Science Denialism Yet Again
Face Masks Still Don't Work As A Mitigation Against COVID
Once again, the “scientific community” is trying to undo the clear and unambiguous science that argues against any notion of efficacy for universal masking as a precaution against COVID-19.
The question of whether and to what extent face masks work to prevent respiratory infections such as COVID and influenza has split the scientific community for decades.
Although there is strong evidence face masks significantly reduce transmission of such infections both in health-care settings and in the community, some experts do not agree.
This time, the commentator in question, C Raina MacIntyre, Professor of Global Biosecurity at UNSW Sydney, is taking aim at a Cochrane Review article which examines a collection of Randomized Controlled Trials on universal masking strategies, and failed to find any conclusive benefit to masking.
There is uncertainty about the effects of face masks. 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. The pooled results of RCTs did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection.
The Cochrane Review, however, merely reiterates what has been found to be true time and again regarding universal masking: there is no obvious benefit to universal masking strategies.
Aside from the toxic and ineffective mRNA inoculations, universal masking is the one narrative surrounding COVID-19 that has proven nearly impervious to reason, logic, and evidence.
We must not forget that the primary voices of the Pandemic Panic Narrative itself, including the ever-punctilious Anthony Fauci, all initially declaimed the widespread use of face masks as a COVID mitigation—right before deciding that masks really did work after all.
The legacy media had been advocating the "no mask" position quite strongly even before March.
Even if there are cases next door, the answer is no, you do NOT need to get or wear any face masks—surgical masks, "N95 masks," respirator masks, or anything else—to protect yourself against the coronavirus. Not only do you not need them, you shouldn’t wear them, according to infection prevention specialist Eli Perencevich, MD, a professor of medicine and epidemiology at the University of Iowa’s College of Medicine.
"The average healthy person does not need to have a mask, and they shouldn’t be wearing masks," Dr. Perencevich said. "There’s no evidence that wearing masks on healthy people will protect them. They wear them incorrectly, and they can increase the risk of infection because they’re touching their face more often."
The message was clear: masks were bad. Do not wear masks.
Then, in April of 2020, quite literally overnight, the narrative on masks reversed gears, and masks were now so effective they warranted the use of coercive mandates to make sure everyone wore one.
Yet while the narrative reversed itself, the science did not. The studies from the 2000’s that refuted claims of efficacy of masking against infectious respiratory disease are still part of the clinical literature, still valid, and still pointing out that masking was ineffective.
There are at least four separate studies on the effect of healthy people wearing masks as well as hand hygiene around symptomatic individuals:
There is the 2008 Hong Kong study of 198 households, which found "The laboratory-based or clinical secondary attack ratios did not significantly differ across the intervention arms." In other words, the masks made no difference.
There is the 2009 Australian study of 286 individuals across 143 households which concluded that "...household use of face masks is associated with low adherence and is ineffective for controlling seasonal respiratory disease."
There is the 2009 Hong Kong study of 259 households which found that among the mask-wearing groups "the differences compared with the control group were not significant."
There is the 2012 German study of 84 households comparing mask-only (M) and mask-plus-hand-hygiene (MH) strategies which found "there was no statistically significant effect of the M and MH interventions on secondary infections."
One point must be emphasized: these studies evaluate wearing masks as a mitigation/containment strategy. These studies do not offer any insight or commentary on the efficacy of an individual mask at blocking individual virion particles from entering the nose and mouth.
Despite these well-established studies refuting masking since long before COVID appeared, “the Science™” still pushes the idea that masks are necessary against COVID.
Where this latest defense of the science denialism over face masks truly goes off the rails, however, is in Ms. MacIntyre’s assertion that Randomized Controlled Trials are not “necessarily” the best way to evaluate pharmaceutical and non-pharmaceutical interventions against disease.
The Cochrane Review combined randomized controlled trials (RCTs) using meta-analysis. RCTs test an intervention in one group and compare it with a "control" group that doesn't receive the intervention or receives a different intervention. A meta-analysis pools the results of multiple studies.
This approach assumes (a) RCTs are the "best" evidence and (b) combining results from multiple RCTs will give you an average "effect size."
But RCTs are only the undisputed gold standard for certain kinds of questions. For other questions, a mix of study designs is better. And RCTs should be combined in a meta-analysis only if they are all addressing the same research question in the same way.
Yes, you read that right. RCTs are not really the “gold standard” in clinical research after all. Never mind that there are multiple papers within the clinical literature explicitly stating that RCTs indeed are said “gold standard”123.
This is a convenient assertion for the author to make—especially since she offers up zero evidence as to why RCTs are inappropriate for studying universal masking as a disease intervention. With a single unproven statement, she immediately dismisses not just the four RCTs from 2008-2012 that I referenced in my first article on this topic, but all of over fourteen RCTS specifically researching face masks and infectious respiratory disease, including COVID.
Ironically, she also dismisses her own research contribution4 to the subject, which specifically excluded all manner of masking except N95 respirators as an effective intervention against infectious respiratory disease (emphasis mine):
A total of 19 randomised controlled trials were included in this study – 8 in community settings, 6 in healthcare settings and 5 as source control. Most of these randomised controlled trials used different interventions and outcome measures. In the community, masks appeared to be effective with and without hand hygiene, and both together are more protective. Randomised controlled trials in health care workers showed that respirators, if worn continually during a shift, were effective but not if worn intermittently. Medical masks were not effective, and cloth masks even less effective. When used by sick patients randomised controlled trials suggested protection of well contacts.
Of course, even if we accept Ms MacIntyre’s assertion that N95 respirators really are effective against COVID, the economics of universal masking using N95 respirators is simply unworkable.
Even at a replacement rate of 1 every 2-3 days, one person would need roughly 10 masks each and every month. A family of four would need 40. A nation of 330 million would need over 3 billion masks each month, every month. None of which could be recycled or reused.
When devising public health strategies such as universal masking, the economics are an indispensable part of the process—strategies which no one can afford are always a non-starter by definition.
Additionally, Ms. MacIntyre commits the very sin of which she accuses the Cochrane Review—i.e., failing to consider how the SARS-CoV-2 virus is spread.
Like most if not all infectious respiratory pathogens, SARS-CoV-2 spreads principally via airborne transmission, but most crucially, it aerosolizes as it becomes airborne5.
People infected with SARS-CoV-2 produce many small respiratory particles laden with virus as they exhale. Some of these will be inhaled almost immediately by those within a typical conversational “short range” distance (<1 m), while the remainder disperse over longer distances to be inhaled by others further away (>2 m). Traditionalists will refer to the larger short range particles as droplets and the smaller long range particles as droplet nuclei, but they are all aerosols because they can be inhaled directly from the air.
An aerosol, by definition, is the suspension of particulates or droplets in the air, usually of extremely small size.
This is an important characteristic of airborne transmission, because even the “experts” who promote the use of masks admit that one of the most common form of face mask, the so-called “medical mask”, is only effective against large respiratory droplets, not aerosols.
Also called surgical masks, these are loosefitting disposable masks. They're meant to protect the wearer from contact with droplets and sprays that may contain germs. A medical mask also filters out large particles in the air when the wearer breathes in.
Simply put, medical masks—which even Ms. MacIntyre has acknowledged are mechanistically ineffective against infectious respiratory pathogens—generally fail to block aerosolized particulates and droplets, and so would not block airborne transmission of SARS-CoV-2 virus.
Cloth masks are frequently even less able to impede aerosols, which explains Ms. MacIntyre’s (correct) 2020 conclusion that cloth masks were ineffective against infectious respiratory pathogens.
Thus, with N95 respirators at a minimum economically unfeasible, and all other masking options even mechanistically ineffective, masking is simply not a workable public health strategy, and the data of at least fourteen random controlled trials proves it.
Furthermore, universal masking is not merely a communal extension of the mechanistic properties of an individual face mask. Rather it is a public health strategy, making consideration of the mechanistic qualities of a face mask an incomplete basis of evaluation. The individual properties of a single face mask simply cannot be directly extrapolated to the public health strategy of universal masking.
What many also failed to notice at the time was that studies that look at individuals – as opposed to populations – can lead to erroneous policy decisions. Studies which involve individuals frequently track people who have specifically chosen to wear a mask. But policies on mandatory masks are very different – they involve lots of people who don’t like wearing masks every day, and many people who won’t wear one at all. A study which only looks at keen mask-wearers will not reflect how people comply on a population level.
In all public health strategies, the realities of human behavior are as indispensable a set of considerations as the economics. A strategy for which compliance is difficult or burdensome—a strategy for which compliance is at best problematic—is never going to be an effective public health strategy. The discomfort and inconvenience of face masks is on its own more than enough to derail any consideration of universal masking as a public health strategy, as it renders compliance problematic to the point of virtual impossibility.
This, of course, has been the repeated conclusion of RCTs large and small studying universal masking as a public health strategy. Even for the relatively few types of masks that might be mechanistically effective, such as N95/KN95 respirators, extending their use across even a small group quickly erodes any utility against COVID that they might have at the individual level.
Contrary to what Ms MacIntyre would have you believe, the actual body of scientific evidence, the body to which she herself has contributed, has from the outset been clear and unmistakable: universal masking has never been effective against infectious respiratory disease. No amount of Faucist science denialism on this point will alter the overwhelming reality of the clinical evidence demonstrating this.
Zabor, Emily C et al. “Randomized Controlled Trials.” Chest vol. 158,1S (2020): S79-S87. doi:10.1016/j.chest.2020.03.013
Meldrum, M L. “A brief history of the randomized controlled trial. From oranges and lemons to the gold standard.” Hematology/oncology clinics of North America vol. 14,4 (2000): 745-60, vii. doi:10.1016/s0889-8588(05)70309-9
Bothwell, Laura E, and Scott H Podolsky. “The Emergence of the Randomized, Controlled Trial.” The New England journal of medicine vol. 375,6 (2016): 501-4. doi:10.1056/NEJMp1604635
MacIntyre, C Raina, and Abrar Ahmad Chughtai. “A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients.” International journal of nursing studies vol. 108 (2020): 103629. doi:10.1016/j.ijnurstu.2020.103629
Tang, J. W., et al. “Covid-19 Has Redefined Airborne Transmission.” BMJ, vol. 373, no. 913, 2021, https://doi.org/10.1136/bmj.n913.
If it’s true one can be infected through the eye mucosa, that blows the mask thing out of the water, no?
Correct, they don't work as a mitigation against Covid. But they were very effective as a psychological weapon, a constant reminder that we should be afraid of the horrible pandemic! Without the masks, I'm confident most people would have shrugged it off by the end or 2020, i.e. before the toxic shots came on the scene.
Two years ago, January of 2021 I noticed an amazing contrast. I had spent the previous several months up in SE PA where indoor masking was mandatory. People were miserable, grumpy, and afraid there. Then we headed down to NE FL, as we normally do right after the holidays. There were no mask mandates here, and although some people wore them voluntarily, most did not. The difference in people's attitude was night and day. Things were darn close to normal here!