We need #masks4all

um hello there and thank you for joining us my name is Jeremy Howard I am the co-founder of fast AI and this is yeah the co-founder first day I met Roy Thomas I am Rachel Thomas my background is I have a PhD in math and I previously worked as a software engineer and data scientist more recently I’m the founding director of the center for applied data ethics at the University of San Francisco and as Jeremy said I’m also the co-founder of fast AI so rachel is a mathematician slash data scientist slash software engineer turned data ethicist I am the opposite my major was actually in ethics and nowadays I’m a professional data scientist so we both together are super interested in combining data and ethics and policy and society and we found ourselves in a funny position last week where we were studying recording a big annual course which hundreds of thousands of people a year watch right at the time that the co vid 19 thing was exploding and so we did some work looking at covered 19 in terms of from the what the data looks like much to our surprise the report we wrote has been read by well over half a million people the video we created as part of this course is being watched by thousands of people and there’s our question for us to do more of that so here we are doing more of that and today we’re going to tackle a topic which I think is likely to be the most important topic we’ve ever tackled so let’s jump in so this is I think the hardest situation I’ve ever been in trying to teach and the reason why is because I am in the United States of America and here in the US over the last 24 hours there has been this extraordinary new movement which is basically to say let’s just let people die on the assumption that that’s going to help the stock market and so I if I seem a little less than jovial today it’s because I am less than Joshi or today so I’m not going to be talking about that in particular hopefully it’s actually pretty obvious that well I mean economists are already saying it would cost about five trillion dollars before we even start taking account of the lost productivity due to the fact that people would not be going to work anymore when all of their friends and family are dying around them so economically not a great idea and you know societally may be one of the most evil things i’ve ever heard in history um but we’ve got to not focus on that we’re going to focus on a potentially interesting part of a really important possible solution to the longer term the first thing I wanted to mention is we’ve been talking a lot about the importance of stopping the spread and a key part of that has been locking things down as soon as possible and interestingly we’re already seeing in the u.s. the impact of that in the u.s. Kentucky and Tennessee right next to each other they are testing at similar rates and so you would expect them to have a similar spread Kentucky Guardian ahead of Tennessee when it came to during a lockdown in terms of the the you know they actually just get declared a state of emergency back on maps at six and you can see already the difference between the in Tennessee positive cases positive tests versus a number of positive tests in Kentucky is an extraordinary big difference so so the the stuff we are now seeing starting to happen around the Western world with these lock downs again and again we’re seeing the earlier the better the orange bar here is the number of positive cases in Tennessee and the blue bar here is the number of positive cases in Kentucky whereas the lighter blue and lighter orange is the number of tests that have been done there’s still people saying that maybe not that many people are actually dying and finding all kinds of obscure ways to murder the data to suggest that even Italy is actually not that bad but the the fact is if you look for example in the region around Bergamo in Italy the number of people who died last week was four times higher than the number of people that died a year earlier so like regardless of how you think about what kind of testing is being done

or you know what kind of post mortems are being done or or whatever there’s four times more people dying you know of all causes in in this region it’s this thing is killing people at an astonishing rate and it’s not even close to peaking so obviously we we need these lock downs but the question is what happens next and we saw last week this tweet from the Surgeon General saying don’t buy masks they’re not effective except for health care providers and this has been kind of a pretty common refrain it’s certainly not only the US Surgeon General that’s saying that and there certainly is a big issue doctors are saying there is not enough protective equipment including enough masks for hospitals so PPE is referring to this protective equipment masks gowns eyes shields there is a huge shortage and so perhaps the reason that a lot of policy folks are saying masks are not useful is to stop people buying them I mean since what he’s saying here don’t buy masks in the hope that that will cause there to be more masks available for folks in hospitals you know interestingly when you actually look at what hospitals are doing they’re saying please please donate us protective equipment these are things we need not just protective equipment but even testing equipment but interestingly they’re even saying handmade masks would be useful so you know it’s it’s it’s interesting to see what the actual hospitals are saying they want and so when hospitals are saying we need masks and even handmade masks would be useful it it starts to question this idea that like they’re not useful for the public so like why you do hospitals what do mean if they’re not useful to the public like how does this work there’s also some interesting empirical data very rough empirical data but if you look at all the countries which have flat curves they are all countries actually wear masks wearing is is extremely normal and not wearing a mask in places like public transport would be considered very anti-social so there’s this kind of country level data that that suggests that well something’s going on in these countries and and is masks part of that Taiwan does not appear on this at all because this they basically didn’t have enough cases to appear on this graph at the time that this tweet came out they only have a hundred and fifty three cases and two deaths in the whole of Taiwan even though they’re right next to China where this thing blasted off so what happened in China in Taiwan they are making 10 million masks per day now I thought that sounded crazy unlikely but actually this is the leader of Taiwan and here she is saying yes Taiwan is now making 10 million masks per day and they’re a small country I think they’re like 30 million people or if you like a small region depending on your politics around this so that kind of got me interested like thinking well if masks are important and a small country like this can can can create so many you know what does that mean for a country like the u.s. is that something we should be doing and so I started doing some research and I saw for example University of Michigan study on pandemic flu not on covert 19 but there’s similarities and they found that combining hand-washing and using masks makes a huge difference to the spread of pandemic flu seventy five percent reduction now seventy five percent reduction would be the difference between a pandemic and something that would just die out and fizzle away so this is again indicative it’s not proof so I started digging in some more and I

asked the wider community to help and we now have a list of 30 papers or nearly 30 maybe it’s 28 papers that have actually studied the question of the efficacy of masks as a way to stop spread and transmission from many different angles and many different types of masks and all of the research I’ve seen points to any kind of mask as being helpful to significantly stopping transmission so this has been quite a learning journey for me and so I’ve really focused on on what does the data say and just looking at primary research papers not at government recommendations not a blogs but at actual science and we’ll provide the link to the papers with the video one of the most interesting things I discovered is in the Czech Republic which has a really fantastic healthcare system and is doing a lot of testing they actually made Basque compulsory for the whole country since March 18th if you want to go anywhere you have to wear a mask outside the house and they have these are little illustrations the the check here means your mask protects me my mask protects you and they’re really focusing on the social side that if I have a mask on I and I might be sick and I don’t know about it I am actually doing a pro-social thing by helping you to not get sick in the whole country there’s only been two deaths and look at how the you know we’re not seeing the exponential growth in new cases it’s actually flattened out so this is a super interesting situation so I started wondering like oh how did that happen yeah how did this country like the like very unusual in Europe to see masks wearing so how did this happen and there is this fantastic story about what happened you can find it at tiny CC slash masks rule strongly recommend reading it but basically what it says let me jump to it now what it says is this guy Peter look Peter Ludwig who is a kind of a social-media influencer who focuses in science communication made a video about the importance of wearing masks and that kind of kicked off this huge community reaction it’s an amazing story and this is this is the video this is this is Peter and I after really digging into the data and the virology and the science of this I am pretty convinced that everybody wearing masks could be a key or probably is a key part of the solution to stopping the lockdown eventually getting the economy back on track restoring normal normalcy to society and reducing the spread um I am not as good a science communicator as Peter is so what I’m gonna do is I am just going to tell you what he said with his pictures okay so I get no credit for this I’m just repeating what he said because maybe you don’t speak Czech okay so Peter started out here’s a fantastic video by pointing out Mongolia Mongolia is right on the border of China so lots of people moving backwards and forwards all right and somehow at the time that he did this the 14th of March they had only one case today it’s gone up to four cases it actually turned out that one case checked themselves out of hospital and against the law went and hung out with 200 people over the next few days which is a terrible terrible idea but how come Mongolia had only one case and so Peter said he noticed that something striking about Mongolia was they had a policy that you have to wear masks since January which is pretty extraordinary um so Peter went on to describe and I’m music some of my own slides now his slide so much more he’s so presentation is much nicer than mine but I wanted to show you some additional information here so he described how there are different kinds of masks there are what are called respirators the most common type being the n95 it’s just a rating and they’re they’re full seal

hospital-grade things right versus surgical masks which of these just loose-fitting pieces of cloth the the key thing here is that these these different pieces of protective equipment protect you from from different things but what’s interesting is as Peter mentioned there there is research that shows that even the basic loose-fitting pieces of cloth actually works super well against a wide variety of viruses so this is actually the research that he’s pointing at and this comes from Smart Filters comm but the actual data comes from this report Davis Adel they’ve just made it into a nice picture and what they found is that against 0.02 micron particles surgical masks are super effective vacuum cleaner but bags are super effective dish towels are super effective cotton t-shirts are super effective and then and actually in this study they had two different sized particles they also looked at 0.1 micron particles I think it was 0.1 and they found the same things were even more effective because point o2 is particularly small they also looked at kind of doubling them up and they also looked at how well can you breathe through these different materials and they actually came up with some suggestions around things that are easy to breathe through so in this case two t-shirts easy to breathe through and end up being pretty effective so anyway you can check out this sir fantastic article or the original paper for yourself but basically the story they found in in this research and a lot of other research I’ve looked at is for stopping the spread of viruses you don’t need n95 respirator masks at all you know I mean they’re great but lots of other things work great as well so what’s going on here how does this work because covert 19 is a 120 nanometer sized virus so Peter points out that like well how can these you know simple pieces of cloth protect from that because they don’t they have bigger holes in 120 nanometers and the point Peter made though and is described again and again in all the research I’ve looked at is that Co vid 19 is spread through droplets in other words you Koff and let’s pose into your face right and specifically it goes into your eyes or it goes into your nose or goes into your mouth also talking sometimes I’ve noticed when I talk a little bits of fly out I’m sure we’re all like that so these are droplets and the droplets is what the mask catches so there are three categories of transmission described by virologist says contact transmission droplet transmission airborne transmission so contact us when you actually touch someone or something with a virus and this is a big issue if you touch you know we talked last week about sanitation if you touch a surface which somebody who is infected as touched also and then you touch your face that can get you sick um what we’re talking about for masks though is the coughing and talking which seems to be such a common vector for spread because that’s actually how on the whole this particular virus is kind of expelled airborne is a nightmare airborne is when things they say it’s they aerosolize they’d hear into it they turn into an aerosol they float in the air in tiny tiny tiny like a sub remember it was 0.5 micron droplets for ages that can actually happen in a hospital there are certain procedures in the hospital which cause the droplets to aerosolize and and the kinds of masks we’re talking about the basic masks don’t really help there so in a hospital setting where there’s potential aerosolization you need the good masks so actually oxford university just published today a new report about this where they described how basic masks are fine except for if you’re in a hospital around an aerosol generating procedure or a GP and this is a list of a GPS so you’re probably not doing these things at home right so so you’re fine to use whatever couple of layers of t-shirt right in the

hospital even unless this is what the University of Oxford is saying from their research it’s this is with kovat 19 research this is not just any old research so like basic masks homemade masks this is why the university we looked at earlier asking for homemade masks even because they they do really help so there’s been a lot of research already empirical research showing that these basic marks act basic masks actually help in practice for example for SARS so this is from slate Sadako Dexcom a summary of some research they have a link to a paper about SARS which looked at how folks that were wearing even surgical masks got no infections at all this is the Oxford study that I mentioned and so their conclusion again standard surgical masks can be used for most community level clinical interactions let alone at home right so they weren’t explicitly looking at home but we’ve seen from the other research that basic materials are just as good as surgical masks or very close to the research empirical researchers also found that basic masks do help in practice empirically and practice they do help in non healthcare settings again not covert 19 but swine flu when they looked at the result of a flight in which there were folks with swine flu on that flight those people that were a basic mask were zero percent that wore masks got sick competive 35 percent of non wearers got sick so there are huge differences when you use even basic masks this is totally in line with what virologists say so this virologist says covert exposure dose matters this is really important kind of when you’re thinking about the science here masks can help anyone because they reduce the amount of virus released or taken in and the immune system wants a low dose so if you keep little dose low then the virus has to divide many times to get to high levels and then the immune systems got lots of time to kick in right so this is like kind of counterintuitive but this is actually what the data is now showing us and the science is now showing us is that the transmission of this virus seems to occur primarily through sustained exposure right so in Hong Kong and Singapore they define that as less than six feet away from somebody for at least 15 minutes in Hong Kong or 30 minutes in Singapore right so this is super important for like understanding how this virus works it’s not about just passing somebody in the street unless they coughed on you but actually being around somebody for us extended period of time and close to them so a key point which we absolutely know now we’ve got plenty of data to show this now is that many people are infectious before they have symptoms so it’s not okay just to wait until you’re coughing before you start putting a mask on something like 50 percent of people with the virus are asymptomatic and they are spreading it even then so this is a key reason why you have to get the mask on early so that these little pictures here is his Peter is describing how when you wear a mask you stop other people from interested infecting you but you might be infected we have no idea you might never get a day symptoms right but you could be spreading it to your friends your family your community your co-workers without knowing it so you need to wear a mask for that reason as well so he describes this as a selfless motivation and it has been a key part of the messaging in the Czech Republic is this idea that it says this is such a pro-social behavior to wear a mask because you are protecting the people in your community the people in your workplace so if we look at it we saw that graph earlier that showed there’s quite a few countries now that are controlling this without a lockdown like Korea and in every country that that has controlled it without a lockdown or isn’t in a lockdown anymore I should say they’re doing four things they’re doing rigorous testing they’re doing rigorous contact tracing so if you’re tested positive who’s everybody you’ve you’ve been near they quarantine anybody who’s found positive and

everybody’s wearing masks on you know on public transport at work you know anywhere they’re around other people outside of their family so like from a data science point of view this is you know we don’t need proof right none of these our economy destroying levels of cost right masks I mean it can make our own masks for like ten cents so you know these are things that allow us to get the economy going again and avoid people dying so we save lives and potentially trillions of dollars and it’s not this is not like some crazy idea that might just work this is something that lots of countries have done and it’s already worked so it’s like why isn’t everybody doing this we need the lockdowns do all to get to the point because so many countries like the US and the UK are way too late but you know in a few weeks or a few months once we’re past the apex this is what we need to be doing and it’s going to be super hard to do the masks bit because we’re you know our governments have been stigmatizing this you know they’re saying you don’t need them if you wear a mask you’re taking it from hospitals so there are now all these Asian countries that acted quickly to contain the virus and when you actually look at like just the traffic on the streets they’re kind of back to about normal so there’s lots of data you can look at in this case this is a TomTom traffic congestion right and it’s just fascinating to look at these countries where the last seven days versus historical average this is from the financial times I believe sorry for accidentally cutting off the citation which I tried to keep yeah you can see how there are countries that are nearly back to normal people are moving around again so Peter used you know used all that to try to get rid of the first idea which is we don’t need masks we don’t need masks so that was his cross that off so the second argument he dealt with is there’s no point saying you need masks because there are no masks so his point was we’ll make them go and make masks and so here are pictures of people in the Czech Republic after this video came out making masks and hanging them up on mask trees for anybody to come and pick up the needs one and one of the things you notice here is the masks don’t look professional and I think this is really important right because if you have a polka dot a polka dot mask nobody’s going to come up to you and say you’re stealing you know professional hospital-grade masks you know that they’re they’re cute and so part of the the Czech community reaction was to have like you know humor and you know just make it as as fun as possible get everybody involved and so even kids have their Jena koala I don’t know why there’s koalas in Czech Republic I guess it’s a just are there on a visit oh it has its own masks there are all kinds of interesting things you could use for these masks so one chap pointed out that 3m has a household filter which cost 22 bucks and gives you enough for sixty masks and it is actually officially virus rated so you know if you want to go fancy you can spend 30 cents and cut those up as we’ve already noted things like cotton should be just fine too but yeah string staples and hot glue 22 dollars worth of this stuff maybe a bit of cloth on each side to make it more comfortable so the the call to action that Peter made was basically he said I want everybody in the Czech Republic to wear a mask everybody 100% of the country which I mean that sounds crazy to me that that could be possible because at the time this was something that had a social stigma around it so he pointed out something really interesting which is that this would not be if this was successful it would not be the first time that something with a social stigma turned around just like in most Western countries I remember when I was growing up dogs would poop on the sidewalk and you would leave it there and he pointed out that we managed to change the social expectation that if a dog poops you pick it up and before that changed no question people would have been like oh my gosh you’re picking up poop that’s gross whereas now it’s like excuse me you seem to have left your dog’s fecal matter on the sidewalk please pick it up thank you very much so you know these things can change

social expectations can change and so he his his hope was that if you see somebody without a mask you know people will stare at them and think who is this antisocial person so he made three particular asks he said share this video take a selfie wearing a mask and use the hashtag masks for all well actually the Czech version but let’s pick the English version and influence influences should set a good example for their followers and so I think I’d be super cool if like you know celebrities started rocking their own homemade colorful masks maybe pictures of them King themselves you know I mean I think that would be super important and you know the the the point is that this is a little wordplay out of like the most important values to folks in the Czech Republic and the biggest one was kindness and so he is saying like this is this is the most kind thing you can do is to have a little bit of inconvenience yourself in order to protect those around you oh my god it was successful so today when politicians appear in public they’re all rockin masks people are putting masks pictures on the public transport on the statues it’s it’s extraordinary so there’s a lot of recommendations out there for face masks Michael Lin who is a biochem researcher has lots of great information that we can share similar kind of stuff with what we’ve described about bit some some more links actually a article that just came out today we might need to update this is that actually this looks correct so he’s actually already got the new thing if you put a mask in the oven at 160 fahrenheit 70 centigrade for 30 minutes it sterilizes it and you can use it again as much as you like no alcohol so there’s actually a new Harvard study I just saw today which actually has as has shown this interestingly you can see this is coming from a way she and QQ you know Chinese sites a lot of the best information we have is coming from Chinese sites because they’re the ones with the you know months months more experience of this so a really interesting thing that appears all the time in like the training that doctors talk about for masks fitting is if you want to know if your masks working pretty well go somewhere like it’s smelly like some sugary water or some smoke or something and see if you can still smell it with your mask on and if you if it’s if you can smell it a lot less then you’re blocking the particles so that’s kind of the rule of thumb that you keep I keep seeing people talking about ok so that is what I wanted to say about masks I guess you know I I’m not a big YouTube influencer thought leader or whatever I’m just a data scientist but I guess my job is to look at data and try to figure out what it says and the data is super super clear on this it’s not like there’s no 100% perfect proof randomized control trial for this exact the illness disease such a thing would be impossible because it hasn’t really been around long enough you can’t really do a randomized controlled trial where you say hey you’re not allowed to use a mask and you are but from a kind of a Bayesian prior perspective the evidence is so incredibly strong that this is a good idea the cost is so low the upside is so huge in terms of lives saved and the economy being able to get back up and running again it seems like madness to me not to do this so I will repeat Peters quote alarms here and say let’s make this happen and particularly you know let’s see influences come out wearing masks start start making masks we’re going to have links with this video to how to make them at home it’s very cheap it’s very easy and let’s hope that we can make happen in the US and the UK in other countries what the what the the Czech folks have done so incredibly well