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Dust Masks and the Politician's Syllogism

In our lives, we're constantly challenged by far more than we can fully understand. I work on complex systems for a living; my interests lie in reducing the harm those complex systems can do because we can't fully understand them. My work is with computers, but it's fascinating to look into other fields and learn from them.

This past fall I found myself feeling trapped indoors. I was living in South Korea, and for the first time in my life was forced to confront what millions -- maybe billions -- of people face every day: nearly constant, dangerous levels of air pollution.

I found myself falling into a common mental trap; I could see it in others as well. The politician's syllogism describes it well:

  1. We must do something
  2. This is something
  3. Therefore, we must do this.

I felt trapped and powerless; of course, I wanted to protect myself from this air pollution and keep myself healthy. So I started doing research and taking actions. I started observing what other people were doing.

This fall, while northern California briefly had some of the most dangerous air in the world due to wildfires, I was witnessing firsthand another, more presistent problem: the mix of dust from the rapidly expanding Gobi Desert with small-particle air pollution produced by burning all kinds of things in Korea and China, from gasoline and diesel in cars, to coal in power plants, to wood for heating homes.

During my three months in South Korea I saw days that looked like something out of Blade Runner 2049, occasionally mixed with some of the most beautiful fall foliage and clear skies in the world. I'm in the less-polluted Fukuoka, Japan now, but every morning, I check the AQICN website for data on how bad the air is, before I make decisions about going running. It's surprisingly hard to find well-presented, contextualized data on air quality, even though the monitors are out there, all over the world. AQICN does a good job on short-term information.

There's obvious health effects from inhaling large quantities of smoke, as in the California wildfires. But, over time, inhaling smaller quantities of fine particles, known as PM2.5, causes heart attacks and cancer; more recent studies have suggested that PM2.5 can make you dumber, too.

News articles regularly claim that the problem has gotten significantly worse within the past ten years; I have no better-quantified sources, but it's clear that there's a significant problem. In the United States, most of us aren't confronted with this reality every day.

We must come to a point as a global society where "burn it" is never an acceptable solution to a problem -- whether it's burning gasoline in cars, coal in power plants, wood in your stove or firepit, a cigarette around other, non-consenting people, or even leaves and farm waste in your backyard. That's the only solution to the problem, and despite overwhelming evidence of the harm done by all kinds of smoke and particulate matter, the world has often repeated the same mistakes over and over again. This is the something that must really be done.

On the other hand, I can't convince society to stop burning things overnight. There are many more important people than me working on these problems; this week's COP24 conference is one of the most recent and high-profile efforts.

So, last November, I found myself hiking a mountain in South Korea while wearing an N95 dust mask. By the end of the day, I could see the filter changing color from white to brown. I made myself safer, right? I've done something.

But how much did I really do? How much did the other people wearing dust masks do? Have a look at the illustration for this BBC article about air pollution in Delhi. There is a child with a dust mask hanging off her face -- "using" it hardly seems an accurate description -- it's so oversized it might as well be a necklace. There's no way that this mask could help filter air. I want to believe this picture was posed by an overzealous photographer, but I don't know.

The rest of the people in the picture seem to be wearing masks that are held on by loops behind the ears. Likewise, this was the only style of mask I saw in South Korea. You might be asking "so what?" right about now.

You have probably heard the term "N95 mask" at some point. Roughly speaking, an "N95 mask" is one that's certified by the American government agency NIOSH to keep out 95% of fine particles, all the way down to viruses. They work as long as they don't get wet and there isn't a lot of oil in the air (there's separate ratings, R95 and P95, for that). NIOSH's mandate is to protect workers, and the standards were initially used to protect people working in dusty environments. However, the N95 standard has proved useful in many situations where protection needs to be improvised, from polluted air to the Ebola virus.

There's a long and detailed standard for N95 masks. One thing they emphasize is that the mask must fit tightly for it to work. Otherwise, you'll just breathe around the mask. When I take off an N95 mask, there are creases in my skin from the tight fit.

In practice, this almost always means that N95 masks are held on my elastic loops that go all the way behind the head, to get a tight fit. Every item in 3M's lineup of respirators is designed this way. Going back to that BBC picture, it's likely that even if the dust masks those people are wearing can filter dust, they're breathing around the masks rather than through them.

I'm speaking from personal experience as well. N95-rated masks are not widely available in South Korea; I had brought some with me from the US, but bought some additional KF94-rated masks while I was there. As I understand it, KF94 is supposed to be generally similar to N95. However, I'm convinced that there is a flaw in their testing system, as it was impossible for me to get a good seal around my face. The the masks just loop back behind the ears, and there was no sealing material around the edges. Most KF94 masks are just a paper material with some ear loops; unlike good quality N95 masks, they don't have any foam to help make a good seal.

It's a good thing I don't have a beard, either. No N95 or KF94 mask can form a seal over a beard.

The only way I could actually feel like I was breathing through the KF94 mask, instead of around it, was to tie the ear loops all the way back behind my head. Even then, I didn't have a lot of confidence in them. These KF94 masks were Kleenex brand; they're manufactured and sold by an American company. And the masks they're selling are useless.

I looked at the people around me wearing these masks, and I wondered: how is it that they didn't notice? Was the feeling of doing something enough? What about the people who manufactured the masks? What are they thinking?

The CDC, among its many public services, provides a public index of every NIOSH-approved N95 respirator as well as the "donning procedure" for each model -- how to put it on so that it's effective. They have forced manufacturers to consider how the masks are actually used.

To make matters worse, many of the masks I saw in South Korea were clearly surgical masks, not even KF94 masks. Surgical masks are not designed to filter air. They are just to stop the wearer's spit and mucus from going everywhere.

Then there's children, who need protection the most. Does anyone even make child-sized N95 masks? I'm not sure; NIOSH is primarily concerned with the health of working-age people. Searching on Amazon for "N95 masks child size" yields a mix of small-adult-size 3M masks, masks that are obviously lying about N95 compliance, and some that might or might not be in compliance. There are many products on Amazon that claim to be N95 certified, but clearly cannot be, and they are not being policed.

NIOSH does some really useful work. For instance, in 2015 NIOSH determined that pregnant women could safely wear N95 masks while exerting themselves. That's positive data for one of the most vulnerable groups, and it made me more confident I could exert myself and go hiking with an N95 mask on. The NIOSH annual budget is about $300 million, depending on who is setting the budget. I won't even claim to begin to know what that money goes to. But I would suggest that we are not doing enough to protect consumers.

The amount of cognitive effort most people are willing to put in is quite small. Most people can absorb a message like "I should wear a mask," but after that, messages get distorted. Masks are sold through many venues, and many are willing to buy from the cheapest supplier they can find. It's very difficult for ordinary people to make informed decisions.

We're lucky enough in the US to be relatively well-informed and well-supplied -- charities distribute N95 masks during wildfires and local media and government drive home the N95 standard. There's still a lot of debate over best practices. There's more awareness of danger in general -- when I was in Seoul I was horrified to see workers grinding paint off of metal with no protection at one of the most prominent museums in the country. I have to believe that happens less in the United States.

Still, products that can easily be confused with similar products that don't work should be regulated like cigarettes. I'd suggest renaming surgical masks to something like "surgical spitguards" -- something absurd enough to impress on people that they dont filter air -- and banning dust masks that can't meet N95 rules. There should be strict rules on labeling, about using simple language and large type on packaging. Companies should be penalized for selling or facilitating the sale of counterfeit items. It seems like we have spent a lot of effort as a society protecting people from counterfeit Gucci handbags, while spending almost no effort protecting people from useless products. I believe that this is possible without stopping innovation.

There's also the problem that all N95 masks are not created equal. The NIOSH study on pregnant women and respirators noted that modern materials have made breathing through N95 masks much easier. But there's really no way to tell which ones are best, or using better materials; I usually buy 3M because of their good corporate reputation, but who knows? The N95 standards don't really address these issues. This leads to mixed signals about how and when to use N95 masks. Then there's the misunderstandings about what they can prevent. They can filter PM2.5 dust, but they cannot filter dangerous gases such as nitrous oxide or ozone. Scientific literacy among the general public is, I suspect, not always high enough to counteract this, and it likely never will be.

We have to become better as a society about protecting each other. There are so many things that are obvious, like the need for a mask to have a tight seal, that most people will somehow miss, even as they feel they are doing something.

This brings me back to the politician's syllogism. If you've read all of this, you're probably feeling confident about using 3M-branded N95 masks when there's a lot of air pollution. But that's not my real point.

I was reflecting on all of the time and effort I spent on this, and I remembered that it's about the marathon, not the sprint. It's the exposure to PM2.5 every day for years that will harm people the most. It's simply not possible to mitigate this risk with N95 masks. They're too uncomfortable to wear every day, all of the time. Even eight hours a day on only the worst days is difficult. Wearing them while sleeping is effectively an impossiblity. Indoor air filters, if they're not snake oil, can help somewhat, but exposure is inevitable. Assuming that all indoor spaces have better air quality, as is often advised, is also probably problematic -- even if buildings have appropriate filtration systems, who is maintaining them? Are they effective? It's surprisingly difficult to find good data on this for the United States, let alone other countries.

There is no shortcut to fixing air pollution. Masks and filters make some people feel like they have more control, but their effect is quite limited. The wide range of unsubstantiated health claims on many of these dust masks speak to how fear can be quite profitable.

We know that PM2.5 can seriously harm cardiovascular health, but there's lots of things that can harm cardiovascular health. Food, for instance: my diet, especially when living in Asia, probably contains too much red meat and saturated fat, and not enough vegetables. (Don't even start thinking about carcinogens in rice, or in popular Korean foods like bracken).

And then, even in polluted parts of the world, even in places where cyclists are more likely to be hit by a car, you will probably live longer if you cycle to work instead of driving. (There's certainly no harm in wearing an N95 mask while cycling in traffic, although the "washable" masks I saw many people wearing in Seoul might be useless).

I'm not even remotely qualified to start quantifying relative harm for air pollution vs. diet vs. lifestyle. But for me, one of the worst things about air pollution was its psychological effect -- I had little desire to go outside, and I was worried about exercising. I really did feel trapped. It became much harder to live a healthy lifestyle. N95 masks can't fix that.

By all means, educate yourself and use N95 masks. You might even want to use R95 or P95 masks -- some global cities might be full of burning oil from old two-stroke engines. And use a properly maintained indoor air filter that doesn't try to sell snake oil to you. But don't fall into the trap. Doing something is not enough. I feel that if we really felt the inadequacy of our solutions more strongly, we might also be more motivated to truly solve these problems. Cigarette boxes have clear messages printed on them like "SMOKING KILLS"; perhaps we should print warnings on masks that say "ONLY A SHORT-TERM SOLUTION."

When I was a younger computer programmer, I heard a talk about abstraction. It was eye-opening for me. None of us can deal with the world, in all of its complexity, all of the time. Even one small subject, like the proper use of protective dust masks, requires an enormous amount of expertise and knowledge to navigate successfully. We all use simplified working models to cope. I could've written about any one of a hundred choices I have been confronted with this year instead of N95 masks.

I think that empowering institutions to help us navigate this world effectively is one of the great modern challenges. Blind trust in authority -- in anyone -- is never a good idea, but there are ways to improve trust in institutions and to help people develop better mental models.

To that end, one important first step is to acknowledge that we each have a limited capacity for complexity, information, and decisionmaking. It took me hours to write this article, let alone do the research that went into it, but without that research it's likely I would have made a totally ineffective choice. As I go through each day, I have to remind myself that my first instinct might not be the one that will keep me and others healthy, safe, or even happy. My models might not be effective enough, or I might be employing wishful thinking. I might be falling into the comfortable illusion of doing something.