Masks

Masks Have Made No Meaningful Difference to Delta – Oxford Professor

Professor Jim Naismith, Director of the Rosalind Franklin Institute and Professor of Structural Biology at the University of Oxford, has pointed out that, despite England dropping its mask mandate in July while Scotland kept its one in force, there is no evidence of this policy making any difference in the two countries’ infection rates. He writes:

The ONS survey results on prevalence shows that the Scottish and English approach to masking, although formally different since July, has made no meaningful difference to Delta. In both countries very high levels of prevalence have continued for months. Thus the new changes announced are unlikely to have much of an impact if Omicron does indeed spread rapidly.

You can see the ONS graphs below for yourself, and he’s right. Yet the Government has re-imposed masks in schools, shops and on public transport, despite there being no evidence that they make any significant impact on the spread of disease.

Comprehensive Review of Face Mask Studies Finds No Evidence of Benefit

The Cato Institute has published its latest working paper, a critical review of the evidence for face masks to prevent the spread of Covid. Entitled “Evidence for Community Cloth Face Masking to Limit the Spread of SARS‐​CoV‑2: A Critical Review” and written by Ian Liu, Vinay Prasad and Jonathan Darrow, the paper is an admirably thorough and balanced overview of the published evidence on the efficacy of face masks. While even-handedly acknowledging and summarising the studies that show benefit, the authors’ overall conclusion is that: “More than a century after the 1918 influenza pandemic, examination of the efficacy of masks has produced a large volume of mostly low- to moderate-quality evidence that has largely failed to demonstrate their value in most settings.”

At 61 pages in length, however, not everyone will make it through to the end, so here’s a TL;DR, with some key quotes to serve as a handy overview. The paper is, of course, worth reading in full, though.

Here’s the authors’ own summary from the abstract:

The use of cloth facemasks in community settings has become an accepted public policy response to decrease disease transmission during the COVID-19 pandemic. Yet evidence of facemask efficacy is based primarily on observational studies that are subject to confounding and on mechanistic studies that rely on surrogate endpoints (such as droplet dispersion) as proxies for disease transmission. The available clinical evidence of facemask efficacy is of low quality and the best available clinical evidence has mostly failed to show efficacy, with fourteen of sixteen identified randomised controlled trials comparing face masks to no mask controls failing to find statistically significant benefit in the intent-to-treat populations. Of sixteen quantitative meta-analyses, eight were equivocal or critical as to whether evidence supports a public recommendation of masks, and the remaining eight supported a public mask intervention on limited evidence primarily on the basis of the precautionary principle. Although weak evidence should not preclude precautionary actions in the face of unprecedented events such as the COVID-19 pandemic, ethical principles require that the strength of the evidence and best estimates of amount of benefit be truthfully communicated to the public.

The authors open by recalling the initial advice on masks from the WHO and others and the pre-Covid evidence it was based on.

Until April 2020, World Health Organization COVID-19 guidelines stated that “[c]loth (e.g. cotton or gauze) masks are not recommended under any circumstance”, which were updated in June 2020 to state that “the widespread use of masks by healthy people in the community setting is not yet supported by high quality or direct scientific evidence”. In the surgical theatre context, a Cochrane review found “no statistically significant difference in infection rates between the masked and unmasked group in any of the trials”. Another Cochrane review, of influenza-like-illness, found “low certainty evidence from nine trials (3,507 participants) that wearing a mask may make little or no difference to the outcome of influenza-like illness (ILI) compared to not wearing a mask (risk ratio 0.99, CI 0.82 to 1.18).”

Postcard From Genoa

We’re publishing a new Postcard today by Roger Watson, a Professor of Nursing at the University of Hull. He’s just back from a teaching stint at the University of Genoa and did not have a happy time. Here is an extract:

If anyone who is unvaccinated is considering visiting Italy soon, I would strongly advise against it. Britain seems very civilised in comparison, despite having a run in with a BA official who questioned me about my lack of a mask on leaving the first class lounge in Heathrow, seemingly unaware that we were still on British soil. But, as reported in a Postcard from Istanbul, once the curtain was drawn behind us in BA Club Class, the masks were off and not donned again until arrival in Milan. From Milan I took the train to Genoa to work at the University of Genoa, where I teach regularly, for a week. It is worth noting that I completed the European Passenger Location Form using details from my British passport but, to avoid the queue at the border, I used my Irish passport to enter Italy. I expected to be questioned about the lack of congruence between this passport and the one used to complete the online form which, I assumed, would have to match at immigration. I was through like the proverbial dose of pesto thus indicating, beyond reasonable doubt, that the completion and submission of passenger location forms is a complete waste of time.

You may enter Italy unvaccinated after the requisite Covid tests and then a period of quarantine. But, thereafter, freedom does not beckon as, wherever you step out of quarantine, you will remain… indefinitely. No form of public transport such as trains, buses and internal flights is permitted without displaying a euphemistically named ‘Green Pass’ (Italy’s vaccine passport). If anyone from the U.K. wants to see what the introduction of vaccine passports will be like, then Italy is already there. Mask wearing is strongly enforced on public transport with repeated ‘mascherina’ messages over the PA system.

Social distancing is requested too but the one exception was taxis where, ironically, you can be squeezed into very close proximity with your fellow passengers without the benefit of any social distancing. The situation is exacerbated by the fact that passengers are not allowed to travel in the front of the taxi beside the driver, so it was common for three people to be arse cheek by jowl in the back. On one journey I was asked to mask up in a taxi that had no functioning seat belt.

Worth reading in full.

The New ONS Study Claiming Masks Cut Infection Risk in Half and Vaccines are Better Than Natural Immunity is Riddled With Problems

What do you do when people have spotted that infection rates are higher in the vaccinated than the unvaccinated and are spreading this ‘misinformation‘ on the internet?

It appears that you commission the ONS to come up with a model that fixes the problem. Or rather, in this case, three models.

The ONS on Monday published a new ‘technical article‘ based on its Covid Infection Survey that provides “analysis of populations in the U.K. by risk of testing positive for COVID-19”. It covers the two-week period August 29th to September 11th, though regular updates are now promised.

It involves no fewer than three models, briefly summarised as:

Our first model, Model 1 (the core model), predicts the likelihood of an individual testing positive based on general demographic characteristics in order to help identify broad groups where infections are persisting or arising. …

We then built upon Model 1 resulting in Model 2, the screening model. This includes the core demographic characteristics from Model 1 and incorporates other characteristics individually to identify other factors associated with testing positive for COVID-19. …

Finally, Model 3 (the behaviours model) adds behaviour variables to the core demographic characteristics from Model 1 and the screened characteristics that were kept in Model 2.

I’m sure this talk of models built on models is filling you with confidence.

I’m not sure it filled the authors with very much confidence, though, as their main findings are stated without specific figures:

● People who had received one or two doses of a coronavirus vaccine were less likely to test positive for coronavirus (COVID-19) in the fortnight ending September 11th 2021.

● People living in a household of three or more occupants were more likely to test positive for COVID-19 in the fortnight ending September 11th 2021.

● Those in younger age groups were more likely to test positive for COVID-19 in the fortnight ending September 11th 2021.

● People who never wore a face covering in enclosed spaces were more likely to test positive for COVID-19 in the fortnight ending September 11th 2021.

● Those who reported socially distanced contact with 11 or more people aged 18 to 69 years outside their household were more likely to test positive for COVID-19, in the fortnight ending September 11th 2021.

The media made much of the mask finding, with the Mail declaring: “People who don’t wear face masks indoors are up to TWICE as likely to test positive for Covid.”

Community Masking: Where did ‘The Science’ Come From?

Before 2020, evidence for the efficacy of community masking – that is, asking ordinary members of the public to wear cloth or surgical masks when going about their business – was shaky at best.

This evidence was reviewed in detail by Jeffrey Anderson, a former director of the Bureau of Justice Statistics. He notes that:

of the 14 RCTs that have tested the effectiveness of masks in preventing the transmission of respiratory viruses, three suggest, but do not provide any statistically significant evidence in intention-to-treat analysis, that masks might be useful. The other eleven suggest that masks are either useless—whether compared with no masks or because they appear not to add to good hand hygiene alone—or actually counterproductive.

In another piece that’s well worth reading, Professor Steve Templeton provides a list of quotations from what he calls “the BP era” (Before Things Got Political). Each quotation, taken from one or other expert, testifies to the lack of evidence that community masking works against respiratory pathogens.

For example, in a systematic review published early last year, Jingyi Xiao and colleagues “did not find evidence that surgical-type face masks are effective in reducing laboratory-confirmed influenza transmission, either when worn by infected persons… or by persons in the general  community to reduce their susceptibility”.

This is presumably why, at the start of the COVID-19 pandemic, health authorities in both the U.K. and the U.S. advised against community masking.

For example, on 4th March 2020, Chris Whitty told Sky News that “wearing a mask if you don’t have an infection reduces the risk almost not at all”. And as late as 3rd April, Jonathan Van Tam said “there is no evidence that general wearing of face masks… affects the spread of the disease”.

Likewise, in a tweet sent on 27th February, the CDC said that it “does not currently recommend the use of facemasks”. And two days later, the U.S. Surgeon General urged people to “STOP BUYING MASKS” because they are “NOT effective” at preventing the general public from catching coronavirus.

In a video interview from May of 2019, Anthony Fauci actually laughed at the notion of wearing a face mask. The interviewer asks him, “The best way for me to prevent getting an infectious disease… is what? Wearing a mask?” To which Fauci replies, “No, no no… you avoid all the paranoid aspects.”

Yet by the summer of 2020, the health authorities in both countries had done an about-face, and were now recommending face masks to the public. These recommendations subsequently became mandates.

‘The Science,’ in other words, had changed. But what prompted this change? The charitable answer is that new evidence emerged suggesting that community masking does work against SARS-CoV-2. However, this new evidence looks just as shaky – if not shakier – than the pre-Covid evidence.

Great Barrington Author Gets Mobbed by His Stanford Colleagues

Jay Bhattacharya is a Professor of Medicine at Stanford University, and one of the three co-authors of the Great Barrington Declaration, which outlines a focused protection strategy for dealing with COVID-19.

Although many academics disagree with Bhattacharya about the merits of focused protection, you’d hope they would treat him with respect when expressing their disagreement. Unfortunately, in the era of wokeness and safetyism on campus, this is too much to ask for.

Professor Bhattacharya recently became the subject of a censorious petition circulated by his own colleagues at Stanford.

Although the petition does not name him explicitly, it refers to a “Stanford faculty member” who – gasp – “defends the Governor of Florida’s rejection of mask mandates”. It then directly quotes Bhattacharya as saying “there is no high-quality evidence to support the assertion that masks stop the disease from spreading”.

Note how reasonable this supposedly controversial statement is. Bhattacharya didn’t say there is “no evidence”. He said there is “no high-quality evidence”, which strikes me as entirely defensible. Although there has been one RCT of community masking – the Bangladesh mask study – its results were inconclusive at best.

What’s more, Bhattacharya’s statement concerned the effect of children wearing masks, and there haven’t been any RCTs on that. (The Bangladesh mask study – which had not been published at the time his comments were made – only monitored adults.)

According to the petitioners, Bhattacharya “sows mistrust of policies designed to protect the public health and puts young children, their families and their teachers at risk”. Quite a charge to level at one of your own colleagues. And this wasn’t an off-hand remark in a heated conversation; it was written in a letter to the University President.

The petitioners “recognise the right of every member of the scientific community to express their views and opinions”. But “a time comes,” they write, “when skepticism can no longer be seen as anything other than willful disregard of countervailing facts”.

Perhaps the petitioners are aware of another large-scale RCT of community masking, which does show an unambiguous benefit? If so, it was not mentioned in their missive.

They go on to say: “Encouraging others to deviate from nationally-advocated policy during a pandemic jeopardises us all.” Given that the authorities initially advised against mask-wearing, this must mean the first scientists who questioned that advice were also “jeopardising us all”.

Maybe Bhattacharya’s critics can pen a belated letter denouncing those scientists who “encouraged others to deviate from” the U.S. Surgeon General’s advice in February of 2020. He urged people to “STOP BUYING MASKS” because they are “NOT effective” at preventing the general public from catching coronavirus.

The petitioners conclude their missive by asking the University President to “forcefully declare your faith in the measures you are relying upon to bring us back to campus”. And if that doesn’t sound like a religious exhortation, I don’t know what does.

Incidentally, the petition against Bhattacharya isn’t the first example of Stanford academics mobbing one of their own colleagues for questioning the received wisdom on Covid policy.

Last October, 98 faculty members signed a petition criticising Dr Scott Atlas, whom they accused of spreading “falsehoods and misrepresentations of science”. As a matter of fact, a recent study of academic cancel culture found that Stanford had experienced more incidents than any other U.S. university.

Based on this evidence, it looks like Stanford scholars need to spend more time doing teaching and research, and less time denouncing their colleagues.

This post has been updated.

Another Study Claims to Show Masks Work Against Covid – But Does No Such Thing

A new study has appeared claiming that cloth masks work to reduce the spread of COVID-19 – provided they’re made of three layers of cotton. The Mail reports on its findings.

Researchers at the Indian Institute of Science used synthetic cough droplets to model how well different mask types stand up to coronavirus particles.

They found that surgical and N95 masks are still the most effective at stopping coronavirus spread.

Cloth masks may be a suitable alternative if these masks only if they have at least three layers and are made of cotton, the team found.

These findings may be particularly useful for lower-income countries like India, where surgical masks are not easily accessible to the general population.

In fact, though, the study has not shown anything about the effectiveness of cloth masks to prevent infection. It is not a study of real-world transmission at all but a laboratory test of how masks stop synthetic droplets. These droplets are around 500 micrometres in diameter, so not aerosols, which are typically considered to be much smaller (certainly less than 100 micrometres and possibly less than five). It therefore hasn’t even considered how well the masks impede aerosol transmission, which is one of the main modes of transmission.

A recent study, the Bangladesh mask study, did look at the real-world effectiveness of cloth masks. It found a slight reduction from 0.76% antibody prevalence in control villages (no masks) to 0.74% prevalence in cloth mask villages, though this was not statistically significant. There were numerous problems with this study, not least than it was confounded by additional interventions (an awareness campaign) and did not properly measure initial antibody and prior infection levels. However, even with these limitations it still indicates very little discernible difference.

The Danish mask study, Danmask-19, found no statistically significant effect on infection from wearing surgical masks either. This is in line with pre-Covid evidence on the lack of effectiveness of masks in protecting from respiratory infection and transmission.

When will the mask zealots admit that their pet intervention is a dud?

We Should Have Trusted Our Immune Systems

There follows a guest post by retired dentist and Daily Sceptic contributor Dr. Mark Shaw, who says that just as dentists are taught to intervene as little as possible and trust the human body, public health experts should heed the same lesson.

As well as dentistry, sport has played a big, happy part of my life. Athletics, cross country and squash mainly but also many other competitive sports. So I was relieved to find that, following a long spell on the NHS waiting list, I wouldn’t need a hip replacement after all. I’d used the waiting time to do as much research on hip physio as possible and found that my mobility was improving steadily and significantly. My experience and knowledge of sports injuries through intense training and competing for my country had definitely helped.

When I sat down with the consultant for the assessment of my hip I described the progress made and how keen I was to avoid, or at least put off, an operation. The consultant orthopaedic surgeon seemed happy with my attitude and said that nothing would improve on my original hip and that, no matter how bad the hip looked on the X-ray, as long as I could function and manage the pain, I should avoid surgical treatment and continue with my physio and general health measures. Happy days!

This experience reminded me of my own profession (including its history) and the training involved and how medical science has responded to Covid.

In the early years of training we were taught about the ‘old’ treatments and how advances in technology had changed the way we removed decay and designed restorative work (fillings, crowns and bridges etc.). After qualifying and through the years this theme continued. Restorative work involves working out how little, if any, healthy tooth tissue you can get away with removing. All our technology and materials still can’t beat the real thing.

Prevention of the causes of gum disease and tooth decay through education is therefore the most important aspect of dentistry in my opinion. Appropriately frequent monitoring (check-ups) – and treatment as a last resort.

The Bangladesh Mask Study Is a Missed Opportunity

On August 31st, a new randomised controlled trial on mask efficacy was published online. This study is the first of its kind. While the well-known Danish mask study looked at whether wearing a mask reduces one’s own risk of infection, the new study looked at whether community masking reduces the general level of infection.

The main argument for wearing a mask has always been that it makes infected people less likely to transmit the virus, rather than it provides any protection to the wearer. Hence the new study is a far more valid test of the claim that community masking ‘works’.

As I’ll explain, however, it’s a missed opportunity. And this is a shame because some aspects of the experimental design are quite powerful, and – given the number of people involved – it must have been very expensive (meaning there’s now less money available for the next big study).

The basic set-up was as follows. The authors randomly assigned 600 villages in rural Bangladesh – comprising more than 300,000 people – to one of two groups: an intervention group and a control group.

Villages in the intervention group received an eight-week mask promotion campaign, which involved distribution of masks, promotion of masks in public spaces, and role-modelling by community leaders (including imams at local mosques). Villages in the control group did not receive any interventions.

The main outcome variables were measures of seroprevalence. Using phone and in-person surveys, the researchers obtained data on the number of people who experienced COVID-19 symptoms after the intervention. They then collected blood samples from some of those individuals to gauge the number who were seropositive.

Overall, mask-wearing reached 42.3% in the intervention villages, compared to 13.3% in the control villages. What about the outcome variables? 7.6% of participants in the intervention villages reported COVID-19 symptoms, compared to 8.6% in the control villages.

And when the researchers zoomed in on those who reported COVID-19 symptoms and tested positive for antibodies, the seroprevalence was 0.68% in the intervention villages, versus 0.76% in the control villages. (Note: the figure in the chart below is ‘0.69’ because it’s an adjusted value from a model.)

New York Times Article Calls for Universal Masking in Schools, but It Doesn’t Stack Up

The authors of a recent New York Times op-ed describe universal masking as “one of the effective and efficient strategies for preventing SARS-CoV-2 transmission in schools”. And given the putative evidence supporting this measure, they ask rhetorically, “Why not require universal masking?”

The authors – a paediatrician and an epidemiologist – cite evidence from a recent study carried out in North Carolina. They collected data on COVID-19 infections among 864,515 students in the state’s school system from March 1st through June 25th, 2021. During this period, there was a mask mandate in place for all K-12 schools.

In total, 6,484 primary infections were recorded, and only 308 secondary infections. (Secondary infections refer to those among the contacts of students who were initially identified as infected.) “We believe this low rate of transmission occurred,” the authors write, because of universal masking.

By contrast, they note that “one school in Israel without a mask mandate… reported an outbreak of COVID-19 involving 153 students”. And “outbreaks at youth camps in Texas, Illinois and Florida show how quickly COVID-19 can spread among adolescents… who are largely unmasked”.

However, there are a number of problems with this argument. As you may have already noticed, there was no control group. The authors observed a low secondary attack rate, and then attributed this to the state’s mask mandate.

Yet infections were falling over the relevant time period in North Carolina as a whole. Only 390 cases were recorded on June 25th, compared to over 2,000 on March 2nd. And several previous studies have found “much lower” secondary attack rates among children, so it may not be that surprising the authors observed a low value.  

As David Zweig notes, schools in some parts of Europe and the U.S. did not have mask mandates, and there were no corresponding explosions of cases. What’s more, the Israeli study isn’t as clear-cut as the authors suggest. All schools in the country were exempt from masks for three days, so a single outbreak isn’t strong evidence for mask efficacy.

But put all that to one side. Suppose the authors are correct that universal masking reduces transmission in schools. Is it therefore worth doing? I would argue no.

First, there are tangible costs to mask-wearing. They’re uncomfortable. They get dirty. And they don’t allow you to see other people’s faces, which hampers learning (particularly for the youngest children) as well as social interaction more generally.

Second, it’s not even clear that we want to prevent children from becoming infected. For starters, they face an extremely low risk of death from COVID-19. According to a recent English study, the survival rate for under-18s is 99.995%. And if COVID-19 becomes endemic, which seems very likely, they’ll have to get it at some point. So why not now?

In fact, we might want to encourage children to become infected, the better to build up population immunity and protect the most vulnerable. (I’m of course exempting children who have a serious underlying health condition.)

Vaccination is another option, but I believe we should focus vaccines on those who actually need them, such as elderly people in other countries. And in any case, many people don’t want their children to be vaccinated.

The authors of the New York Times piece make two claims: universal masking cuts transmission in schools; and therefore we should require it. I’m sceptical of the first claim, but even if it’s true, the second doesn’t follow. Wearing masks is costly, and it’s not even clear we want to prevent infections among healthy children.

Kids have already paid a heavy price during the pandemic, thanks to months of ill-advised school closures. Rather than forcing them to wear masks, which could further diminish their learning, we should end the mandates and let them get back to normal.

Stop Press: For a rigorous and comprehensive review of the evidence on mask efficacy, see this piece in City Journal by Jeffrey H. Anderson, a former Director of the Bureau of Justice Statistics.