I bring my car to a halt at the checkpoint. An obese young woman wearing a mask recites the obligatory incantation:
"Are you currently experiencing or have you experienced any of the following flu-like symptoms not attributable to another condition in the past fourteen days: fever, cough, shortness of breath or difficulty breathing, sore throat, new loss of taste or smell, chills, head or muscle aches, nausea, diarrhea, vomiting, or other unexplained flu-like symptoms?"
I answer in the negative. Then she asks for permission to take my temperature. I consent and she aims a gun-shaped object at me and projects a beam of light at my skull, then asks where my mask is.
I strap on a mask which I retrieved a minute ago from the floor of my car, and she nods affirmatively and then awards me a light-blue smiley faced sticker signifying something or other. I am tempted to ask her if she thinks she is more likely to lose years off her life due to Covid-19 or to sloth and gluttony, but I do not.
Just another day in Clown World.
Does anyone else remember those distant dark ages--like, oh, say, five months ago--when our rulers instructed us not to wear masks to protect ourselves against Covid-19? Masks don't work, we were told, and anyway health care workers need them.
The CDC repeatedly told reporters that the agency "does not currently recommend the use of face masks for the general public," while the Surgeon General of the United States tweeted "Seriously people--STOP BUYING MASKS! They are not effective in preventing general public from catching #Coronavirus, but if healthcare providers can't get them to care for sick patients, it puts them and our communities at risk!"
They never explained why health care workers should need masks if they don't work, or why masks apparently work for healthcare workers but not the rest of us, but never mind that for now. On 3 April, President Trump announced that the CDC recommended the general public use simple cloth masks--although still not the medical masks or respirators used by actual health care workers.
The president went on to undercut his own message, adding "I don't think I'm going to be doing it."
Two weeks later, Andrew Cuomo, governor of the state that has been hardest hit by the coronavirus, ordered all citizens to wear face coverings in public. "You don't have a right to infect me," he explained.
The governor had already ordered nursing homes in New York State to re-admit thousands of Covid-19 patients who had been transferred to hospitals, and to accept new patients infected with the virus as long as they were "medically stable." Governor Cuomo has been accused by some of causing thousands of unnecessary deaths of elderly nursing home patients, although an investigation by the Cuomo administration found no evidence of wrong-doing by the Cuomo administration.
But again, never mind that for now. What caused this abrupt about-face regarding mask-wearing for the general public?
It certainly wasn't due to any new experimental evidence. Just two days before President trump made his announcement, a review by the University of Minnesota Center for Infectious Disease and Policy concluded that "We do not recommend requiring the general public who do not have symptoms of COVID-19-like illness to routinely wear cloth or surgical masks because there is no scientific evidence they are effective in reducing the risks of SARS-CoV-2 transmission."
Four days after President Trump's announcement, a meta-analysis by the Nordic Cochrane Collaboration concluded that "compared to no masks, there was no reduction of influenza-like illness (ILI) cases or influenza for masks in the general population, nor in healthcare workers." Influenza is a virus transmitted aerially, just as Covid-19 is.
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A May 2020 CDC review found "no significant reduction in influenza transmission with the use of face masks." That same month a commentary in the New England Journal of Medicine stated "We know that wearing a mask outside health care facilities offers little, if any, protection from infection."
A month later, the World Health Organization stated "There is no direct evidence on the effectiveness of universal masking on healthy people." That same month, a rapid review by the Norwegian Institute of Public Health concluded "There is no reliable evidence of the effectiveness of non-medical facemasks in community settings," and that any benefits that did accrue would be so tiny as to be undetectable.
In fairness, it should be pointed out that yet another meta-analysis published 27 June in the Lancetreported that face masks could result in a large reduction in the risk of infection--although the authors themselves rated the evidence as "low certainty." This study deserves closer examination.
I contacted Tom Jefferson, an Oxford University researcher and the senior author of the Cochrane Collaboration meta-analysis, and asked him why the results reported in the Lancet paper were so different from those of the Cochrane Collaboration. He replied that he had not read that part of the Lancet study, but he and a colleague, Carl Heneghan, had re-analyzed the data on social distancing cited in that paper and found numerous irregularities.
According to Drs. Jefferson and Heneghan, the Lancet meta-analysis cited data incorrectly, or data that could not be found at all in the original papers. One of the studies had no test-positive cases--only "suspected" and "probable" cases--while another reported a relative risk even though one of the two arms had zero events. So it appears that the conclusions of the Lancet paper--at the very least--ought to be taken with a grain of salt.
Moreover, nearly all the empirical studies on the efficacy of masks concerned respirators or medical masks, which we commoners aren't supposed to be wearing anyway. What about cloth masks? There has been one--literally one--experimental study on the effectiveness of cloth masks in preventing the spread of airborne viruses in a clinical setting.
The study, carried out in Viet Nam by a team of Vietnamese and Australian researchers, focused on 1,607 health care workers in high-risk settings. These workers were divided into three groups. One was instructed to wear medical masks, the second to use cloth masks, and the third group, the control group, was asked to continue doing whatever they had been doing all along, which may or may not have included mask wearing (the IRB had deemed it would be unethical to ask them not to wear masks if they wished to do so).
In fact, workers in the two mask arms of the trial wore their masks only about half of the time, while those in the control arm wore masks about a quarter of the time (these may have been either medical masks or cloth masks).
So how did all this work out? The rate of influenza-like illness (ILI) was lowest in the medical mask arm, followed by the control arm, and highest in the cloth mask arm. After controlling for compliance and all the other factors they could think of, the researchers found that the rate of ILI was significantly higher in the cloth masks arm than in either the medical mask arm or the control arm. There was no significant difference between the medical mask arm and the control arm.
In fairness, it ought to be recalled that some of the workers in the control arm were wearing masks, including both medical and cloth masks. Could this have accounted for the lower rate of ILI in the control arm? A secondary analysis by the researchers showed it was extremely unlikely that the lower rate of infection in the control group was due solely to the protective effect of medical masks.
In plain English, the researchers found no evidence that cloth masks protect against infection--and some reason to believe that they might actually be making things worse, possibly by concentrating and retaining pathogens the wearer might otherwise avoid by not using a mask.
And remember, these were professional health care workers, each of whom was provided with one mask for every day of the week and who were instructed to wash the masks after every day's use. It seems highly unlikely outcomes would be better among in the wider world, with an endless variety of masks, which are not fitted to the face, and which are made of materials that have not been tested for filtration efficiency, being utilized by individuals with no healthcare training.
There may be unknown harms to mask-wearing as well. We already mentioned the possibility that masks could actually serve as a reservoir of disease-causing pathogens. Another potential harm is hypoxia, or lowered oxygen levels. One study showed that patients wearing an N95 mask for four hours during hemodialysis exhibited significantly reduced blood oxygen levels. Another showed that surgical masks induced significant dyspnea during a six-minute walking test. These findings are especially concerning given that hypoxia is known to induce the production of Hypoxia-Inducible Factor 1α, which reduces the activity of the T-cells which play an essential role in defending the body against invaders--such as Covid-19.
Next: Part 2: A Fever Pitch of Hysteria
