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After nine months, we still know masks don’t work

OPINION

BY LEN CABRERA

After nine months, we still know masks don’t work

Recently we highlighted an article by UF researchers that showed asymptomatic and presymptomatic spread of COVID-19 in households is essentially zero (0.7 ± 4.2 percent secondary attack rate). This result is important because potential asymptomatic spread was the basis for mask mandates across the country. Despite all the models and theories used to support non-pharmaceutical interventions (NPI), real-world evidence continues to show that these NPIs (mask mandates, lockdowns, etc.) are not effective.

Prior to COVID-19, the CDC’s Community Mitigation Guidelines to Prevent Pandemic Influenza (2017) said, “CDC does not routinely recommend the use of face masks by well persons in the home or other community settings as a means of avoiding infection” (p15). The document specifically talked about disposable surgical, medical, or dental procedure masks, not random cloth face masks. The document said that persons at high risk of complications (of flu) or who are caring for ill family members should wear masks but said, “little evidence supports the use of face masks by well persons in community settings” (p14).

In a January 28, 2020 press conference, Dr. Anthony Fauci said, “In all the history of respiratory-borne viruses of any type, asymptomatic transmission has never been the driver of outbreaks. The driver of outbreaks is always a symptomatic person. Even if there’s a rare asymptomatic person that might transmit, an epidemic is not driven by asymptomatic carriers.” 

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Even as late as April 6, the WHO’s guidelines said members of the general public “only need to wear a mask if you are taking care of a person with COVID-19” or “if you are coughing or sneezing.”

But COVID-19 was a “novel” (new) virus, so public health agencies tossed out all previous guidance on dealing with viruses. The WHO guidelines changed on June 5: “governments should encourage the general public to wear masks in specific situations and settings as part of a comprehensive approach to suppress SARS-CoV-2 transmission.” The stated reason for the change in guidance was that potential asymptomatic transmission from the new virus required universal mask mandates to maybe slow the spread.

Bureaucracies move slowly, even when propagating a narrative, so the June 5 WHO guidance also said:

  • “There is limited evidence that wearing a medical mask by healthy individuals in households… or among attendees of mass gatherings may be beneficial as a measure preventing transmission.”
  • “cluster randomized controlled trials… showed no impact on risk of laboratory-confirmed influenza.”
  • “There is no direct evidence (from studies on COVID-19 and in healthy people in the community) on the effectiveness of universal masking of healthy people in the community to prevent infection with respiratory viruses, including COVID-19.”
  • “At the present time, the widespread use of masks by healthy people in the community setting is not yet supported by high quality or direct scientific evidence and there are potential benefits and harms to consider.”

Early evidence already suggested there was not much asymptomatic spread from COVID-19. In a press conference in Geneva (video posted by Bloomberg on June 8), Dr Maria Van Kerkhove, head of the WHO’s Emerging Diseases and Zoonosis Unit, was asked, “What proportion of asymptomatic people actually transmit?” (1:15 in video)

Her answer: “We have a number of reports from countries that are doing very detailed contact tracing. They’re following asymptomatic cases. They’re following contacts, and they’re not finding secondary transmission onward. It’s very rare” (1:33 in video). “It still appears to be rare that an asymptomatic individual actually transmits onward” (2:09 in video).

That information would undermine the new direction in mask policy, so Dr. Anthony Fauci went on Good Morning America to claim that Dr. Van Kerkhove’s statement was false “because there’s no evidence to indicate that’s the case”; he went on to claim that epidemiological studies show asymptomatic people can transmit SARS-CoV-2 “even when they are without symptoms.” He didn’t say if those studies looked at actual data or were based on models, like the studies that claim masks work by assuming they reduce transmissibility by 50%. (Read all about masks in our June 30 review of medical literature.)

Dr. Van Kerkhove quickly retracted her statement, saying, “I was responding to a question at the press conference. I wasn’t stating a policy of WHO or anything like that. I was just trying to articulate what we know.” That sums up the COVID era: “what we know” often tends to conflict with what we’re told.

That was months ago, and now we have even more data on this “novel” coronavirus. Now we know asymptomatic spread is rare, thanks to UF researchers and others. We also know that PCR tests are counter-productive because they are too sensitive and result in many false positives (even acknowledged by The Spectator and The New York Times). The tests are so bad that a Portuguese court said people cannot be quarantined only because of a positive PCR test.

We also know the mortality rate is very low for a vast majority of the population. Even the most vulnerable 70+ age group has close to a 95% chance of surviving COVID-19. The CDC’s age-stratified “current best estimate” for the infection fatality rate is:

  • 0-19 years: 0.003%
  • 20-49 years: 0.02%
  • 50-69 years: 0.5%
  • 70+ years: 5.4%

Yet governors double down on ineffective and unnecessary NPIs, and the Bill of Rights continues to be superseded by emergency orders. Scott Morefield wrote in TownHall about a RationalGround.com analysis showing that masks do not work to stop the spread of COVID-19. The analysis compared states with and without mask mandates and found higher average cases per 100,000 population in states with mask mandates.

Many will claim to find fault with such a result because the aggregate analysis lacks nuance. They’ll argue that the states with mask mandates are geographically different, or they have more dense populations, or they already had higher infection rates, or (the favorite unverifiable claim) cases in those states would have been even higher without the masks. To preempt those arguments, the Rational Ground analysis also looked at individual counties within a single state: Florida.

There are 22 of 67 counties in Florida with a mask mandate. (Alachua County is one of the 22.) Between May 1 and December 15, there is essentially no difference in population-adjusted cases between masked and unmasked counties: 23 vs 22 cases per 100,000 population. (NOTE: For areas with a mask mandate, the study started counting cases 14 days after the mandate went into effect.)

I reproduced the numbers from the Rational Ground analysis (23 vs. 22). Further, of the 20 counties that implemented a mask mandate after May 1 (so we have data with and without a mandate), only 3 had a reduction in average daily cases. (I used the same 14-day window after the mandate to give it time to have an effect.) When restricting the analysis to these 20 counties, it’s no longer a wash. Average cases per 100,000 population per day are higher with the mandate than without: 22 vs. 15.

Let’s consider two neighboring counties: Alachua (with a mask mandate since May 4) and Marion (with no mandate). Using cases for May 18 to December 15 (allowing 14 days for the Alachua mandate to have an effect on cases), the average cases per 100,000 population per day were 24 for Alachua and 19 for Marion. During that period of time, daily cases per 100,000 population in Alachua County exceeded those in Marion County for 137 of the 212 days (65%). (NOTE: Updating the study period from May 18 to January 8, using the January 9, 2021 case line data, Alachua County still leads Marion County in average daily cases per 100,000 population: 27 to 23.)

This result isn’t unique. Ian Miller posts charts on RationalGround.com and Twitter (@ianmSC). He has a graph showing that daily cases for Florida counties without mask mandates have been lower than counties with mandates since October 15.

His graphs often show that cases and hospitalizations are similar between neighboring states, regardless of masking orders. 

Here’s another example of charts showing similar daily cases by region

This data isn’t surprising to people who paid attention at the start of the pandemic when, seemingly overnight, all public health organizations changed long-standing positions on mask use. The data clearly show that NPIs, especially mask mandates, do not work. The fact that politicians continue to push them shows that they rely on ignorance and compliance to abuse their authority.

Alachua County’s charter states in Section 27.08(5), “Such executive orders shall be limited to those necessary to eliminate or contain conditions that threaten the health, safety, or welfare of the citizens of the county” (emphasis added). County commissioners have not made a case for the necessity of mask wearing by the general public, and they can’t, because there is little evidence showing that such a policy prevents transmission of COVID-19.

  • Please do not further confuse our Dear Leaders with facts. They will stomp their feet and pout.

  • Len, Shands has wonderful doctors. See one to get that “anti mask” stick out of your arse. Thank you and speedy recovery.
    .
    Stick to wasting your time on something worthwhile, like joining the local John Birchers to hate you some Communists.

  • It’s impossible to determine the effectiveness of masks when the PCR test to determine cases produces up to 90 percent false positives.

  • “asymptomatic spread was the basis for mask mandates across the country” – asymptomatic spread was A BASIS for mask mandates, not THE BASIS. When you make policy based on epidemiology, you’re taking into account characteristics of both the virus AND the imperfect people transmitting it. To get good data you have to pretend that there’s a clear distinction between symptomatic and asymptomatic, as if people aren’t making decisions at the margin as to whether or not their headache is because they didn’t drink enough water or due to COVID, or their cough is because they smoked too much, or because they have COVID. Then take into account COVID-19’s cluster-pattern of transmission (i.e. 10% of people are responsible for 80-90% of transmissions), the futility of relying on symptomatic vs asymptomatic to determine whether or not you are part of that 10%, and the reasonable assumption that PCR tests and cycle thresholds are far from a conclusive measure of a COVID positive person’s contagiousness (it took scientists almost a decade to feel confident about what cycle thresholds can tell us about HIV rates of transmission), and it should be easy for a humble person to step back from the data and realize that both asymptomatic spread AND people’s inability to judge whether or not they are capable of spreading virus are the reasons for mask mandates.

    You’re also using WAY too few metrics to compare COVID-19 to other viruses, and ignoring a big part of the picture that real decision makers see when they approach a COVID response. EVERYONE knows that a huge majority or people, even old people and people with pre-existing conditions survive COVID-19. The real issue is the insane amount of time and resources that the healthcare system needs in order to ensure that that death rate stays low. Lots of hospitals are approaching max capacity for COVID ICUs and ventilators, and for hospitals with the capacity to do so, patients that are likely to die on ventilators get put on ECMO. ECMO, of course, requires even more intense round-the-clock specialized care than ventilation, it’s even harder to find qualified staff, and the federal government is certainly not stockpiling ECMO machines. Simply squawking “95% of people survive” does not acknowledge that the real fear is the tiny number of people who will have serious cases, because an increase in cases that you and your data would consider inconsequential could very easily be enough to force doctors and nurses to begin making decisions about who deserves treatment. Hopefully you’ll never have to hear a doctor tell you that your parent or friend does not get treatment because an outlier 22-year old needs it more. If it does come to that, I don’t think your data will be much consolation. We’re not just trying to keep people from dying of COVID-19, we’re trying to keep them from dying from lack of care, and right now that story is buried in the incredibly small percentage of overall “serious” cases that your narrative relies on. Ultimately, even “data-driven” arguments can be useless when they’re as selective as you are about what metrics are worth reporting.

    You should probably also realize that very few scientists consider their research the final word on anything. If you wanted to truly understand the efficacy of mask wearing you could find just as much evidence in support of mandates as you could saying that they don’t work. Most of the research is fine and valuable and worth acknowledging, but I hope we agree that a leader with the hubris to ignore 50% of a body of research in favor of the 50% that feels better is not a leader worth electing, and a blog that would do so is not “local news you can trust.” However, you do seem like a smart guy so I worry that the argument is disingenuous more than it is ignorant. I think you know that even the UF researchers of note would not draw conclusions with the same zealousness that you have. I have little faith in government or elected leaders, but I do feel better knowing that when faced with imperfect information and conflicting advice from across the globe, even most conservative state and local leaders across the country have the humility to realize that nobody knows enough to justify easing mask mandates. There’s an obvious, humble policy-decision to make, and your determination to argue otherwise is indicative of your role as complainers and click-getters, not as decision-makers. This is a kid’s table argument for bloggers and their audiences, not for people with real responsibility.

  • The narrative that hospitals are overwhelmed is not supported by the published data. There may be a few hospitals at high levels however generally speaking the need to bend the curve to account for a strain on hospitals is well past.

    And, it would be best to compare hospital capacities to comparable time periods in previous years. You will find periods of elevated capacity in the past – check California during the ’17-’18 flu outbreak. They were actually spilling into tents that year whereas they have not bee in that situation with Covid. Also, hospitals are set-up to be full, their optimal capacity is around 85% which leaves little room for any kind of large outbreak.

    • Again, “hospital capacity” is not THE published data, it’s a part of the published data. Many hospitals have been able to expand COVID units and add beds, but the hang-up is happening in the hiring process. Rural hospitals in particular have exhausted their supply of new and travel nurses, and newly-built COVID beds can’t be filled because there’s no one to staff them, which is why states like TN (which has almost exhausted its ICU bed capacity) are having to adopt COVID patients from neighboring states where hospitals don’t have the manpower to care for them.
      I agree that it’s worthwhile to look at past outbreaks, but a historical comparison that comes without caveat hasn’t been thought through. Consider one: serious COVID cases stay in hospitals for longer, and often require more specialized and expensive care than flu cases. That changes the calculus dramatically for how far you can go with spillover tents. Which is part of why, rather than setting up tents, I would bet that as we speak your local hospital is frantically trying to turn its waiting areas, food courts, etc. into spillover COVID space.
      I’ll add that all the assumptions that you and the article make could be spot on. In fact, I also tend to think that a lot of the damage we’re seeing here is self-inflicted. But realize that the policy we’re considering is, “should people wear masks?” It’s the simplest POSSIBLE solution, and when confronted with a ton of evidence saying “yes,” and plenty of evidence saying “no,” it takes a lot of hubris to jump on the “no” train. I think that’s part of the reason why every country and almost every locality on Earth has encouraged mask wearing as part of its pandemic response, despite polls indicating that at least 50% of Earth’s inhabitants report caring “very little” about Alachua County’s economy and conservative prospects in local elections.
      It’s really only easy to justify opposition to masks if you’re more concerned with the popularity of your opinion than you are of its actual implications.

      P.S. It’s also interesting to consider how mask wearing affects people’s willingness to engage in “everyday life,” seeing as much of the drop in restaurant and tourism revenue happened before mask mandates. There’s not a lot of great data here, but policy makers in both parties are thinking about mask-wearing, regardless of its efficacy, as a way to encourage economic activity, not suppress it.

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