Everyone knows that face masks are effective in combating the COVID-19 pandemic. Indeed, most infectious disease experts tell us that, until a vaccine becomes available, widespread public use of face masks is the only way to slow the spread of SARS-CoV-2, the virus that causes COVID-19. Yet many Americans have been reluctant to adopt their use. As such, the governors of many states have enacted statewide mandates, and Democrat presidential candidate, Joe Biden, has promised to enact a nationwide mandate, if scientists recommend it. The American news media claims that the mask science is settled; most scientists already support a nationwide mandate; those who don’t are ridiculed.
Doctor Scott Atlas, a COVID-19 advisor to president Trump, is regularly excoriated for not doing enough to break America’s resistance to mask-wearing. Earlier this month, Doctor Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, told CNN, “Well, if people are not wearing masks, then maybe we should be mandating it”. Less than a week later, Fauci was badgered by Shepard Smith in a CNBC interview for his equivocation. In the swirl of fear and panic spread by the American news media, “maybe” was not acceptable.
Face masks are effective, only a nationwide mandate can save us, the science is settled. So we are told.
The best face masks go by the name N95 (aka respirators), so called because they have a filtration rate of 95%. According to an August 11 JAMA report, N95 masks “require intermittent, individualized fit testing and a seal check on donning.” Nevertheless, even with suboptimal fit, the filtration efficiency of N95 masks exceeds 90%. Surgical masks secured with either ties or ear loops are second best. These masks have a “much lower filtration efficiency of 37% to 69%, as might be expected by their more comfortable, thinner filter and looser fit.” Both types -- N95 masks and surgical masks -- are used to protect clinicians and healthcare workers, in hospital settings.
For the general public, cloth masks are recommended. Asserts CDC Director, Dr. Robert R. Redfield, “Cloth face coverings are one of the most powerful weapons we have to slow and stop the spread of the virus – particularly when used universally within a community setting.” Yet an October 2020 CDC report on the use of cloth face masks to protect individuals against SARS-CoV-2 concludes that “The filtration, effectiveness, fit, and performance of cloth masks are inferior to those of medical masks and respirators.” The degree of inferiority (e.g., the extent to which their filtration efficiency falls below 37% to 69%) is not quantified, but to the CDC’s knowledge, “only 1 randomized controlled trial has been conducted to examine the efficacy of cloth masks in healthcare settings, and the results do not favor use of cloth masks.”
And to the knowledge of the World Health Organization (WHO), “There are currently no studies that have evaluated the effectiveness and potential adverse effects of universal or targeted continuous mask use by health workers in preventing transmission of SARS-CoV-2.”
Perhaps the science behind face mask effectiveness against pandemic influenza could justify a mandate for their use against SARS-CoV-2. Alas, in 2019, WHO conducted a "systematic review of the evidence on the effectiveness of [non-pharmaceutical interventions], including personal protective measures, environmental measures, social distancing measures and travel-related measures." For face masks, it found (after analyzing 10 separate, randomized, controlled trials) "no evidence that face masks are effective in reducing transmission of laboratory-confirmed influenza."
If there are no scientific studies that have measured the effectiveness of cloth face masks against SARS-CoV-2, then why are they being recommended, let alone mandated, for use by the general public? How is this different from foisting a vaccine onto the public, when the effectiveness of that vaccine has not been thoroughly established? Note that Dr. Fauci adamantly denigrated hydroxychloroquine as a treatment for COVID-19, saying that he had “not seen yet a randomized placebo-controlled trial that’s done that [shown efficacy] … I don’t have any horse in the game one way or the other. I just look at the data”. Yet Fauci is now on the verge of promoting a nationwide mask mandate – not with scientific data from randomized placebo-controlled trials, but solely with political pressure from the likes of Shepard Smith.
In the absence of such studies, what is the evidence possessed by those infectious disease experts, journalists, and politicians who clamor for a nationwide mask mandate? Although there is some anecdotal evidence (and the intuitive sense that a cloth mask should capture most viral particles), there is significant empirical evidence that mask-wearing is of little value. A recent large-scale meta-analysis of face mask effectiveness in protecting the general public against acute respiratory infections (ARI) did not bode well for even surgical masks. The study involved almost 24 thousand participants, from 11 countries, with ages ranging from 7 to 89 years. It’s conclusion: “Surgical mask wearing among individuals in non-healthcare settings is not significantly associated with reduction in ARI”. During the summer, Europe was praised for its success in controlling COVID-19, while the US was criticized. Europe had imposed much more austere lock-down rules; the European populace embraced the assiduous use of cloth face masks. By comparison, the US response was said to be lackadaisical. But by mid-September, Europe had moved ahead of the US in new infections – casting doubt on the efficacy of strict lock-down measures.
Recognizing the lack of definitive scientific evidence, a team of Danish researchers conducted a major randomized controlled trial, face mask study. It began in April; it was concluded in June. Finally, a legitimate scientific study would establish the efficacy of cloth face masks to thwart COVID-19, when worn by the general public. But to the team’s dismay, the study has been rejected by elite medical journals, and the researchers are not allowed to discuss what the journals were dissatisfied with. It’s arduously difficult to believe that, if the study found cloth face masks to be effective, it would not have been published months ago. Just think of the thousands of lives that would have been saved.
In covering this story, writer Daniel Payne noted, “there have been indications that the study may be ruffling feathers among medical officials and researchers, with some of the study's directors suggesting, cryptically, that its results may run against the grain of current public orthodoxy on mask usage. “ Perhaps the research found that cloth face masks are useless, or less than useless.
In summary, no one knows that cloth face masks are effective in combating the COVID-19 pandemic. Face mask science is not settled. Given that there are no large scale randomized controlled trial studies to measure their effectiveness, the science has not even started. And infectious disease experts, politicians, and journalists who insist on a cloth face mask mandate (nationwide or statewide) are disingenuous morons.