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Tag: high-risk environments

  • The Pandemic’s ‘Ghost Architecture’ Is Still Haunting Us

    The Pandemic’s ‘Ghost Architecture’ Is Still Haunting Us

    Last Friday, in a bathroom at the Newark airport, I encountered a phrase I hadn’t seen in a long time: Stop the spread. It accompanied an automatic hand-sanitizing station, which groaned weakly when I passed my hand beneath it, dispensing nothing. Presumably set up in the early pandemic, the sign and dispenser had long ago become relics. Basically everyone seemed to ignore them. Elsewhere in the terminal, I spotted prompts to maintain a safe distance and reduce overcrowding, while maskless passengers sat elbow-to-elbow in waiting areas and mobbed the gates.

    Beginning in 2020, COVID signage and equipment were everywhere. Stickers indicated how to stand six feet apart. Arrows on the grocery-store floor directed shopping-cart traffic. Plastic barriers enforced distancing. Masks required signs dotted store windows, before they were eventually replaced by softer pronouncements such as masks recommended and masks welcome. Such messages—some more helpful than others—became an unavoidable part of navigating pandemic life.

    Four years later, the coronavirus has not disappeared—but the health measures are gone, and so is most daily concern about the pandemic. Yet much of this COVID signage remains, impossible to miss even if the messages are ignored or outdated. In New York, where I live, notices linger in the doorways of apartment buildings and stores. A colleague in Woburn, Massachusetts, sent me a photo of a sign reminding park-goers to gather in groups of 10 or less; another, in Washington, D.C., showed me stickers on the floors of a bookstore and pier bearing faded reminders to stay six feet apart. “These are artifacts from another moment that none of us want to return to,” Eric Klinenberg, a sociologist at NYU and the author of 2020: One City, Seven People, and the Year Everything Changed, told me. All these fliers, signs, and stickers make up the “ghost architecture” of the pandemic, and they are still haunting America today.

    That some COVID signage persists makes sense, considering how much of it once existed. According to the COVID-19 Signage Archive, one store in Key West had a reminder to mask up during the initial Omicron wave: Do not wear it above chin or below nose. In the summer of 2021, a placard at a Houston grocery store indicated that the shopping carts had been “sanitizd.” And in November 2020, you could have stepped on a customized welcome mat in Washington, D.C., that read Thank you for practicing 6 ft social distancing. Eli Fessler, a software engineer who launched the crowdsourced archive in December 2020, wanted “to preserve some aspect of [COVID signage] because it felt so ephemeral,” he told me. The gallery now comprises nearly 4,000 photos of signs around the world, including submissions he received as recently as this past October: a keep safe distance sign in Incheon, South Korea.

    No doubt certain instances of ghost architecture can be attributed to forgetfulness, laziness, or apathy. Remnants of social-distancing stickers on some New York City sidewalks appear too tattered to bother scraping away; outdoor-dining sheds, elaborately constructed but now barely used, are a hassle to dismantle. A faded decal posted at a restaurant near my home in Manhattan depicts social-distancing guidelines for ordering takeout alcohol that haven’t been relevant since 2020. “There’s a very human side to this,” Fessler said. “We forget to take things down. We forget to update signs.”

    But not all of it can be chalked up to negligence. Signs taped to a door can be removed as easily as they are posted; plastic barriers can be taken down. Apart from the ease, ghost architecture should have disappeared by now because spotting it is never pleasant. Even in passing, the signs can awaken uncomfortable memories of the early pandemic. The country’s overarching response to the pandemic is what Klinenberg calls the “will not to know”—a conscious denial that COVID changed life in any meaningful way. Surely, then, some examples are left there on purpose, even if they evoke bad memories.

    When I recently encountered the masks required sign that’s still in the doorway of my local pizza shop, my mind flashed back to more distressing times: Remember when that was a thing? The sign awakened a nagging voice in my brain reminding me that I used to mask up and encourage others to do the same, filling me with guilt that I no longer do so. Perhaps the shop owner has felt something similar. Though uncomfortable, the signs may persist because taking them down requires engaging with their messages head-on, prompting a round of fraught self-examination: Do I no longer believe in masking? Why not? “We have to consciously and purposely say we no longer need this,” Klinenberg told me.

    Outdated signs are likely more prevalent in places that embraced public-health measures to begin with, namely bluer areas. “I would be surprised to see the same level of ghost architecture in Florida, Texas, or Alabama,” Klinenberg said. But ghost architecture seems to persist everywhere. A colleague sent a photo of a floor sticker in a Boise, Idaho, restaurant that continues to thank diners for practicing social distancing. These COVID callbacks are sometimes even virtual: An outdated website for a Miami Beach spa still encourages guests to physically distance and to “swipe your own credit card.”

    Most of all, the persistence of ghost architecture directly reflects the failure of public-health messaging to clearly state what measures were needed, and when. Much of the signage grew out of garbled communication in the first place: “Six feet” directives, for example, far outlasted the point when public-health experts knew it was a faulty benchmark for stopping transmission.

    The rollback of public-health precautions has been just as chaotic. Masking policy has vacillated wildly since the arrival of vaccines; although the federal COVID emergency declaration officially ended last May, there was no corresponding call to end public-health measures across the country. Instead, individual policies lapsed at different times in different states, and in some cases were setting-specific: California didn’t end its mask requirement for high-risk environments such as nursing homes until last April. Most people still don’t know how to think about COVID, Klinenberg said, and it’s easier to just leave things as they are.

    If these signs are the result of confusing COVID messaging, they are also adding to the problem. Prompts to wash or sanitize your hands are generally harmless. In other situations, however, ghost architecture can perpetuate misguided beliefs, such as thinking that keeping six feet apart is protective in a room full of unmasked people, or that masks alone are foolproof against COVID. To people who must still take precautions for health reasons, the fact that signs are still up, only to be ignored, can feel like a slap in the face. The downside to letting ghost architecture persist is that it sustains uncertainty about how to behave, during a pandemic or otherwise.

    The contradiction inherent in ghost architecture is that it both calls to mind the pandemic and reflects a widespread indifference to it. Maybe people don’t bother to take the signs down because they assume that nobody will follow them anyway, Fessler said. Avoidance and apathy are keeping them in place, and there’s not much reason to think that will change. At this rate, COVID’s ghost signage may follow the same trajectory as the defunct Cold War–era nuclear-fallout-shelter signs that lingered on New York City buildings for more than half a century, at once misleading observers and reminding them that the nuclear threat, though diminished, is still present.

    The signs I saw at the Newark airport seemed to me hopelessly obsolete, yet they still stoked unease about how little I think about COVID now, even though the virus is still far deadlier than the flu and other common respiratory illnesses. Passing another stop the spread hand-sanitizing station, I put my palm under the dispenser, expecting nothing. But this time, a dollop of gel squirted into my hand.

    Yasmin Tayag

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  • Somehow, the Science on Masks Still Isn’t Settled

    Somehow, the Science on Masks Still Isn’t Settled

    For many Americans, wearing a mask has become a relic. But fighting about masks, it seems, has not.

    Masking has widely been seen as one of the best COVID precautions that people can take. Still, it has sparked ceaseless arguments: over mandates, what types of masks we should wear, and even how to wear them. A new review and meta-analysis of masking studies suggests that the detractors may have a point. The paper—a rigorous assessment of 78 studies—was published by Cochrane, an independent policy institution that has become well known for its reviews. The review’s authors found “little to no” evidence that masking at the population level reduced COVID infections, concluding that there is “uncertainty about the effects of face masks.” That result held when the researchers compared surgical masks with N95 masks, and when they compared surgical masks with nothing.

    On Twitter, longtime critics of masking and mandates held this up as the proof they’d long waited for. The Washington Free Beacon, a conservative outlet, quoted a researcher who has called the analysis the “scientific nail in the coffin for mask mandates.” The vaccine skeptic Robert Malone used it to refute what he called “self-appointed ‘experts’” on masking. Some researchers weighed in with more nuanced interpretations, pointing out limitations in the review’s methods that made it difficult to draw firm conclusions. Even the CDC director, Rochelle Walensky, pushed back against the paper in a congressional testimony this week, citing its small sample size of COVID-specific studies. The argument is heated and technical, and probably won’t be resolved anytime soon. But the fact that the fight is ongoing makes clear that there still isn’t a firm answer to among the most crucial of pandemic questions: Just how effective are masks at stopping COVID?

    An important feature of Cochrane reviews is that they look only at “randomized controlled trials,” considered the gold standard for certain types of research because they compare the impact of one intervention with another while tightly controlling for biases and confounding variables. The trials considered in the review compared groups of people who masked with those who didn’t in an effort to estimate how effective masking is at blunting the spread of COVID in a general population. The population-level detail is important: It indicates uncertainty about whether requiring everyone to wear a mask makes a difference in viral spread. This is different from the impact of individual masking, which has been better researched. Doctors, after all, routinely mask when they’re around sick patients and do not seem to be infected more often than anyone else. “We have fairly decent evidence that masks can protect the wearer,” Jennifer Nuzzo, an epidemiologist at Brown University, told me. “Where I think it sort of falls apart is relating that to the population level.”

    The research on individual masking generally shows what we have come to expect: High-quality masks provide a physical barrier between the wearer and infectious particles, if worn correctly. For instance, in one study, N95 masks were shown to block 57 to 90 percent of particles, depending on how well they fit; cloth and surgical masks are less effective. The caveat is that much of that support came from laboratory research and observational studies, which don’t account for the messiness of real life.

    That the Cochrane review reasonably challenges the effectiveness of population-level masking doesn’t mean the findings of previous studies in support of masking are moot. A common theme among criticisms of the review is that it considered only a small number of studies by virtue of Cochrane’s standards; there just aren’t that many randomized controlled trials on COVID and masks. In fact, most of those included in the review are about the impact of masking on other respiratory illnesses, namely the flu. Although some similarities between the viruses are likely, Nuzzo explained on Twitter, COVID-specific trials would be ideal.

    The handful of trials in the review that focus on COVID don’t show strong support for masking. One, from Bangladesh, which looked at both cloth and surgical masks, found a 9 percent decrease in symptomatic cases in masked versus unmasked groups (and a reanalysis of that study found signs of bias in the way the data were collected and interpreted); another, from Denmark, suggested that surgical masks offered no statistically significant protection at all.

    Criticisms of the review posit that it might have come to a different conclusion if more and better-quality studies had been available. The paper’s authors acknowledge that the trials they considered were prone to bias and didn’t control for inconsistent adherence to the interventions. “The low to moderate certainty of evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect,” they concluded. If high-quality masks worn properly work well at an individual level, after all, then it stands to reason that  high-quality masks worn properly by many people in any situation should indeed provide some level of protection.

    Tom Jefferson, the review’s lead author, did not respond to a request for comment. But in a recent interview about the controversy, he stood by the practical implications of the new study. “There’s still no evidence that masks are effective during a pandemic,” he said.

    Squaring all of this uncertainty with the support for masking and mandates early in the pandemic is difficult. Evidence for it was scarce in the early days of the pandemic, Nuzzo acknowledged, but health officials had to act. Transmission was high, and the costs of masking were seen as low; it was not immediately clear how inconvenient and unmanageable masks could be, especially in settings such as schools. Mask mandates have largely expired in most places, but it doesn’t hurt most people to err on the side of caution. Nuzzo still wears a mask in high-risk environments. “Will that prevent me from ever getting COVID? No,” she said, but it reduces her risk—and that’s good enough.

    What is most frustrating about this masking uncertainty is that the pandemic has presented many opportunities for the U.S. to gather stronger data on the effects of population-level masking, but those studies have not happened. Masking policies were made on sound but limited data, and when decisions are made that way, “you need to continually assess whether those assumptions are correct,” Nuzzo said—much like how NASA collects huge amounts of data to prepare for all the things that could go wrong with a shuttle launch. Unfortunately, she said, “we don’t have Houston for the pandemic.”

    Obtaining stronger data is still possible, though it won’t be easy. A major challenge of studying the effect of population-level masking in the real world is that people aren’t good at wearing masks, which of course is a problem with the effectiveness of masks too. It would be straightforward enough if you could guarantee that participants wore their masks perfectly and consistently throughout the study period. But in the real world, masks fit poorly and slip off noses, and people are generally eager to take them off whenever possible.

    Ideally, the research needed to gather strong data—about masks, and other lingering pandemic questions—would be conducted through the government. The U.K., for example, has funded large randomized controlled trials of COVID drugs such as molnupiravir. So far, that doesn’t seem to have happened in the U.S.  None of the new studies on masking included in the Cochrane review were funded by the U.S. government. “The fact that we never as a country really set up studies to answer the most pressing questions is a failure,” said Nuzzo. What the CDC could do is organize and fund a research network to study COVID, much like the centers of excellence the agency has for fields such as food safety and tuberculosis.

    The window of opportunity hasn’t closed yet. The Cochrane review, for all of its controversy, is a reminder that more research on masking is needed, if only to address whether pro-mask policies warrant the rage they incite. You would think that the policy makers who encouraged masking would have made finding that support a priority. “If you’re going to burn your political capital, it’d be nice to have the evidence to say that it’s necessary,” Nuzzo said.

    At this point, even the strongest possible evidence is unlikely to change some people’s behavior, considering how politicized the mask debate has become. But as a country, the lack of conclusive evidence leaves us ill-prepared for the next viral outbreak—COVID or otherwise. The risk is still low, but bird flu is showing troubling signs that it could make the jump from animals to humans. If it does, should officials be telling everyone to mask up? That America has never amassed good evidence to show the effect of population-level masking for COVID, Nuzzo said, has been a missed opportunity. The best time to learn more about masking is before we are asked to do it again.

    Yasmin Tayag

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