I can think of many reasons why elastomeric respirators haven’t been widely used.
Slow expert opinion change: airborne transmission is not significant/only cause of infection
Bad assumptions: variants won’t become significantly more contagious
Unfamiliarity with elastomeric respirators: no/few studies, seem too uncomfortable, some advantages aren’t obvious (e.g., better face seal and comfort)
Naive empiricism: China’s lockdowns “worked,” and other Asian countries (like Hong Kong, South Korea, Taiwan, and Japan) controlled covid well without respirators
Hope: a combination of cloth/surgical masks and vaccines is good enough (see “Naive empiricism”)
Traditional expert training: contact tracing, vaccines, quarantine, social distancing
Low death rate: there’s less pressure to use the most effective means of dealing with the pandemic
Complacency: most people that would die of covid have already died
I suspect that the main reason was that most experts thought that a combination of traditional masks, contact tracing, vaccines, quarantine, and social distancing would be good enough. Old school epidemiology and naive empiricism strongly suggested this: China’s lockdowns “worked,” and other Asian countries (like Hong Kong, South Korea, Taiwan, and Japan) controlled covid well with masks, contact tracing, and border restrictions but without respirators, hard lockdowns, or even vaccines.
However, in the rest of the world, these solutions weren’t practical (due to the rise of more contagious variants) or available (vaccines).
Thanks, lots of good insights in your comment. Reading it, two potential interventions come to my mind:
Figure out reasons for expert/institutional inertia (why didn’t they change their minds quickly once they saw evidence of airborne transmission, or more contagious variants, or traditional measures not working well enough) and try to change that.
Do studies on elastomeric respirators and try to make them part of future editions of epidemiology textbooks, so they become part of the default toolkit that experts reach for.
It’s mostly too late for intervention #1. Now, everyone knows about these issues. However, it may do some good to replace a lot of old experts with much better ones like Zeynep Tufekci. Tufekci wasn’t perfect (never mentioned elastomerics), but she quickly got a lot of things right (even took lab leak seriously) and for the right reasons.
Intervention #2 has more merit, but I fear that the lack of urgency will take over and it will take too long to deploy elastomerics and/or PAPRs (which have certain advantages over elastomerics) at scale. This is starting to happen; I’ve seen a lot of talk about designing better respirators but nothing about deploying (or even recommending) the current generation of elastomerics to adults. The perfect is starting to become the enemy of the good.
If the current crop of experts can’t be reasoned with in a timely manner, one potential solution is to set-up an independent pandemic risk reduction organization. This org would make recommendations (e.g., elastomerics should replace other PPE, cheap PAPRs should be developed to replace elastomerics), take action (e.g., quick studies, cheap PAPR development and distribution), and be advised by experts like Tufekci. A possible source of funding might be the EA community.
Expert anti-valve bias: most elastomerics have exhalation valves
And to be clear, I don’t think any of these reasons are enough (although, this somewhat depends on when in the pandemic these reasons were used) to justify not recommending the use of elastomerics.
I can think of many reasons why elastomeric respirators haven’t been widely used.
Slow expert opinion change: airborne transmission is not significant/only cause of infection
Bad assumptions: variants won’t become significantly more contagious
Unfamiliarity with elastomeric respirators: no/few studies, seem too uncomfortable, some advantages aren’t obvious (e.g., better face seal and comfort)
Naive empiricism: China’s lockdowns “worked,” and other Asian countries (like Hong Kong, South Korea, Taiwan, and Japan) controlled covid well without respirators
Hope: a combination of cloth/surgical masks and vaccines is good enough (see “Naive empiricism”)
Traditional expert training: contact tracing, vaccines, quarantine, social distancing
Low death rate: there’s less pressure to use the most effective means of dealing with the pandemic
Complacency: most people that would die of covid have already died
I suspect that the main reason was that most experts thought that a combination of traditional masks, contact tracing, vaccines, quarantine, and social distancing would be good enough. Old school epidemiology and naive empiricism strongly suggested this: China’s lockdowns “worked,” and other Asian countries (like Hong Kong, South Korea, Taiwan, and Japan) controlled covid well with masks, contact tracing, and border restrictions but without respirators, hard lockdowns, or even vaccines.
However, in the rest of the world, these solutions weren’t practical (due to the rise of more contagious variants) or available (vaccines).
Thanks, lots of good insights in your comment. Reading it, two potential interventions come to my mind:
Figure out reasons for expert/institutional inertia (why didn’t they change their minds quickly once they saw evidence of airborne transmission, or more contagious variants, or traditional measures not working well enough) and try to change that.
Do studies on elastomeric respirators and try to make them part of future editions of epidemiology textbooks, so they become part of the default toolkit that experts reach for.
It’s mostly too late for intervention #1. Now, everyone knows about these issues. However, it may do some good to replace a lot of old experts with much better ones like Zeynep Tufekci. Tufekci wasn’t perfect (never mentioned elastomerics), but she quickly got a lot of things right (even took lab leak seriously) and for the right reasons.
Intervention #2 has more merit, but I fear that the lack of urgency will take over and it will take too long to deploy elastomerics and/or PAPRs (which have certain advantages over elastomerics) at scale. This is starting to happen; I’ve seen a lot of talk about designing better respirators but nothing about deploying (or even recommending) the current generation of elastomerics to adults. The perfect is starting to become the enemy of the good.
If the current crop of experts can’t be reasoned with in a timely manner, one potential solution is to set-up an independent pandemic risk reduction organization. This org would make recommendations (e.g., elastomerics should replace other PPE, cheap PAPRs should be developed to replace elastomerics), take action (e.g., quick studies, cheap PAPR development and distribution), and be advised by experts like Tufekci. A possible source of funding might be the EA community.
Here’s another reason I forgot to mention:
Expert anti-valve bias: most elastomerics have exhalation valves
And to be clear, I don’t think any of these reasons are enough (although, this somewhat depends on when in the pandemic these reasons were used) to justify not recommending the use of elastomerics.