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Science

Masks Work. So What Went Wrong with a Highly Publicized COVID Mask Analysis? (scientificamerican.com) 501

A Harvard professor on the history of science looks at our response to the pandemic, criticizing "a report that gave the false impression that masking didn't help." From Scientific American: The group's report was published by Cochrane, an organization that collects databases and periodically issues "systematic" reviews of scientific evidence relevant to health care. This year it published a paper addressing the efficacy of physical interventions to slow the spread of respiratory illness such as COVID... The review of studies of masking concluded that the "results were inconclusive..." [and] it was "uncertain whether wearing [surgical] masks or N95/P2 respirators helps to slow the spread of respiratory viruses." Still, the authors were also uncertain about that uncertainty, stating that their confidence in their conclusion was "low to moderate." You can see why the average person could be confused... The Cochrane finding was not that masking didn't work but that scientists lacked sufficient evidence of sufficient quality to conclude that they worked...

Cochrane has made this mistake before. In 2016 a flurry of media reports declared that flossing your teeth was a waste of time... The answer demonstrates a third issue with the Cochrane approach: how it defines evidence. The organization states that its reviews "identify, appraise and synthesize all the empirical evidence that meets pre-specified eligibility criteria." The problem is what those eligibility criteria are. Cochrane Reviews base their findings on randomized controlled trials (RCTs), often called the "gold standard" of scientific evidence. But many questions can't be answered well with RCTs, and some can't be answered at all...

In fact, there is strong evidence that masks do work to prevent the spread of respiratory illness. It just doesn't come from RCTs. It comes from Kansas. In July 2020 the governor of Kansas issued an executive order requiring masks in public places. Just a few weeks earlier, however, the legislature had passed a bill authorizing counties to opt out of any statewide provision. In the months that followed, COVID rates decreased in all 24 counties with mask mandates and continued to increase in 81 other counties that opted out of them... Cochrane ignored this epidemiological evidence because it didn't meet its rigid standard.

I have called this approach "methodological fetishism," when scientists fixate on a preferred methodology and dismiss studies that don't follow it. Sadly, it's not unique to Cochrane. By dogmatically insisting on a particular definition of rigor, scientists in the past have landed on wrong answers more than once.

Vox also points out that while Cochrane's review included 78 studies, "only six were actually conducted during the Covid-19 pandemic... Instead, most of them looked at flu transmission in normal conditions, and many of them were about other interventions like hand-washing.

"Only two of the studies are about Covid and masking in particular. Furthermore, neither of those studies looked directly at whether people wear masks, but instead at whether people were encouraged or told to wear masks by researchers."
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Masks Work. So What Went Wrong with a Highly Publicized COVID Mask Analysis?

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  • by iAmWaySmarterThanYou ( 10095012 ) on Monday October 23, 2023 @07:52AM (#63944985)

    I don't care how many people wear a mask when they're not covering their nose or they're wearing it over their chin.

    • Re: (Score:3, Insightful)

      The benefits of wearing the types of masks available to the public is still unknown as the scientist never really went through the trouble of creating proper studies with proper control groups. Mostly what we saw were meta data studies which by nature are almost always inherently flawed.

      One could even argue that 'message' that masks made things safe emboldened people to go out into crowded areas more because 'they wore a mask'. I've seen families of 4 wearing masks walking through the grocery store. If
      • by AmiMoJo ( 196126 ) on Monday October 23, 2023 @09:02AM (#63945185) Homepage Journal

        We have a pretty good idea of how effective different kinds of masks are, because it is easy to measure. The uncertainty is over how effective asking the general public to wear masks in various settings is, because you will end up with a mixture of different kinds, and people not wearing them properly.

        If you are concerned about COVID then the best thing to do is get an FFP3 mask, because those protect you from infection. FFP3 requires greater than 99% of the particles that carry airborne viruses to be filtered out. You need to make the effort to wear them properly, and do a basic fit-test to ensure there is no leakage. Since nobody else bothers masking now you can get one with an exhalation valve to keep them cool and breathing easy.

        I prefer Moldex ones with neoprene seals. Very easy to don and doff, good seal, and comfortable enough to wear on 13+ hour flights.

        • I prefer Moldex ones with neoprene seals. Very easy to don and doff, good seal, and comfortable enough to wear on 13+ hour flights.

          Just curious...are you actually still wearing masks?

          If so, are you immune impaired or have some sort of medical problems?

      • by Ol Olsoc ( 1175323 ) on Monday October 23, 2023 @10:22AM (#63945487)

        The benefits of wearing the types of masks available to the public is still unknown as the scientist never really went through the trouble of creating proper studies with proper control groups. Mostly what we saw were meta data studies which by nature are almost always inherently flawed.

        Even worse, we never got the needed studies of how the son of man, son of god told us of injecting bleach. He tried to help, and just like Jesus, the Democrats are crucifying him. Repent America!

        Now to be serious, what did you want? Purposely attempting to infect people, one group with no masking, others with various levels of masking? then see who dies?

        Yah, no. Maybe 1930's Germany or the creeps that ran the Tuskegee experiment might approve, but we try to keep some semblance of ethics these days.

        It isn't rocket surgery. Measurements of masks are made all the time, and aerosol ejection from humans has known sizes and velocities. To make a study where you purposely expose a control group to something that may kill them wouldn't be remotely ethical.

        Although, there is a self selected group of people that refuse to vaccinate. They are now the control group.

  • by iamhigh ( 1252742 ) on Monday October 23, 2023 @08:13AM (#63945049)
    If you look at the Kansas data it's pretty clear the mask mandate was implemented when populated areas were at their peak, but more rural and suburban areas were still slowly catching up to the population centers. The non-mandate counties never reached the infection rate of mandated counties. https://www.cdc.gov/mmwr/volum... [cdc.gov]
    • Re: (Score:2, Insightful)

      by buck-yar ( 164658 )
      Ditto, I read their 'conclusive evidence' and rolled my eyes. One mans strong evidence is flimsy to another. In the end, we each need to make our own decisions. Govt should provide correct information, not tell people what to do based on the opinion of a few authorities. They are not always right and people shouldn't be subjects living under a king, ordered what to do.
    • Rural areas did less systematic testing, and areas which would opt out would also be less likely to implement testing even more. And in some locations, even when loved ones died, they tried to block covid from being recorded as a cause https://www.usatoday.com/in-depth/news/nation/2021/12/22/covid-deaths-obscured-inaccurate-death-certificates/8899157002/ [usatoday.com]. I agree that the Kansas data isn't the slam dunk the summary says, but these others complicating factor are also relevant here which strongly suggest th
    • by AmiMoJo ( 196126 ) on Monday October 23, 2023 @09:07AM (#63945209) Homepage Journal

      The obvious explanation for that is that rural and suburban areas are less densely populated.

      You also have to be careful when comparing "infection rates". There are potentially two benefits to masking.

      1. Reduced overall number of infections.
      2. Reduced rate of infection, so as not to overwhelm hospitals.

      In practice it's a combination of both that you see in areas where masking was done properly, i.e. a high percentage of people wearing them properly and not reducing their other COVID protection measures like washing hands more frequently and creating airflow indoors. Unfortunately, from what I can tell outside of Japan that rarely ever happened.

  • by IronDragon ( 74186 ) on Monday October 23, 2023 @08:14AM (#63945051) Homepage

    ..for the deadliest virus in human history /s^2

    • Masks exist to prevent transmission, not to prevent death once one has it. The fatality rate of a virus isn't relevant to that consideration. And calling covid the deadliest virus in history is a simple strawman. Covid is not as deadly as Ebola or the 1918 flu, and people have generally not asserted otherwise. A virus doesn't need to be the deadliest in history to be really bad.
      • by mjwx ( 966435 )

        Masks exist to prevent transmission, not to prevent death once one has it. The fatality rate of a virus isn't relevant to that consideration. And calling covid the deadliest virus in history is a simple strawman. Covid is not as deadly as Ebola or the 1918 flu, and people have generally not asserted otherwise. A virus doesn't need to be the deadliest in history to be really bad.

        Ebola is quite deadly, but also very complex so it can't just sit around on surfaces for a week like COVID did, you pretty much require direct contact with infected blood. The 1918 and 20 flu pandemics were so deadly because we didn't understand how viruses worked back then. The infected were stacked in like cordwood with uninfected, when they died the next patient was piled onto the virus laden sheets... No quarantine of the infected, no sanitation procedures, the actual virus is thought to be weaker than

    • Re:A paper mask (Score:5, Interesting)

      by drinkypoo ( 153816 ) <drink@hyperlogos.org> on Monday October 23, 2023 @08:59AM (#63945167) Homepage Journal

      A lot of automotive enthusiasts have been tricked into thinking the same way about the air going into their engines. But a paper filter is actually the most effective, and people switching to cotton filters (e.g. K&N(tm)) have "dusted" their motors by failing to keep up with filter maintenance. Paper filters both have smaller pores and exert an electrostatic effect. Cotton filters depend on fresh oil to trap airborne particulates, and people don't wash and reoil them enough.

      Modern "paper" filters are spectacular and enormously effective. But because they're called "paper" (which is not particularly accurate, in that many of them are made entirely out of petroleum plastics, and contain nothing even derived from wood) people doubt them like you're doing here.

    • ..for the deadliest virus in human history /s^2

      Black death? That was the deadliest pandemic in human history, and I don't think anybody suggested paper masks for it.

  • by MagicMerlin ( 576324 ) on Monday October 23, 2023 @08:27AM (#63945071)
    The question isn't, "do masks work?", rather, "do mask policies work?". It's not clear that mask mandates had any real impact on mortality. Policies implementing social restrictions were incredibly divisive, and it's good to look around see how things played out and the data may suggest that voluntary mask rules, while limited in effect, put the choice to the wearer.
    • by AmiMoJo ( 196126 ) on Monday October 23, 2023 @09:12AM (#63945239) Homepage Journal

      Respiratory viruses are taking advantage of flaws in human nature. We could easily reduce their spread, with small and minimally inconveniencing changes to behaviour, and by spending relatively small amounts of money on equipment like UV lamps for offices. But we don't. In fact many people are quite hostile to such things.

      Interestingly the same isn't the case for sexually transmitted diseases, where education is generally effective and many people are willing to use PPE (condoms) to protect themselves. Maybe the near certainty of having to go to the STD clinic to get your urethra swabbed is more of a deterrent than the small possibility of death or life-long disability. If only COVID tests had been administered anally.

  • by cirby ( 2599 ) on Monday October 23, 2023 @08:35AM (#63945095)

    This "defense" is pretty thin.

    Yes, an N95 respirator, if correctly fitted, can reduce the incidence of certain viral diseases. But it's a partial solution in even the best of conditions (which were seldom seen in 2020-2021).

    No, a cheap mask made out of N95 material doesn't do a damned thing versus many respiratory viruses. Since it's not fully fitted to the face, the viruses just float around the edges of the mask when you breathe in and out. Plain cloth? Might as well be wearing a sign saying "viruses keep out," for all the good it does.

    For bacterial diseases carried on particles? Yeah, might be useful, but that's a whole different situation.

    Here's a clue: If someone is wearing glasses and a mask, and their glasses are fogging up when they breathe, the mask is ineffective.

    The one stupid assumption the authorities made at the start of COVID was that it was ONLY carried by larger liquid particles. The evidence for that was flimsy at best, and we found out fairly quickly that it wasn't true. Yes, a cloth or poorly-fitted N95 mask can stop some particles, but neither of them will stop a single virus - and no standard mask will stop a virus particle coming in contact with the eye. Yeah, it turned out that you can catch it that way, too, just like the flu.

    The Scientific American article is just flailing around, trying to excuse the bad medical advice that so many bureaucrats gave during COVID. They're trying to justify cheap mask use by discrediting a bunch of actual studies, but fail to notice that there really wasn't any evidence FOR non-fitted non-N95 mask wearing in the first place.

    • I am not sure fogging is necessarily a sign of ineffectiveness. N95 respirators are designed to keep particles away from the user. On inhalation they press closer to the face if correctly fitted. But a leak on exhalation will not harm the user much (maybe a little will come in at the end of the exhalation?). And i assume the fogging is from exhalation.

      I suspect a better sign of poor fit is if the mask material is failing to move in and out with breathing.

      (None of this is based on actual research, just specu

    • by drinkypoo ( 153816 ) <drink@hyperlogos.org> on Monday October 23, 2023 @09:04AM (#63945193) Homepage Journal

      The one stupid assumption the authorities made at the start of COVID was that it was ONLY carried by larger liquid particles.

      Nobody assumed that. Nobody believed that masks were going to stop all covid transmission, either. What was believed is that they would reduce infection rates and severities, and that's what the evidence shows. Where mask mandates were issued early and largely obeyed the rates are lower than in other places. As it turns out, viral load matters, and you are more likely to get a more serious case of most any virus if you are exposed to more of it. Also, the less you put into the air, the less there will be available for others to breathe in. The total number of droplets and their size are therefore both relevant. By catching the bulk of emissions during coughs or sneezes, the masks reduce both.

      The Scientific American article is just flailing around

      You're attacking a straw man because you don't understand the argument, whether naturally or willfully. You don't get to accuse others of flailing.

    • by CAIMLAS ( 41445 ) on Monday October 23, 2023 @12:55PM (#63946035)

      Not only do viruses float around the edge of the mask, they are then effectively trapped for recirculation. Studies have shown that surgical masks increase bacterial and viral infection likelihood of the wearer. Those masks are to protect the surgery subject from spittle infection.

  • by JoshuaZ ( 1134087 ) on Monday October 23, 2023 @08:36AM (#63945099) Homepage
    A problem with the Kansas type argument is that people in counties which would be inclined to opt out are probably more likely to not take other precautions. And county governments themselves which opt out are also more likely to not take other covid precautions. There is similar data from Germany where different parts put in mask mandates at different times but the same basic problem is an issue (although in that case it really looks like that that wasn't what happened and masks really worked). See https://www.pnas.org/doi/10.1073/pnas.2015954117 [pnas.org]. There's also some related data from the Boston area schools, which has the advantage that since they are demographically very similar, this sort of complicating factor is less likely to be an issue. https://www.nejm.org/doi/full/10.1056/NEJMoa2211029 [nejm.org]. If one combines this with the one decent randomized trial in Bangladesh https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9036942/ [nih.gov] it seems that the bottom line is that masks very likely work, but the Kansas data is not the slam dunk that the OP summary makes it sound like it is.
  • If you are not in- or exhaling all the air through the mask then part of the viruses get in or out. So at percentage if the mask working? Can you get Covid only from at least 1000 viruses or is 1 already enough to start replicating?

    • Re:Air leakage (Score:5, Insightful)

      by robbak ( 775424 ) on Monday October 23, 2023 @08:52AM (#63945137) Homepage

      The fewer virus particles, the less likely you are to catch it and the less severe it will likely be. Yes, one particle could infect one cell (unlikely), but even then the infection would ramp slowly allowing your immune system to get the upper hand quicker.

    • Spit shield. (Score:4, Interesting)

      by Fly Swatter ( 30498 ) on Monday October 23, 2023 @08:53AM (#63945141) Homepage
      Masks work for keeping your sloppy yapping from spraying all over the person you are talking to. Did you notice most stores installed a clear plastic shield between the sales clerk and the customer? Think about that the next time you can't sleep at night.
      • Did you notice most stores installed a clear plastic shield between the sales clerk and the customer?

        Thank goodness those are pretty much all taken down now....

  • ...any methodology to gain legitimacy is acceptable. I think masks work because in Japan people used to wear them before COVID, and it worked in reducing spread of flu.
  • ... but you can't save people who don't want to be saved. In the Netherlands we call them 'wappies'.

  • correlation (Score:5, Insightful)

    by nicubunu ( 242346 ) on Monday October 23, 2023 @09:08AM (#63945215) Homepage

    COVID rates decreased in all 24 counties with mask mandates and continued to increase in 81 other counties that opted out of them

    I think I favorite expression around here is "correlation doesn't equal causation"

  • ...that we abandon a well-acknowledge and rigurous scientific tool. That's cute but misses the point

    Masks in conjunction with other methods work - Namely washing hands and maintaining social distance. If you're touching your face all the time to apply/unapply a mask and aren't washing your hands, well... then you're pretty much defeating the purpose of the mask.

    If you're hanging around large groups of very probably infected individuals... you may as well not be wearing the mask if its not securely fastened

  • Painters wear an intensive mask with side filters that can still allow paint to enter the mask.

    But yeah, that cheetah print cloth mask is definitely going to protect you from COVID-19...

    I do agree that masks alter the trajectory of the aerosol plume we expel at one another when we talk, so they're better than nothing, but I would never count on them to give me 100%.

    Let's not talk of the useless plastic barriers hung at every checkout.
  • by RobinH ( 124750 ) on Monday October 23, 2023 @10:28AM (#63945503) Homepage

    Prior to the pandemic there was some evidence that masks don't work for "respiratory illnesses", and this was about 90% from studies about the flu. Early talking points from medical people tended to cite these studies. After (cloth) mask mandates became a thing you'd see memes circulate with a list of "42 studies that prove masks work." Well, I'm one of those kinds of people who click on links, so after hours of clicking through those links what I can tell you is that I wasn't swayed one way or the other. Most of them that showed a clear result were only measuring droplet movement in a laboratory environment. The few that tried to measure the impacts of mask mandates on real world transmission rates showed tiny, tiny changes, if any. Sure, that may be due to compliance. But the fact is that evidence that cloth masks reduce transmission just wasn't there, at least back then. And cloth masks were all that were available at the beginning.

    The problem I found when trying to look at the transmission rates vs. interventions is that everybody seemed to be implement mask mandates at the same time that they implemented lockdowns. In our area the lockdowns were turned on and off repeatedly, and you could see very measurable changes in transmission rates, but masking was implemented quite early at the same time as a lockdown, and masking was never turned off independently.

    I hate wearing a mask, but will absolutely wear one if it's mandated, and due to what I've read I did my best to find N95 or at least surgical masks once they were available.

    But this argument being had in the media isn't science. It's an "us" vs. "them" ideological war, and I want no part of it. Scientists don't scream at people and shame them for their opinions. They publish their evidence and let other people review it.

  • by brunes69 ( 86786 ) <[slashdot] [at] [keirstead.org]> on Monday October 23, 2023 @10:54AM (#63945575)

    In fact, there is strong evidence that masks do work to prevent the spread of respiratory illness. It just doesn't come from RCTs. It comes from Kansas. In July 2020 the governor of Kansas issued an executive order requiring masks in public places. Just a few weeks earlier, however, the legislature had passed a bill authorizing counties to opt out of any statewide provision. In the months that followed, COVID rates decreased in all 24 counties with mask mandates and continued to increase in 81 other counties that opted out of them... Cochrane ignored this epidemiological evidence because it didn't meet its rigid standard.

    This isn't "strong evidence" at all. Strong evidence comes from a double-blind placebo-controlled study. The evidence sited is nor strong, it is actually quite weak, because there are too many variables being uncontrolled for. Right off the top of my head, I can tell you that counties that CHOSE to mandate masking are also likely counties with higher numbers of population who vaccinated and were generally ultra cautious... so was the reduction due to the masks or due to these other factors?!

    This conflating of strong evidence with weak evidence throughout the COVID pandemic is why no one trusts the media or their elected officials anymore.

    Fund a proper study or GTFO.

  • by Darren Hiebert ( 626456 ) on Monday October 23, 2023 @11:00AM (#63945595) Homepage
    Scientific American long ago stopped being a reliable source for unbiased scientific information and became little more than a mouthpiece for the extremes of the left. I was sad to have to give it up years ago after subscribing to it for decades.
  • by rew ( 6140 ) <r.e.wolff@BitWizard.nl> on Monday October 23, 2023 @01:05PM (#63946087) Homepage

    Why did the masks work in Kansas? It could be that the masks prevented people from getting infected as you would think.

    But maybe there is another mechanism. Maybe the awareness of "an issue with a contagious disease" makes people more careful, and the continuous reminders by seeing people with masks and having one on yourself creates that awareness.... That's what the non RCT studies cannot tell you.

    My doctor prescribes me something for "high blood pressure". I call it the "zero F***s were given" medicine. It is possible that the effect is completely psychological. Work not done? No stress, go home. Doctors require RCT tests to prove effectiveness before they will prescribe a medicine. This could pass the tests that way....

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