A few months into the COVID pandemic, public health authorities began to encourage, and in some cases, mandate the wearing of masks to reduce the virus’ transmission.  It seemed like a logical proposition, after all, doesn’t everyone working in an operating room wear one?

But actually, prior to COVID, most of the research had concluded that masks did little to reduce the transmission of respiratory viruses.  In this 2010 Cambridge paper, researchers reviewed twelve studies on the efficacy of masks.  The authors concluded, “While there is some experimental evidence that masks should be able to reduce infectiousness under controlled conditions, there is less evidence on whether this translates to effectiveness in natural settings.  There is little evidence to support the effectiveness of face masks to reduce the risk of infection.”  (Emphasis added.)

Indeed, the consensus of opinion in public health agencies in the early days of the pandemic was that masks were not effective in preventing transmission of the virus.  In February 2020, then U.S. Surgeon General, Jerome Adams, posted on Twitter that masks “. . . are NOT effective in preventing general public from catching #Coronavirus.”  Until April 2020, the guidance from the CDC and the WHO was that no one other than the healthcare workers should wear masks and Fauci was advising friends in emails that wearing masks while traveling was unnecessary.

But in the late spring of 2020, as COVID cases began to soar, the sentiment of public health authorities began to shift and soon all were recommending masks and even calling for mask mandates.  The supposed justification for the change was that the science had “evolved.” But when public health authorities began to change their tune in the spring of 2020, there had been no new studies. What evolved was not the science, but the group think of public health authorities.  The impression I got at the time, and still believe was the case, was that as cases began to soar in 2020, public health authorities began throwing everything including the kitchen sink, and masks, at trying to control the virus.

As the pandemic wore on, more and more research papers were released, with most finding some benefit from masking.  I read through many of those as they were released.  Most found a very small benefit from masking, but all were observational studies, as opposed to random trials.  Because it is impossible to control for other variables in observational studies, the small differences the studies found were meaningless.  Also, many of the studies reeked of confirmation bias.

Recently the debate over masks was reignited with the publication of a Cochrane¹ review, which found “Wearing masks in the community probably makes little or no difference to the outcome of influenza/COVID‐19 like illness compared to not wearing masks.”

One might have hoped that the Cochrane analysis would have put the argument over masks to bed once and for all.  But that proved not to be the case as many public health authorities doubled down on their masking recommendations.  At a Congressional hearing after the Cochrane study was released, CDC Director Rochelle Walensky even continued to argue in favor of mask mandates in schools, something I always thought was particularly ridiculous. But the push-back on the Cochrane review was surprisingly tepid and mostly met with derision and ridicule. The reaction made it clear that the tide has turned on masks, even in the scientific community.

One of the best discussions on the efficacy of masks I have read was a post on FactCheck.org.  In that article, Professor Benjamin Cowling², an epidemiologist at the University of Hong Kong, summarized what FactCheck.org found, “there is good mechanistic evidence from laboratory studies that masks should have an effect on transmission . . . evidence from randomized trials has not been consistent with a large effect of masks on transmission, but has been consistent with a small effect of masks on transmission.”

That is close to where I come down.  It only makes sense that any kind of barrier that keeps two people from breathing on each other must reduce the number of viruses that are transmitted.  But we will never know whether that reduction is enough to make any meaningful difference in an infection spreading. The real world is not a lab and is just too messy to ever make such a determination.

There is some evidence that a person can protect themselves from a respiratory infection by wearing an N-95mask if they wear it correctly and rigorously, something that is quite difficult to maintain.  So, masking may make some sense for people with special health risks.

But regardless of where the "experts” are on masking, the American public has moved on.  A recent Gallup poll found that 70% of Americans have completely abandoned wearing masks.  I very rarely see anyone wearing a mask these days outside of a healthcare setting.

I think the Cochrane review makes it clear that there was never enough definitive evidence to justify governments mandating masking, and especially not for children.  Hopefully those days are now behind us and in the future whether to mask up or not will be entirely a personal choice.

Note 1 – Cochrane is an independent policy institution and is well known for its review of research studies.

Note 2 – Professor Cowling was one of the authors of the 2010 study that found no evidence of an effect on community transmission.

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