Excellent analysis. As noted, publication bias undermines any semblance of science in the MMWR and studies cited by the CDC. On careful reading of their Covid-related studies, the reader can detect value-laden (i.e. non-scientific) language that pushes an editorial narrative. Typically, this is to promote masking, vaccinations, social distancing, and to ignore infection-based immunity.
Here's another possible source of bias: Compared to the later to unmask districts, students at the wealthier and earlier to unmask districts travelled more widely during spring holiday and could have been more likely to pick up travel-related Covid.
Well, as noted before, the vaccinated seem to be dying from Covid at 3.25x the rate of the ‘unvaccinated’. And, since the ‘unvaccinated’ include those who have actually received the jab but not both jabs or have both jabs but not more than two weeks before, the actual risk ratio is much higher. Turns out that the shots produce an immune response that is ineffective against the current variants and suppresses you immune system too. So, maybe these shots are not such a good idea. Information courtesy of Epimetheus.
Thank you again for this analysis. Hopefully, you will send an editorial to NEJM.
You note that some schools may unmasked earlier than indicated in the article.
Perhaps it is worth to add that Brookline reinstated mask mandates on May 23. I do not know if other school districts did the same thing?
In addition to all your great comments on the Diff in Diff analysis, I also think one could comment on the Narrative in general of this article. For example, in the first lines, it is written:
"By the end of February 2022, children and ado-
lescents in the United States had a higher preva-
lence of infection with severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) than any
other age group;."
Perhaps this age group had a higher prevalence of infection; however, they would not have the highest prevalence of severe acute COVID-19. This narrative is repeated throughout the article.
Furthermore the estimates of additional cases in unmasked school districs are just wrong. There is no direct causal relation between unmasking in school and infection rates, and therefore one should refrain from making these kinds of "absolute number estimates".
As you also write, the article does not discuss the harms of masking.
In particular this sentence "To date, there is no clear evidence that masking inhibits learning or harms development."
I do not believe it is correct to write this There are studies showing harm to kids for example on learning language and social cues.
It is furthermore inappropriate to write that masks may put an end to structural racism. If you look at it from the other side, the conclusion could be that low-income kids were masked for extended periods, even though they probably were more immune than rich kids.
Finally the point you have regarding not taking back county COVID level and immunity level into account is important.
They didn't say that masks would mitigate structural racism, but that it might help mitigate the impact of structural racism.
Also, they actually mask kids a great deal MORE "across the pond" - "the pond" being the Pacific Ocean, without the apparent downsides that Tracey suggests are proven and while correlation isn't causation, (and I'd course there are confounders) in association with lower morbidity and mortality
It is likely that testing rates diverged when masks were removed. It was at just that time that home testing kits became freely available. My suburban district adopted a weekly home testing program which parents could opt into. It coincided with the lifting of the mandate. Other districts may have done something similar. It is likely that home testing regardless of symptoms increased more in the affluent suburban districts than in Boston and Chelsea. If so, that could account for much of the divergence in test positivity.
This is exactly the kind of pseudo-scientific garbage that lead me to cancel my NEJM subscription. When medicine and politics jump into bed together, you get politics.
If you gratuitously out yourself as a far left ideologue in a supposedly scientific paper, everything about your paper - which just so happens to reach a conclusion that supports a far left sacred cow (“mask mandates are awesome!”) - is automatically highly suspect. These people are not doing science. They’re doing modern Lysenkoism.
Thank you for this discussion of what appears to be a hugely scientifically-flawed article in what was formerly a highly trusted journal. The whole matter smacks of preconceived notions of social engineering where nothing like that should belong. The arguments here are revealing and convincing.
Massachusetts doctors in particular are more likely to be genuinely evil people compared to doctors in other parts of the country, speaking as someone who has worked with researchers nationwide. Highly overpaid, agenda-driven elites drunk on power and moral superiority.
Another way to assess the validity of the study would be to compare covid case rates among the schools districts that rescinded mask mandates at the same time. If rates vary between these districts as much as the variance between masked and non masked districts, that would provide further evidence that masks may not be the variable driving the differences in outcome.
We should be listening to the PPE Engineers. The only masks that work are fit-tested half-face respirators. Google it, they are funny looking. The virus is too small for anything else to work.
Yet another abysmal failure of "experts" and leaders to be have the courage to be truthful. Observational study done and published only to support the prevailing narrative.
So Parents of Boston, rest assure that this will be used to MASK your children again!! I implore you Speak up and fight for your children.
Excellent work. If anything, this critique is more charitable than Ian Miller's:
https://ianmsc.substack.com/p/boston-school-masking-study-is-an
https://www.acpjournals.org/doi/10.7326/m22-3219
Excellent analysis. As noted, publication bias undermines any semblance of science in the MMWR and studies cited by the CDC. On careful reading of their Covid-related studies, the reader can detect value-laden (i.e. non-scientific) language that pushes an editorial narrative. Typically, this is to promote masking, vaccinations, social distancing, and to ignore infection-based immunity.
Here's another possible source of bias: Compared to the later to unmask districts, students at the wealthier and earlier to unmask districts travelled more widely during spring holiday and could have been more likely to pick up travel-related Covid.
If RSV is spread by droplets then it’s quite possible masks would reduce that
Well, as noted before, the vaccinated seem to be dying from Covid at 3.25x the rate of the ‘unvaccinated’. And, since the ‘unvaccinated’ include those who have actually received the jab but not both jabs or have both jabs but not more than two weeks before, the actual risk ratio is much higher. Turns out that the shots produce an immune response that is ineffective against the current variants and suppresses you immune system too. So, maybe these shots are not such a good idea. Information courtesy of Epimetheus.
Thank you again for this analysis. Hopefully, you will send an editorial to NEJM.
You note that some schools may unmasked earlier than indicated in the article.
Perhaps it is worth to add that Brookline reinstated mask mandates on May 23. I do not know if other school districts did the same thing?
In addition to all your great comments on the Diff in Diff analysis, I also think one could comment on the Narrative in general of this article. For example, in the first lines, it is written:
"By the end of February 2022, children and ado-
lescents in the United States had a higher preva-
lence of infection with severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) than any
other age group;."
Perhaps this age group had a higher prevalence of infection; however, they would not have the highest prevalence of severe acute COVID-19. This narrative is repeated throughout the article.
Furthermore the estimates of additional cases in unmasked school districs are just wrong. There is no direct causal relation between unmasking in school and infection rates, and therefore one should refrain from making these kinds of "absolute number estimates".
As you also write, the article does not discuss the harms of masking.
In particular this sentence "To date, there is no clear evidence that masking inhibits learning or harms development."
I do not believe it is correct to write this There are studies showing harm to kids for example on learning language and social cues.
It is furthermore inappropriate to write that masks may put an end to structural racism. If you look at it from the other side, the conclusion could be that low-income kids were masked for extended periods, even though they probably were more immune than rich kids.
Finally the point you have regarding not taking back county COVID level and immunity level into account is important.
Thank you again.
Really good analysis. Thank you! You digested this enough for a rural PA like me to understand and hopefully explain to others.
Would recommend fixing the numerous grammatical errors and typos in the last half of this post to make it more understandable for the general public.
Typically misleading from Vinay
They didn't say that masks would mitigate structural racism, but that it might help mitigate the impact of structural racism.
Also, they actually mask kids a great deal MORE "across the pond" - "the pond" being the Pacific Ocean, without the apparent downsides that Tracey suggests are proven and while correlation isn't causation, (and I'd course there are confounders) in association with lower morbidity and mortality
It is likely that testing rates diverged when masks were removed. It was at just that time that home testing kits became freely available. My suburban district adopted a weekly home testing program which parents could opt into. It coincided with the lifting of the mandate. Other districts may have done something similar. It is likely that home testing regardless of symptoms increased more in the affluent suburban districts than in Boston and Chelsea. If so, that could account for much of the divergence in test positivity.
This is exactly the kind of pseudo-scientific garbage that lead me to cancel my NEJM subscription. When medicine and politics jump into bed together, you get politics.
If you gratuitously out yourself as a far left ideologue in a supposedly scientific paper, everything about your paper - which just so happens to reach a conclusion that supports a far left sacred cow (“mask mandates are awesome!”) - is automatically highly suspect. These people are not doing science. They’re doing modern Lysenkoism.
Thank you for this discussion of what appears to be a hugely scientifically-flawed article in what was formerly a highly trusted journal. The whole matter smacks of preconceived notions of social engineering where nothing like that should belong. The arguments here are revealing and convincing.
Massachusetts doctors in particular are more likely to be genuinely evil people compared to doctors in other parts of the country, speaking as someone who has worked with researchers nationwide. Highly overpaid, agenda-driven elites drunk on power and moral superiority.
Another way to assess the validity of the study would be to compare covid case rates among the schools districts that rescinded mask mandates at the same time. If rates vary between these districts as much as the variance between masked and non masked districts, that would provide further evidence that masks may not be the variable driving the differences in outcome.
We should be listening to the PPE Engineers. The only masks that work are fit-tested half-face respirators. Google it, they are funny looking. The virus is too small for anything else to work.
https://www.youtube.com/watch?v=oYEo4T6V25w
Yet another abysmal failure of "experts" and leaders to be have the courage to be truthful. Observational study done and published only to support the prevailing narrative.
So Parents of Boston, rest assure that this will be used to MASK your children again!! I implore you Speak up and fight for your children.