A Look at Evidence for Mask Effectiveness vs. COVID-19
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(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:
- Studies of studies: analyses of lots of studies, often referred to as “meta-analysis.” (See What Is a Systematic Review/Meta-analysis?)
- 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:
- What Is a Control Group?
- Hirsh Health Sciences Library: Study Designs in the Health Sciences: RCTs.
- Introduction to RCTs in particular (and the role of DBPCTs): University of North Carolina, ERIC Notebook: Randomized Controlled Trials. See also AOGS Review: A Simplified Guide to Randomized Controlled Trials:
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.
- Other kinds of studies and investigations: items from “rigorous but only indirectly relevant” to “study design not clear” to “anecdotal.”
- 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:
- Health Affairs, June 2020: Community Use Of Face Masks And COVID-19: Evidence From A Natural Experiment Of State Mandates In The US
- Publisher unclear, June 2020: Association of country-wide coronavirus mortality with demographics, testing, lockdowns, and public wearing of masks (Update June 15, 2020).
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).
- American Hospital Association, American Medical Association, American Nurses Association (and a bit more from AMA)
- Mayo Clinic (See also Debunked myths about face masks)
- Cleveland Clinic
- Johns Hopkins
- 300 Doctors in Iowa
- Infectious Disease Society of America
- Australasian Society of Clinical Immunology and Allergy
- Ottawa Public Health
- Public Health Agency of Canada
- Canadian Thoracic Society
- British Medical Association (BMI, Northern Ireland)
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.
Aaron Blumer 2016 Bio
Aaron Blumer is a Michigan native and graduate of Bob Jones University and Central Baptist Theological Seminary (Plymouth, MN). He and his family live in small-town western Wisconsin, not far from where he pastored for thirteen years. In his full time job, he is content manager for a law-enforcement digital library service. (Views expressed are the author's own and not his employer's, church's, etc.)
- 57 views
Since there are a whole host of infectious viruses which mask wearing may help limit, are we to believe that mask mandates will ever just go away? And shouldn’t we at least try to do something - anything - if there’s any chance it might protect people? Get used to the new normal, folks.
I’m sad nobody likes my opening scene for Speedemic …
Tyler is a pastor in Olympia, WA and works in State government.
[pvawter]Since there are a whole host of infectious viruses which mask wearing may help limit, are we to believe that mask mandates will ever just go away? And shouldn’t we at least try to do something - anything - if there’s any chance it might protect people? Get used to the new normal, folks.
As someone who travels the whole world and has spent many a Sunday in churches in Southeast Asia, it is very funny to see the distinct differences in attitudes. For years I have been going to churches where masks are common. You will notice here that the comments against masks are all related to overreaction or infringement on someone’s freedom. When I am in Singapore, Hong Kong or other places, the entire culture is focused on masks as a sign of respect. If you are coughing or sneezing or sick without a mask it is highly offensive and you are looked down on and sometimes called out. Both worshipping the same God, but two totally different attitudes. I agree with your point. We say that we are for sanctity of life, and life is important. We will fight against abortion, march against it, preach against it. Abortion this year claimed 600,000 lives. We are 4.5 months into this pandemic and we are at 170,000 lost lives. If this continues we will be somewhere between 450,000 and 500,000 lives lost in a 12 month period. There are children who no longer have a dad to go home to, a grandparent they can no longer spend time with, or even a child who is no longer running through the home. All over a disease that for most intents and purposes can be controlled with something as simple as wearing a fabric mask when I can’t social distance, practice social distancing and wash my hands. And we as Christians sit here and argue about it. If me wearing a mask gives the opportunity for a child to grow up with their mother or father, why on earth would I not do this. I don’t get it and I don’t comprehend it. Scripture does not teach us to love ourselves, but to sacrifice ourselves for our neighbor. The greatest travesty for this whole pandemic is the failure of the Church to take a lead on what sacrificing ourselves for our neighbor really means and what that looks like. Instead the secular world is doing a better job than most Christians.
When does being a good example go too far?
https://www.jsonline.com/story/news/politics/2020/08/10/dnr-tells-staff…
Excerpt:
[Milwaukee Journal Sentinel]The head of the Department of Natural Resources is telling employees to wear face masks on teleconferences — even when they’re not around others and at no risk of spreading the coronavirus.
Natural Resources Secretary Preston Cole reminded employees in a July 31 email that Gov. Tony Evers’ mask order was going into effect the next day. That means every DNR employee must wear a mask while in a DNR facility, noted Cole, an appointee of the Democratic governor.
“Also, wear your mask, even if you are home, to participate in a virtual meeting that involves being seen — such as on Zoom or another video-conferencing platform — by non-DNR staff,” Cole told his employees. “Set the safety example which shows you as a DNR public service employee care about the safety and health of others.”
Where does it end?
Dave Barnhart
Where does it end? It ends here, with this article from the BBC titled “Sex and coronavirus: How to have it safely:”
The Terrence Higgins Trust has published advice suggesting people avoid kissing, wear a face covering and choose positions that aren’t face-to-face during sex.
It may sound tough, but people need to find a way “to balance our need for sex and intimacy with the risks of the spread of COVID-19”, the Trust says.
The best sexual partner during the pandemic is yourself or someone you live with, the Trust says.
Tyler is a pastor in Olympia, WA and works in State government.
[pvawter]Since there are a whole host of infectious viruses which mask wearing may help limit, are we to believe that mask mandates will ever just go away? And shouldn’t we at least try to do something - anything - if there’s any chance it might protect people? Get used to the new normal, folks.
I’m not sure if this is meant as an argument against mask-wearing for the pandemic. It’s possible that this logic could become a thing going forward. I can’t predict that one way or the other.
As argument against masking right now though, it doesn’t work. Global pandemics are, so far, relatively rare. And none of the other ailments masks might help for have this kind of infection rate. Fatality rate per infection? That’s still hard to tell. We have pretty high fatality per known infection, but we don’t have a handle yet on how many are infected and asymptomatic.
There really isn’t anything similar in our normal roster of bugs.
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.
[Aaron Blumer]I’m not sure if this is meant as an argument against mask-wearing for the pandemic. It’s possible that this logic could become a thing going forward. I can’t predict that one way or the other.
As argument against masking right now though, it doesn’t work. Global pandemics are, so far, relatively rare. And none of the other ailments masks might help for have this kind of infection rate. Fatality rate per infection? That’s still hard to tell. We have pretty high fatality per known infection, but we don’t have a handle yet on how many are infected and asymptomatic.
There really isn’t anything similar in our normal roster of bugs.
Except that’s not the moral reasoning used to argue for masks. I think you yourself have said something like, “masks are cheap and easy and might help protect people from COVID, so why not use them?” That exact reasoning means we should be wearing masks indefinitely, since there is always a chance that masks could protect someone from a disease I may or may not have. Why not err on the side of caution? If it saves one life…
Except that’s not the moral reasoning used to argue for masks. I think you yourself have said something like, “masks are cheap and easy and might help protect people from COVID, so why not use them?” That exact reasoning means we should be wearing masks indefinitely, since there is always a chance that masks could protect someone from a disease I may or may not have. Why not err on the side of caution? If it saves one life…
Let me see if I can make this more clear…
“masks are cheap and easy and might help protect people from COVID, so why not use them?”
I thought it was evident from the context that this means “masks are cheap and easy and might help protect people from COVID, so why not use them? in response to this current global pandemic that is unlike the normal flus and stuff we deal with all the time”
I’m not going to answer for anyone else’s moral reasoning. My own reasoning is that we’re talking about this pandemic, not relatively minor routine infections.
If it saves one life…
This is nowhere in anything I’ve written.
So, again, as I said in the article…
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.
I guess I do have a question: do you acknowledge that the current pandemic is considerably more severe than the routine respiratory illnesses we see every year? If you do, then the “but this will lead to masks all the time forever!” objection is purely hypothetical and trivial. If you don’t… that’s another topic, but probably one I’m not interested in going into right now. For me, that’s in the “not in dispute” column at this point.
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.
[Aaron Blumer]Except that’s not the moral reasoning used to argue for masks. I think you yourself have said something like, “masks are cheap and easy and might help protect people from COVID, so why not use them?” That exact reasoning means we should be wearing masks indefinitely, since there is always a chance that masks could protect someone from a disease I may or may not have. Why not err on the side of caution? If it saves one life…
Let me see if I can make this more clear…
“masks are cheap and easy and might help protect people from COVID, so why not use them?”
I thought it was evident from the context that this means “masks are cheap and easy and might help protect people from COVID, so why not use them? in response to this current global pandemic that is unlike the normal flus and stuff we deal with all the time”
I’m not going to answer for anyone else’s moral reasoning. My own reasoning is that we’re talking about this pandemic, not relatively minor routine infections.
If it saves one life…
This is nowhere in anything I’ve written.
So, again, as I said in the article…
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.
I guess I do have a question: do you acknowledge that the current pandemic is considerably more severe than the routine respiratory illnesses we see every year? If you do, then the “but this will lead to masks all the time forever!” objection is purely hypothetical and trivial. If you don’t… that’s another topic, but probably one I’m not interested in going into right now. For me, that’s in the “not in dispute” column at this point.
Aaron, you can try to make a distinction if you want, but i’m simply pointing out that the very same reasoning used in favor of masks during the covid pandemic applies to every other serious infectious disease. The yearly influenza is quite serious and deadly to tens of thousands annually. I don’t think the comparison is a stretch at all.
[Aaron Blumer]I guess I do have a question: do you acknowledge that the current pandemic is considerably more severe than the routine respiratory illnesses we see every year?
Maybe that’s the difference in our points of view on masks. I think most can look at the numbers and see that Covid this year is more severe than the flu most years. The difference may hang on the definition of “considerably.”
Consider the following facts:
- There have definitely been more deaths per-capita in the US than most years of the flu, though that would exclude the Asian and HK flu epidemics 60-70 years ago, where the per-capita number of deaths are comparable, BUT…
- Children are much less likely to get seriously ill or die from Covid than from influenza, which kills children as easily as it does adults.
- Most Covid deaths have been among those with severe complicating conditions, or the extremely elderly.
- We don’t know the true extent of how many asymptomatic cases of Covid there have already been among the populace, so the death rate may be not much more than that for influenza.
Given those facts, it’s quite reasonable to think that if you are not part of the at-risk population, Covid really isn’t much worse than the flu. So it would also be reasonable to ask — how bad does a disease have to be for masks to be a reasonable precaution? Is 150,000 Covid deaths a good number where 60,000 influenza deaths isn’t? I think it’s at least worth asking and considering the question.
Dave Barnhart
Thanks Dave you have obviously been doing some research like I have when you concluded:
Consider the following facts:
There have definitely been more deaths per-capita in the US than most years of the flu, though that would exclude the Asian and HK flu epidemics 60-70 years ago, where the per-capita number of deaths are comparable, BUT…
Children are much less likely to get seriously ill or die from Covid than from influenza, which kills children as easily as it does adults.
Most Covid deaths have been among those with severe complicating conditions, or the extremely elderly.
We don’t know the true extent of how many asymptomatic cases of Covid there have already been among the populace, so the death rate may be not much more than that for influenza.
Add to your list that about 1/3 of the deaths were in NY and the surrounding states. Some have suggested that we should not be wasting our time doing the research and finding the truth. Instead we should just save our time and listen to the media authorities and the government. What happened to being Bereans? If this COVID is not as serious as many think it is - the data supports your suggestion that it is not- then I have a duty as a Christian to make sure and not spread false information that needlessly panics people.
Further there is scientific research that tells us that masks do not stop the spread. If masks hurt people and they do not stop the spread, then we should not be pushing them.
From a Christian standpoint I am quite worried about the legalistic angle of this. We have an issue that is being pushed based on questionable science and it is being suggested that if we do not do it, then we are not as good of Christians. It is an issue that is not prescribed by the scripture, yet we are being told we have a responsibility to do it as Christians. This is far more legalistic than anything I have seen in the church in a long time.
[JD Miller]Some have suggested that we should not be wasting our time doing the research and finding the truth. Instead we should just save our time and listen to the media authorities and the government. What happened to being Bereans? If this COVID is not as serious as many think it is - the data supports your suggestion that it is not- then I have a duty as a Christian to make sure and not spread false information that needlessly panics people.
I think some of this comes as a backlash to our current culture. Because of the loss of trust in authority combined with the instant availability of information that Aaron and others have mentioned in detail on SI and elsewhere, I would agree with him that we do have the phenomenon of “the death of expertise.” People no longer think there is such a thing as an expert, or they think they have all the information when it can be looked up on the internet, so there’s no longer a need to consult an expert. Obviously, this is highly problematic, as most of us can really be experts in only 1 or 2 fields at a time.
Unfortunately, the opposite phenomenon is also happening. People who see the instant “expertise” of every commenter on the internet all of a sudden seem to put too much trust in the “true” experts, completely discounting the relatively large amount of real information that can be learned by reading, research, and common sense. I think most of us would be somewhere in the middle of that spectrum, neither considering ourselves experts in every field while completely discounting what the real experts say, nor trusting everything we hear the experts say, especially when it conflicts with either clear fact or our faith.
Trusting the “experts” has at least a couple obvious problems:
- Some fields are so large or so complex that you have competing experts that disagree. This happens all the time at the edges of scientific fields, whether in math, physics, stronomy, climatology, epidemiology, etc. This is especially true when something is new, like a new discovery of a disease or astronomical phenomenon, and not all the facts are in. When there is disagreement, which expert should the layman trust?
- Because of both point 1 and human nature, “expertise” or “science” today are highly politicized. Every commentator or person in authority (and to be honest, any of us as well) will bring out the experts that support or at least mostly support what we already believe or want to say. If a governor wants a lockdown order or masks, he trots out a scientist with both the belief and the evidence from studies to back it up that agrees with those actions. Those protesting will bring out experts with studies showing that masks and lockdowns do not help. So what are we Bereans to do?
Simply put, there is no easy answer, but like it or not, to some extent it still comes down to each of us having to decide how and what to trust. We have to do as much as we can to examine the trustworthiness of the competing parties and their claims, and then come to a decision. Some would say that’s putting my non-existent expertise over that of the true experts, but I’d say it’s simply a recognition that there are competing authorities and experts and we still have to move forward with our lives and make some choices based on the best information we have.
When it comes to law, I need to obey my authorities, except for only the most obvious violations of biblical command. When it comes to which authorities I trust, it can be a different answer, especially if I believe my authorities to be motivated by hostility to Christianity, to plain reason, or even to my political views. I don’t have to trust my mayor, governor, congressmen or president over recognized authorities in other jurisdictions. Regarding Covid, I’ll continue to wear masks where I must, but I don’t have to believe in their efficacy. When it comes to personal behavior outside of what is prescribed, I can choose to do something like what is done in different states or countries, especially when it’s clear that taking a different tack hasn’t at all resulted in the apocalyptic outcomes predicted by some of my own authorities.
Dave Barnhart
Dave, thank you for your latest response. You have summed up my views wonderfully and brought better clarity to what I wanted to say.
Aaron, you can try to make a distinction if you want, but i’m simply pointing out that the very same reasoning used in favor of masks during the covid pandemic applies to every other serious infectious disease. The yearly influenza is quite serious and deadly to tens of thousands annually. I don’t think the comparison is a stretch at all.
I would like to see where the argument is being made that we should all start wearing masks all the time against routine illnesses vs. pandemics and novel viruses. Show me where “if it saves one life” occurs in any of the publications I linked to in the article.
In fairness to you, it may be that this argument has been going on in the mainstream media. I haven’t seen it even there, but I don’t normally pay a lot of attention. I don’t consider video, in general, to be a good source of information unless nothing I can read is available.
So maybe the logic you describe is out there. I suspect it’s a straw man. Kind of like the “panic” and “mass hysteria” I’ve frequently seen alleged but have never seen happen.
Maybe that’s the difference in our points of view on masks. I think most can look at the numbers and see that Covid this year is more severe than the flu most years. The difference may hang on the definition of “considerably.”
Well, the fact that we don’t yet know what the margin is is itself a distinction. It’s called a “novel coronavirus” because it’s new. Unlike flus and all the other stuff, we didn’t know what it would do, and still know little. This is one of the reasons for more caution and more effort to contain… along with about a thousand people day still dying of it (on avg) in our country alone.
About the “at-risk population.” There isn’t any segment of the population that isn’t at risk. Certainly some groups are at far greater risk. But this is language used of (a) developing the illness symptomatically and (b) dying. It’s not an “at risk of spreading” thing. Everybody, as far as we know, is about equally at risk of spreading it. So, as far as masks go, it’s about ending the pandemic not specifically about preventing the deaths of those most at risk. The latter is a reality that should help motivate the former.
I would think everyone would be more eager to see this thing end.
It’s ironic to me that back when shutting everything down was strategy 1, people were more open to everyone masking up as a means to end the lockdown. Now, it’s we don’t want to be locked down and we don’t want to mask up either. … well, do you want this pandemic to end? We don’t get what we want with this thing. None of us do. Zero of us. We all want it to be over yesterday, but, barring that, to be over next week with no inconvenience whatsoever to our daily lives. This is a silly fantasy. Whatever ends it will include lots of inconvenience. We should accept that. (It’s like getting work done at the dentist. Might as well embrace the pain and get it over with.)
About trusting experts…
We do indeed have a problem. I don’t know what the answer is. As human knowledge and technology expands there are more and more specialties to be expert in. In a culture with no shared source of ultimate meaning and no shared ultimate source of moral standards, “truth” is increasingly just one more stick in the pile to hit your opponents with. Everything is measured in terms of effectiveness for a result we, or some group we identify with, thinks it wants at the moment. In other words, all claims to truth have been weaponized. There is very little seeking of truth for its own sake rather than as a means for defeating some enemy.
Well… so it is in the social media and mainstream media and right and left wing media. It’s hard work to find media sources that are interested in going where facts lead vs. cheerleading for a constituency or preaching to a choir about how bad the other guys are.
I hesitatingly recommend The Death of Expertise (affiliate link) by Tom Nichols… because I don’t yet know of a better book on the topic. I hesitate because Nichols’ approach to the topic is not winsome to the people who need it most: populists/anti-elitists. And he seems way too rosy about experts until you get much later in the book. In the section on education, he seems to simply assume that all change is bad, and work from there. (He’s certainly right that it ain’t what it used to be.) I haven’t finished the book yet, so I don’t know if he has some good ideas on how to get out of the mess we’re in.
But despite all that, there is insight along the way into how to view expertise, how to better understand what it is.
And the challenges of listening to/trusting the right people have been exaggerated. I have a couple thousand words of notes on this topic waiting for me to get around to organizing them and writing an article. The really short version, so far:
- Stay away from video. There are exceptions, but most experts write, and most video is oversimplified to the point of distortion and also overdramatized.
- Stay away from obviously political sources (by “political” I don’t mean “about politics,” I mean “committed to a political party/tactical agenda”).
- In response to claims that so and so is an “expert,” look at things like (a) experience in the fields most relevant to the question (all MDs are not equally expert on this or that, any more than all salesmen are experts on every product for sale, or all farmers are experts on every crop or machine or livestock animal), and (b) respect and recognition by his/her field of expertise over time. I would add, look for (c) what kind of respect does this person command across political lines, where that can be known?
- Put the truth-seeking glasses on first, not the political/culture-war glasses. Save those for later, if you get to them at all. A prior step: learn to recognize when you’re wearing political/culture-war glasses in the first place. I fear many have wearing them like long-term contact lenses 24x7 for so long, they can’t remember if they’ve even got them on anymore. They’re grafted onto their eyeballs. Everything is not political.
- Edit to add: seek truth with a keen awareness of confirmation bias. I see so much selective appeal to outlier “experts” to confirm a narrative. Our loyalty needs to be to truth, not to a story we’re looking for stuff to confirm.
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.
So, as far as masks go, it’s about ending the pandemic not specifically about preventing the deaths of those most at risk. The latter is a reality that should help motivate the former.
I would think everyone would be more eager to see this thing end.
I am definitely eager to see this end, but I do not believe completely stopping the spread is the way to see it end. Many have been scratching their heads trying to figure out why we in South Dakota have not had our hospitals overwhelmed without a statewide lockdown or mask mandate and all the tourists coming in. One of the theories is that we are in a similar situation to Sweden. We have not heard much about Sweden lately because they seem to have gotten through it and have attained a measure of herd immunity. We see the same thing in New York City. Preventing all spread is simply delaying the inevitable unless a vaccine is developed.
This is not some kook theory either. The experts were telling us this back in March when we first implemented the lockdowns to flatten the curve so the hospitals were not overwhelmed and then we could manage the spread. South Dakota followed those recommendations and we were not overwhelmed. Further our economy was not destroyed.
The first things we were told was to wash our hands and avoid stress. The less stress we have the stronger our immune system will be. I think this is also a huge factor as to why we have had such low hospitalizations in South Dakota. If we are going to save lives maybe we need to stop scaring people. I am not trying to be simplistic, I am simply looking at the results.
Completely stopping the spread is not the way out of this and some experts have been telling us this all along. Many have died and will continue to die as a result of the lockdowns as well. The lives of starving children around the world as a result of the shutdowns are also important.
Earlier they were saying that they thought 60-70% had to be infected to get herd immunity, but now there is data that about 50% of people are not getting infected and my have some natural immunity. That means that only about 20% of a population has to get it before we have herd immunity. Sweden, NY City and other places appear to have reached that. That would also explain why when they do the antibody testing of an area about the highest that they find is around 25% infected. I believe that the the Sioux Falls area is close to that as well. When we had it back in March, there were people all over Sioux Falls coughing like crazy and their cough sounded just like ours did. If a lot of them were Covid victims, that would explain why it is not getting out of hand now. I beleive enough have already been infected to slow the spread. Sure we are still finding new cases, but we are testing more too. Hospitals are not overwelmed however.
We all want to save lives, but we should be able to disagree with how to go about it, without shaming one another or accusing people we disagree with of blindly following Trump. I find the Trump thing especially insulting because I think he has dropped the ball on showing the importance of managed herd immunity. At the same time, I do respect him stepping back and letting states manage it as they see fit so we can see the results of different approaches. I am also thankful for our governor here in South Dakota.
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