Blast From the Past: A Letter to the Editor re Facemasks (That He Refused to Publish)
I sent this letter in to a few papers, all of whom refused to publish it.
(I skipped the first paragraph because it’s irrelevant to facemasks.)
To begin, the conventional wisdom of the worldwide medical and public policy community prior to Covid, embodied in various papers, studies and the like, was that there is no evidentiary basis that facemasks inhibit community transmission of airborne respiratory viruses. Examples of such papers include multiple pandemic guidance protocols from the CDC (2007 & 2017) and from the WHO (2019) among countless others. This was reflected in individual studies of facemasks in community settings during flu or influenza season or outbreaks, in meta-analysis studies (where the authors analyze a bunch of studies on one topic or question collectively to see if there is a discernible commonality among their various findings), and from historical observation (going back all the way to the Spanish Flu of 1918 where cloth facemasks similarly became a commonly used device that in retrospect failed spectacularly; though back then, unlike today, the doctors and scientists were honest enough to admit it). This was even articulated in a 2016 lawsuit in Canada where the judge ruled that hospitals could not compel nurses to wear facemasks during severe flu seasons due to the lack of evidentiary basis demonstrating facemask efficacy in inhibiting the transmission of the flu in any setting. This “paucity of evidence” remained a generally acknowledged fact even in most of the new studies conducted/written during covid in favor of public use of facemasks (as anyone who bothers to read the studies past the oft- sensational toplines and abstracts would see). During SARS-1, Australia actually threatened manufacturers of facemasks with massive fines for advertising that facemasks offered protection from contracting SARS. This stance was by no means controversial. Common sense indicating that a mask where the pores are hundreds of times larger than the size of a virion or that is not tightly fitted cannot possibly prevent the infiltration or exfiltration of virions once upon a time was, well, common.
In addition to the mechanistic implausibility for facemasks preventing aerosolized transmission of viruses (yes, aerosolized, not droplets), it was further assumed by standard public health policy that facemasks in the hands of the untrained public posed an increased risk of transmission of the very pathogen that the facemask was attempting to stymie (as stated in all of the aforementioned papers). The short explanation of this is that people do not wear and dispose of the masks properly and thus the masks themselves become a source of viral transmission. The only shortsightedness of this fear is that they failed to account for the systematic disregarding of proper mask protocol by so many members of the medical community ([in]famously embodied by the CDC director picking up his mask, putting it down, holding it up, (then declaring that it provides more protection than a vaccine would!?!), all during a nationally televised hearing in front of a senate committee). (There are other mechanisms associated with facemask usage that would plausibly lead to increased transmission, but that requires its own article.)
This disposition against the public at large using facemasks as a method of both individual protection and as source control was emphatically supported by the medical and academic community for a few weeks as Covid started to become a public crisis. If you look at the statements of the various public figures who inveighed against the public usage of facemasks, you will see that they generally went far beyond a simple “don’t do it, it’s not that effective and we need to conserve PPE for healthcare workers” – they were often definitive rejections that emphatically regarded population-wide mask usage as “what a stupid idea”, which reflected an innate, reflexive dismissal grounded in decades of conventional medical wisdom and experience on the subject.
Fortunately, though, we do not have to rely on untested speculation to determine whether facemask usage by the public diminished the transmission of Covid, because there is an avalanche of irrefutably conclusive data from the past year that facemasks were generally correlated with an increase of covid incidence and severity by literally every conceivable metric. This is obvious to anyone with a smidgen of intellectual honesty from a cursory look at how places that had nearly universal mask compliance did not fare any better versus those that did not. This, however, doesn’t begin to capture the real story. When you break down the data by geography and seasonality, you can see that the basic structure of the graphical “curve” was identical everywhere, literally, regardless of what policies were in place. For example, in the US, the contiguous part of the country is broken down into 5 distinct geographical areas based on climate by NOAA, and the curves for all of the states and counties in each of these areas are essentially identical. The only difference between such places is that the curve is larger and higher in places where there was higher compliance with masks and more draconian lockdown policies enforced. This remained true even when disaggregated to a county-by-county level for all 3,143 counties in the US, as was done by the data analysts at RationalGround. They further discovered that even when you looked at places that at one point had mask mandates and at another point did not, irrelevant of which came first, they uniformly did worse with mask usage than without (and that was true even when filtering out all of the same confounding factors); and the overall difference was stark – 17 new confirmed covid infections/100,000 people/day for the non-mask mandate states/counties vs a whopping 27/100,000 people/day new confirmed covid infections for states/counties with a mask mandate. These results were often in spite of factors that one would logically think should tend to cause increased transmission, such as population density, i.e., places with higher population density and less mask usage did better than similarly geographically situated places with lower population density that had more mask usage. One cannot conceivably claim that masks help, as do the majority of public health “experts”, when practically every mask-compliant country/state/county fares noticeably worse than similarly situated places without those policies and individual behavior; this is literally the proverbial definition of insanity, “one who repeatedly does the same action over and over expecting different results”. And unlike the studies that purport to show masks work - sophisticated sophistry disguised by byzantine regressional analyses that forecloses the possibility of any layperson (and even many non-laypeople) piercing the veil of Greek hieroglyph-written equations, these analyses are reproducible by anyone using the same publicly available data.
The absolute failure of facemasks to exhibit any discernible reduction on any covid metric can’t be simply adduced to merely the public’s inability to use masks properly, because even in studies/observations that eliminated improper mask usage and disposal, facemasks failed to correlate with any reduction (quote from Daniel Horowitz’s article detailing this study):
The Naval Medical Research Center in Maryland in conjunction with Mount Sinai Hospital in New York published a study in the NEJM where they split a group of more than 3,000 incoming recruits for basic Marine training into two units, a control group that followed enhanced hygiene protocols, and a group that:
[W]ore double-layered cloth masks at all times indoors and outdoors, except when sleeping or eating; practiced social distancing of at least 6 feet; were not allowed to leave campus; did not have access to personal electronics and other items that might contribute to surface transmission; and routinely washed their hands. They slept in double-occupancy rooms with sinks, ate in shared dining facilities, and used shared bathrooms. All recruits cleaned their rooms daily, sanitized bathrooms after each use with bleach wipes, and ate pre-plated meals in a dining hall that was cleaned with bleach after each platoon had eaten. Most instruction and exercises were conducted outdoors. All movement of recruits was supervised, and unidirectional flow was implemented, with designated building entry and exit points to minimize contact among persons. All recruits, regardless of participation in the study, underwent daily temperature and symptom screening. Six instructors who were assigned to each platoon worked in 8-hour shifts and enforced the quarantine measures.
The result? There wasn’t a statistically significant difference between the two, and the control group fared slightly better. One thing about army boot camps is that there is absolute compliance, and they were all appropriately trained in proper mask protocols, and yet there was no benefit derived from wearing masks. This was in addition to the Fort Benning outbreak earlier this year, where despite having these same protocols in place and testing every recruit prior to commencing with the training camp, the base still suffered the covid outbreak anyway.
What about all the “evidence” that facemasks have reduced covid? The CDC, responding to a written question by Senator Ted Cruz inquiring what actual evidence undergirded the CDC’s guidance on facemasks, cited a lone study by Goldman Sachs whose conclusion was that for every 15% of the population that uses masks (properly and everywhere they “should” be wearing them), there would be an [additional] 1% less transmission. This yields a maximum 6.67% reduction possible from public masking, and that’s still assuming highly unrealistic individual behavior by the public. That the CDC, the world’s preeminent public health organization (and even with their extra billions of Covid funding), could only cite a model analysis conducted by a Wall St firm, is itself a searing indictment of the CDC, which exists in large part to conduct research. One has to wonder how come the CDC has not conducted a massive double-blind RCT for facemask efficacy, the “gold standard” for medical evidence, on something so critical. The GS study, at any rate, is ultimately mathematical-model driven speculation, not real-world “evidence”, and certainly not observed realia.
The CDC earlier this year released a “study” that selectively chose arbitrary start and cut off dates so that the study only looked at the time period where there was a “lull” between 2 covid waves while a mask mandate was in place and “concluded” that this was due to the mask mandates, despite the fact that starting the succeeding week from the study’s area of analysis there was a massive spike as wave 2 hit, and that the mask mandates were in place during part, or all depending on where, of the first wave. To quote one of my favorite lines from the bench, “to state the proposition bluntly is to refute it decisively”.
Another example in this vein would be when researchers from MIT and the University of California San Francisco published a preprint study on 10/23/2020, "Decrease in Hospitalizations for COVID-19 after Mask Mandates in 1083 U.S. Counties." That held up until early November, when “increased rates of SARS- CoV-2 cases in the areas that we originally analyzed in this study" required its retraction.
The CDC recently released a February 2021 MMWR report entitled “Decline in COVID-19 Hospitalization Growth Rates Associated with Statewide Mask Mandates”, that comically adduced by way of regression analysis that a decrease in hospitalization rates of growth of up to 5.6% in adults to the use of facemasks/mask mandates, disregarding the far more salient query of how do places without mandates/mask usage fare by comparison, which would have unambiguously refuted the CDC’s entire premise. This is junk science at its finest. Obviously, I can’t go through every study that’s out there one by one in this context, but suffice it to say that the rest of the so-called evidence for facemask efficacy is similarly riddled with the same rank sophistry and gross incompetence.
On the topic of incompetence, a fundamental misconception of almost everyone is that medical personnel have specific expertise regarding facemasks. This is emphatically untrue. The mechanics of facemasks are based upon aerodynamics, filtration characteristics of various materials, the physical and chemical properties of various types of particulate matter, etc., and how they function together. This is the domain of industrial hygienists, who spend a few years learning these subjects (among others) -- of which there are about 200 accredited by OSHA -- not doctors. I challenge anyone to find a doctor, nurse, surgeon, hospital administrator, or other medical personnel (especially Drs Fauci, Redfield, and Birx), that can pass even a basic quiz on these subjects.
The mechanistic impossibility of facemasks blocking any covid particles was demonstrated so convincingly by preeminent expert industrial hygienist Steven Petty in Kentucky state court that the judge sided with him on all his factual assertions about facemask mechanics and utter lack of conceivable mechanistic plausibility for inhibiting viral transmission both as PPE and as source control.
This is just a cursory overview of the general points against masks, but there is considerably more to say on every aforementioned point. Proper scientific analysis cannot be accurately captured and distilled, let alone produced, by soundbites and quick repartees. To tweak a famous Churchill line, “never in history has so much been perpetrated by so few against so many on the basis of so little”.