It turns out that masks are mostly a symbolic talisman
Something like wearing garlic around your neck:
In the community, mask-wearing “probably makes little to no difference” in either influenza-like or COVID-like illness (0.95) or “laboratory-confirmed” infections of either virus (1.01). While the confirmed-infections finding had a much wider confidence interval, the team called both these results “moderate-certainty evidence.”
Researchers had more trouble determining the effect of respirators such as N95s — which the CDC only recommended two years into the pandemic — versus surgical masks. Five studies (four healthcare and one household), with a total of 16,000 participants, found a risk ratio of 0.70 for “clinical respiratory illness” but deemed it “very low-certainty evidence,” with a wide confidence interval. The RR was 0.82 for influenza-like illness, deemed “low-certainty” with a smaller confidence interval.
They were more confident in results for respirators versus surgical masks on lab-confirmed influenza: RR of 1.10 among the 8,400 participants in those trials, and no difference when the household trial was excluded.
It’s all quite technical, and you can find the actual study at this link. I haven’t read it yet.
A few caveats: meta-analyses have some possible negatives:
Two main criticisms of meta-analysis are that it combines different types of studies (“mixing apples and oranges”), and that the summary effect may ignore important differences between studies. Meta-analysis should be avoided if studies are too heterogeneous to be comparable, as the metaanalytical results may be meaningless and true effects may be obscured. However, meta-analyses, by their very nature, address broader questions than individual studies. Therefore, it can be said that a meta-analysis is similar to asking a question about fruits, for which both apples and oranges can contribute valuable information.
The phrase “garbage in, garbage out” means that if a meta-analysis includes low-quality studies, its results will be biased and incorrect. Meta-analysis includes a set of criteria for determining which studies to analyze. Hence, meta-analysis should be based on stricter criteria regarding the quality of studies to be included. When the available studies are flawed, a meta-analysis may employ sensitivity analyses to identify the influence of study biases.
Much more at the link.
That said, my personal opinion at this point – and I believe it’s been my opinion for most of the pandemic – is that masks might give a tiny tiny edge but that’s all. I have always been against mask mandates, but I’ve also never mocked those who wear them. I can’t remember when I jettisoned mine, but it was a long long time ago except for places like the select doctors’ offices where they are mandatory (they were not required last April in Los Angeles, however, at the office of my eye surgeon). I know people who are immune-compromised, cannot be vaccinated, and who probably would be at unusually grave risk from contracting COVID, and when they go to the market or any indoor space of that nature they continue to wear masks. I understand why they might want that tiny edge and why they might believe – or at least hope – that masks still offer it.
I think much the same, Neo. When I see people with N95s in public places, I do them the courtesy of assuming they are immune-compromised. And whether or not people are masked, I am more cautious about getting really close to them in stores, and I will stay home myself if at all possible when I have the sniffles, to avoid possibly making someone ill.
If these people were masking in grocery stores or whatever prior to January 2020 every flu season then fine they are being consistent but we know they weren’t because we have eyes.
I never say anything to these people but I do think less of them especially the younger ones. These are the people that would force everyone to mask up again in a heartbeat. These people are mentally ill.
Yet, next Tue I have a Doc appointment. They reminded me that I have to wear a Mask.
Even younger people can have immune system problems. I think less of people who try to force me to conform to their ideas, but I don’t worry about people who politely leave me alone.
Mosquito netting has always made the best boat hull.
Kate,
Well then here in western WA we must have a lot of younger people with immune system problems because you still see them masking up in stores (not all or close to all but I would estimate 10% which would be a hell of a lot of immono compromised young people).
Seems unlikely to be immune problems but more likely mental problems.
I suspect that people who live in red areas don’t realize that a lot of people of all ages are still masking in the blue zones.
This story comes to mind.
https://nypost.com/2023/02/02/stephen-colberts-masked-up-audience-mocked-their-brains-are-broken/
I’ve had limited experience of one meta study. My main take away was that it wasn’t a substitute for a single good study and that if there was a good study in the group, it completely dominated the results. Nor was a simply a case of tossing lots of studies into the basket, they had to be evaluated and sometimes the results needed to be recoded/translated. That was in the very early days, but I doubt that they have improved a great deal since then.
Bottom line: good data rules.
Griffin:
That’s quite a bunch of conclusions you’ve come to.
Young people can have compromised immune systems, or cancer, or any number of other problems that would make them decide to wear masks if it helps a little. And mask-wearing does not indicate a need or desire to force everyone to wear masks. Some people do have that desire and some don’t.
neo,
Yes, I’m basing my thoughts on what I see in my area every day. Pre 2020 it was extremely rare to ever see a person in public wearing a mask. Now you can’t go to a moderately busy Walmart without seeing a dozen or more people, often younger, wearing masks. Where were all these people prior to 2020 during flu seasons?
It seems pretty safe to say that all these younger people are not immuno compromised or cancer patients.
I would add that people wearing masks also maintains the sense of danger and fear that has pervaded the last three years where everyone was seen as some disease vector.
They are like the proverbial ‘tin foil hat’ people and should be pitied at this point.
Griffin:
Of course they’e not all immune-compromised or cancer patients. But you don’t know their motives or their health status, including their mental health status.
I prefer to not worry about what other people do and not to assume I know their motives until they make them clear. People who scold others for not masking are a different story. But most people I see are just minding their own business.
Chuck,
That’s my impression, also. I understand the point of meta analysis, it’s a valid approach, but if there is one study that was done significantly better than all the rest a meta analysis will muddy that result.
Okay, immunocompromised person here [M J R, owing to kidney transplant at year-end 2019], so I am very interested in these sorts of things now. I followed neo’s link to the actual study.
I long ago decided that cloth masks were essentially theater, at best marginally helpful in large, indoor crowds, especially if someone(s) is(are) coughing or sneezing. I don’t want to play that game, so I decided early on that I would go with N95s, in my case, with elastic around the back of the head (instead of looped around the ears), so that the mask fits reasonably tightly. And when I go with N95s, it’s only indoors.
Therefore, I was interested in the study’s reported results for N95s, which reports an RR (risk ratio) of 0.70, with a caveat (see below). First, I will link to CDC’s definition of RR, along with the following interpretive paragraph from the CDC text [CDC is very politically compromised at this point, but I think it’s safe to imagine that their textbook definition predates the compromising]:
https://www.cdc.gov/csels/dsepd/ss1978/lesson3/section5.html
“A risk ratio of 1.0 indicates identical risk among the two groups. A risk ratio greater than 1.0 indicates an increased risk for the group in the numerator, usually the exposed group. A risk ratio less than 1.0 indicates a decreased risk for the exposed group, indicating that perhaps exposure actually protects against disease occurrence.”
The caveat surrounding RR = 0.70 is the confidence interval. The study reports a 95 percent confidence interval of (0.45 to 1.10), which I can note in passing is not quite symmetric around the 0.70. (“Not quite symmetric” is okay with me, I’m just noting it.)
The study rates “certainty of the evidence” as “very low”, and it buttresses that with three additional caveats:
“a Downgraded one level for study limitations (lack of blinding).
“b Downgraded one level for imprecision (wide confidence interval or no meta?analysis conducted).
“c Downgraded one level for inconsistency of results (heterogeneity).”
M J R ‘s tentative conclusions applicable to M J R:
(1) 0.70 is pretty low compared to the neutral 1.0, *suggesting* decreased risk (but see (2) and (3));
(2) the 95 percent confidence interval is pretty huge, even stretching beyond 1.0, but at the low end, it also stretches lower than 0.50.
(3) the very best conclusion *I* can draw is that we need more such experiments to arrive at any reasonable conclusion.
Personal note — I am getting extremely tired of these damn masks, but . . .
– my wife wears a cloth mask when out-‘n’-about; she’s always been very cautious in this regard, plus now, there’s the added caution of her not bringing covid cooties home to me;
– as noted, I do the N95 thing, and I need to honor her caution and not bring any cooties of any race, nationality, or creed home to her (or home with me);
– finally, I am getting extremely tired of these damn masks, but I said that already.
neo,
I have never said a thing to any stranger about their mask in all the years this garbage has been going on but I have thought less about many (mostly younger and often people I KNOW have no conditions) people and I definitely believe that a shocking number of people have been broken by these last few years and we will be dealing with the consequences for many years to come.
M J R, I think, as annoying as the darned things are, that it is reasonable for you to wear an N95 as you do inside places where there are lots of people. I hope you can take it off easily upon going outside.
Thanks *so* much, Kate. I really appreciate your response. (And yes, I do think it’s reasonable, if annoying.)
When I return to the outside world, I merely slip the mask down to and around my neck, and then I let it hang there until I can take it off over my head — which generally requires using both hands.
Said it before, but in this case I’d ask the question.
We have been led/allowed to believe that “trapped” means transported to an alternate universe, never to darken our world again.
No, trapped means this whole mess, getting messier with each respiration, is sitting right in front of your face, filtering out oxygen and replacing it with virus (I exaggerate) at every respiration.
You, or the next guy, touch it and then the elevator call button, the door handle the checkout table, ….
Any of our betters ever think of that? No, it’s in a controlled environment with controlled handling.
So why not make half as big a fuss about that as about wearing it? Because they know we–or everybody else but we–would pay no attention and by implication negate the entire exercise. Can’t have that.
In my corner of Wild and Wonderful West Virginia I don’t see too many masks anymore, not even in medical offices. I was in Munich, Germany in September and they were still requiring masks on public transportation. I was not in compliance on the train from the airport and was chastised by a fellow passenger. I politely declined his advice to put on a mask.
The Germans do like to follow the rules. I was always amused that even the “rebels” dressed in leather and with multiple tats and piercings almost always wore the mask.
I think the level of compliance Americans are willing to allow to government edict has been high for some time.
Covid just revealed how compliant we are.
Think back to people wearing masks while jogging or riding a bike outdoors or wearing a mask while driving a car by themselves.
We are an anxious/fearful society. The government has become our savior. The government is now required to “do something”, even when there is nothing it can do.
In the case of MJR, people with medical conditions were wearing masks before Covid.
I will say about surgical/cloth masks– the government made it clear they offered no protection for the wearer, it was about protecting those around us.
In the case of N95 masks, if properly worn, do offer protection, but they also lower blood oxygen levels. About wearing them properly, I was remodeling houses before and during the China virus in very dusty conditions. When you took the mask off, you would see traces of dirt on your face where the dust entered between the mask and skin.
Well, here in socially conscious Seattle they make grand signals of Virtue. Some folks still wear them outdoors (as the Governor and the Mayor did command us), and who’s to contradict them? I jettisoned mine as an early-adopter, but did submit to jabs, and do back rapidly off from coughing humans. And although various friends and family have contracted one or more Covid cases (I haven’t), none have died. Somehow the drama of those overcrowded hospital rooms has just faded away, and it’s mostly like an extended flu season.
@Brian E We are an anxious/fearful society.
Much of the responsibility for that goes to our hyper-dramatic ‘news’ organs, who serve up lavish helpings of fear at every opportunity, knowing that the most desperate headlines sell the most papers.
I live in SW Michigan. Very rare to see a mask. I really don’t care what others do, but, our governor (Cruella with a few pounds) Whitmer already made her mark killing people by mishandling the situation. The decision to go for 100% prevention of getting the virus killed a lot of people.
Viruses are smaller than a wavelength of light. You can’t see them with an optical microscope. You need an electron microscope. Expecting a paper or cloth mask to keep viruses out is like expecting a chain link fence to keep mosquitoes out.
Ray. Correct. But the point is those traveling on microscopic droplets. Coming out of the lungs, as moist as an exhalation is, it would be odd if here were any free virus thingies floating around by their lonesome.
The droplets are trapped in the mask, along with their load, and transferred to some place else every time somebody touches his mask and then touches something else.
Can’t figure out how to design a study, but if you could, in effect, spray virus floating alone into the air, what would be the concentration of them at three feet two seconds later? And variations.
What I do know is that every mask I received at work came out of a box marked “Not For Medical Use” or “Does Not Prevent The Spread Of COVID-19 Or Other Coronavirus”.
And I don’t imagine I was alone.
Here in southwest Ohio masks have just recently been made “optional” at Doctors’ offices and hospitals. The notification says something about “according to CDC guidance at current infection levels”. My wife and I happily stuffed our masks back in our pockets.
What I have concluded from the studies is that the effect of masks, if there is any, is small and likely dominated by uncontrolled factors. That is why the study results are all over the place. If masks shutdown infection 100% there would be no problem demonstrating that.
The problem is that that in itself is an hypothesis. It isn’t hard to demonstrate that masks stop droplets above a given size, but demonstrating that that stops the spread of the virus is a different thing for which the evidence is all over the place.
Still a lot of masking here in Western MA; it’s seems to me to be (and no, I haven’t polled everyone) mostly virtue signaling. One sees more mask-wearing at Trader Joe’s and Whole Foods than one does at UMASS hockey games; more people masked up in their Priuses (Prii?) and Teslas than in their F 150s. Masks are mostly an outward sign of membership in the Church of Covid.
Here in Central New Jersey – most folks are NOT wearing masks any more.
However, I still wear one not because I fear for my own safety. but, I do it for two reasons.
The first is a general courtesy to employees of the store that I am going into. Many of the employees still wear a mask at the grocery store, the library, etc. If my wearing a mask gives them a little more feeling of “safety” then it won’t hurt me to wear a mask.
At my barber no one wears a mask any more, so, I don’t either but then there aren’t many people there when I go.
The second reason is personal in that I have my elderly mother under hospice care living with me. Even if a mask doesn’t do any good – it gives me a sense of doing “everything possible” to prevent her from catching something through me. Of course it is very ironic that I wear the SAME disposable mask for weeks on end!
So, yea, for me it is a talisman.
TomR.
Correct about demonstrating stopping spread. My assertion is that the trapped droplets are concentrated and then distributed by touch on any handy surface and in a public place, picked up by the next person–probably 49 seconds on average–to touch that surface. Is that a more highly concentrated hit of virus than walking where an infected person had exhaled three seconds earlier?
Dr Vinay Prasad has been very balanced on Covid. This thread on masking in hospitals (and doctor’s offices I would add) is very good and my experience of the last few months leads me to believe it. Compliance by the staff is very low and most doctors don’t really enforce it either.
https://twitter.com/VPrasadMDMPH/status/1621646125039255554
I would especially highlight point 14 in Dr Prasad’s thread on the protection’s masks provide the immunocompromised. Do what you want and if it makes you feel better fine but there is no hard evidence to support it.
https://twitter.com/VPrasadMDMPH/status/1621718148021125121
I think we should look not only at the lack of proven benefit from mask-wearing, but crucially at the harms of doing so — everything is a tradeoff.
During the pandemic, masks greatly added to the atmosphere of panic and apocalypse (which I think was why Fauci switched from declaring them essentially useless to mandating them). Masking also created the impression that *everyone* was endangered or potentially endangering others. Even if masks were 100% effective, they would do absolutely nothing to prevent you giving others Covid if you did not have Covid. And if others did not have Covid, their mask was not protecting you.
No study, ever, claimed 100% effectiveness for masks, but psychologically people fell easily into the scapegoating of others as they had. I had a friend who caught Covid blame it on being on a plane with an unmasked passenger nearby. He had no reason to think that passenger was ill, or that masked passengers near him were well, or that he even got in on the flight. But the natural judgmentalism of human beings, aided by the media, led to that terrible attitude of so many.
It goes without saying that I’m sure my friend equates masklessness and evil, careless, dumb flyover people, so that perpetuating the use of masks is, to me, just perpetuating hatred and social division.
And other have written about the disservice to the hard of hearing, and the ill effects on child development, etc.
Charles, I appreciate your concern for your mother — I have a 92 year old mother, luckily not in hospice, and know the feeling of “I hope I’m not the one who kills her!” but unless it is your mother who feels reassured by your mask, I think she would rather see your face in her last days (when mine was in hospital during the bad flu season of 2018, we were given masks, and told that they must be changed every 30 minutes if we used them — and the staff didn’t seem that insistent that we do).
If masks make a difference wouldn’t the contagion rate be way higher in Florida than California?
Here is the Dr Vinay Prasad article to go with the twitter thread I linked above on masking in hospitals. There is just no evidence that masks have any verifiable effect and as Nancy B mentioned above there are real downsides that too many people just cruise right by.
https://sensiblemed.substack.com/p/hospital-masking-should-be-optional?sd=pf
Postoperative wound infections and surgical face masks: a controlled study
Your results may vary. The physics of the problem are equally unflattering.
When I see people with N95s in public places
N95 is a certification. They must be individually adapted. They must be handled to ensure sterility. They, and, in fact, every mask, respirator, etc. offer no source control.