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Studies Have Yet to Show Face Masks Protect Public from COVID-19

Responding to omicron, the latest COVID-19 variant, some public officials and private employers have imposed or reimposed mandated masking to help stem the disease’s transmission.

“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,” write Ian T. Liu, Vinay Prasad, and Jonathan J. Darrow in “Evidence for Community Cloth Face Masking to Limit the Spread of SARS‐​CoV‑2: A Critical Review,” a working paper published by the Cato Institute on November 8, 2021.

“The available clinical evidence of facemask efficacy is of low quality and the best available clinical evidence has mostly failed to show efficacy, with 14 of 16 identified randomized controlled trials comparing face masks to no mask controls failing to find statistically significant benefit in the intent-to-treat populations,” write the authors.

Doubts Raised Before Pandemic

Prior to the pandemic, there was scant evidence that masking—“at least as commonly practiced in the United States, using cloth masks—is effective at suppressing various types of respiratory infection,” the authors write.

They note that in the surgical operating room context, a review by the Cochrane Collaboration—a nonprofit that provides comprehensive summaries of evidence on various medical topics—found “no statistically significant difference in infection rates between the masked and unmasked group in any in any of the trials.”

A Cochrane review of masking and influenza-like illness found “that wearing a mask may make little or no difference to the outcome of influenza-like illness … compared to not wearing a mask,” write the Cato authors.

WHO Was Skeptical?

The World Health Organization (WHO) was initially skeptical about the usefulness of having the public wear cloth masks to stem the spread of the coronavirus. The WHO’s initial COVID-19 guidelines stated that “cloth (e.g., cotton or gauze) are not recommended under any circumstance.” In a subsequent update, the WHO noted “the widespread use of masks by healthy people is not yet supported by high quality or direct scientific evidence.”

Nevertheless, by September 2020, the U.S. government had distributed 600 million facemasks to the public, and 32 states and numerous municipalities implemented local mask mandates at some point.

New York City slapped a $1,000 fine on those refusing to wear a mask in public, and presidential candidate Joe Biden declared in a speech, “Wearing a mask is not a political statement, it is a scientific imperative.”

Little Evidence Masks Effective

There is a widespread misconception infectious particles are primarily emitted during forceful expiration such as sneezing, but little evidence frequent public sneezing has led to the spread of the virus, write the authors.

Larger “droplets” (greater than 10 micrometers) and smaller “aerosols” containing the virus are more infectious.

“The greater the role of aerosols in spreading SARS-CoV-2, the less important is the filtering capability of masks, because exhaled air easily flows around a mask’s edges,” the authors of the Cato paper write in a summary of their findings in the journal Regulation (Winter 2021-2022). “The extent to which droplets penetrate a mask has not been established as a reliable surrogate for the prevention of disease transmission.”

Randomized Controlled Trials?

The best evidence of masks’ effectiveness would be from cluster-random-controlled trials (RCTs) showing individuals wearing cloth masks have lower viral spread than those not wearing cloth masks, with high participation and adherence to protocols, write the Cato authors.

“The only two sizeable studies evaluating masks in the context of COVID-19 failed to demonstrate statistically significant reductions in confirmed viral transmission either for surgical masks (one study) or for cloth masks (the other study),” they write.

Others have expressed doubts about the wisdom of mandatory masking. “Many schools force children to wear masks, contrary to very clear science and simple logic,” writes Scott Atlas, M.D., a radiologist, and former Trump administration health care adviser, in A Plague Upon Our House: My Fight at the Trump White House to Stop COVID from Destroying America. “Must we prove that the earth is round again?” Atlas writes.

‘Preconceived Notions’

“More than a century after the 1918 influenza pandemic, examination of the efficacy of cloth masks has produced a large volume of mostly low-quality evidence that has generally failed to demonstrate their value in most settings,” write the Cato authors in Regulation.

 “When repeated attempts are undertaken to demonstrate an expected or desired outcome, there is the risk of declaring the effort resolved once results consistent with preconceived notions are generated, regardless of the number and extent of previous failures,” write the Cato authors.

Masking is an instrument of political control and does nothing to protect public health, Joel S. Hirschhorn, author of Pandemic Blunder: Fauci and Public Health Blocked Early Home COVID Treatment, told Health Care News.

“I have been firmly convinced during the pandemic that there is no reliable scientific basis for believing that masking is an effective contagion-control measure,” said Hirschhorn. “Masking is used by incompetent public health officials to control lives, not to protect lives. From the earliest days of the pandemic, there were reliable test data showing the ineffectiveness of masking.  It continues as political action, not as a needed or sensible public health strategy.”

Chad Savage, M.D., founder of YourChoice Direct Care and policy advisor to The Heartland Institute, which publishes Health Care News concurs.  

“Despite the lack of substantial, quality evidence of mask efficacy, many continue to push for broad masking,” said Savage. “This is likely due to the need to do ‘something’ against a scary contagion. For to admit the lack of mask-efficacy is to deprive oneself of the perception of a nidus of control and the concept that we may have no agency is beyond many to accept no matter the evidence.”

Bonner R. Cohen, Ph.D. (bcohen@nationalcenter.org) is a senior fellow at the National Center for Public Policy Research.

Internet info:

Ian T. Liu, J.D., Vinay Prasad, M.D., Jonathan L. Darrow, S.J.D., “Evidence of Community Cloth Face Masking to Limit the Spread of SARS-CoV-2: A Critical Review,” Cato Institute,  November 8, 2021: https://www.cato.org/sites/cato.org/files/2021-11/working-paper-64.pdf

Bonner R Cohen
Bonner R Cohen
Bonner R. Cohen is a senior fellow with the National Center for Public Policy Research, a position he has held since 2002.

9 COMMENTS

  1. The discussion surrounding masks to mitigate the spread of viruses has become much too political, lacking common sense. Government’s mandates have caused many to adopt the “you can’t make me do it” syndrome. If you can limit exposure to Covid, flu, or ANY pathogen, then why not do it? People are now not making the logical decision to don a well- fitting n95 mask (which IS effective to some extent) because of the political/fashionable context of the issue. The big mistake of government was in trying to coerce people instead of just suggesting that they might avoid disease by looking silly with a mask on. If I am in a crowd with virus of any type floating around, I wear the n95 mask. It is simply common sense. This article is about cloth masks which are a waste of time and should not be confused with masks with high filtration and low leakage.

    • I fully agree that the government has made things worse by forcing Americans to take actions that violate their good common sense. It is puzzling to me what public situation would require an n95 masks today, unless you are a first responder or facing some grave calamity where breathable air is toxic. We have survived for hundreds of years without n95 masks. Secondly, n95s have to be fitted properly and are not reuseable as the cloth mask. The cloth mask is a charade. Governors ordered them and now local health departments, cities like NY and DC, to show the public “they’re responding to the ‘virus.’ I think the public is finally getting smart to this ruse.

    • If they cared about health they would tell you how to build our immune system and stop putting crap in the foods that make you sick in the first place.

    • This article includes surgical masks too. They discus them twice.

      First I want to say our government has been remiss in their approach to PPE. Doctors and scientists use PPE. However, they are not PPE experts. The experts are Industrial Hygenist, who develope protocols and scientifically evaluate everything from engineering controls i.e. dilution, filtration, ventilation, masks, respirators etc… you get the idea.

      SM, you’re saying the public should move from masks to N95 and I assume that includes KN95 respirators. According to the Engineering Hygiene Hierarchy of Controls the N95/KN95 are the lowest grade of respirators. These low grade respirators are a 1 time use, meaning after 1 use they must be thrown away. They also come in S M L so choosing the correct size is essential and a perfect seal must be made.

      A quick look at these respirators: KN95 with a perfect seal is @ 46.3% effective. A KN95 with gaps is 3.4% effective. However, the KN95 during 2020-2021 failed NIOSH requiremenys 60% of the time. Meaning only 40% would give you 46.3% efficacy if perfectly fitted or 3% if not. With some differences KN95 and N95 are nearly the same. Lets look at N95. Being the lowest grade of respirators the N95, perfectly fitting, will provide 95% protection from partials 0.3 micron Covid-19 is 0.1 microns.

      OHSA is the governing body that writes the rules and regulations…so lets take a quick look.
      Here are some of the requirements for respirators:
      A medical clearance to use it
      No facial hair
      Initial fit requirement
      Training on how to use

      3M manufacturers N95 respirators here are some of their limitations in the paperwork accompanying a box:

      Not designed for children

      Only designed for adult occupational settings and trained – Code 29 CFR 1910.13 OSHA

      Must be medically cleared

      Failure to follow instructions may result in death

      Must be able to seal or do not use.

      As you can see, these respirators are not exactly what you think they are, sorry, but it’s true.

  2. I guess most of you missed the early Japanese articles of the restaurant, where the SARS-COV 2 carrier was seated under a vent, and the other patrons “downwind” uniformly were infected- but not patrons seated elsewhere. Airborne is airborne. Any barrier or dispersant, will reduce chances of infection. Don’t wear a mask or mitigate risk: no problem- we’ll send you the $150,000 ICU bill, or your survivor family will receive it! Masks are a simple answer.

    • The situation in the Japanese restaurant is very obviously different from long hours of masking with masks of dubious quality, often worn improperly, with few or no air currents present in the room. But don’t let that stop your guilt tripping.

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