Dr. Tom Jefferson is the lead author of the newly updated Cochrane review on the evidence on masks and other physical interventions for combating respiratory viruses like SARS-CoV-2. Following the publication of the review Dr. Jefferson was interviewed by his colleague, Oxford’s Professor Carl Heneghan. There follows a full transcript of the interview.
CH: Welcome to the Trust the Evidence podcast with Carl Heneghan and Tom Jefferson. We’re coming to you today because last night was the release of a Cochrane systematic review on physical interventions to interrupt or reduce the spread of respiratory viruses, which Tom leads. Tom, I’m just going to come to you with a first question. This is an update of the Cochrane review. So just tell me how long have you been doing this review and which update is this now.
TJ: So, a Cochrane review is a study which synthesises all available studies – all that we can find or identity – on a particular topic. It follows a highly structured format and is always preceded by publication of a protocol. All this is to minimise the bias. Also, it is extensively transparent. In this case we are looking at about 300 pages of review. Now, the review called “Physical interventions to interrupt or reduce the spread of respiratory viruses” is called in code A122 for short and I will be using that acronym simply because it is just too long a title. So the protocol was first published in 2006 and then the first version was published in 2007, updated in 2009, 2010, 2011, and then 2020, so this 2023 is the fifth update of this review. And the reason why we update the reviews is they are soon out of date if we don’t do that, especially in some fast moving topics.
CH: So it’s interesting what’s happening here is that if I look at this you’ve sort of updated it for the swine flu pandemic of 2009-2011, and then there was a large gap until now, when you’ve had two updates within a couple of years. And I think that’s quite interesting because there’s a lot of interest in the interventions within this review. Let me just say what physical interventions are. They are screening at entry ports, isolation, quarantine, physical distance, personal protection, hand hygiene, face masks, glasses and gargling. That’s a lot of interventions but I’m sure most people out of all those will be really interested in terms of the masks results, so I’ll come to them later. But first, what did you include differently in this review compared to just two or three years ago, what new studies are included, and what difference has it made?
TJ: The original review had randomised and non-randomised evidence, but when we got to 2020 we had 67 trials, it had grown exponentially, with all sorts of physical interventions, so we decided there was no point in looking at low quality evidence which was difficult to interpret and no conclusions could be drawn from, if we had this massive wealth of trials. So in 2020 we went forward only with randomised control trials, and we had 67. We’ve since added another 11, so we’ve got 78 in this update. Forty-three trials contribute to the metanalysis, that’s the statistical pooling and analysis of the results. So 11 studies added in this update and the total of the participants in the whole review is 610,872, so it is a very huge dataset of randomised data.
CH: Interesting, so we’ve got a significant amount of randomised controlled data so we’ll come back to your observational data later. But here’s the first result I want to go to, medical and surgical masks compared to no mask. And what you say in the results is that we included 12 trials, and it says that wearing masks in the community probably makes little or no difference to the outcome of influenza-like illness (ILI) or COVID-19-like illness compared to not wearing masks. Now could you just decode what that actually means, because there are lots of Covid-like or influenza-like illness, and what that result means now in the context of this new evidence
TJ. The result means that regardless of what pathogen or what presenting symptom there is no evidence from high quality studies that either medical or surgical masks make any difference to transmission, which is the whole point of wearing or not wearing a mask or any of these other interventions like hand-washing.
CH. OK. And then the other outcome you’ve got here is that wearing masks makes little or no difference to the outcome of laboratory confirmed influenza or SARS-CoV-2 compared to not wearing masks. And the relative risk there is 1.01, right on the line of no effect, with six trials, nearly 14,000 participants and moderate certainty evidence. So when you say moderate certainty evidence, what does that mean also in the context of that what I consider is an important result because it’s got an objective outcome
TJ. The outcome is objective because the trials, such trials, actually did confirm the presence of those particular agents. What the result means is that irrespective of the agent that we are looking at, whether it’s a known agent , or whether it’s within the influenza-like general ILI box, it makes no difference, there doesn’t appear to be any convincing evidence that masks make any difference to transmission. They may do, but the evidence is not present from trials at present. And they may do if mixed up with other interventions but we’ll come to that later because there are some comparisons for that.
CH: OK, and then I’m just going to cover some of the others. You’ve got medical/surgical mask compared to no mask, and it probably makes no difference, so a similar outcome. We’ve got N95 masks, and we’re very uncertain on the effects of those compared with surgical masks on clinical respiratory illness. But let’s just before we get to what this means, hand hygiene compared to control, what did you find there with hand hygiene?
TJ. Well, hand hygiene and disinfection of surfaces are the two most promising interventions. Now by that I don’t mean that people should do backflips – the effect of either is quite small. But for instance, in schools where children at breaks were supervised by teachers in these trials, there was a 10-11% decrease on average of influenza-like illness. However, the problem with schoolchildren and the problem with hand washing is that if you don’t have a programme which institutionalises handwashing, the effect seen in the trial soon fades and children go back to not washing their hands. The same goes for surfaces, for disinfecting surfaces.
CH. Now look, I’m going to take you to task here. In the author conclusions people are going to read this review and start to look at this and say, look, we’ve got the high quality evidence, we’ve got randomised controlled trials and particularly at the mask level they’re going to say, look, you’re showing in the community this lack of effect, but you start with the high risk of bias in the trial, variation in outcome measurement, and relatively low adherence with the intervention during the studies, which hampers us drawing firm conclusions. Now I push that point because the obvious answer then is to go to all the observational studies where people have done systematic reviews and certainly drawn firm conclusions about what to do. So could you just elaborate on what that means in the context of 78 trials – that’s a lot of randomised control trial evidence – can you elaborate on what that means
TJ. It’s called caution, and it’s called being honest with the evidence that we have found. This is the best evidence that we have, but unlike some of the ideologists pushing the idea that non-randomised studies, observational studies could give answers, some of them come up with sweeping answers, sweeping statements, certainties, which simply do not belong to science. Science is not about certainty, science is about uncertainty, it’s about trying to move on the agenda, and accumulate knowledge. The use of non-randomised studies in respiratory virus assessment of interventions with respiratory viruses means that people do not understand, those who did those studies do not understand the play of several factors. For instance the seasonality, for instance the capricious comings and goings of these agents, they’re here one day, and gone the next. If you look at the SARS-CoV-2 behaviour in the U.K. surveillance for the last 12 months its up and down, and it’s just completely independent of any intervention, and also it’s very quickly up and very quickly down. Observational studies cannot account for that. Also, a very large proportion of observational studies are retrospective, and so they are subjected to merciless recall bias; researchers draw conclusions from data that they got from asking questions such as “Can you remember a month ago how many times you wore a mask” or “hat you did on this or what you did on the other day” without keeping a diary. This is just simply not science. Inferring meterage, distancing, when the original studies did no such thing. So this is just an endless list of bias which cannot be taken into account by observational studies. And the only way that we have to answer questions is to run large prospective randomised control trials to answer a specific question in a specific population.
CH: OK well look, when you look at the grey tables – and I find them very helpful – of viral respiratory illness, confirmed influenza or SARS-CoV-2, you said the risk with no mask is 40 per thousand, that’s a study population, and it says the risk in randomised studies with the mask is 40 per thousand, and that is the line of no effect, in effect. But that effect could be somewhere between 29 to 57 per thousand, so it could increase the risk or it could also decrease it by about 10 per thousand, and that’s moderate certain evidence. So let’s say we take the best plausible effect and do more research, and you find out you get 10 per thousand less infections within the course of this – most of this is short term evidence. What that shows to me is that the best you could assume is there is a small potential benefit when you step outside the door for individuals, but at a population level in the community this is not going to change the course of the pandemic. And to be honest that’s exactly what we have seen out there in the world, if you did an observational study that you followed for long enough. And this is moderate evidence, I don’t think you’re ever going to get to high quality evidence because you’re relying on things like adherence, which reflects the real world and not the quality of the outcome. I think people will measure different outcomes, because here you’ve got SARS-CoV-2, influenza outcomes, so you may never get beyond moderate quality evidence and this is as good as it gets, what would you say to that?
TJ: I would agree, but also the underlying principle of wearing masks outside is that we know how SARS-CoV-2 and the other respiratory viruses are transmitting for certain – and we don’t. Readers of our riddles will know that the evidence is complex, it goes back 100 years, it’s sometimes contradictory, and the transmission is probably situational. In some studies you see a quite close pointer towards close contact and droplets, but the so-called airborne aerosol route simply doesn’t have any convincing evidence if you use the same meter to judge it. And it’s not a certainty, it never is a certainty, it cannot be a certainty, it has to be a probability. Or, if you’re using legal jargon, its ‘more likely than not’ or ‘less likely than not’, less likely than yes.
CH: I’m just going to finish with one final question. You end with the need for large well-designed RCTs addressing the effects of these interventions in multiple settings. I’d agree with that totally. Schools for instance is a helpful setting, you’ve got workers in different settings, whether it’s shops or even in certain settings like care homes, right now what difference does it make. The question I have, which is my final question, is: Why have we failed to do those randomised control trials, and for instance here in the U.K. we haven’t done a single randomised study for masks, and I’m asking you why do you think that is?
TJ: I think it’s because there’s a very strange going-on because for years and years and years the Chief Medical Officers and their departments are supposed to have been preparing for the next pandemic, they even had some high-placed people doing that, importantly, and yet they had completely failed to invest in assessment and development of physical interventions, new physical interventions, and even new materials and new technologies. They have completely failed to do that, and the backlash from that has been that those two weeks in March when they all were saying that masks and other forms of personal barriers didn’t work and then they changed their minds and went into this mask mandate mode, which appears to have been instigated by a few very vocal, strident observers, I wouldn’t call them scientists, and instead of trying to answer the question with an emergency protocol and randomising the population, or large chunks of population, explaining the limits of our knowledge, they went for certainty. They went “do this and nothing will happen to you”; well we know what happened. Something did happen to society but it wasn’t the minimising of the circulation of SARS-CoV-2, and this is a story that needs to be told and retold many times and in different way so that next time round maybe somebody will take notice.
Dr. Carl Heneghan is the Oxford Professor of Evidence-Based Medicine and Dr. Tom Jefferson is an epidemiologist based in Rome and lead author of the latest update to the Cochrane review of physical interventions to interrupt or reduce the spread of respiratory viruses. This is a transcript of an interview published on Trust The Evidence, which you can subscribe to here.
Stop Press: For another interview with Dr. Tom Jefferson, see this article by Dr. Maryanne Demasi on her Substack.
To join in with the discussion please make a donation to The Daily Sceptic.
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Your house gets burgled —-Where are the Police? How many burglaries were solved last year or the year before? Yet if you have little disagreement on the Internet somewhere the Police are now supposed to have nothing better to do than chase after people saying some stuff in their own bloody house. ——–All of this reveals one thing only. The Cultural Marxists that control our lives now don’t care if you get burgled or stabbed, they only care that you do not say anything to undermine their pathetic leftist policies that are deliberately destroying western culture. ——The “Hate Crime” laws are really just “Different Opinion” laws and we should all realise that Liberal Progressives and Cultural Marxists don’t like you having an opinion, unless it is THEIRS.
Out in the shires you rarely see the police so it follows we must be totally crime-free!
Yep, that’s why the countryside is ”racist”, you know? Because it hasn’t yet been colonized, but give it time. The ‘no-go’ ghettos and parallel societies must be established in the inner city areas first.
No just the results of the fly tippers.
Hear hear! There’s going to be a significant increase in freedom-loving folk in Clown World, Scotland getting criminal records very soon then. And I’ll bet none of them are from the Transtifa or Muslim communities. It reminds me of the bonkers human rights abuses of the Plandemonium years, where police drones would find a lone ( maskless! ) person, hiking in the middle of nowhere instead of being stuck at home, and fine them. Or people would get fined due to their neighbour grassing them up for having 4 guests round the house instead of the permitted 3. Or meeting your friend for an al fresco cuppa on a bench at the seaside saw you get cuffed and forcibly removed. Essentially, perfectly normal human behaviour was weaponized and criminalized. Same as with these farcical new ‘laws’. There needs to be zero compliance, simple as that. As with people rebelling and opposing anything en masse, the Gestapo and authoritarians can’t punish everyone collectively. Legit criminals are going to have a field day with this too so we’ll await the rise in serious actual crime as a natural consequence of this monumental p*ss-take.
I’m waiting for the first person to be prosecuted in their own home for “hate speech” ….. because the ever-listening Alexa they willingly brought into their home reports them to the Police.
Hi Toby
I would say that a significant aspect to the modus operandi of progressives where law is concerned, is that they avoid the discussion and realisation that they are undoing previous principles by avoiding a direct repeal and instead overlay the old with new progressive ideas/legislation. Maybe they justify this approach with some reference to evolution, but it is an inevitable wet dream of a fudge for advisors and lawyers, leaving the man in the street unsure of what they law actually really means.
I would also suggest that one of the significant realisations of the American declaration of Independence and the subsequent Amendment principles was that law was needed for two functions. 1.) to enable the executive to control and organise society but 2.) and significant to the reasons for the American revolution, to define the limits of that executive over and against the basic rights of the common people.
Your statement that we might not need the equivalent of a 1st amendment, because we already have it buried in common law misses this “who is the law directed at” point, and also the problem of legal overlay.
I would however suggest that the old principle and the one enshrined in the first amendment, (certainly the way you have described it), is not quite what is needed anyway. It does need to be stronger than immediate violence, because a drip, drip, drip can be just as deadly and prejudiced. The boundaries of all freedom of action are enshrined in the Golden rule principle, do unto other what you would have then do to you, or give unto others the freedoms you would want (if you actually bothered to stop and think about it properly) for yourself.
The new Hate speech legislation as well as being a progressive overlay of the common law principle, which you cited, is in effect a new anti- blasphemy law. It fails to distinguish between; speech and action which is in effect violent or anti another person’s basic person, and what is against what in effect another person believes. One of the reasons for this is because the Equality act 2010 principle of protected characteristic muddles this aspect up, which has then been made worse by the common language and common scientific wars explicit within the transgender debate (underlined by similar regarding Covid and also the Co2 climate change issue). Basically what the Hate speech and misinformation approach will enshrine is an inability for society to self- correct in any area covered by these new “red tape” shibboleths, because no one will be allowed to critique it for want of being labelled/arrested/cancelled as a hater or a spreader of misinformation. This quite literally incites hatred against all those who believe in the right to critique beliefs to see whether they work or not. It puts us back into a new dark age with a new inquisition.
Like the American’s in the revolution what is needed is a new realisation of what the basic rights of man are, and they then need to then be enshrined in a new basic bill of rights (even if this is partly just a bringing forward or restatement of what is already there), with an active free court which can defend them “in principle” over and against the executive and interests groups overlaying and undermining them with other stuff. (Note the court would also need to defend them against subsequent progressive overreach of them. Basic public equality rights should not be muddled or conflated with private diversity rights, apart from the fact that public basic equality right are the foundation upon which private diversity ones sit)
One reason why the American’s are also in trouble over all of this is because their court system is too slow, but it may yet still drag them out of this mire. Also the principle of a “man of standing” is unwarranted, when there is no balancing demand on new overlaying legislation or products. Given basic rights any new legislation/products should up front explicitly indicate how it does not reduce undermine basic rights principles, which should be open to immediate challenge by the basic rights court.
Parliament can be sovereign, but they are cannot be sovereign over the basic rights upon which their sovereignty depends.
Very good comment you made. ———–I always remember this—There are two important things about “Free Speech” (1) It is Free, and (2) It is only Speech. ——–Once free speech is removed then people are no longer free. Is this the goal of the Cultural Marxists ?—-YES.
“…law was needed for two functions. 1.) to enable the executive to control and organise society”
I thought law was there to define the boundaries when they needed defining such as when someone does to someone what they don’t want done to them. We ceased being a top down economy/society with the execution of Charles I and therefore in the main the individual was not controlled or ‘organised’ by the executive, but by there own conscience. For the most part we have been a high trust society which came from Christian traditions with a foundation of just 10 laws. People did not murder or rob because the law forbade them but because they understood and judged both (and other transgressions) to be wrong. In addition, and although not enshrined in law, it was considered unjust to pick on those that couldn’t defend themselves. What the new Hate Crime laws are doing is removing the ability of people to defend themselves that can and allowing those that imagine themselves as victims free reign to hate anyone of their choosing.
Any news on why comments were blocked on the Melissa Kite article? Did I miss it?
Nothing that I have seen
Two dimwits have downvoted stewart for asking a question, and probably the same two dimwits have downvoted me for answering. I do wonder why such dimwits would bother reading DS, which is about questioning everything last time I looked.
My theory is that they are rather low-IQ obsessives who either (a) don’t understand the points being made, so like to dismiss them to feel better; or (b) have an irresistible compulsion to balance thumbs up/thumbs down to equal numbers, however futile the attempt.
Downticks are inevitable for this theory, but it’s as good an explanation as any.
I think it’s mainly “I don’t like what you are saying, or what I think you are saying, but I am too lazy to say why, or subconsciously I feel my argument is weak”.
Mutual upticks are welcome.
When everybody in Scotland has had a ‘hate crime’ charged against them – real, perceived or simply made up – what are they going to do then?
Everyone in Scotland is bound to hate Hummus Yoosuffer for f***king up their country, so the cute HateMonstery police should blanket charge the whole population to save time and paperwork. After all, there are only so many trees in the world.
Everyone, that is, except the intellectually-challenged 1984 Leftards, and those Scots who routinely express hatred for the English aka as the Scottish Nationalist-Socialist Party, SNaziP for short.
Below is a crime map of Glasgow by Sally Nichols. I have just shown 3 different views of specific crimes – Serious Assault, Common Assault (Misc. Offence), Hate Crime (Misc. Offence). Is it necessary to point out where priorities need to be, because all those writing and implementing laws are the brightest and best possessing large quantities of knowledge and wisdom?
(to see the image details Open Image in New Tab)
The author is correct in asserting that the assault on freedom of expression goes back to the Race Relations Act of the 1960s. Since this legislation was passed there have been 36 years of Conservative Party led government. Not only has the Conservative Party failed to repeal this appalling legislation, it has accepted and promoted even worse legislation. For freedom and democracy to be restored the Conservative Party must be destroyed.
This article is quite staggering, to know that we already had a First Amendment as part of English Common Law, until that fateful year of 1965.
In that same year, “Race Relations” acts were almost simultaneously shoved through both the UK Parliament and the US Congress, to crush all opposition to “The Great Replacement”. That same year, another act set up the UK Law Commission “to keep the law of England and Wales under review and to recommend reforms”. Since then, “Approximately 70% of the Law Commission’s law reform recommendations have been enacted or accepted by Government.”
In other words, the beginnings of a “Judocracy” = “Rule by Judges”. You can see this in the words of one Third World immigration lawyer in the UK, who said that every immigration law passed by Parliament needed to be “tested in court”.
The Law Commission says that “At any one time, around 15 to 20 areas of law will be under review. Law Commission projects cover a wide range of subjects that belong to the criminal law, property law, family and trust law, public law, and commercial law.
The Law Commission has a rolling programme of law reform projects, and every three years or so it consults on any new projects that should be added to the list of those that it already has under way.”
Sensibly suggesting that all the hate speech and equality laws be revoked, Toby Young’s final paragraph says, “What is the prospect of such a proposal finding its way into the Conservative manifesto?”
None, of course. But how about the Reform manifesto, I wonder? And let’s abolish the Law Commission while we’re at it.
Indeed. You have to ask yourself why anyone thought or pretended to think that the Race Relations Act 1965 and the various acts that followed it were needed, and whether it may have been better to avoid the “problems” it was purported to be solving. If only leading politicians had warned us.
Barbara Lerner Spectre explained it very clearly in her sweet, soft, reasonable voice, at 0:38 seconds here:
Barbara Lerner Spectre – YouTube
Still waiting for her explanation of why Israel is allowed to maintain its “monolithic” non-multicultural society, but Europe cannot be allowed to do so.
Well I know nothing about her beyond the words she speaks here, but based on that evidence she is happy to harm me and my family so I would regard her as an enemy. She is sadly probably right that Europe will not survive though.
Interested to hear from the dimwit downvoter you’ve attracted as to what you’ve said that they object to.
In case there are any new downvoters here, my view is that you should engage or jog on, because if you don’t then you’ve missed the point of DS.
Of course Europe managed to survive for millennia without becoming “multicultural”. She’s just making a ridiculous attempt to justify The Great Replacement.
I don’t mind getting downvotes at all, and I certainly don’t whine about getting plenty of them, either.
The point of the Daily Sceptic is Freedom of Speech, and that includes downvoting as much as you want.
I don’t “mind it, I just find it disappointing. I am fine with people disagreeing with me vehemently, but I want to hear their arguments in case it makes me change my mind – or it might make my thinking clearer.
Don’t worry, sometimes people downvote just for spite, or to try to drive you away, not because they have any valid arguments against your comment.
Just ignore them and carry on.
Indeed
Shame though because you’ve touched on a subject that merits debate – the future of our civilisation
Well, sometimes people will write excellent DS articles that don’t get many comments in response, but that doesn’t mean readers haven’t taken their points onboard, and are pondering them at leisure. And sometimes commenters happen to express your own view even better than you can yourself, so you just upvote them and move on to another article. And sometimes you can’t summon the energy for a debate at that moment, but leave it for another day.
All good points
Enoch Powell tried to.
Another good reason to never visit Scotland again and boycott all Scottish produce.
I’m on it already. Who wants to visit a country ruled and ruined by idiots?
Oops, I live in the UK, so perhaps it’s time to look into emigrating to Switzerland. They have direct democracy there, in the form of referenda. It might not eliminate all the ruling idiots, but at least you’re given a say on important issues such as demonising a whole population for expressing their views.
Scotland is izlam’s dream, go-to country now, isn’t it? Blasphemy is a HateMonstery crime. How did that happen? Who elected Hummus Yoosuffer?
I had to work in Scotland for a couple of years and never been back since. I found the majority of Scots to be surly individuals with a massive chip on their shoulder. If they vote for this moronic far left political party, they have themselves to blame.
It seems eminently possible that, should this become law in England and Wales, spurious accusations of ‘hate speech’ could be made against almost anybody. Would it therefore be appropriate to report a politician for a ‘hate crime’ if they proposed, supported or spoke up for a cause that I deemed offensive or psychologically hateful to myself? I’m sure this would create a veritable flood of incidents requiring to be ‘investigated’ and may cause said politician to review the effectiveness of such a law.
What is the prospect? Nil. Nada. Niet. There is no prospect whatsoever because the not-a-Conservative-Party is now almost as left wing as Labour and its Masters in the WEF wouldn’t allow it.
I wonder if Scottish Police will be attending, mob-handed, ready to arrest 60,000 football fans when Rangers and Celtic play a derby? Or won’t their faiths be “protected” by the law ….. only the Religion of Peace?
I wonder if there is anyone with time on their hands (and a high pain threshold) who can listen to the ramblings of the MSP’s in Holyrood and report every instance they hear?
I wonder how long it would take for Humza Yousaf to get dobbed in?