Media Lens (ML) provides a first-rate critical eye on the media, especially the British mediascape, as well as sundry events in the world. In a recent piece, ML pointed to the science as supporting the effectiveness of wearing face masks against respiratory viral infections. In addition to citing science to buttress their support of mask wearing, ML attempted to dismiss those with opposing views as conspiracy theorists.1 If that and the science was not persuasive, the fallback was to appeal to one’s sense of ethics.
ML critiqued a tweet by Mail on Sunday columnist Peter Hitchens on the use of face masks:
the primary purpose of enforced muzzle wearing in public spaces (which protects nobody against anything) is to humiliate the wearer and make him or her accustomed to unquestioning obedience to authority.
ML commented, “This was indeed a conspiracy theory – literally, and also, in our opinion, in the deranged and dangerous sense commonly used by journalists.”
I with ML that this lone statement by Hitchens comes across as conspiratorial because there was no evidence offered in support of it. I do not concur that the statement per se is either deranged or dangerous.
ML then switched its focus to a comment in Off-Guardian by Iain Davis:
Face masks work well for surgeons who want to avoid dribbling or sneezing into their patients, but are useless when it comes to stopping viral infections. In terms of preventing the spread of COVID 19 there is no evidence that they achieve anything at all.
ML chided both Hitchens and Off-Guardian: “Hitchens and OffGuardian had better be right. If they are not, they are handing out advice that is encouraging people to take risks that could cost lives.”
Two points, 1) the logic that derives from the ML writers is that people ought to accept some information at face value, without solid evidence, even from those same authorities, e.g., the UK government, known to be steeped in prevarication; 2) ML’s criticism did not extend to or mention that other authorities, such as Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases in the US, had in March also said there was no need to wear a mask. Nor did ML mention that the World Health Organization (WHO) had said there was no need for healthy people to wear face masks.
Moreover, ML failed to mention a pertinent sentence in the Off-Guardian article: “If there are health risks associated with wearing face masks, and there are, this notion of protection rapidly becomes a nonsense.”
ML’s accusation of possibly putting people take risk, skimmed past Davis’s charge that wearing masks has known risks. What readers are left with is a choice between a possible risk versus known risks. Albeit the COVID-19 risk can be quite lethal and contagious.
ML noted the Off-Guardian’s focus was not on coronaviruses but on “research mostly relating to influenza and influenza-like illness.” To buttress their argument, ML pointed to a study by Cheng et al. (2020) who said:
Previous research on the use of masks in non-health-care settings had predominantly focused on the protection of the wearers and was related to influenza or influenza-like illness. These studies were not designed to evaluate mass masking in whole communities.2
First, I’d say the focus of Davis’s Off-Guardian article was on anti-authoritarianism and conflicting UK government guidance about whether wearing face masks protects against Covid-19. Second, given that SARS-CoV-2 was believed to be a recent type of respiratory-infecting coronavirus, it seems quite reasonable to compare it to the data on other respiratory-disease causing viruses.
Cheng et al. concluded, “An evidence review and analysis have supported mass masking in this pandemic.”
If one checks the studies cited to by Cheng et al., one finds the “evidence review” by Howard et al. (2020) is supportive:
The preponderance of evidence indicates that mask wearing reduces the transmissibility per contact by reducing transmission of infected droplets in both laboratory and clinical contexts.3
However, when one reads the Greenhalgh et al. (2020) “analysis” cited by Cheng et al., stated is,
The evidence base on the efficacy and acceptability of the different types of face mask in preventing respiratory infections during epidemics is sparse and contested.4
Even though the evidence for the efficacy of face mask usage was absent, the authors still encouraged the wearing the masks.
This raises an ethical question: should policy makers apply the precautionary principle now and encourage people to wear face masks on the grounds that we have little to lose and potentially something to gain from this measure? We believe they should.4
It is a case of the science being shunted aside. In his paper pointing out that the scientific evidence does not support the prophylaxis of masks, Denis Rancourt argued that the precautionary principle does not apply in this case:
In light of the medical research, therefore, it is difficult to understand why public-health authorities are not consistently adamant about this established scientific result, since the distributed psychological, economic and environmental harm from a broad recommendation to wear masks is significant, not to mention the unknown potential harm from concentration and distribution of pathogens on and from used masks. In this case, public authorities would be turning the precautionary principle on its head.5
Greenhalgh et al. did raise a caution, saying:
External validity relates to a different question: whether findings of primary studies done in a different population with a different disease or risk state are relevant to the current policy question. We argue that there should be a greater focus on external validity in evaluation of masks.
The Lancet article also admits and explains,
Research has also not been done during a pandemic when mass masking compliance is high enough for its effectiveness to be assessed. But absence of evidence of effectiveness from clinical trials on mass masking should not be equated with evidence of ineffectiveness.2
Absence of evidence is not evidence of absence. This is true, but it is not rigorous science. Scientific rigor demands that when the null hypothesis (what researchers predict will happen before carrying out an experiment) fails to reach statistical significance that the hypothesis be rejected and the theory from which it derived also be rejected. Ergo, the Lancet is recommending measures from an admitted epistemological lacuna. Science never claims truth or proof. Science tests hypotheses that are falsifiable.6
ML quoted Richard Stutt, lead author of a Cambridge University study:
If widespread facemask use by the public is combined with physical distancing and some lockdown, it may offer an acceptable way of managing the pandemic and reopening economic activity long before there is a working vaccine.
Is a combination required for effective protection? Obviously, if you are in a lockdown or sufficiently physically distant from other humans or creatures that can transmit the virus, then there should be no need for a mask, so mask usage would only apply when one is out in public. But absent a randomized controlled trial (RCT) supporting the prophylaxis of face mask usage, we are unable to pronounce on the efficacy of wearing face masks.
Renata Retkute, coauthor and Cambridge team member said, “We have little to lose from the widespread adoption of facemasks, but the gains could be significant.” [emphasis added] Rancourt has already addressed the “little to lose” assertion for this something that “could be.”5
ML noted an American Thoracic Society report by the Chinese University of Hong Kong on “how public interest in face masks may have affected the severity of COVID-19 epidemics and potentially contained the outbreak in 42 countries in 6 continents.”
Sunny Wong, one of the study’s authors, commented:
One classic example is seen in Hong Kong. Despite [Hong Kong’s] proximity to mainland China, its infection rate of COVID-19 is generally modest with only 1,110 cases to-date. This correlates with an almost ubiquitous use of face masks in the city (up to 98.8 percent by respondents in a survey). Similar patterns are seen in other Asian areas, such as Taiwan, Thailand and Malaysia. To date, there are more than two million cases in the U.S. and more than one million cases in Brazil.
Wong stated that this is correlational. He ascribes no causation.
A sentence ML did not mention from the article is: “While, the authors acknowledge that face masks are seen as important in slowing the rise of COVID-19 infections, it is difficult to assess whether it is more effective than handwashing or social distancing alone.” [emphasis added]
Next, ML looks at a study by Virginia Commonwealth University on coronavirus death rates in 198 countries to gain insight into why some countries had very high death rates and others very low. Lead author Christopher Leffler commented:
What we found was that of the big variables that you can control which influence mortality, one was wearing masks.
It wasn’t just by a few per cent, it was up to a hundred times less mortality. The countries that introduced masks from the very beginning of their outbreak have had hardly any deaths. [ML emphasis]
Well, this was a news channels report. The study cited was Leffler et al. (2020) in ResearchGate.7 ResearchGate is an online site for science papers. It had originally published a paper by Denis Rancourt that masks don’t work5 and later retracted it. Yes, censorship is alive and kicking in science.8
Leffler et al. concluded,
These results support the universal wearing of masks by the public to suppress the spread of the coronavirus. Given the low levels of coronavirus mortality seen in the Asian countries which adopted widespread public mask usage early in the outbreak, it seems highly unlikely that masks are harmful. [emphasis added]
Saying masks are not harmful9 is different from saying masks are protective. Again this is not a RCT. Rancourt looked at meta-analyses of RCT studies on the efficacy of face masks and his article was published, received 400,000 views, and was then censored. Subsequently, a post hoc study was published at ResearchGate with a conclusion that coincides with status quo approval of the Establishment.
In their article, Leffler et al. pointed to a study by Xiao et al. (2020) who concluded:
Although mechanistic studies support the potential effect of hand hygiene or face masks, evidence from 14 randomized controlled trials of these measures did not support a substantial effect on transmission of laboratory-confirmed influenza.10 [emphasis added]
Leffler et al. still pointing to the Xiao et al study nonetheless sought support for face mask use:
Much of the randomized controlled data on the effect of mask-wearing on the spread of respiratory viruses relates to influenza. One recent meta-analysis of 10 trials in families, students, or religious pilgrims found that the relative risk for influenza with the use of face masks was 0.78, a 22% reduction, though the findings were not statistically significant.11 [emphasis added]
Leffler et al. further speculated, “Even if one accepts that masks would only reduce transmissions by 22%, then after 10 cycles of the infection, mask-wearing would reduce the level of infection in the population by 91.7%, as compared with a non-mask wearing population…”12
However, Leffler et al. was referring to a paper cited within in the Xiao et al. study, namely Balaban et al. (2012) who gathered data on Muslims making a pilgramage to Mecca that produced results in contradiction to how Leffler et al. reported the findings. Balaban et al. stated:
Compared with other protective behaviors, wearing face masks during Hajj seemed to have little protective effect. Wearing a face mask was actually associated with greater likelihood of respiratory illness. This finding is consistent with previous findings that face masks either offered no significant protection or were associated with sore throat and with longer duration of sore throat and fever symptoms among Hajj pilgrims.13
Balaban et al.’s finding was damning for any protection from viral infiltration by mask wearing. Furthermore, the authors found mask wearing to be associated “with greater likelihood of respiratory illness.” Thus, it appears Leffler et al. were lax in their literature review and engaged in cherry-picking information, giving the appearance of a confirmation bias.
Leffler et al. did note several concerns about what the data examined pertain for the verisimilitude of their conclusions.14 Among these were:
- “One major limitation is that evidence concerning the actual prevalence of mask-wearing by the public is unavailable for most countries.”
- “Some countries which used masks were better able to maintain or resume normal business and educational activities.
- “Limits on international travel were significantly associated with lower per-capita mortality from coronavirus. As compared with no restrictions, complete shutdown of the border throughout the outbreak was independently associated with 86% lower per-capita mortality.”
- “The adoption of numerous public health policies at the same time can make it difficult to tease out the relative importance of each.”
- “We also acknowledge that country-wide analyses are subject to the ecologic fallacy.”
ML refer to a “dramatic verdict” in the Proceedings of the US National Academy of Sciences:
Our analysis reveals that the difference with and without mandated face covering represents the determinant in shaping the trends of the pandemic worldwide. We conclude that wearing of face masks in public corresponds to the most effective means to prevent interhuman transmission, and this inexpensive practice, in conjunction with extensive testing, quarantine, and contact tracking, poses the most probable fighting opportunity to stop the COVID-19 pandemic, prior to the development of a vaccine. [ML emphasis]15
It flies in the face of logic that wearing face masks would be more effective than a quarantine or isolation.
The PNAS researchers, Zhang et al., cautioned,
It is also important to emphasize that sound science should be effectively communicated to policy makers and should constitute the prime foundation in decision-making amid this pandemic. Implementing policies without a scientific basis could lead to catastrophic consequences, particularly in light of attempts to reopen the economy in many countries.16
For science purists, post hoc analysis of data is not considered sound science. It is too tempting to take existing data and shape them to a preconceived outcome — the confirmation bias. I submit that the proper scientific course for Zhang et al. would be after going through the data, to then formulate a hypothesis, set up and implement an experiment, gather the data, and carry out tests for statistical significance.
The Lancet study had reached similar conclusions:
We encourage consideration of mass masking during the coming phases of the COVID-19 pandemic, which are expected to occur in the absence of an effective COVID-19 vaccine… Mass masking for source control is in our view a useful and low-cost adjunct to social distancing and hand hygiene during the COVID-19 pandemic.2
The Lancet paper made the distinction that face masks protect other people from the wearer, not vice versa: “People often wear masks to protect themselves, but we suggest a stronger public health rationale is source control to protect others from respiratory droplets.”
ML turned to Rich Davis, Clinical Microbiology Laboratory director at Providence Sacred Heart Hospital in the US. Davis has published photographs showing how face masks block respiratory droplets coming from the mouth and throat. However, Davis used bacteria which he acknowledged to be “incredibly different from viruses!” He reasoned:
But since we expect respiratory droplets to be what primarily spreads #COVID19, I exploit the presence of (easily to grow and visualize) bacteria in respiratory droplets, to show where they go.
First, there exists confusion about the terms droplets and aerosols. In general, a droplet is considered to be a water particle that submits to gravity; therefore, it is less likely to be inhaled. Aerosols are tinier and tend to remain suspended for a much longer duration than droplets. The aerosols containing SARS-CoV-2 virions were found to remain infectious longer and reach deeper into the lungs than droplets.17 Second, The problem with this comparison is that bacteria are much larger (100+ times larger) than viruses, especially compared to the minuscule SARS-CoV-2 virus. Masks may be dense enough to block bacteria, but they are porous to coronaviruses that are tiny enough to pass through the mesh of masks and even respirators.
The Paucity of Scientific Evidence for Face Mask Prophylaxis
ML argue that the compulsory wearing of face masks “in a fast-moving field, where some kind of overview is needed promptly, it is the most reasonable approach, bearing in mind the usual caveats that the work has not gone through a thorough process of vetting and checking as part of the normal academic peer-review process. This nevertheless remains highly credible evidence.”
The evidence that ML present in their article, for this writer, is far from highly credible. In fact, the evidence is contrary to what ML claim. So this writer wonders given the paucity of scientific support for facemask wearing, why did ML even pursue the scientific route which is strongly against what ML assert?
But ML had another card in their backpocket should the science not be convincing for face mask wearing. ML pulled out the ethics card.
Some honesty is necessary in this debate. The evidence supporting face mask usage as protecting against being infected with COVID-19 is extremely weak. For example, at least 3387 healthcare workers in China contracted COVID-19, and 23 died.18 Supposedly, these healthcare workers had access to N95 respirators and PPE.
SARS-CoV-2 is a novel coronavirus. We are still learning much about it.19 Much of the information disseminated is contradictory, even self-contradictory; it is evolving, and with that our understanding is evolving. There is no solid scientific evidence in support of wearing face masks; consequently, the theory that face masks will filter out viruses must be discarded.
The Right Thing to Do?
Nonetheless, I will not state with 100% certainty that face masks are totally useless. Science does not state with a 100% certainty. Maybe tomorrow the sun will appear to rise in the West, and then the knowledge about the sunrise20 will be amended to integrate the new information with what is now understood.
Most of us live together in a society. We ought also to make our decisions based on living with and among others and not just on the state of scientific knowledge at a given period in time. It is preferable that we come across as caring and not arrogant or righteous in our knowledge of facts and evidence. Those who eschew mask wearing can try to avoid it as much as possible through isolation. But maybe one has to travel by bus one day. Here is the question I suggest posing to oneself: Is it better to maintain fidelity to one’s convictions and risk incurring ill will among other passengers by not wearing a mask on bus trips?21
Essentially, a steely knowledge of the science will not be enough to smooth the ruffled feathers among some science skeptics.
A preferred perspective to viewing oneself, and others, as submitting to false dictates by the State (despite being secure in one’s knowledge that such dictates are not based in rigorous scientific evidence), is to view oneself as instead choosing a path of least resistance to get along with others. When one comes across as pleasant and respectful, it is easier to engage in dialogue with fellow citizens on whether mask wearing is essential or not.
The Ontario Civil Liberties Association took a position. It wrote a letter to the director general of the WHO, Dr. Tedros Adhanom Ghebreyesus, asking for a retraction of the WHO’s recommendation favoring the use of face masks as preventative of COVID-19 transmission. Two excerpts from the letter:
… the WHO cannot collect and rely on potentially biased studies to make recommendations that can have devastating effects (see below) on the lives of literally billions. Rather, the WHO must apply a stringent standards threshold, and accept only randomized controlled trials with verified outcomes. In this application, the mere fact that several such quality studies have not ever confirmed the positive effects reported in bias-susceptible reports should be a red flag.
and
It is an unjustified authoritarian imposition, and a fundamental indignity, to have the State impose its evaluation of risk on the individual, one which has no basis in science, and which is smaller than a multitude of risks that are both common and often created or condoned by the State.
ML posed an ethical hypothetical: “Given that [certainty that face masks are worthless is highly questionable], should we not all err on the side of caution by using face masks, particularly when interacting with the old and infirm who are at most risk from Covid-19?” [ML emphasis]
It is all too easy to pose a leading ethical hypothetical. E.g., what if acquiescing to the directives of the Establishment to wear face masks causes predictable harm to people? What if the 1%-ers take advantage of the docilized citizenry to consolidate control over the working class and cut social services and healthcare, leading to greater penury, ill health, and a shortened life span?
Different situations will evoke different moral responses among humans. Humans have different origins, different upbringings, different challenges, different ways of thinking, and different experiences that will influence a person’s concept of what is right or wrong. A moral basis would call upon each person to recognize that morality is not always a unanimously clear-cut concept for all people.
To Wear or not Wear a Mask
Dissident Voice editor Angie Tibbs’s email provides a perspective for consideration on the fear evoked by media reports of COVID-19 and whether to wear or not wear a mask:
Well, science aside, what about health issues? The taxi driver who brought me home from my ill-fated visit to the hospital on Friday morning has asthma, and she refuses to wear a mask because it creates a worse problem than she would normally have. Are the respiratory problems of people taken into consideration with respect to mask wearing?
In my case, I’ve only worn one when I visited the hospital because I had to. I am extremely claustrophobic at the best or times, and wearing a mask only increases that. As well, on the three occasions I’ve worn one I was constantly pulling the damn thing down from my eyes. On Friday past at the hospital every time I moved my head the mask moved, hitting off my eyes. I ended up at home later having to spend most of the day and night away from my computer and editing DV submissions. If masks are provided in hospitals and you’re ordered to wear one (or else leave) the least one can expect is a mask that is not in an attack mode!
I go to the market in a cab, sitting in the rear seat with a screen between myself and the driver. At the market I wipe the cart and my hands with the sanitizer provided, put on plastic or rubber gloves and follow the floor markings to where I need to go. I’m in and out of there as quickly as possible. If others want to wear masks, they can. If others don’t, they don’t have to. If someone is ill, they ought not be out amongst the public at all. I spent the first month of this virus (from March 23 to April 18) refusing to step outside the door, not because I was sick but because I was scared, scared because I foolishly listened to the fearmongering of the media. I wouldn’t even go to the market. Instead I had a friend pick up my groceries and paid her. How f***ing insane is that? On April 18 I went off early to the grocery store for the first time in weeks and found I wasn’t allowed to carry in my shopping bags. I had to leave them, pick up my groceries in plastic bags, and head down again to get my shopping bags – only to find out the idiot guard or whoever had “thrown them out”. On Saturday past at this same grocery store, the checkout clerk asked: “Did you bring your shopping bags?” I was surprised. “No, we’re not allowed to do that here.” To which he replied “You will have to bring them in the future”. Hell!! Talk about changing the rules!
Regarding how to deal with and protect oneself and others from contracting COVID-19, I do not claim scientific certainty. I do not claim moral certainty. What I do realize is that many of us are learning through this experience, and many of us reach our own conclusions and act in the belief that we are doing what is right.
- I was very disappointed by ML, who have always seemed a cut above, in resorting to ad hominem.
- Kar Keung Cheng, Tai Hing Lam, Chi Chiu Leung, Wearing face masks in the community during the COVID-19 pandemic: altruism and solidarity, Lancet, April 16, 2020. DOI:https://doi.org/10.1016/S0140-6736(20)30918-1
- Jeremy Howard, Austin Huang, Zhiyuan Li, Zeynep Tufekci, Vladimir Zdimal,Helene-Mari van der Westhuizen, Arne von Delft, Amy Price, Lex Fridmand, Lei-Han Tang, Viola Tang, Gregory L. Watson, Christina E. Bax, Reshama Shaikh, Frederik Questier, Danny Hernandez, Larry F.Chun, Christina M. Ramirez,and Anne W. Rimoin, Face Masks Against COVID-19:An Evidence Review, (available as pdf) Preprints, 12 April 2020.
- Greenhalgh Trisha, Schmid Manuel B, Czypionka Thomas, Bassler Dirk, Gruer Laurence. Face masks for the public during the covid-19 crisis, BMJ, 2020; 369 :m1435
- Denis Rancourt, Masks Don’t Work: A review of science relevant to COVID-19 social policy, ResearchGate, April 2020.
- See Karl Popper, The Logic of Scientific Discovery (New York: Routledge Classics, 2005): 18-20.
- Leffler, Christopher; Ing, Edsel; Lykins, Joseph; Hogan, Matthew; McKeown, Craig; and Grzybowski, Andrzej. (2020). Association of country-wide coronavirus mortality with demographics, testing, lockdowns, and public wearing of masks (Update July 2, 2020). ResearchGate.
- See Denis Rancourt, “COVID censorship at ResearchGate: Things scientists cannot say,” Activist Teacher, 5 June 2020.
- This is disputed. “There are significant anticipated harms from the widespread use of masks in the general population, which both the World Health Organization (WHO) and the OCLA have described in detail. [http://ocla.ca/ocla-letter-who/ ].” See “OCLA Recommends Civil Disobedience Against Mandatory Masking,” Ontario Civil Liberties Association, 30 June 2020. Disclosure: Denis Rancourt is a researcher with OCLA.
- Xiao J, Shiu EY, Gao H, Wong JY, Fong MW, Ryu S, Cowling BJ. Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings- Personal Protective and Environmental Measures. Emerging Infectious Diseases. 2020; 26(5): 967-75. https://pubmed.ncbi.nlm.nih.gov/32027586/
- Leffler et al., p 27.
- Leffler et al., p 28.
- Victor Balaban, William M. Stauffer, Adnan Hammad, Mohamud Afgarshe, Mohamed Abd‐Alla, Qanta Ahmed, Ziad A. Memish, Janan Saba, Elizabeth Harton, Gabriel Palumbo, Nina Marano, Protective Practices and Respiratory Illness Among US Travelers to the 2009 Hajj, Journal of Travel Medicine, 19(3), 1 May 2012: 163–168.
- Leffler et al., p 29.
- Renyi Zhang, Yixin Li, Annie L. Zhang, Yuan Wang, Mario J. Molina. Identifying airborne transmission as the dominant route for the spread of COVID-19. Proceedings of the National Academy of Sciences, June 2020, 117(26) 14857-14863; DOI: 10.1073/pnas.2009637117
- Zhang et al., p 7.
- Matthew Meselson, Droplets and Aerosols in the Transmission of SARS-CoV-2. N Engl J Med, April 15, 2020, 382:2063. DOI: 10.1056/NEJMc2009324. Meselson, “suggests the advisability of wearing a suitable mask whenever it is thought that infected persons may be nearby and of providing adequate ventilation of enclosed spaces where such persons are known to be or may recently have been.”
- Mingkun Zhan, Yaxun Qin, Xiang Xue, & Shuaijun Zhu, Death from Covid-19 of 23 Health Care Workers in China. N Engl J Med, April 15, 2020, 382: 2267-2268. About those who died, Zhan et al. speculated, “The infections in these patients may have resulted from inadequate precautions and insufficient protection in the early stages of the epidemic.”
- For example, rather than a respiratory infection, COVID-19 is now considered to be a vascular infection causing blood clots. Catherine Matacic, “Blood vessel attack could trigger coronavirus’ fatal ‘second phase’,” Science, 2 June 2020.
- Strictly speaking, the sun is actually not rising; it is the motion of the Earth that gives the appearance of the Sun rising above the horizon.
- Granted: “In some areas of the United States, you’re more likely to be harassed for wearing a mask rather than not wearing one.” Amit Katwala, “The rise of mask shaming reveals the tricky science of social change,” Wired, 27 June 2020.