or maskless people die, and then we start using respirator masks. Either way, we're going to get masks."

Which prompted me to ask: "What do you think will change about the public's acceptance of our current status quo that would force this conclusion? Obviously, there is currently an acceptance of having a covid pandemic forever. Especially since the death and disability from it are downplayed, misdiagnosed and ignored. Do you think that a sufficient % of the population will change their mind simply because of time, or is there another factor you didn't mention?"

Anon: "The unmasked people will die. They are dying fast enough to change the percentage of masked people in the population. This is kind of depressing but there you have it. It's going to change, whether or not any individual changes their minds. :shrug:

Me: "At the rate they are dying, this implies a multi-decade process. Or am I mistaken about the death rate?"

Anon: "It might take that long, if people were very lucky. It might not, and all the mathematical models I have say it will not take that long. Among the so-called "fully vaccinated" population, the acute-phase death rate is 0.6% per infection. The post-acute-phase death rate in the next year or two (heart attacks, strokes, etc) is another ~0.6% per infection, for a total of about 1.2%. (These "delayed action" deaths are one of the reasons people are not perceiving the risks accurately -- people are not connecting them with Covid, except in the scientific papers.) 

Long Covid rates appear to be about 3.5% per infection, in addition. (The vaccines are now always multiple variants behind, so I suspect the numbers will revert to the non-vaccinated numbers going forward: those are all about twice as high. But let's assume that doesn't happen and that the "vaccinated" numbers hold true.) So the risks appear linear from infections 1 through 3 according to large scale studies. (so, 3 infections = 1.2% * 3 = 3.6% chance of death). People are now getting infected more than once a year on average, and the rate is *increasing*. While the data's got large error bars, the central estimate is currently 1.5 infections per year for the overall population (which includes people who are masking), though it could be anywhere from 1 per year to 2 per year in reality. But it's definitely been *rising*.

We know that temporary immunity from infection wears off around the 3 month mark (it varies from 6 weeks to 4 months). So people can get the *same* variant 4 times a year (8 if it's wearing off quickly). With multiple variants, that isn't even a limit; people can get two different variants *at once*. So far, all variants have been roughly equally deadly. So if we assume that the linear risk continues, and that 1.5 infections per year is a steady average, then, 2 years = 3 infections = 3.6% dead, 10.5% Long Covid 4 years = 6 infections = 7.2% dead, 21% Long Covid 6 years = 9 infections = 10.8% dead, 31.5% Long Covid (Not all of this Long Covid is the completely bedbound version. The chances of the bedbound version appear to be 0.5% - 2% per infection. If we assume it's 1%, then again, 6 years = 9 infections = 9% bedbound Long Covid) This alone is more than enough to change the political balance. And remember, I'm making *optimistic* assumptions here -- if people get infected *more* frequently these numbers are *higher*. If we go up to the likely limit of 4 infections per year: 2 years = 8 infections = 9.6% dead, 28% Long Covid 4 years = 16 infections = 19.2% dead, 56% Long Covid 6 years = 24 infections = 28.8% dead, 84% Long Covid That's assuming linearity, which at this point you can't, because people can only die once. You can get Long Covid repeatedly, and if we figured that in, that would reduce the total number of people who had Long Covid. But the numbers are still monumental. (I didn't mention that the numerous autoimmune diseases which Covid causes *also* lead to elevated death rates, because I don't have numbers for that.) 

And remember, I'm still optimistically assuming a "fully vaccinated" population. If not, double all those numbers. But wait, it gets worse! Covid damages the immune system by causing an immunosuppressed state -- this is for at least 3 months in everyone. This causes people to catch other things (whooping cough, RSV, measles, strep A / scarlet fever, influenza), and the death rates of all of those are up. (They're also all airborne and stopped by respirator masks). I haven't even tried to add those numbers into my estimates. And in many people (including many cases of Long Covid) the immunosuppression appears to be forever, like AIDS. This means people die many years down the road from an infection they got earlier (like with HIV). Maybe 5-10 years later (it was typically 10 with HIV), rather than the 2 years later for the Covid-induced heart attacks. 

China is now mass-deploying *very expensive* HIV drugs to try to treat this. We aren't, and did I mention *very expensive*? We won't be deploying them for the entire population, probably. We haven't had enough time to actually have any decent statistics on how common this Covid-AIDS is: all we know for sure is that the risk of it keeps going up with reinfections, and it's at least 0.5% per infection. So this is a large count of deaths happening on "delayed action", which again, people are overlooking now, but the people still die. 

But wait, it gets worse! Remember I made the assumption of linear risk? I don't think that's true. Covid causes organ damage which takes years to heal -- in everyone. If you don't have time to heal that, because, for example, you catch Covid AGAIN in 6 months, it's like being stabbed repeatedly in a place where you already have a stab wound. At some point, the dangers start being superlinear. So I've been keeping an eye out for highest numbers of infections, to see what the "canaries in the coal mine" look like. Everyone who has had 10 separate infections is seriously messed up, and I haven't heard of anyone with 13 separate infections who is alive. (Biden was severely messed up by infection #3.) 

Assume that most people didn't get infected until the end of 2021, when precautions started disappearing and the Omicron spike happened. Assume 1.5 infections per year from then on (probably slightly less for 2022). The average person has then had 3 or 4 infections so far. At the current rate of population infection, the average maskless person will reach 13 infections in 6 or 7 years (by 2030 or 2031), and based on what we know so far, they'll all be dead. What you're seeing now is like is the person who's jumped off the Empire State Building saying, as they pass floor #50, "I feel fine so far!" 

Now maybe all my numbers are too high by a factor of 2. There are large error bars. But the bottom line is that with repeat infections happening over and over and over again, it adds up fast. The repeat infections are the killer. People were able to ignore the 1918 flu because it was one-and-done -- once it had run through the population, people couldn't get it a second time. Covid-19 is quite the opposite. There is NO long-term immunity -- it all wears off in 3 months -- and we were told this by experts on coronaviruses way back in March 2020. This means that, for people who don't wear their masks, the repeat infections are just going to keep coming, and coming, and coming, until they kill. This is not multi-decade. This is within the next decade.

If you look at actual polls, 8% of the population is masking up reliably, and about 30% is trying to take precautions (although most of them don't know what the right precautions *are*). Many of the rest will really just play follow-the-leader. It doesn't take much of a population shift to displace the hegemonic anti-masking leadership. With about 1/3 basically on our side already, the *maximum* that would be needed -- if everyone else was a hardcore anti-masker -- would be the death -- or bedbound disablement -- of half of the anti-maskers (and none of the maskers). But I think most of them aren't hardcore anti-maskers so the population change needed to tip the scales is far, far smaller than that. Absolute worst case scenario, the dreadful "everyone dies after 13 infections" scenario, we get there around 2030. It's not very far away really

Covid is really benefiting from common human cognitive errors -- not associating the post-Covid deaths with Covid, for instance -- or assuming that "doing what everyone else does" is safe. The virus also benefits from people's lack of numeracy. Some of us realize that 1.2% death rate per infection is ENORMOUS but most people think, inaccurately, that it's "small". There's an incredible catalog of psychological errors which are allowing Covid to mass-reproduce. Another numeracy issue: a test-fitted respirator mask can reduce your risk by a factor of *100* or *more*. No other intervention can reduce it by more than a factor of *5* (that's air filters), with the vaccines bewing worse than a factor of *2*. It's pretty obvious the respirator masks are far far more effective than anything else when I put it that way. But when I describe the respirator masks as 99% effective and the air filters as 80% effective, people don't get the same impression -- they don't realize the respirator masks are *20 times better*. This is because most people aren't numerate enough to understand that I'm saying the same thing. I've had to start rewriting my communications to try to adapt to people's level of numeracy


While I've made this prediction before, it's such an awful prediction that I have shied away from having my name loudly attached to it as "the person who predicted that". I know people tend to shoot the messenger. It'll happen whether my name is attached to it or not."