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

Aaron Blumer
Coronavirus
COVID-19
Masks
Health

(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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Discussion

Profile picture for user Don Johnson
Don Johnson
Tue, 08/11/20 12:00 am

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

Profile picture for user TylerR
TylerR
Tue, 08/11/20 12:00 am

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.

Profile picture for user TylerR
TylerR
Tue, 08/11/20 12:00 am

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.

Profile picture for user Andrew K
Andrew K
Tue, 08/11/20 12:00 am

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

Profile picture for user Don Johnson
Don Johnson
Tue, 08/11/20 12:00 am

… 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

Profile picture for user Andrew K
Andrew K
Tue, 08/11/20 12:00 am

[Andrew K]

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?

User image
dgszweda
Tue, 08/11/20 12:00 am

[Don Johnson]

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.

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JD Miller
Tue, 08/11/20 12:00 am

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.

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dgszweda
Tue, 08/11/20 12:00 am

[JD Miller]

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.

Profile picture for user Aaron Blumer
Aaron Blumer
Tue, 08/11/20 12:00 am

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.” :-) 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.

Profile picture for user Andrew K
Andrew K
Tue, 08/11/20 12:00 am

[Aaron Blumer]

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-shou…

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

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. :)

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Aaron Blumer
Tue, 08/11/20 12:00 am

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.