“Masks aren’t effective. Masks increase risk if worn improperly. Masks embolden people.”

It was all based on dogma, not science.

A novel idea: block the virus

Some research questions require carefully conducted epidemiological studies or randomized trials to examine, and others are sufficiently obvious that we could safely forego such endeavors. In my view, the question of whether face masks reduce transmission rates of respiratory viruses falls squarely into the second category. The virus is spread via respiratory droplets, and masks block those droplets.

Of course, there has been research on this topic over the years, and like any research question not all studies have reached the same conclusion. My goal here is not to comprehensively review the scientific evidence on masks, but to illustrate that the new policy establishes that several of the reasons provided for the original policy were untrue, and driven by dogma rather than science.

The recommendations

Up until a few days ago — i.e., for the first ~3 months of the pandemic —the World Health Organization (WHO), Centers for Disease Control (CDC), and US Surgeon General Jerome Adams were all aligned in not recommending face masks for the general public.

Let’s start by looking at those recommendations.

WHO

CDC

Surgeon General

The flawed rationale

“Masks aren’t effective”

In his tweet, the Surgeon General stated plainly:

Masks “are NOT effective in preventing [the] general public from catching coronavirus.”

A similar non-effectiveness claim was recently made by CDC deputy director Dr. Jay Butler:

“There’s really no evidence that wearing a mask will reduce your risk of any respiratory infection.”

On April 3, the Surgeon General and CDC both made a U-turn, recommending people wear homemade cloth masks in public — which completely contradicts their previous claims.

Actually, the new policy implies masks are very effective, and I’ll explain why. There’s no question that N95 respirators are the best option, say in a healthcare setting, followed by surgical masks and finally homemade masks or face coverings or whatever you want to call them. Recommending cloth coverings for the general public implies cloth coverings are effective in preventing transmission, which implies “masks” — N95 or surgical — would be even more effective.

By the way, I understand that the Surgeon General and others are maintaining the idea that masks work by preventing infected mask-wearers from transmitting the virus to other people, not by preventing healthy mask-wearers from becoming infected by others. This is an extremely dubious claim because it contradicts the widespread use of masks by healthcare providers and caregivers. Those populations wear masks to prevent becoming infected.

“Masks increase risk if worn incorrectly”

The argument here is that masks are somehow difficult to wear— that if they aren’t properly fit and maintained, they can increase rather than decrease risk.

On March 2, the Surgeon General said in an interview:

“You can increase your risk of getting it by wearing a mask if you are not a health care provider.”

On March 30, the executive director of WHO stated:

“There is no specific evidence to suggest that the wearing of masks by the mass population has any potential benefit. In fact, there’s some evidence to suggest the opposite in the misuse of wearing a mask properly or fitting it properly.”

I seriously doubt this is backed up by any real scientific evidence. I searched around and found lots of public health professionals and doctors saying it, but none citing any specific studies. And unlike the question of whether droplet-blocking masks can prevent transmission, this statement requires some hard evidence.

Interestingly, I found the “masks can increase risk” theory stated in one recent Lancet editorial — with no reference!

“Masks embolden people”

This is the classic bad argument against effective interventions. Seat belts make people drive faster, football helmets make people hit harder, etc.

Dr. Debora Birx, Response Coordinator for the White House Coronavirus Task Force, delivered exactly that concern on April 2:

“…we don’t want people to get an artificial sense of protection because they’re behind a mask.”

Obviously, it’s rarely a good idea to withhold recommendations on the basis that they might lull people into a false sense of security. Virtually nobody is going to maintain a 100% quarantine for the remainder of the pandemic. It’s critical that any means of reducing risk when venturing out is transparently communicated to the general public.

A strange new predicament

Unsurprisingly, letting recommendations be driven by dogma rather than science has led public health agencies to a predicament. The CDC, Surgeon General, and White House Coronavirus Task Force have all finally reversed their position on masks.

Actually, they’re not recommending masks, but “cloth face coverings” so that surgical masks and N95 respirators can be left for healthcare providers.

On one level, it makes sense. There’s an obvious shortage, and we need to prioritize those with the highest exposure.

On another level, it makes no sense whatsoever. Overnight, the official position went from “masks are not effective for the general public” to “makeshift masks are effective for the general public.”

It went from “imperfect fitting and maintenance can actually increase your risk” to “just put something over your face, it’s better than nothing.”

The WHO, meanwhile, is sticking to their guns. Their website still broadcasts a classic don’t-take-precautions-until-absolutely-necessary philosophy:

“If you are healthy, you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection.”

This is obviously ill-advised, yet somehow unsurprising given their track record on COVID-19 so far. I’ll leave you with this tweet from January 10.