Yesterday the New York Times posted a non-paywalled column admitting that “mask mandates have not done much to reduce Covid caseloads over the past two years” and conceding, albeit reluctantly, that there are far more effective ways to reduce the residual risks posed by the disease.
The writer finds it paradoxical that “masks work and mask mandates do not work”. By “masks work”, he means –
Masks reduce the spread of the Covid virus by preventing virus particles from traveling from one person’s nose or mouth into the air and infecting another person. Laboratory studies have repeatedly demonstrated the effect.
In fact, as others have pointed out, real-world studies, including many that were available when Covid broke out, have demonstrated that the sort of masks that people actually wear are marginally effective at best.
Randomized controlled trials (RCTs) on mask use, generally more reliable than observational studies, though not infallible, typically show that cloth and surgical masks offer little protection. A few RCTs suggest that perfect adherence to an exacting mask protocol may guard against influenza, but meta-analyses find little on the whole to suggest that masks offer meaningful protection. WHO guidelines from 2019 on influenza say that despite “mechanistic plausibility for the potential effectiveness” of masks, studies showed a benefit too small to be established with any certainty. Another literature review by researchers from the University of Hong Kong agrees. Its best estimate for the protective effect of surgical masks against influenza, based on ten RCTs published through 2018, was just 22 percent, and it could not rule out zero effect.
For a more comprehensive summary of the evidence, see Jeffrey H. Anderson, “Do Masks Work?: A Review of the Evidence”.
In the early days of the epidemic, medical authorities like Anthony Fauxi discouraged the public from buying and wearing protective masks. Dr. Fauxi now insists that he was lying. It seems to me more plausible that he was “following the science” back then, only to dismiss it later, when mask wearing became an emblem of good citizenship. Mask mandates weren’t based on any scientific consensus but on the old, familiar syllogism:
Something must be done!
This is something.
Therefore. . . .
Fighting an epidemic with masks is like fighting flood waters with a levee that has gaps. The masking gaps are glaringly obvious:
Airplane passengers remove their masks to have a drink. Restaurant patrons go maskless as soon as they walk in the door. Schoolchildren let their masks slide down their faces. So do adults: Research by the University of Minnesota suggests that between 25 percent and 30 percent of Americans consistently wear their masks below their nose.
And the outcome is just what one would predict – and that many troglodytes did predict:
In U.S. cities where mask use has been more common, Covid has spread at a similar rate as in mask-resistant cities. Mask mandates in schools also seem to have done little to reduce the spread. Hong Kong, despite almost universal mask-wearing, recently endured one of the world’s worst Covid outbreaks.
Advocates of mandates sometimes argue that they do have a big effect even if it is not evident in population-wide data, because of how many other factors are at play. But this argument seems unpersuasive.
After all, the effect of vaccines on severe illness is blazingly obvious in the geographic data: Places with higher vaccination rates have suffered many fewer Covid deaths. The patterns are clear even though the world is a messy place, with many factors other than vaccines influencing Covid death rates.
Yet when you look at the data on mask-wearing – both before vaccines were available and after, as well as both in the U.S. and abroad – you struggle to see any patterns.
And so the writer gives in.
If the mandate has even a modest benefit, it can be worth it.
But this approach is not sustainable for years on end. Masks hinder communication, fog glasses and can be uncomfortable. There is a reason that children and airline passengers have broken out in applause when told they can take off their masks.
In the current stage of the pandemic, there are less divisive measures that are more effective than mask mandates. Booster shots are widely available. A drug that can further protect the immunocompromised, known as Evusheld, is increasingly available. So are post-infection treatments, like Paxlovid, that make Covid less severe.
Will any of this commentary persuade hard core, progressive Times readers? Not immediately, I’m sure, but perhaps, as evidence and experience peck away at their preconceptions, Mad Mask Mountain will be worn down.
Further reading: Not long after I posted this entry, I saw the Foundation for Economic Education’s reaction to the same Times column: “The New York Times Explains Why Mask Mandates Don’t Work”.
Also worth your notice is a paper published in The Lancet under the formidable title, “Revisiting Pediatric COVID-19 Cases in Counties With and Without School Mask Requirements – United States, July 1-October 20 2021” (caveat: not yet peer-reviewed). It revisits and enlarges a study of school mask mandates that the Centers for Disease Control has cited in support of swaddling schoolchildren. The new study reaches the opposite conclusion. Those who don’t want to read the whole thing will find a summary here.
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