A Look at Evidence for Mask Effectiveness vs. COVID-19

(Note: CDC does not recommend masks for children under age 2.)

Curiosity might kill cats but it’s a really good thing in humans. We could all use more of it. I offer the following to the masks-vs-COVID curious. My view on both mask use and hydroxychloroquine (HCQ) use—along with most other COVID-related questions—has been that being dogmatic isn’t appropriate either way.

That said, my overall impression of the evidence continues to be that masks are very likely somewhat helpful and HCQ very likely isn’t. This post focuses on masks.

Types of Evidence

Evidence comes in many forms. Here I’ll look at these categories:

  1. Studies of studies: analyses of lots of studies, often referred to as “meta-analysis.” (See What Is a Systematic Review/Meta-analysis?)
  2. Randomized controlled trials (RCTs): studies that include a randomized control group for comparison purposes and for isolating the variable being tested. Double-Blind Placebo Controlled Trials (DBPCTs) are a type of RCT used when tests of substances are involved. If you have gaps in your background, or need a refresher, some reading:

An RCT is a study design that is generally used in experiments testing the effectiveness and/or safety of one or more interventions. The intervention being tested is allocated to two or more study groups that are followed prospectively, outcomes of interest are recorded, and comparisons are made between intervention and control groups. The control group may receive no intervention, a standard treatment, or a placebo. The intervention can be therapeutic or preventive and does not necessarily have to be a pharmaceutical agent or a surgical intervention.

  1. Other kinds of studies and investigations: items from “rigorous but only indirectly relevant” to “study design not clear” to “anecdotal.”
  2. Independent organizations of professionals experienced in the most relevant fields.

1. Studies of Studies

The Lancet Meta-Analysis

June 2020. Full title: Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis

Our search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25 697 patients). [Emphsis added]

A Summary of findings:

The findings of this systematic review of 172 studies (44 comparative studies; n=25 697 patients) on COVID-19, SARS, and MERS provide the best available evidence that current policies of at least 1 m physical distancing are associated with a large reduction in infection, and distances of 2 m might be more effective. These data also suggest that wearing face masks protects people (both health-care workers and the general public) against infection by these coronaviruses, and that eye protection could confer additional benefit. However, none of these interventions afforded complete protection from infection, and their optimum role might need risk assessment and several contextual considerations. No randomised trials were identified for these interventions in COVID-19, SARS, or MERS

Note that The Lancet here uses a space where we use a comma in large numbers, so “25 697” is 25,697. In statistics “n” stands for the number of data points—in this case, people.

A bit more detail from the study:

Face mask use could result in a large reduction in risk of infection … with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12–16-layer cotton masks; pinteraction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD –10·6%, 95% CI –12·5 to –7·7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings.

The Lancet study sees a pattern of benefit for both n95 and high quality non-n95 masks but cautions that RCTs are needed to arrive at anything like certainty.

International Journal of Nursing Studies Review

August 2020. Full title: A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients.

A systematic review of randomized controlled clinical trials on use of respiratory protection by healthcare workers, sick patients and community members was conducted. Articles were searched on Medline and Embase using key search terms. [Emphasis added.]

The studies analyzed go back years and don’t specifically examine SARS-CoV-2. They’re RCTs of how respiratory viruses, especially flu viruses, are hindered by masks. The study includes these observations:

The study suggests that community mask use by well people could be beneficial, particularly for COVID-19, where transmission may be pre-symptomatic. The studies of masks as source control also suggest a benefit, and may be important during the COVID-19 pandemic in universal community face mask use as well as in health care settings. Trials in healthcare workers support the use of respirators continuously during a shift. This may prevent health worker infections and deaths from COVID-19, as aerosolisation in the hospital setting has been documented.

“Source control” here refers to people with symptoms known to be infected.

It may also help to note that in the studies, close fitting masks meeting the N95 standard or better are often referred to as “respirators” rather than “masks.” “Medical masks” are distinct from N95 respirators, and “cloth masks” or “face masks” refer to masks not manufactured for health care workers in clinical environments. (For more, see FDA: N95 Respirators Surgical Masks, and Face Masks.)

In general, the results show protection for healthcare workers and community members, and likely benefit of masks used as source control. We found eight clinical trials … on the use of masks in the community (Table 1).…

To date, six randomised controlled trials … have been conducted on the use of masks and/or respirators by healthcare workers in health care settings (Table 2).

The analysis includes remarks about studies that attempted to compare respirator effectiveness to surgical mask effectiveness in clinical settings. It isn’t yet clear to me what the authors are saying on that point, but it doesn’t appear to be relevant to the overall picture.

2. Randomized Controlled Trials

The two RCT lists below are all from the International Journal of Nursing Studies meta-analysis above. I’m listing these here for convenience as evidence that RCTs of mask effectiveness against viruses do exist. Some have existed for more than a decade.

Community mask RCTs

  • B.J. Cowling, R.O. Fung, C.K. Cheng, V.J. Fang, K.H. Chan, W.H. Seto, et al. Preliminary findings of a randomized trial of non-pharmaceutical interventions to prevent influenza transmission in households. PLoS ONE, 3 (5) (2008), p. e2101
  • C.R. MacIntyre, S. Cauchemez, D.E. Dwyer, H. Seale, P. Cheung, G. Browne, et al. Face mask use and control of respiratory virus transmission in households. Emerg. Infect. Dis., 15 (2) (2009), p. 233
  • B.J. Cowling, K.H. Chan, V.J. Fang, C.K. Cheng, R.O. Fung, W. Wai, et al. Facemasks and hand hygiene to prevent influenza transmission in households: a cluster randomized trial. Ann. Intern. Med., 151 (7) (2009), pp. 437-446.
  • A.E. Aiello, G.F. Murray, V. Perez, R.M. Coulborn, B.M. Davis, M. Uddin, et al. Mask use, hand hygiene, and seasonal influenza-like illness among young adults: a randomized intervention trial. J. Infect. Dis., 201 (4) (2010), pp. 491-498.
  • A.E. Aiello, V. Perez, R.M. Coulborn, B.M. Davis, M. Uddin, A.S. Monto. Facemasks, hand hygiene, and influenza among young adults: a randomized intervention trial. PLoS ONE, 7 (1) (2012).
  • E.L. Larson, Y.-.H. Ferng, J. Wong-McLoughlin, S. Wang, M. Haber, S.S. Morse. Impact of non-pharmaceutical interventions on URIs and influenza in crowded, urban households. Public Health Rep., 125 (2) (2010), pp. 178-191.
  • J.M. Simmerman, P. Suntarattiwong, J. Levy, R.G. Jarman, S. Kaewchana, R.V. Gibbons, et al. Findings from a household randomized controlled trial of hand washing and face masks to reduce influenza transmission in Bangkok, Thailand. Influenza Other Respir. Viruses, 5 (4) (2011), pp. 256-267.
  • Suess, C. Remschmidt, S.B. Schink, B. Schweiger, A. Nitsche, K. Schroeder, et al. The role of facemasks and hand hygiene in the prevention of influenza transmission in households: results from a cluster randomised trial; Berlin, Germany, 2009-2011. BMC Infect. Dis., 12 (2012), p. 26.

Health care worker RCTs

  • J.L. Jacobs, S. Ohde, O. Takahashi, Y. Tokuda, F. Omata, T. Fukui. Use of surgical face masks to reduce the incidence of the common cold among health care workers in Japan: a randomized controlled trial. Am. J. Infect. Control, 37 (5) (2009), pp. 417-419.
  • Loeb, N. Dafoe, J. Mahony, M. John, A. Sarabia, V. Glavin, et al. Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial. JAMA, 302 (17) (2009), pp. 1865-1871.
  • C.R. MacIntyre, Q. Wang, S. Cauchemez, H. Seale, D.E. Dwyer, P. Yang, et al. A cluster randomized clinical trial comparing fit-tested and non-fit-tested N95 respirators to medical masks to prevent respiratory virus infection in health care workers. Influenza Other Respir. Viruses, 5 (3) (2011), pp. 170-179.
  • C.R. MacIntyre, Q. Wang, H. Seale, P. Yang, W. Shi, Z. Gao, et al. A randomized clinical trial of three options for N95 respirators and medical masks in health workers. Am. J. Respir. Crit. Care Med., 187 (9) (2013), pp. 960-966.
  • L.J. Radonovich, M.S. Simberkoff, M.T. Bessesen, A.C. Brown, D.A.T. Cummings, C.A. Gaydos, et al. N95 respirators vs medical masks for preventing influenza among health care personnel: a randomized clinical trial. JAMA J. Am. Med. Assoc., 322 (9) (2019), pp. 824-833.

3. Other studies

Anecdotal: Springfield-Greene County, Missouri

Two hairstylists with COVID-19 ended up not infecting any of their 140 clients. The official release from Springfield-Greene County Health Department credits masks along with other measures, but with only two main data points and no controls for other variables, what can it prove? At best, anecdotal evidence for (or against) mask effectiveness is low value (though not worthless).

Non RCT Studies Linking Positive Outcomes to Mask Wearing

A not yet-peer reviewed paper. Full title: Association of country-wide coronavirus mortality with demographics, testing, lockdowns, and public wearing of masks.

Update August 4, 2020. The study is not an RCT but uses statistical methods to attempt to control (or something like that) for variables.

In countries with cultural norms or government policies supporting public mask-wearing, per-capita coronavirus mortality increased on average by just 15.8% each week, as compared with 62.1% each week in remaining countries. Conclusions. Societal norms and government policies supporting the wearing of masks by the public, as well as international travel controls, are independently associated with lower per-capita mortality from COVID-19.

Other studies of this sort, linking improved outcomes with mask-wearing:

I’m skeptical of the power of statistical methods to control for non-mask factors that may have influenced outcomes in these locations. What’s clear, though: the pattern in most of these studies is consistent with the idea that masks help slow the spread of disease in general and COVID-19 in particular.

Duke University Mechanical Study of Masks for Ability to Block Droplets

August 8, Science Advances. Full title: Low-cost measurement of facemask efficacy for filtering expelled droplets during speech.

We tested 14 commonly available masks or masks [sic] alternatives, one patch of mask material, and a professionally fit-tested N95 mask (see Fig. 2 and Table 1 for details). For reference, we recorded control trials where the speaker wore no protective mask or covering. Each test was performed with the same protocol… . We used a computer algorithm (see Materials and Methods) to count the number of particles within each video.

This small study is an RCT, but of a different kind, focusing on droplet blocking rather than infection outcomes. The study doesn’t include a summary of results (despite having a “Results” heading. I hate it when they do that!). Study authors did summarize findings in interviews for WRAL and CNN.

The gist: fitted N95s performed well, surgical masks nearly as well, high quality cloth masks “pretty good,” and bandanas worst of all. Of course, the study doesn’t “prove” masks work in preventing the spread of coronavirus. It is evidence that cloth masks produce reduction in the spread of droplets.

4. Independent organizations of experienced, specialized professionals

For many of us, the most compelling evidence that it’s worth the effort to get as many people as possible masked up when in crowded places is the wide range of organizations of professionals who are in favor of mask use.

A more or less random sample (I’m skipping WHO and CDC, which everyone must already know by now).

It’s true that the occasional MD can be found who says masks are useless or even harmful, but the consensus is overwhelming that masks are, if not necessarily a huge help, at least worth the trouble of trying.

Summary

While analysis studies (1) show somewhat mixed results, they’re pretty clear that in the past, high quality masks have helped prevent the spread of various kinds of viruses. RCTs (2) show the same pattern: not much yet on masks vs. SARS-CoV-2, but some good evidence for flu and other respiratory viruses. Other kinds of studies (3) also suggest masks are more likely than not to be somewhat helpful against SARS-CoV-2. When it comes to what the majority of people who study infectious disease for a living believe on the subject (4), there is little disagreement that—along with other efforts—masks are worth the bother in the battle to defeat this pandemic.

Does HCQ effectiveness against COVID-19 have anything even close to this kind of supporting evidence? I may write a follow up on that question. It might be very short.

A response to one objection in this already-too-long post: The RCTs I’ve found have not yet specifically tested masks on SARS-CoV-2. It shouldn’t be hard to recognize that, as they say, “absence of proof is not proof of absence.” When it comes to masks, why would coronavirus be different from other respiratory viruses? It might eventually prove to be different, but that evidence doesn’t yet exist.

I expect other objections in the form of misunderstanding or misrepresenting what I’m saying here. I don’t owe anyone a defense of what I’m not claiming.

Conclusion

I’m not convinced that cloth masks make a substantial difference against COVID-19, but I have no doubt at all that they’re worth a large-scale try. Public officials who think they can save lives and get their local economies working better sooner by mandating masks don’t need my support. But for what it’s worth, they have it.

Photo by David Veksler on Unsplash.

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There are 55 Comments

Don Johnson's picture

The best conclusions that you cite say, "may" or "could" -- so what does that prove?

I agree, masks will reduce droplet expulsion, no argument there, but someone who is sneezing and coughing on a regular basis should be staying home anyway. Most people out and about are healthy, and breathing normally, masked or unmasked. Unless such people are wearing N95s or better, they are still breathing out the virus (if they have it), mask or no mask, since the virus is much smaller than the weave of their masks. Maybe a mask will slow the expulsion of air from the mouth/nose, so that it doesn't travel as far as normal unmasked breathing. I doubt it, but I will concede that is a possibility.

Bottom line: I don't think you've advanced the argument very much.

Maranatha!
Don Johnson
Jer 33.3

TylerR's picture

Editor

People have too much time on their hands, too much access to information, too much hubris to admit they often don't fully understand matters in which they have no training or experience, too little trust in "the government," and too much time to listen to other people with all of the above handicaps, and not enough willingness to give public health officials space to suggest a commonsense procedure that may well help ... so you get the controversy about masks.

'Merica.

Now that I have your attention, let me share this cool YouTube video I found on Twitter about how hydroxychloroquine will totally cure COVID-19 ...

Tyler is a pastor in Olympia, WA and works in State government. He's the author of the book What's It Mean to Be a Baptist?

TylerR's picture

Editor

You're correct. This is my plan of action:

  • I'm going to post an endless array of videos on social media about how the interstate speed limit makes no sense.
  • I'm also going to link to many sources (both dubious and semi-credible) to support my view.
  • I'll demand objective proof that the speed limit makes sense as it stands.
  • Then, when proof is provided, I'll demand more studies be done; studies that are done the way I, a non-expert, demand they be done.
  • I know how they should be done because I watched that video on FaceBook; you know the one.
  • Then, I'll refuse to abide by the speed limit because I won't have the magistrate curtail my rights.
  • Then, I'll finance and share a documentary called Speedemic? and recruit people to my cause.
  • Then, I'll claim the Church in America is being persecuted.

Here is my draft script for the opening shots of Speedemic:

  • FADE IN: Camera pans over a rural landscape, settling on a cop standing by a patrol car, wearing aviator shades, looking cool.
    • VOICEOVER: For 20 years, he's patrolled the highways of (insert place here).
  • ... CUT TO SHOT OF COP DRIVING CAR FAST, TALKING URGENTLY INTO RADIO
    • VOICEOVER (con't): Now, he's ready to tell the awful truth about ... the speed limit ...
  • CUT TO SHOT OF SPEEDOMETER READING 71 MPH
    • COP VOICEOVER: People think the speed limit keeps people safe. But, that's not true. People die in crashes all the time going below the speed limit
  • VOICEOVER: Now, from OANN Productions, we bring you the shocking truth. The speed limit is an assault against Americans, against Christians, against liberty, and against freedom.
  • CUT TO COP (by patrol car): It's time people knew the truth. The truth they don't want you to hear about in Washington ...
  • VOICEOVER: What if there's something else going on? What if ... they want to control you?
    • CUT TO COP: I don't think people realize how deep this really goes.
  • FADE OUT

Tyler is a pastor in Olympia, WA and works in State government. He's the author of the book What's It Mean to Be a Baptist?

Andrew K's picture

That baby in the photo shouldn't be wearing a mask.

Don Johnson's picture

... I am not suggesting that we defy authorities. That isn't what this thread is about. Aaron, in the OP, argues for his point of view concerning the effectiveness of masks. My take is that his argument doesn't rest on firm ground.

Then you all jump in with distractions. Usually this happens when you have no real argument.

That's fine, you can play that game if you like, but I'm just pointing out that you have no substance behind you when you do this.

Maranatha!
Don Johnson
Jer 33.3

Andrew K's picture

Andrew K wrote:

That baby in the photo shouldn't be wearing a mask.

I realize my point about the photo seems like a minor quibble, but I'm actually quite serious: kids younger than 3 shouldn't be wearing masks. Definitely not younger than 2. That's the official advice, as there is a significant suffocation risk. I'm kind of surprised nobody else has noted this.

Since I'm not living in the US right now, I'm legitimately curious: how widespread is this guideline ignored; i.e., how often do you see infants and very young children in masks?

dgszweda's picture

Don Johnson wrote:

The best conclusions that you cite say, "may" or "could" -- so what does that prove?

I agree, masks will reduce droplet expulsion, no argument there, but someone who is sneezing and coughing on a regular basis should be staying home anyway. Most people out and about are healthy, and breathing normally, masked or unmasked. Unless such people are wearing N95s or better, they are still breathing out the virus (if they have it), mask or no mask, since the virus is much smaller than the weave of their masks. Maybe a mask will slow the expulsion of air from the mouth/nose, so that it doesn't travel as far as normal unmasked breathing. I doubt it, but I will concede that is a possibility.

Bottom line: I don't think you've advanced the argument very much.

The standard mask does not provide a perfect barrier, like an N95 or greater.  With that said, it doesn't need to.  The purposes are not the same.  The real purpose is not to trap the virus either.  It is to trap droplets, which is how the virus spreads.  If you are experiencing symptoms you should not be out and about.  So this is really primarily about those who are asymptomatic who can spread the disease.  The mask primarily prevents the spread from those individuals as droplets that exit from the mouth or nose.  These droplets (not the virus floating in air) are primarily captured by a mask (again not 100%), but at least 70% or more.  The mask will do very little to protect those not infected from getting infected, unless it is an N95.  That is because when you breathe, air takes the passage of least resistance, not as readily through the filter.  The virus does not travel from an infected person through the breath, but through excretions or water droplets.  Droplets that are less than 5 microns is typically spread over long distances and is not as easily stopped.  Droplets that are greater than 5 microns spread short distances, typically less than 2M and are more easily trapped by cloth, paper fiber....  COVID is spread in droplets that are between 5 microns and 10 microns in size at there smallest and are typically closer to between 20 to 50 microns in size.  Therefore it is not an airborne disease, but a droplet disease.  Wearing a mask will not only stop most of the droplets, but those that do get through are released at a reduced speed, where most are stopped at less than 35cm from the face and only a small amount getting to a 1 meter mark before dropping to a surface.  A few studies are recently getting released that shows that an infected person and an uninfected person who are both wearing a surgical mask, washing their hands and social distancing effectively prevents transmission and actually has a great affect than a total lockdown.

There are going to be those who will still continue to refute this.  Some will find a study here and there, and all the ones that I have seen are dubious, not published in true peer reviewed journals, or are financed by Super PACs and other political interests.  The vast majority of studies (practically all) have shown that while masks are not 100% effective, are a highly effective method when paired with other practices.  I was a scientist at one point in my life, and both my wife and I worked on extreme biological chemicals and viruses and both had to wear all types of masks and breathing apparatuses including full training and semi-annual certification.  So I am pretty well versed in this area.  We followed the science and practice and thus are alive today.

JD Miller's picture

Many of you are missing a very important point.  Love your neighbor is not just about wearing a mask for your neighbor's sake.  My wife was in a store that requires masks the other day.  An overweight lady was there and in tears because she was having trouble breathing. "IF" masks do not help, is it loving to go on a crusade to force people to wear masks when it harms some people?   I do not think it is.   In fact, I view it as inconsiderate.   My wife has asthma and breathing with a mask is very difficult, but not as bad as it was for that lady.  Because of my wife's challenges, she had asked the store employee upon entering if she could briefly remove her mask while in the store to get a breath if no one else was around.  He responded that he had a similar issue and that it would not be a problem for her to do so.  She passed this info onto the lady who was struggling to breath and she was greatly relieved.  For those of us who do not have a problem wearing a mask, it is very inconsiderate to not care about our fellow man who may not have the same abilities that we have.  

   I am not talking about laws or a store's right to impliment policies on their own property.  I am talking about Christians going on a crusade over an issue that harms others when the evidence of mask effectiveness is questionable at best.  The point is, we can virtue signal on both sides of this issue.

dgszweda's picture

JD Miller wrote:

   I am not talking about laws or a store's right to impliment policies on their own property.  I am talking about Christians going on a crusade over an issue that harms others when the evidence of mask effectiveness is questionable at best.  The point is, we can virtue signal on both sides of this issue.

What kind of mask was she wearing?  There are a number of online tools to help people who have mild to moderate asthma handle a mask.  Those that have severe asthma or COPD, it is not recommended that they go out without a mask (even though it is difficult to wear one).  That is because they are in a very high risk category for complications from COVID.

Not sure what you mean about a crusade.  I would never berate anyone over it.  I haven't seen that issue yet, but I guess it is out there.  I am not sure I would classify that the evidence of mask effectiveness is questionable at best.  It is becoming a pretty established belief that the science and evidence supports that masks are very effective.

Aaron Blumer's picture

EditorAdmin

 I am most interested in what people were saying pre 2020 since everything today seems so tainted by bias.  

All of the RCTs listed in the article are from before COVID-19. (Edit, all of the ones in the RCT section... there are a couple of more recent studies that are technically RCTs but not the same kind of study, so I put them under "other")

A whole lot of nothing...The best conclusions that you cite say, "may" or "could" -- so what does that prove?

There's this space between zero and infinity called "something." Smile It's hard to miss but some can do it. In this case, we're talking about the space between zero evidence and 100% certain proof. It's still a really huge space. ... whether some can see it or not, it's still there. It pretty much parallels the space between zero probability and total certainty, so there's a midpoint that we could describe as "equally probable and improbable." My view, as I think I made clear, is that the evidence is somewhere past that point: "more probable than not."

I would also say, though, that it's quite sensible to adopt widespread mask use even if the probability that it helps is well below that midpoint. Why? Again, it comes down to easy to do+possibly important outcome=do it.  Or perhaps, easy to do+some chance it might help=do it. Love your neighbor. Love your enemies.

Maybe a mask will slow the expulsion of air from the mouth/nose, so that it doesn't travel as far as normal unmasked breathing

That much is pretty obvious. You can feel the difference if you have one on! Whether that's hindering spread of infection, again, uncertain, but more likely than not and worth doing.

That baby in the photo shouldn't be wearing a mask.

Neither should be wearing one inside a car... unless it's a taxi I suppose or there are nonfamily members in there. Then again, when you're toting a little one, you often gear up as much as possible before getting out so you don't have to do it when you get out, which is a harder time to do it. (I remember those days!)

Where's the medical advice on babies and masks? I haven't seen anything on that either way.

 ...am not suggesting that we defy authorities. That isn't what this thread is about. Aaron, in the OP, argues for his point of view concerning the effectiveness of masks. My take is that his argument doesn't rest on firm ground.

Don, where is it less firm than I claim? Not just you, but people show an amazing amount of ignoring the thesis these days. But in any case, feel free to specify in what way the argument is not "firm" in support of the actual thesis. Then I'll have something to work with... and maybe I can firm it up, or maybe I can't and the thesis fails. This is too vague for me to do anything with.

You didn't miss my thesis entirely though, because you're right: I'm not talking about doing or not doing it where it's law. Where it's law, it's law and we should do it.

Since I'm not living in the US right now, I'm legitimately curious: how widespread is this guideline ignored; i.e., how often do you see infants and very young children in masks?

I'm not sure, but I think the photo is actually European. Can't remember what gave me that impression... but the fact is, we do not know it is U.S. Anyway, I would like to read up on that, so if you can point me to a source, much appreciated. For what it's worth I have not personally seen any babies wearing masks anywhere. I still see quite a few adults not wearing them, even here in WI where it's law.

The standard mask does not provide a perfect barrier, like an N95 or greater.  With that said, it doesn't need to.  

I would agree but not necessarily in the way you explained. To me, it's clear that less benefit is not zero benefit and that less still adds up. When you take a small benefit and multiply it by millions of people having many more millions of interactions, a little bit of benefit can definitely become significant. I don't know that this holds true in this case, but it does with many other things in life.

It comes back to that space between 0% effective and 100% effective. > 0 is not "nothing"... especially when you start multiplying it.

 "IF" masks do not help, is it loving to go on a crusade to force people to wear masks when it harms some people?

It's unfortunately often necessary to go for what helps most people rather than harming many for the sake of a few. Some people die because seat belts held them in a burning or sinking vehice. Many more are saved by them... it's a bummer, but it's reality. A good solution is to have these mask orders include language that exempts people who have a medical issue that makes it a hazard for them. Pretty sure I've read that some of these orders include that.... and then see about a mask that is less restrictive. So far, all the mask orders I know of still allow those gator/bandana/ninja scarf type things. They are the least effective droplet blockers, it seems, but also restrict breathing pretty much not at all.

Views expressed are always my own and not my employer's, my church's, my family's, my neighbors', or my pets'. The house plants have authorized me to speak for them, however, and they always agree with me.

Andrew K's picture

Aaron Blumer wrote:

That baby in the photo shouldn't be wearing a mask.

Neither should inside a car... unless it's a taxi I suppose or there are nonfamily members in there. Then again, when you're toting a little one, you often gear up as much as possible before getting out so you don't have to do it when you get out, which is a harder time to do it. (I remember those days!)

Where's the medical advice on babies and masks? I haven't seen anything on that either way.

...

Since I'm not living in the US right now, I'm legitimately curious: how widespread is this guideline ignored; i.e., how often do you see infants and very young children in masks?

I'm not sure, but I think the photo is actually European. Can't remember what gave me that impression... but the fact is, we do not know it is U.S. Anyway, I would like to read up on that, so if you can point me to a source, much appreciated. For what it's worth I have not personally seen any babies wearing masks anywhere. I still see quite a few adults not wearing them, even here in WI where it's law.

https://www.webmd.com/lung/news/20200501/coronavirus-social-babies-shoul...

https://www.nationwidechildrens.org/family-resources-education/700childr...

https://kidshealth.org/en/parents/coronavirus-young-kids.html

Why Shouldn't a Baby or Toddler Wear a Face Covering?

Babies and toddlers under 2 years old shouldn't wear a face covering because:

  • They have smaller airways, so breathing through a cloth covering is harder for them.
  • If it's hard for them to breathe and they can't tell anyone or take the covering off by themselves, they could suffocate.
  • Some homemade coverings might have pieces that a baby could choke on, such as strings or elastic bands.
  • They will likely try to remove the covering, causing them to touch their face a lot. This can increase their risk of catching and spreading the virus. [extract from the last link]

First ones that came up. There's plenty more, including from WHO and other orgs. We have a baby, so I researched, naturally. I'm very confused why there hasn't been more messaging about babies and masks. It seems to be getting drowned out in the broader, cultural scuffle. A Chinese friend told me about babies there that have died from wearing masks.

With regard to the family wearing masks in a car, most where I live use taxis or public transport, so I just placed it in my own context. :) 

Aaron Blumer's picture

EditorAdmin

This is in the current Wisconsin mask order... this is not all the exceptions, but I found them interesting so included most of the section.

3. EXCEPTIONS.

a. Individuals who are otherwise required to wear a face covering may remove the face covering in the following situations:

i. While eating or drinking.

ii. When communicating with an individual who is deaf or hard of hearing and communication cannot be achieved through other means.

iii. While obtaining a service that requires the temporary removal of the face covering, such as dental services.

iv. While sleeping.

v. While swimming or on duty as a lifeguard.

vi. While a single individual is giving a religious, political, media, educational, artistic, cultural, musical, or theatrical presentation for an audience, the single speaker may remove the face covering when actively speaking. While the face covering is removed, the speaker must remain at least 6 feet away from all other individuals at all times.

vii. When engaging in work where wearing a face covering would create a risk to the individual, as determined by government safety guidelines.

So, it doesn't appear to exempt for athsma or COPD etc.  EDIT: yes it does, further on... (This also answers my earlier question on where the guidance says no babies. It's apparenlty in CDC's stuff somewhere)

b. In accordance with CDC guidance, the following individuals are exempt from the face covering requirement in Section 2:

i. Children between the ages of 2 and 5 are encouraged to wear a mask when physical distancing is not possible. The CDC does not recommend masks for children under the age of 2.

ii. Individuals who have trouble breathing.

Views expressed are always my own and not my employer's, my church's, my family's, my neighbors', or my pets'. The house plants have authorized me to speak for them, however, and they always agree with me.

Crystal's picture

Don't worry Andrew.  FIRST thing I said to my husband when I pulled up this thread just a bit ago was "That baby shouldn't be in a mask.  I *will* be commenting as that is not safe at all. Please tell me SOMEONE has said something."  Infants are at significant risk of being smothered because of how tiny their breathing passages are.  Masks are a significant risk for them. 
That said, Thankfully I have only seen appropriately aged children wearing masks around here.  Most parents of infants that I have seen have very light and thin pieces of very breathable muslin over their infant bucket seats when indoors in public spaces (with air conditioning-so no danger of overheating.) These pieces of thin cloth are commonly used as nursing covers and are incredibly breathable.  It is mostly just used as a visual "stay away from the baby" notice honestly though.  It is not at all a "mask" type substitute.  

For others,  An excerpt from CDC is as follows.  "Mothers should wear a mask and practice hand hygiene during all contact with their neonates. Of note, plastic infant face shields are not recommended and masks should not be placed on neonates or children younger than 2 years of age."  Link here 

Andrew K wrote:

 

Andrew K wrote:

 

That baby in the photo shouldn't be wearing a mask.

 

 

I realize my point about the photo seems like a minor quibble, but I'm actually quite serious: kids younger than 3 shouldn't be wearing masks. Definitely not younger than 2. That's the official advice, as there is a significant suffocation risk. I'm kind of surprised nobody else has noted this.

Since I'm not living in the US right now, I'm legitimately curious: how widespread is this guideline ignored; i.e., how often do you see infants and very young children in masks?

Aaron Blumer's picture

EditorAdmin

Crystal, Thanks for clearing that up and for the link.

(Maybe I should photoshop that image and put the ol' red circle slash over the baby's mask... actually, it can easily go in a caption.  EDIT: in the caption now.)

Views expressed are always my own and not my employer's, my church's, my family's, my neighbors', or my pets'. The house plants have authorized me to speak for them, however, and they always agree with me.

Crystal's picture

I have tried several different kinds.  Honestly, I have issues with everything I have tried so far.  Switching to just a plastic face shield distorts my vision and causes migraine headaches, so that isn't an option for me either.  
Per the CDC, I should not wear a mask.  (Exemption for "people who have trouble breathing.") But trying telling that to anyone out in the general public.  Post having what we (and my doctors) firmly believe was COVID-19, and being able to leave quarantine my breathing was in a REALLY bad place.  I wore a mask for an extra week beyond even the recommended when I *had* to leave home, and I was a mess.  When I finally just took it off I was ripped into by random people who didn't even bother to ask my reasons for not wearing a mask.  The dirty looks were absolutely astounding.  Even informing people just got me a "Well, if you can't wear a mask then you shouldn't be out in public PERIOD." and the like.  As if they are my doctor, full time maid and offering to take care of ALL of my responsibilities for me with zero charge....  Unless you are volunteering to cover all responsibilities and the extra costs associated with mandating that for those of us that can't wear a mask then you don't get to tell us that we aren't allowed to care for ourselves and our families by getting GROCERIES.  
I am prescribed medication that is used for COPD patients.  Some weeks my asthma makes zero impact in my life, others it flares badly.  My doctors have told me to maintain distance when in stores.  Something I already do.  They fully understand that wearing a mask exacerbates my asthma, and while they grudgingly tell me to put a mask on when possible, they also were clear that breathing is the priority and not wearing a mask is preferred in my situation. 

Add to that the fact that something over my face, and the *sensation* of my breathing being restricted triggers other issues I have going back in my past.  But if I remove the mask away from people in order to work through it and calm myself so that I can avoid an asthma attack, put it back on, and continue shopping...I will inevitably be yelled at (No, that is not an exaggeration-it has happened.  Multiple times.) and someone will get in my face over it-further exacerbating my panic and causing me to have to remain even longer in the store.  
There is zero grace being shown towards people that are struggling with masks.  Many people feel that they are morally superior to anyone they see that doesn't have one on, and they feel that they have every right to get in their faces over it.  I have talked to *multiple* other people that can not wear masks and we are feeling that we are on constant eggshells and on guard for literal physical assault whenever we have to go out.  Even when we are wearing masks-because we know that inevitably we will need to remove the mask briefly- and we have all been attacked over the issue many times already.  
The number of *Christians* that I have seen on Facebook mocking people who claim to have breathing problems astounds me.  The lack of love for those of us that *are* struggling is appalling.  
(I should clarify, this is not to be construed as me yelling at you or raking you over the coals Dgszweda - I am responding to your question about what masks I have tried.  The rest of my commentary is not directed directly at you.  It just pertains to the subject being discussed.) 

dgszweda wrote:

What kind of mask was she wearing?  There are a number of online tools to help people who have mild to moderate asthma handle a mask.  Those that have severe asthma or COPD, it is not recommended that they go out without a mask (even though it is difficult to wear one).  That is because they are in a very high risk category for complications from COVID.

Not sure what you mean about a crusade.  I would never berate anyone over it.  I haven't seen that issue yet, but I guess it is out there.  I am not sure I would classify that the evidence of mask effectiveness is questionable at best.  It is becoming a pretty established belief that the science and evidence supports that masks are very effective.

Crystal's picture

Hey!  Thanks for noting that in the caption!  I really appreciate that!  I just didn't want someone seeing that and thinking it was such a great idea to pop an infant into a mask.  :)  Thanks!

Aaron Blumer wrote:

Crystal, Thanks for clearing that up and for the link.

(Maybe I should photoshop that image and put the ol' red circle slash over the baby's mask... actually, it can easily go in a caption.  EDIT: in the caption now.)

Aaron Blumer's picture

EditorAdmin

People with difficulty breathing do have a dilemma. But the dilemma only exists because wearing a mask or not wearing one somehow became perceived as political. I get how that happened but I still don't understand

  • Why it happened
  • Why it persists

On the first point, the country is desperate for solution-focused--as opposed to political fight-focused or "winning" focused--leadership. Do we really have so few influencers now who won't/can't set aside their political fights long enough to help the country work together to solve what was obviously a huge problem?

On the second, Trump is pro-mask now... so the right wing has his permission now to be OK with masks. So why are they still still clinging to the politicization narrative, which was bogus to begin with?

Views expressed are always my own and not my employer's, my church's, my family's, my neighbors', or my pets'. The house plants have authorized me to speak for them, however, and they always agree with me.

Mark_Smith's picture

Here is a concern I have for people in your situation, Crystal, which if I understood you correctly, is that you have a medical condition where doctors say you should not wear a mask. Correct?

Then why are you out exposing yourself to a virus that attacks people with conditions such as yours?

My point is, you say the mask mandate is prohibitive and people are rude to you without a mask, but you are exposing yourself to a terrible virus by being out in public. It seems to me people in your situation should be quarantining at home. You are the very ones the quarantine was designed to protect!

Another poster above yours talked about a woman so obese she was struggling to breathe with a mask in a store that required one. Once again, obesity that high is a strong indicator that COVID will cause a person serious trouble. They should not be out walking around exposing themselves either way. The same goes for people with asthma so bad they can't wear a mask...

 

JD Miller's picture

Aaron wrote:

On the second, Trump is pro-mask now... so the right wing has his permission now to be OK with masks. So why are they still still clinging to the politicization narrative, which was bogus to begin with?

Aaron, those of us who tend to be more conservative are not getting our positions from Trump- especially on Covid-19.  It looks like you are the one obsessed with Trump, not us.  Trump has been much more pro lockdown than most of us on the right.  He has been much more pro mask than those of us who have been listening to scientists from high ranking universities instead of listening to Dr. Fauchi like Trump has been doing.  My positions on  Covid-19 do not come from Trump.  I had even heard about Hydroxi before Trump had talked about it.  What it comes down to is that we do not just believe whatever NPR and CNN tell us, so since Trump is their enemy and we do not fall in line, we become their enemy too.  So then we get lumped in with Trump simply because we both question the same sources.  This is not intellectually honest.    

I am in a unique place.  We live in South Dakota where there has never been an overreaction to Covid-19.  We did react and did take precautions, but did not cripple our economy.  People got sick and some died, but our death rate has actually been lower than most of the rest of the nation and our economy is still booming.  Our freedoms have been protected (freedoms btw that help us help the poor and spread the gospel). 

I have a hard time seeing what all the overreaction is about.  We just got back from a vacation to the Black Hills of western South Dakota.  The hotel was packed, parking at the attractions was a challenge, and the places were filled.  Few were wearing masks.  We visited some friends while we were in Rapid City and they said it has been like that for months.  Many of the visitors were from out of state- from all over the country.  If these people catch Covid, they will be going back home, so it is hard to guage the spread, but what about the tourism workers?  The hospital in Rapid City has not been overwhelmed and people around Rapid City have been going on mostly like normal.  I posted about this on facebook and I have a Bible college friend in Rapid City who liked the post.  He has noticed the same thing and is not panicked either.  

We are in a different world here in South Dakota- a world without panic.  A world where some get sick and most recover, but a few die.  It is not much different than any other year other than some people are a bit more scared than usual.  Other years people got sick and died too.  Based on the stats nation wide, it looks like about twice as many are dying of Covid-19 as were dying from the flu.  Any death is serious, but it is not worth the unreasonable panic I am seeing.

Crystal's picture

There are any number of sicknesses out there every year that could kill me.  You don't get to tell me how I should and shouldn't handle this virus.  You don't get to prioritize what my life looks like because of your fears.  You do not get to lock me up in the name of "safety" and determine what the next several years of my life look like.  COVID-19 is NOT going to go away.  My doctors are clear about that.  We get to choose how we will live out our lives with that knowledge.  
You don't know what precautions I take when I do go out, and you aren't my doctors. You also apparently completely missed references to the fact that I do indeed wear a mask *many* times when out-referenced by the fact that I am getting attacked when I do have to remove it (while well away from other people-who then approach ME to attack me over it.)  
  
I have lost many friends and family members to automobile accidents.  I don't have the right to tell everyone else whether they should use automobiles or not.  We all understand that using an automobile carries with it a certain amount of risk.  People get to decide what acceptable risk is to them in these choices.  

Mark_Smith wrote:

Here is a concern I have for people in your situation, Crystal, which if I understood you correctly, is that you have a medical condition where doctors say you should not wear a mask. Correct?

Then why are you out exposing yourself to a virus that attacks people with conditions such as yours?

My point is, you say the mask mandate is prohibitive and people are rude to you without a mask, but you are exposing yourself to a terrible virus by being out in public. It seems to me people in your situation should be quarantining at home. You are the very ones the quarantine was designed to protect!

Another poster above yours talked about a woman so obese she was struggling to breathe with a mask in a store that required one. Once again, obesity that high is a strong indicator that COVID will cause a person serious trouble. They should not be out walking around exposing themselves either way. The same goes for people with asthma so bad they can't wear a mask...

 

dcbii's picture

EditorModerator

Aaron Blumer wrote:

People with difficulty breathing do have a dilemma. But the dilemma only exists because wearing a mask or not wearing one somehow became perceived as political. I get how that happened but I still don't understand

  • Why it happened
  • Why it persists

On the first point, the country is desperate for solution-focused--as opposed to political fight-focused or "winning" focused--leadership. Do we really have so few influencers now who won't/can't set aside their political fights long enough to help the country work together to solve what was obviously a huge problem?

On the second, Trump is pro-mask now... so the right wing has his permission now to be OK with masks. So why are they still still clinging to the politicization narrative, which was bogus to begin with?

Well, I can think of a couple answers.

On your first point, as I have posted earlier in one of the other threads, some of us who are "resisters," so to speak, aren't resisting because we think there's NO chance that masks help at all.  We would actually be happy to contribute to an actual solution -- like, e.g. pairing a mask requirement with ceasing lockdowns and opening things up more.  If most or even many businesses are going to have to stay closed anyway, masks or not, then masks are not really contributing to a solution; they're just slowing down the inevitable.  I'd also argue that keeping things closed while requiring masks tends to indicate to people that masks are not really seen as working.  I'd happily change my behavior on them if wearing masks meant reopening.

On your 2nd point, maybe it's because there are many of us who don't worship at the feet of Trump, even when we like a lot of what he is doing.  I'm not taking my view of masks from him any more than I'd take my view of how to treat and talk about women from him.  Clearly, the whole flip-flopping from the WHO and CDC on mask effectiveness hasn't helped either, and these are organizations that ought to have the extensive experience dgszweda refers to above, so that does make the current mask policy look more political than anything else, whether it is in actuality or not.

However, when it comes down to it, my view on this is that the virus is out in the wild, masks aren't going to prevent me from getting it, and it's likely that until and unless a 100% effective vaccine comes out, my chances of getting it in the future (if I haven't already had it, as I had a nasty respiratory illness after returning from Europe in January) approach 100% anyway.  I already wear masks when required and out of love for others that are at risk.  Beyond that, I'd rather just get it over with and be able to go on with life as usual (or not -- if God chooses to take me, then it was my time).  Our country survived the flu epidemics of the 50's and 60's without lockdowns, and the percentage of fatalities in this country was around that of Covid.  Masks on top of lockdowns is not handling this better than previous generations did, IMHO.

Dave Barnhart

Mark_Smith's picture

Our country also survived the first 150+ years not having real medicine, and drinking untreated water. Does that mean we do not use antibiotics, pain medicines, blood pressure medicine, and the like?  Do we not drink treated water?

What about a/c, air travel, internet and cell phones?

With progress you make changes.

We can debate what changes to make and what policies to implement, but the "we survived 1950 and 1917 with no quarantine" does not apply.

Mark_Smith's picture

Granted, this particular disease is borderline on its true deadliness. What if we had an epidemic of smallpox, or ebola, or some novel virus with a death rate of either of those. Say 10 or 20%. Would people in 'Merica (shout out to you Tyler) resist masks and quarantines then?

I think they would.

Mark_Smith's picture

that I have attended the last 4-5 years is now acting like nothing is happening. Especially with the youth group. They are having pool parties, bashes, overnights, everything like normal. No social distancing in Bible studies or Sunday worship either for the youth.  My daughter, who has a trach but is otherwise healthy, still has not re-engaged the youth meetings out of health concerns. What bothers me is no one reaches out to her. Makes me mad actually. So disappointed with the church again.

dcbii's picture

EditorModerator

Mark_Smith wrote:

that I have attended the last 4-5 years is now acting like nothing is happening. Especially with the youth group. They are having pool parties, bashes, overnights, everything like normal. No social distancing in Bible studies or Sunday worship either for the youth.  My daughter, who has a trach but is otherwise healthy, still has not re-engaged the youth meetings out of health concerns. What bothers me is no one reaches out to her. Makes me mad actually. So disappointed with the church again.

Mark, I can see why you might be frustrated with your church -- not taking any precautions at all is not helpful to anyone.  Even though most of our congregation doesn't wear masks, we do distance from one another, close pews, do extra cleaning, etc., etc.  And I agree that not reaching out to your daughter is not acceptable.  Are you looking for video phone contact or something similar?  Because with the conditions your daughter has, most people trying to care for those at risk would stay away out of caution and respect.  I'm certainly avoiding close contact with people at risk, including in my own family.

Regarding an earlier point you made, I don't worship the past, but I don't consider everything in the present to be better either (just look at American culture if you need any examples).  Ideas aren't necessarily better just because they are new.  People have quarantined the at-risk and sick for thousands of years, but now we think it's better to stop the healthy from doing anything?  It's only going to slow down the process of herd immunity.  At least some nations are realizing exactly that.

And by the way, I think that the relative deadliness of Covid does figure in to people's risk calculations.  If we were having an epidemic of something as deadly as Ebola, but also airborne, I'd do a lot more than I'm doing for Covid.  BUT, I'd also not trust cloth masks to keep me safe either.  I'm not sure what most other people would do, as people can in general be pretty stupid, and that characterization applies to most of us at one time or another.  Personally, though, I'd doubt that people would behave exactly the same for a much deadlier disease, as much of what motivates most people is fear.

Dave Barnhart

TylerR's picture

Editor

I will be honest. We made a written "safety plan" per our Governor's orders, and nobody wore masks. I didn't even wear a mask. We were supposed to. I basically said, "meh," and let it go. I know I should have, because people look to the pastors to set an example. About 20% of the folks wore masks, but nobody else did.

Two weeks, an elderly lady approached me and politely said how disappointed she was that nobody wore masks. I apologized to her, sent out a church email asking people to wear masks, and had "Please Wear a Mask" sign placed at the entrances. My whole family now wears masks at church. Miraculously, now 95% of the people wear masks at church.

I should have enforced it earlier, but I didn't. I personally think it's unnecessary, but that's what our public health folks want. It might help. It might not. I know it doesn't hurt anything. So, we do it.

Tyler is a pastor in Olympia, WA and works in State government. He's the author of the book What's It Mean to Be a Baptist?

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