For me this subject always misses the elephant in the room. We can propose a policy, mandated or not. We can do experiments, randomised or not. We can set best practices. But we cannot ever forget human nature and the nature of living which is that it is incredibly difficult if not impossible to keep up the standards required to make masking a way of preventing respiratory infection over more than a very short duration.
When I was studying UK Health and Safety regulations and reading about PPE in the workplace, every H&S measure was considered in relation to the difficulty of doing it consistently and for any length of time. As such PPE, which includes all sorts of masks, was recommended to be the option of last resort because it was well known how difficult it was to adopt and sustain.
Until the idea of 'masking forever' or even 'masking when someone else demands it' takes on board the practical realities of human behaviour, the success of any policy will be subject to inevitable failures that have nothing to do with the masks themselves but everything to do with how difficult it is to use them CORRECTLY, hour after hour, day after day, month after month because this method only works if it is done perfectly, every time at every encounter regardless of the risk. More than this, everyone knows the risk is often incredibly low and many wish to take a higher risk for the obvious reward they get from not wearing a mask perfectly day after day etc.
Inevitably humans start to negotiate and bargain with the level of perfect behaviour needed for long periods of mask wearing but which is so difficult to sustain. The longer time goes on, the less effective the measure is going to be and I can't see any way around it except to set a policy that, like other H&S PPE regulations requires that everything else that can be done is done first and that the wearing of PPE is kept to the absolute minimum one can. In this way, the importance of putting on the mask, wearing it correctly and disposing of it correctly is focused and at a high level WHEN you use it and not diluted by the burden of endless use in unnecessary and burdensome situations.
I think you're using one context to infer value in another (though unstated).
There's never been much debate about the usefulness of wearing a TIGHT fitting, PROPERLY sealed, SHORT-TIME, UNTOUCHED, with proper protocols, N95, in an infectious room.
Your article is running around this one context. But that's really neither here nor there.
The big social debate is on the non-value of community masking.
Cloth masks and surgical masks do nothing (evidence), N95s, SEALED, SHORT-TIME, UNTOUCHED, can have SOME value, in one particular closed space. As soon as you're moving from space to space, or moving it around, or on/off-ing it for sips and snacks, then it has zero value.
In a surgical setting, a surgical mask.
In one hospital room with one patient with UNKNOWN or crazy deadly contagion, sure.
But this virus never justified any of this fear.
It's a virus that kills less than 0.05% of humanity, 3/4 of which were over 80.
It should never have been called a "pandemic" (unless the word pandemic has no material definition).
It was not "novel".
This article fails to address any of the debates of the past 31 months.
Two decades ago, when surgical masks were starting to penetrate the field of dentistry, the dentists fought back hard. But LIABILITY issues, not science, ended up winning the day.
There's been no reduction in illness with dentists who surgical mask.
The entire debate is simply so hyperbolic as to be laughable, were we not crying at the degree of germophobia we this creates in society.
Germophobia, fear, anxiety, are worse for the immune system than this virus.
We lived for years with option #3 prior to Covid and need to continue to do so for the reasons you have laid out, that most people are now immune. The folks who are at risk can wear masks.
No I did not change anything in regards to Vitamin D. Yes maybe a mild case of Covid19 would protect me from a worse case later on, but that is a faulty strategy because there is no guarantee at all that my first case would be mild or even that I would survive it. I am not turning myself into "dry tinder" by masking, assuming it is as effective as I believe it is, because I'm getting vaccinated and boosted. Yes, for a period of time measurable in months, having Covid19 infection plus vaccination would be more effective than vaccination alone. But at my age over 60 that's not a risk worth taking. And given that in my sphere there are people even MORE at risk than I am, getting Covid19 on purpose is a highly faulty strategy because I could infect them. Especially if I should buy into the also faulty assumption that masks don't work. Parties aren't as important as the life of my husband and mother, so mostly I avoid them, and I don't feel that my life suffers in missing them. If there's a very important event such as a funeral, I will attend, but mask.
Your premises A and C are false. You didn't fail to get COVID because you and your patients were wearing "first cloth and then surgical masks. If you don't understand or agree with the physics, I can show you 74 years of meta-analyses of RCTs that show, in not a single case, did mask use significantly reduce transmission of laboratory confirmed influenza and three years of studies and hundreds of graphs showing the same for SARS-2. Please agree to a debate with someone if you believe otherwise. Masks should only be used when warranted. They are SPLASH GUARDS- that's all they are (read all about it in my book "Heroes and Villains: The COVID-19 Book of Lists" available Wednesday, October 5, 2022 at heroesandvillainsbooks.com"
I'm a surgeon. When I have to intubate someone in the ER, I wear a mask and even a plastic shield if it doesn't interfere with my vision because the patient is going to fight me, spit on me, etc. They're worthless in blocking respiratory infections.
Today, the battle against science and conversation is being fought in California, where penalization of physicians' voices which don't match the official narrative is being enshrined into law.
Will any of these doctor authors here speak out against the California law? Does doctors' freedom to voice dissenting opinions matter to them?
Another question is "should we try to avoid all illnesses?" Will not getting sick improve our natural immune systems or degrade them? Maybe being exposed to various viruses, etc is actually a good thing for us? What are we so scared of?
Thank you for the essay. I think it’s pretty simple. Run the cluster RCT and gather evidence. The down side of proposal #1 is that you are making assumptions on effectiveness based on anecdotal evidence. If your anecdotes/assumption A are not representative then advocating for mandatory masking may have the paradoxical effect of putting those at risk or uncomfortable with risk in higher risk situations then they are comfortable with because they feel “safe” wearing a mask. They lose and harm is done by masking when uncertain of the real benefit.
There is no scientific data concluding with a sufficient degree of certainty that masks reduce respiratory infections in any setting. Maybe you should read the literature and that will clarify your doubts.
PS: People promoting the use of masks to prevent respiratory contagions are a danger, not to public health, but to civilization as a whole. So you better clarify yourselves very soon "experts".
The main thing that you have missed is any real discussion of evidence ... you are trying to shape policy based on (informed) anecdotes, and this is as useful as a civil engineer building a bridge based on what feels right.
With respect to mandatory masks, I know of people who have not gotten any healthcare (including emergency room visits!) in the last two years because they physically cannot tolerate masks. Initially, there were carve outs for such people, but once masking became commonplace, the carve outs disappeared. Human nature should not be ignored.
I’ve not read all the comment thread, but so far I haven’t seen mention of what I consider the obvious point that our immunity is based on exposure. Our bodies NEED to ‘see’ antigens in order to create immunity. Continued masking will decrease exposures and weaken our population immunity, being detrimental overall if we continue this practice.
Compared with surgical 😷, N95/P2 😷 have "no statistically significant difference in..preventing SARS-CoV-2 infection" but cause "significantly more headaches, respiratory distress, facial irritation and pressure-related injuries". https://pubmed.ncbi.nlm.nih.gov/35151628/
I wish I could accept the author's unalterable premises about the efficacy of masking; it feels rude not to do so. They just are so contrary to what I have read on the issue, and what evidence the world has seen play out with this pandemic.
For instance, why is it that over the past century, the medical world missed the "fact" that surgical masks inhibit the transmission of aerosolized respiratory viruses? There also were high-quality studies done in modern times (early 2000's?) where nurses working in hospitals wore surgical masks during flu season. There was no protective effect against flu transmission for the nurses or for the patients. Finally, there are endless examples from the past few years where masking can be compared on a large scale. School systems from the same general community where some schools masked and some did not. Japanese schools where kindergarten students did not have to mask but first graders did. States that mandated masking and states that did not. An early high-quality study done in Europe (I think it was the Netherlands) where two adjacent counties, pre-masking, were determined to have identical demographics and rates of transmissions. One county then masked and the other didn't. What they found was there was no protective effect at all for the mask-wearer, and a very tiny decrease in transmission rates in the county that masked. That's just what I can remember off the top of my head.
If masking worked, the medical profession would have noticed it decades ago. If masking worked, then the difference between states and towns and school systems and countries who masked or didn't mask would by now have resulted in an unmistakable blaring siren of a signal.
Well, lookie here. Did anyone check the CDC website to see that it dropped its mask mandate guidelines for healthcare facilities (in the middle night, no doubt)? Guess I should change my vote to Proposal #3 and join the prescient 65%. Of course nothing the CDC does has any "science" behind it so....
Here's a pejorative piece from Ian Miller to get your blood boiling this AM:
For me this subject always misses the elephant in the room. We can propose a policy, mandated or not. We can do experiments, randomised or not. We can set best practices. But we cannot ever forget human nature and the nature of living which is that it is incredibly difficult if not impossible to keep up the standards required to make masking a way of preventing respiratory infection over more than a very short duration.
When I was studying UK Health and Safety regulations and reading about PPE in the workplace, every H&S measure was considered in relation to the difficulty of doing it consistently and for any length of time. As such PPE, which includes all sorts of masks, was recommended to be the option of last resort because it was well known how difficult it was to adopt and sustain.
Until the idea of 'masking forever' or even 'masking when someone else demands it' takes on board the practical realities of human behaviour, the success of any policy will be subject to inevitable failures that have nothing to do with the masks themselves but everything to do with how difficult it is to use them CORRECTLY, hour after hour, day after day, month after month because this method only works if it is done perfectly, every time at every encounter regardless of the risk. More than this, everyone knows the risk is often incredibly low and many wish to take a higher risk for the obvious reward they get from not wearing a mask perfectly day after day etc.
Inevitably humans start to negotiate and bargain with the level of perfect behaviour needed for long periods of mask wearing but which is so difficult to sustain. The longer time goes on, the less effective the measure is going to be and I can't see any way around it except to set a policy that, like other H&S PPE regulations requires that everything else that can be done is done first and that the wearing of PPE is kept to the absolute minimum one can. In this way, the importance of putting on the mask, wearing it correctly and disposing of it correctly is focused and at a high level WHEN you use it and not diluted by the burden of endless use in unnecessary and burdensome situations.
I think you're using one context to infer value in another (though unstated).
There's never been much debate about the usefulness of wearing a TIGHT fitting, PROPERLY sealed, SHORT-TIME, UNTOUCHED, with proper protocols, N95, in an infectious room.
Your article is running around this one context. But that's really neither here nor there.
The big social debate is on the non-value of community masking.
Cloth masks and surgical masks do nothing (evidence), N95s, SEALED, SHORT-TIME, UNTOUCHED, can have SOME value, in one particular closed space. As soon as you're moving from space to space, or moving it around, or on/off-ing it for sips and snacks, then it has zero value.
In a surgical setting, a surgical mask.
In one hospital room with one patient with UNKNOWN or crazy deadly contagion, sure.
But this virus never justified any of this fear.
It's a virus that kills less than 0.05% of humanity, 3/4 of which were over 80.
It should never have been called a "pandemic" (unless the word pandemic has no material definition).
It was not "novel".
This article fails to address any of the debates of the past 31 months.
Two decades ago, when surgical masks were starting to penetrate the field of dentistry, the dentists fought back hard. But LIABILITY issues, not science, ended up winning the day.
There's been no reduction in illness with dentists who surgical mask.
The entire debate is simply so hyperbolic as to be laughable, were we not crying at the degree of germophobia we this creates in society.
Germophobia, fear, anxiety, are worse for the immune system than this virus.
We lived for years with option #3 prior to Covid and need to continue to do so for the reasons you have laid out, that most people are now immune. The folks who are at risk can wear masks.
No I did not change anything in regards to Vitamin D. Yes maybe a mild case of Covid19 would protect me from a worse case later on, but that is a faulty strategy because there is no guarantee at all that my first case would be mild or even that I would survive it. I am not turning myself into "dry tinder" by masking, assuming it is as effective as I believe it is, because I'm getting vaccinated and boosted. Yes, for a period of time measurable in months, having Covid19 infection plus vaccination would be more effective than vaccination alone. But at my age over 60 that's not a risk worth taking. And given that in my sphere there are people even MORE at risk than I am, getting Covid19 on purpose is a highly faulty strategy because I could infect them. Especially if I should buy into the also faulty assumption that masks don't work. Parties aren't as important as the life of my husband and mother, so mostly I avoid them, and I don't feel that my life suffers in missing them. If there's a very important event such as a funeral, I will attend, but mask.
Your premises A and C are false. You didn't fail to get COVID because you and your patients were wearing "first cloth and then surgical masks. If you don't understand or agree with the physics, I can show you 74 years of meta-analyses of RCTs that show, in not a single case, did mask use significantly reduce transmission of laboratory confirmed influenza and three years of studies and hundreds of graphs showing the same for SARS-2. Please agree to a debate with someone if you believe otherwise. Masks should only be used when warranted. They are SPLASH GUARDS- that's all they are (read all about it in my book "Heroes and Villains: The COVID-19 Book of Lists" available Wednesday, October 5, 2022 at heroesandvillainsbooks.com"
I'm a surgeon. When I have to intubate someone in the ER, I wear a mask and even a plastic shield if it doesn't interfere with my vision because the patient is going to fight me, spit on me, etc. They're worthless in blocking respiratory infections.
Okay, Thanks Tom.
Today, the battle against science and conversation is being fought in California, where penalization of physicians' voices which don't match the official narrative is being enshrined into law.
Will any of these doctor authors here speak out against the California law? Does doctors' freedom to voice dissenting opinions matter to them?
Another question is "should we try to avoid all illnesses?" Will not getting sick improve our natural immune systems or degrade them? Maybe being exposed to various viruses, etc is actually a good thing for us? What are we so scared of?
Thank you for the essay. I think it’s pretty simple. Run the cluster RCT and gather evidence. The down side of proposal #1 is that you are making assumptions on effectiveness based on anecdotal evidence. If your anecdotes/assumption A are not representative then advocating for mandatory masking may have the paradoxical effect of putting those at risk or uncomfortable with risk in higher risk situations then they are comfortable with because they feel “safe” wearing a mask. They lose and harm is done by masking when uncertain of the real benefit.
How on earth did we even get to this place? Mandating masks in healthcare facilities is utterly absurd.
Hi Adam Cifu
There is no scientific data concluding with a sufficient degree of certainty that masks reduce respiratory infections in any setting. Maybe you should read the literature and that will clarify your doubts.
PS: People promoting the use of masks to prevent respiratory contagions are a danger, not to public health, but to civilization as a whole. So you better clarify yourselves very soon "experts".
Kind Regards,
Agu
The main thing that you have missed is any real discussion of evidence ... you are trying to shape policy based on (informed) anecdotes, and this is as useful as a civil engineer building a bridge based on what feels right.
With respect to mandatory masks, I know of people who have not gotten any healthcare (including emergency room visits!) in the last two years because they physically cannot tolerate masks. Initially, there were carve outs for such people, but once masking became commonplace, the carve outs disappeared. Human nature should not be ignored.
I’ve not read all the comment thread, but so far I haven’t seen mention of what I consider the obvious point that our immunity is based on exposure. Our bodies NEED to ‘see’ antigens in order to create immunity. Continued masking will decrease exposures and weaken our population immunity, being detrimental overall if we continue this practice.
Compared with surgical 😷, N95/P2 😷 have "no statistically significant difference in..preventing SARS-CoV-2 infection" but cause "significantly more headaches, respiratory distress, facial irritation and pressure-related injuries". https://pubmed.ncbi.nlm.nih.gov/35151628/
I wish I could accept the author's unalterable premises about the efficacy of masking; it feels rude not to do so. They just are so contrary to what I have read on the issue, and what evidence the world has seen play out with this pandemic.
For instance, why is it that over the past century, the medical world missed the "fact" that surgical masks inhibit the transmission of aerosolized respiratory viruses? There also were high-quality studies done in modern times (early 2000's?) where nurses working in hospitals wore surgical masks during flu season. There was no protective effect against flu transmission for the nurses or for the patients. Finally, there are endless examples from the past few years where masking can be compared on a large scale. School systems from the same general community where some schools masked and some did not. Japanese schools where kindergarten students did not have to mask but first graders did. States that mandated masking and states that did not. An early high-quality study done in Europe (I think it was the Netherlands) where two adjacent counties, pre-masking, were determined to have identical demographics and rates of transmissions. One county then masked and the other didn't. What they found was there was no protective effect at all for the mask-wearer, and a very tiny decrease in transmission rates in the county that masked. That's just what I can remember off the top of my head.
If masking worked, the medical profession would have noticed it decades ago. If masking worked, then the difference between states and towns and school systems and countries who masked or didn't mask would by now have resulted in an unmistakable blaring siren of a signal.
Well, lookie here. Did anyone check the CDC website to see that it dropped its mask mandate guidelines for healthcare facilities (in the middle night, no doubt)? Guess I should change my vote to Proposal #3 and join the prescient 65%. Of course nothing the CDC does has any "science" behind it so....
Here's a pejorative piece from Ian Miller to get your blood boiling this AM:
https://www.outkick.com/cdc-quietly-ends-recommendation-for-universal-masking-in-healthcare-facilities/