You’re doing great.

Keep on Truckin’

https://today.uconn.edu/2020/02/keep-truckin-art-r-crumb-contemporary-art-galleries/#

(CNN) Biden and UK to help Australia acquire nuclear-powered submarines in new pushback on China, and America’s deal with UK and Australia leaves France bruised and Europe in the cold on China.

The defense of Australia is difficult. To understand why, consult the map. The Nine Dotted Line dips south to the north shore of Borneo, 1500 miles from Australia. The entire southern demarcation of the Line consists of states that are members of the Non-Aligned Movement, formed in the 1950’s in rejection of the Cold War power blocs.

For the purpose of military alliance, these states placed themselves out-of-bounds. Member countries in conflict areas, Africa, and Austronesia,  exploited the craving of the superpowers to break the mold, extracting arms and expensive aid programs.  Both superpowers spent heavily and received nothing in return. India, the world’s largest democracy, which supposedly implies simpatico interests, has remained tantalizingly immune to the U.S. touch.  The other nonaligned states that form the southern border of the Line are culturally remote compared to India, offering even less promise.

On the west, the line is bordered by Vietnam. Though a mixed economy, government is still vested in the Communist Party of Vietnam. Nonaligned, it is an economic vassal of China. To the north is mainland China.

The eastern boundary, the Philippines, is the crux of the problem. Formerly a staunch U.S. ally, the drift began with the closing of the Subic Bay naval base in 1992. In 2017, Duterte announced intent to withdraw from the Enhanced Defense Cooperation Agreement. He rescinded withdrawal, with renewed threats to withdraw made in 2/21. Duterte is deeply anti-American, unforgiving of the U.S. role in the colonial past. Even  China’s annexation  of bits of offshore territory  hasn’t dented his perspective. China tempts with the lure of alleviation of domestic poverty. In effect the Philippines is a non-aligned, hopeful vassal.

The Nine-Dotted-Line is an almost closed region, bounded by non-aligned vassals, vulnerable to area denial. Although Mike Pompeo put on some high mileage in this area, he was unable to recruit a single non-aligned state, for bases, even to base a few spy planes: (Reuters) Exclusive: Indonesia rejected U.S. request to host spy planes – officials.

The U.S. has three widely dispersed allies capable of limited force projection. Japan, South Korea, and Australia, separated by immense distances from the U.S.,  present a severe logistical challenge. Yet the water  offers potential strategic equalization not possible for land conflict. It was formerly the uncontested domain of the aircraft carrier. In years to come, survival of surface combatants will be increasingly in peril.

This is why the number of commissioned submarines has high budget priority. The chief weakness of the submarine is reduced situational awareness,  alleviated by space and airborne assets. The chief asset is stealth, though there are caveats. The Brits recently claimed tracking of a Virginia class sub, the most silent U.S. boat. At what speed, I might ask?

Contrary to recent press, nuclear submarines are not the most silent. Nuclear propulsion involves steam, which makes noise. Arduous noise isolation results in a very quiet sub. But the utmost in silence is provided by some types of AIP, (air-independent propulsion), which relies on a variety of chemical reactions that do not require atmospheric air.

• The oldest and most limited form of AIP is the electric motor, powered by batteries recharged by diesel engines in surface operation.
• The French system has a burner, with stored oxygen to make steam. This choice allowed design of  the Barracuda class with a propulsion core that could be swapped for nuclear. This form of AIP is not quieter than nuclear. Exhaust gas bubbles may compromise stealth.
• The German Type 212 submarines, which have electric motors powered by fuel cells, are the most quiet submarines in the world, no tell-tale exhaust, deadly in ambush.

The major, deal-breaking problem with AIP is speed. These subs are not fast enough to keep up with a surface fleet. All U.S. surface naval combatants, excepting landing ships/helicopter carriers, are capable of 30+ knots = 35 mph. The AIP Barracuda offered to Australia is rated at 20 knots. It may have a higher sprint speed that burns an unsustainable amount of fuel. And exhaust gas bubbles ruin stealth.

(Politico) Why Australia wanted out of its French submarine deal gives reasons besides the inferiority of the weapon, yet France blames the U.S. in an emotional display.  The CNN articles, written in political style, obscure the essential differences of the U.S. and French viewpoints. To the French, there is no threat; weapon systems are foreign exchange. With historic burden of responsibility, we paid attention to:

• (CNN) Chinese President Xi Jinping tells troops to focus on ‘preparing for war’.
• (Guardian) Xi Jinping warns China won’t be bullied in speech marking 100-year anniversary of CCP.

Xi exhorts preparation for war. This is not the China we used to know and love. When a world leader spoke in this tone, it got our serious attention.  It served as a reminder of the U.S. role of principal defender of the free world. We prepare to defend.

The former European colonial powers remember the loss of empires as painful lessons not to be repeated as engagement for lost causes. The small populations of the EU countries limit their roles to auxiliaries in other than small conflicts. France has been exemplary in 19 interventions in Francophone states of Africa.

Small interventions against primitive opponents are not the ultimate tests of weapon systems, in which only the best prevail. As a weapon system, the AIP Barracuda is of middle rank.  Sufficing for coastal defence, it is inadequate as a fleet submarine, incapable of operation in concert with surface forces.

From the perspective of France, an important business deal has been disrupted. U.S. engagement has another, more pure motive.

We Defend.

(CNN) Expect a bumpy ride this week when FDA advisers consider Covid-19 booster shots.

The two FDA scientists who intend to resign, Dr. Philip Krause and Marion Gruber, are authors on the Lancet article, Considerations in boosting COVID-19 vaccine immune responses, which details objections to the Biden booster plan.

Before we turn the microscope on this, two easy points:

• The Lancet authors, Paul Offit, et al., note that the vaccines, particularly Pfizer and Moderna, greatly exceed the anticipated protection. They use this to justify holding off on boosters. The original protection goal should not be considered acceptable, when better is possible.
• Offit has said he would want to see more serious outcomes, including death, to justify a booster. This is not callousness; there is a fear for the safety of more shots. Safety issues have not been observed with the Israeli Pfizer booster.  And Delta is bad to the bone. Enhanced mortality can be anticipated in advance of fact, without the human cost of waiting for the event.

Microscope. The authors fear increased vaccine reactions with a third dose, “such as myocarditis, which is more common after the second dose of some mRNA vaccines, or Guillain-Barre syndrome, which has been associated with adenovirus-vectored COVID-19 vaccines.”

The article modestly presents a meta-study of prior observational studies of vaccine effectiveness, with appropriate cautioning about the quality of these studies. The aggregate provides “a partial but useful snapshot of the changing situation, and some clear findings emerge.” In the main, that the aggregate of three vaccines is still effective against severe disease. Although there are breakout graphs, the presentation of an aggregate  statistic is troubling, since no one receives an aggregate vaccine. You get one of Pfizer, Moderna, or J&J.

In contradiction to Lancet doubts,  the Israeli study, BNT162b2 vaccine booster dose protection: A nationwide study from Israel , provides what many feel is high quality justification for a Pfizer booster.

Corona_two-dose-vaccination-data (Hebrew/English) is reference 11 of the Lancet paper, which picks a nit: “Of interest, reported effectiveness against severe disease in Israel was lower among people vaccinated either in January or April than in those vaccinated in February or March.” This discrepancy could be discounted by a variety of uncontrolled factors.

The Lancet article picks another nit with A nationwide study: “Mean follow-up was, however, only about 7 person-days (less than expected based on the apparent study design); perhaps more importantly, a very short-term protective effect would not necessarily imply worthwhile long-term benefit.” Rebuttal:

Every study is a synthesis of data. The Israeli study monitored a period of only 3 weeks, for two groups: those who received a booster in this time frame, and those who did not. It employs valid statistical techniques to get the result.  The Lancet authors prefer a less aggressive synthesis, entailing a longer study. Nevertheless, it is pretty convincing,  appropriate to the time-urgency of Delta.

The short study period of three weeks has an advantage. It reduces  the confounding effect of varying levels of COVID community presence, and seasonal factors. So it tends to isolate measurement of vaccine effectiveness. While studies that measure breakthrough over months use comparisons with the unvaccinated, a short study period is an extra bit of isolation.

The Lancet article objects to the use of antibody titers as proxies for immunity. “Even if humoral immunity appears to wane, reductions in neutralising antibody titre do not necessarily predict reductions in vaccine efficacy over time…” This has not yet been established as a fact for  COVID, so the objection is a form of professional judgement.

A booster can be justified in an entirely different way that has nothing to do with titers. (Medical News Today) Longer gap between COVID-19 vaccine doses may increase immune response. Quoting an AstraZenca study, “A gap of up to 45 weeks actually led to a stronger immune response compared with the recommended interval.” This is generally true for many immunizations. (CDC) Recommended and minimum ages and intervals between vaccine doses. A booster shot is plausible as an optimally timed second dose.

If details are too much, paradox. Israel conducted a national study with 1,144,690  participants. Although it is an observational study, the uniformity of the study environment approaches control. Israeli scientific culture is rigorous and critical. The Lancet article is based on a large number of less rigorous studies. For Pfizer, A nationwide study… overpowers Lancet.

So why the resistance? FDA/CDC are constituted to render decisions of the kind that A nationwide study… presents fact in the state of Israel. Nothing in the FDA/CDC charters permit rubber-stamping the authority of another national establishment, even one as competent as Israel.

Yet it might be the right course for Pfizer, the only subject of the Israeli study.  Two shots of Moderna, which has about 3X more mRNA than Pfizer, produce more durable immunity, so a booster is not quite as crucial. It depends on safety profile, which, it is to be hoped, is in process.

J&J is left to someone else.

(CNN) Top US commanders in Afghanistan wrestle with mistakes and regrets as America’s longest war ends.

The discussion is a tribute to the self-critical powers of the U.S. military.  The criticisms have distinct categories:

• Combat. Failure to provision  adequate helicopters; provisioning the Afghans primarily with Humvees, highly vulnerable to IEDs, instead of the far more durable MRAPs.
• Counterinsurgency. Insufficient language skills and cultural knowledge prohibited the level of influence required to compete with the insurgency.
• Civil affairs, nation building. Absence of political partners sharing Western ideals of government. An unachievable political end state. As Wesley Clark says, the Afghans are “tribal.”

In another place in another time, each of these might have been decisive. In Afghanistan, Wesley Clark comes closest. “Tribal” might say it all about the Afghans. The rest is what we have to say about our own intellectual baggage.

It is said the intervention failed to address what we call corruption. Our Western standards  are only partly products of  hundreds of years of civil evolution in the modern period. In religious perspective, still strong in the West, corruption is a “sin”,  an object to “fight” or “conquer”.

What sounds good on Sundays isn’t so real the rest of the week. Corruption is an iceberg. Blowing the top off with a howitzer simply reveals hidden bulk. In the Afghan tribal system, it’s just business as usual.

Corruption is a characteristic of a social system of exchange. In the West, it was not suppressed by moral force; other causes apply. The Age of Discovery, and the Industrial Revolution required reliable monetary disposition over great distances, and later, in complex  finance of vast enterprise. Wealth was leveraged, creating more wealth.  Corruption was not conquered; it was out-competed by the benefits of lawful finance.

Theories of counterinsurgency don’t delve this deep. To do so postulates complexities beyond the scope of a military operation. The corruption problem is addressed by proselytizing for the “one true faith.” (Wikipedia, Counterinsurgency) Martin van Creveld writes,

The first, and absolutely indispensable, thing to do is throw overboard 99 percent of the literature on counterinsurgency, counterguerrilla, counterterrorism, and the like. Since most of it was written by the losing side, it is of little value.^[29]

Creveld explores many other reasons, not particular to Afghanistan, why counterinsurgency usually fails. This is one more: Afghanistan has no legitimate economy. From Trump Wants to Fire U.S. Commander in Afghanistan,

The bare-bones boiled-down essence of modern government is just a few things:

• • • Raise revenue by taxation.
    • Use at least some of the taxes to provide services.
    • Facilitate commerce.
    • The services provided justify the taxes enough for popular acquiescence.

You can add all the bells and whistles. But it’s the irreducible minimum. Anything less, and it becomes a protection racket.

In the framework of a protection racket, corruption out-competes the alternative. Hence, no political end-point.

Could the U.S. have prevailed? There are a few tricks that could have been tried. British India was a colonial enterprise, while our ethos is raising democracy.  The strategies by which the British dominated India may have had utility in pursuit of our lofty goal.

The British conquest of India, which took a couple hundred years, was not mainly by combat. The greater part was the buying-off of the hundreds of princely states. The British raised indigenous forces that, despite occasional rebellions, were instrumental in defense of the entire Empire.

The tiny detail is that the British were the paymasters. A professional Indian soldier had a choice, to serve a princely state, or the British. The princes were slow payers; the Brits paid on time. This inspired astonishing loyalty.

The alternate path:

• Run Afghanistan as if a colony, but absent the element of exploitation.
• Develop the place, with industry complementing natural resources.
• Establish economic conditions where lawful monetary exchange out-competes corruption, and a government is more than a protection racket.
• Hand the keys to government back to Afghans in stages.
• Exit.

This takes a long time. But we didn’t know we had 20 years.

I remember 9/11 as a flash, an instantaneous moment. So most of my remembering is of before, of which I had lived a long time, and after, which I continue to live. The flash was at blinding brilliance in a televised statement by NY officials. The body language of one presenter was so panicked, I surmised a nuclear threat, the “suitcase nuke”. Later, it was disclosed there had been a hoax.

The period before, in the 90’s, and up until the day, resembled the Belle Époque, replete with  the fruits of a serene, wealthy society in manifestations of cultural arts and pleasures, with scope much greater than the essential stories which in her book The White Album, Joan Didion  says we tell ourselves in order to live.

After the flash, I groped desperately for those stories and, finding the cupboard bare, retreated briefly into myself as I contemplated the interconnectedness of all things. Philly commuter trains stopped running because they were controlled from NY.  Still in shock, pronoun “I” became “we”; contrary to survivalist nuts, we are all in this together; the nation is our boat; if it sinks, we all go down together. As with COVID,  the preoccupying question became “How do we survive this, pick up, and carry on?

So we ditched the fulsome beauty and  expansive openness of our Belle Époque, hunkered down, ditched the frivolities, and carried on. The watchwords: avenge, detect, defend. In the dim afterlife of the Époque,  targeting of ethnicities was notably absent. As the flash distanced. I speculated on how and when the demands of fighting terror, and inattention to domestic problems, would corrode the American moral viewpoint.

We lost innocence, openness, and the invulnerability of surrounding oceans. Guarding against terror, we lost the quality the Church of the SubGenius calls “slack”, the co-existence of inside the system with outside, the habitat of pranksters,  creatives, and people who like to smell flowers. Now a joke can get you strip-searched.

It is popularly believed that 9/11 is somehow responsible for our current state of decay. In diversion of funds from infrastructure, this is undoubtedly true.  As to the human cost, I am skeptical that it is the primary cause. For that, we must look elsewhere, beginning with Walter Lippmann’s proposal of how democracy works.  Some of this appears in the previous article, Biden’s COVID Plan; Napkin Calculation #5, Total Mortality.

(CNN) Biden’s six-step Covid plan, explained.

Napkin calculation #5 follows. Unlike previous calculations, it requires political preface.

The plan is scientifically sound and politically risky. Roughly a third of the electorate march to the beat of a primitive drum, eschewing the obligations that come with the rights of citizenship. The triviality of secession from masks and vaccines, the small stakes, evidence deep division.

This was last diagnosed in 1858, when the stakes were much higher, by a senatorial candidate in Illinois, in this speech:

…“A house divided against itself, cannot stand.” I believe this government cannot endure permanently half slave and half free. I do not expect the Union to be dissolved — I do not expect the house to fall — but I do expect it will cease to be divided…

The speaker,  Abraham Lincoln, was optimistic.  The house did divide; discordant reunion followed, touched upon a century later by JFK in his inaugural speech: “And so, my fellow Americans: ask not what your country can do for you — ask what you can do for your country.”

Is wearing a mask too much sacrifice? A mask is noninvasive. It makes no change to the body of the wearer. Not so for a vaccine. Since I am fervently in favor of vaccination, and my viewpoint is not primarily legal, I can only watch with nervous awe as this plays out, and do a little diagnosis of the body politic.

The geography of the U.S. is a blessing and a burden. The Northeast Megalopolis and California are dense and cosmopolitan. The Rustbelt and the agrarian center have different ethos-es. Population densities and travel distances foster  illusions of autonomy, versus the interconnectedness of a megalopolis. This is the origin of red states versus blue.

The illusion of regional autonomy is old, implicit in the Whiskey Rebellion of 1791, implicit also in the divisive doctrine of states’ rights. These are old wounds, periodically picked open in politics. In the latter half of the 20th century, network television may have promoted unity and civility, with projection of  moderated politics into the heartland, minus  extremism. A credible external threat, communism, also contributed.

The vertical dominance of TV networks has been replaced by myriad lateral connections of social media. As one extremist explained to me, “It’s so easy to find people who think like you do.” Every region of the interior has its own web, selective towards regional attitudes, exclusive of the cosmopolitan coasts. External threats exist, but lack obvious-to-the-electorate appearance.

This is a good part of why COVID is political.  There is more in the way of explanation, but it isn’t as complicated as Spengler would make it. In 1976, during the 1976 swine flu outbreak,  people lined up and got and their shots — or didn’t, but it was not political.  During the 1918 influenza pandemic, some refused masks, and there was some organization to it, but there wasn’t a national schism.

Rejection of masks and shots figure as tragic proxies for a national malaise, a loss of purpose and responsibility that threatens the very existence of American democracy. Vaccine  mandates put more stress on weak joints in the structure. Why, then, has Biden chosen this course? The answer comes as napkin calculation #5.

Napkin calculations are not to be trusted, though #1 through 4 have done pretty well. The fatality rate of all COVID variants remains informed guesswork. For the original strain, one estimate is 1.7%. For delta, double that. So a napkin calc shows what is possible. Assume:

• 80 million hardcore never-vaxers.
• 85%  eventually contract delta.
• 3.4%  die.

This is 2,312,000 fatalities over an unspecified time frame. The progression could be diminished or interrupted by changing attitudes towards vaccination, or the development of really effective antiviral therapy for later stages of disease. It could be increased by mutations. Impossible? The Black Death dwarfed this number.

This is not the kind of thing you talk about on CNN. Joe Biden must have asked his advisors, what’s the worst it could do? And they told  him, in hushed tones, “unlikely but possible.” Then there was a little meditation, and a choice. He made the choice because  he is a moral person. The choice, not to save his presidency, but to save a lot of people, mostly members of the other party. That takes guts I haven’t seen in a long time.

In other quarters, soulless political operatives, in note of the resulting acceleration of the demographic shift, may reconsider the value of some voices.

The demands of elder care seem consuming, but I’ll write something soon.

Bob

(CNN) Fauci’s new 2022 timeline for Covid fight could be a political disaster for Biden and Democrats.

This is about Fauci’s prediction, for spring 2022. In my book, relative to the evolving state of knowledge along the timeline of this epidemic,  Fauci’s handling of the epidemic has been unimpeachable.  Quoting,

“As we get into the spring, we could start getting back to a degree of normality, namely reassuming the things that we were hoping we could do — restaurants, theaters, that kind of thing,” Fauci told CNN’s Anderson Cooper.

For a steward of public health, this is the right thing to say. If  this blog had broad readership, I would not want to undermine Fauci’s hopeful message. Relative obscurity releases this blog from the obligations of a steward. There has to be hope – in a reasonable time frame.

The principal obstacles to the timeline are:

• Current vaccines, while tremendously beneficial to the individual, even with the Delta variant, are inadequate to suppress community presence. See Delta Strain; the Rough Ride Begins.
• Israel experience indicates that a non-Delta specific Pfizer booster is still not sufficiently protective to suppress community presence of Delta.
• The school age population will become a tremendous reservoir of Delta, in constant contact with the more susceptible adult community. (For the math inclined: This is the driving term of an equation for adult infection, so powerful that even for adult R < 1, it can drive infection in the adult community  all by itself.)
• The school-age reservoir will not drain until late June ’22.
• Although social distancing suppressed the winter 20-21 flu season, Delta may compromise resistance to secondary infection, to the point that co-infection with Delta is common, bringing lethality up to 2020 levels.
• All of the troublesome COVID variants have come from outside the vaccinated world. All of them have traveled well. While vaccination in the U.S. has a suppressive effect on domestic mutation, this is like rearranging the deck chairs on the Titanic.
• Some 100 -140 million recalcitrant U.S. adults may never vaccinate. This group will be ravaged. Survivors will be slow to change their minds. The rest of us have need for protection from this reservoir.

From (CNN) Fauci: You get vaccinated… Smouldering Epidemic or Western Wildfire?,

A sociological argument renormalizes this epidemic:

• • • People tend to cluster with others of similar attitudes.
    • The U..S. is in a state of deep division which accentuates clustering.
    • Antivaxers comprise such a group, with social interactions biased to stay within this group.
    • This group of perhaps 140 million moves through a vacuum in which groups with other attitudes do not socially exist.
    • This is in effect an unvaccinated nation of 140M, as was the U.S. in February 2020, except the virus is much worse.
    • Fulmination is possible.

Crash production of a Delta-specific variant could avert some of this, possibly leading to a decent summer ’22. From (CNN) White House frustrated with Irresponsible Delta Variant Coverage…Napkin Calculation #4,

It is possible that a Delta specific booster would both

• • • Reduce the relative risk, which stands at 20-40%
    • Reduce the viral load of breakthroughs.

Time relevant delivery of  boosters and strain adjustments requires a policy tweak that is actually baked into seasonal flu vaccines, and was the crux of Operation Warp Speed, production in advance of proof.

A decade ago, there were DARPA programs for rapid vaccine production to defend against biological warfare. The  programs were successful in rapid production of vaccines of variable quality, for deployment against dire threat. But the loop was never closed; identification  of dire need was never pursued. The process infrastructure for identification of dire need remains vacant.

So we may be in dire need of a Delta-specific booster, with no established process or criteria to establish it. If epidemiology were a mature science, if it could predict with some confidence, that X00,000, or X000,000 people will die this winter, it would be an easy decision. Since epidemiology is not on track for this kind of predictive power, is there another course of action? Yes.

Produce a Delta-specific booster in advance of proofs of need/efficacy. Defer the decision to deploy until more decidable. In the meantime, work at occupying the vacancy of decision infrastructure.

At worst, it’s a waste of money.

From (August 2017) Trump Wants to Fire U.S. Commander in Afghanistan,

The bare-bones boiled-down essence of modern government is just a few things:

• • • Raise revenue by taxation.
    • Use at least some of the taxes to provide services.
    • Facilitate commerce.
    • The services provided justify the taxes enough for popular acquiescence.

You can add all the bells and whistles. But it’s the irreducible minimum. Anything less, and it becomes a protection racket.

Afghanistan has no legitimate economy. Mullah Omar’s gang used to joke that the country couldn’t even make glass. The only trade is underground, opium, immune to civil taxes. But opium makes money for the Taliban. Indirectly, they can tax it, by shaking down the farmers.

This is the essence of the debacle. An even more compact criteria:

• A state with a history of strong government embodies possibility of restoration by foreign intervention.
• A state without a history of strong government lacks even the possibility.

Afghanistan did not have an indigenous central government until the 1747 appointment of Ahmad Shāh Durrānī. It did not resemble a modern state. It was a brief imitation of ancient empire builders, sustained by plunder.

From Biden: Leaving Afghanistan,

I have grave certainty that they [Taliban] won’t uphold. This will be a slaughter of the good. The   future reeks of the fall of Saigon, when our friends were falling off helicopter skids as they begged for rescue. I suspect that the slaughter of innocents bothers H.R. McMaster even more than the strategic retreat.

To remain would only delay the inevitable. Afghanistan is caught in the gyre of a primitive cultural ocean.  Eventually, China, and perhaps India will, in exploitation, bring some measure of humanity.

Do I feel bad? Yes. We spent our blood and treasure unwisely. Venezuela has much better prospects for catalyzed change.

More Afghanistan articles here.

Have a look at (CNN) White House frustrated with Irresponsible Delta Variant Coverage…Napkin Calculation #4. I’ll drop in some text.

So let’s try another intervention, vaccine+masks. (PNAS) Face masks considerably reduce COVID-19 cases in Germany. Quoting,

…Weighing various estimates, we conclude that 20 d after becoming mandatory face masks have reduced the number of new infections by around 45%.

This approximates a relative risk reduction of 1/2 = 0.5.  In combination with 100% vaccination,

• • • For Pfizer and Delta, R_mask = 9*( 0.2 to 0.4)*0.5 = 0.9 to 1.8.

This is a bad number. If napkin calculations have credibility, it implies disaster. Though not fact,  it should not be dismissed. It is the result of high viral load of Delta breakthroughs.

The implication  is that R remains above 1, implying runaway, forest fire growth. This glum observation is based on the typical public-use mask, which is derived from the fluid barrier procedure mask, which is not designed for infectious disease control. This class of masks is relatively comfortable to wear; it reduces transmission by about half. In the above calc, it’s the factor 0.5.

Healthcare workers in infectious disease wards use far more effective and uncomfortable N95 masks, which are designed to protect against most aerosols. Experimental factors for transmission reduction may not exist; let’s guess 0.1, a tenth.

So substitute 0.1 for 0.5:

• For Pfizer and Delta, R_mask = 9*( 0.2 to 0.4)*0.1 = 0.18  to 0.36

Less than 1, these are good numbers! If everyone in the U.S. wore N95 masks and practiced perfect aseptic  technique, COVID would vanish. Given the political climate,  unreasoning resistance to masks, and general impracticality, why have I written this?

Many people might be eager to make limited use of N95 masks, in situations they perceive as hazardous. Mask receptivity may jump in those who meet Delta up close and personal. So this is a proposal for the White House task force:

• Subsidize N95 production.
• Make the masks widely available.
• Possibly be surprised at the uptake.

As for refusniks, you do what you can; they do what they will. They may soon become more receptive.