The effectiveness or otherwise of wearing masks

I’m not taking a position on whether masks work, but I think I have a perspective that predates the current issue.

In my youth, I was somewhat of a fan of the novels of Walker Percy. As a young man, Percy was trained to be an MD, but his career was interrupted by tuberculosis:

Martha Montello, “From Eye to Ear in Percy’s Fiction: Changing the Paradigm for Clinical Medicine,” in The Last Physician: Walker Percy and the Moral Life of Medicine (Carl Elliott and John D. Lantos, editors), page 47

I hadn’t read the above quote back in my twenties, but I’d read somewhere that Percy’s tuberculosis was attributable to his not having worn a mask while doing work that involved tissue that contained tuberculosis microorganisms. I’m not even saying that I know that that is why Walker Percy got tuberculosis. I’m just saying that when the mask issue arose last year, the above-referenced idea was already in the back of my head.

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I get your point, but this is a radically different scenario, in all sorts of ways.

I’m aware that there was a time when, for example, doctors would laugh out loud at the idea of washing your hands before surgery. But we’re not talking about a medical setting; we’re talking about using masks in ways they were never intended for, and what limited evidence there is (bizarrely, nobody has really bothered to check) suggests that masks aren’t going to save the world. Even the WHO doesn’t suggest that they work. They tell you to wear one, but nowhere do they offer any evidence as the basis for that advice.

IIRC, the most optimistic evidence to date is that masks reduce transmission by about 30% if worn absolutely religiously, but that is not the same as saying it reduces anybody’s risk of death by 30%. It’s a statement about the rate of transmission. Over a long enough time period - a year, perhaps - the total number of people who have been infected and/or killed will tend towards a certain endpoint regardless.

Other lines of research have suggested that masks may reduce the severity of symptoms for the wearer, but nobody is quite sure why, and the effect doesn’t seem to be especially dramatic.

IIRC masks were originally touted as nothing more than a way to ‘flatten the curve’. They’ve now acquired magical powers that are completely unsupported by science.

I get your point, too, and I’m not a science-head, so I couldn’t strive against you there even if I wanted to. :slight_smile:

But I get the impression that there’s a whole big realm that’s at least partially immune to the clearing out of interfering factors and the devising of proper apparatuses in which to test the things that need testing, and that there’s a lot of overlap between that wild realm and public health.

So the public health people have to improvise and guess and so on.

I think the health authorities have not done themselves any favours by being so dogmatic: “do as you’re told and all will be well”. I think people would have retained their sanity, and been a lot more trusting and willing to try things out, if they’d been more honest: “the situation is evolving, we don’t really know what works and what doesn’t, and you can expect us to flipflop for a bit as we figure things out.”

If they’d done that, they could have run large-scale trials on (say) masks in a real-world setting and quickly collected data. They could have dropped things that proved to be pointless, without any blowback. But by insisting that everyone has to wear their masks, or stay at home, or whatever it was, there was no control group. Nobody was even allowed to self-select as a control: if you start from the assumption that something works, then by definition it’s unethical to tell people (allow people?) to not use it. So we ended up clinging on to interventions that were not merely untested but weren’t even being examined for effectiveness on-the-fly.

I find n95s much easier to breathe in than surgical masks, due to the shape not collapsing against your face.

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Well, there is that, but they definitely reduce airflow. If you find that your mask is not reducing airflow, it’s not working properly.

What makes me laugh are the people wearing “sophisticated” variants with outflow valves. Totally defeats the object.

I was going to say, “Well, that’s how governments react to crises,” but then I remembered one of my dad’s favorites from FDR:

Speech, Oglethorpe University, May 22, 1932

Again, I’m not passing on the issue in the thread title, but I agree with you that it would have been better if the government had been more up-front, and that may apply to a lot of countries.

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Yes, and all three groups are dead wrong.

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Even the WHO say that you don’t need to wear a mask while exercising; therefore the WHO are stupid and Taiwan’s CECC know something that the WHO do not, yes? Entirely possible, of course. But it may also be that, because you don’t have any background in science, statistics, etc., most of the world’s research is inaccessible to you and you’re just repeating what you’ve been told.

To be clear: it may be that masks have some limited benefit in specific settings that make them worthwhile. Medics, for example, would probably be best advised to wear them when they are interacting with patients - not merely because of COVID but for all sorts of other reasons. For the rest of us, the evidence simply isn’t there.

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Indeed, although I’d add the proviso that sometimes doing something is not better than doing nothing, and it’s very difficult to know when that might be the case. The debate still rages on whether FDR’s policy experiments worked as advertised or whether they made things worse; the underlying problem, again, is that there was no control population. The whole of the US was enrolled every time he tried something, so there was no way to gauge exactly what good or harm each “something” actually did.

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While exercising. Key words there. That doesn’t mean “masks are completely useless in all circumstances”.

Why do you think those words are “key”?

That was not my argument. I was suggesting that they are, on an assessment of harms vs. benefits, largely pointless outside of their intended use-case. They do not “save lives” to the extent that mandates and fines must be imposed; nor should people be encouraged to think of themselves as “safe” just because they’re wearing a mask. You might think that’s splitting hairs, but the practical implications are pretty serious.

EDIT: Let me try to put this in context. From your previous posts I gather you’re pretty worried about COVID because (IIRC) you’re in your mid- or late-50s and are a bit out-of-shape. Statistically, you have about a 15% chance of having moderate-to-serious cardiovascular disease, which in turn puts you at higher risk of a life-changing CVD event, or death. In your demographic, you have a roughly 0.5% chance of dying from a heart attack or stroke in the next 12 months (and a somewhat higher chance of surviving a heart attack or stroke). Your all-cause risk of death is in the ballpark of 1%.

Now, you can reduce that risk of all-cause mortality from 1% to somewhere below 0.5% by just improving your diet and doing some regular exercise - not only your risk of heart disease is reduced, but also a surprising number of other risks too, including COVID. Compare that with your risk of dying of COVID: in the US, 10% of those in your age group who died in 2020 died of-or-with COVID (the others died of the usual things). Let us say, for the sake of argument, that that was equivalent to 10% excess deaths and that religiously wearing a mask completely protects you from COVID. A mask therefore offers you an absolute risk reduction from ~1.1% to the expected 1.0% of 2019, best case. Given that masks aren’t even close to 100% protective, it’s not a very impressive result, is it, compared to the effect you can anticipate from changing your lifestyle?

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WHO urges vaccinated to continue to wear masks. How the Turntables!

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People can never feel safe. It must not be permitted!

While the WHO have endorsed masks for several months now, they’ve never put forward any evidence regarding their effectiveness. It seems that once people have accepted something as True, it no longer matters whether it actually is True or not.

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Just saw this article from a couple of days ago - thought it was quite interesting.

https://science.sciencemag.org/content/372/6549/1439

It’s open access, but a couple of random quotes:

Face masks are a well-established preventive measure, but their effectiveness for mitigating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission is still under debate. We show that variations in mask efficacy can be explained by different regimes of virus abundance and are related to population-average infection probability and reproduction number. For SARS-CoV-2, the viral load of infectious individuals can vary by orders of magnitude. We find that most environments and contacts are under conditions of low virus abundance (virus-limited), where surgical masks are effective at preventing virus spread. More-advanced masks and other protective equipment are required in potentially virus-rich indoor environments, including medical centers and hospitals. Masks are particularly effective in combination with other preventive measures like ventilation and distancing.

The effectiveness of masks, however, is still under debate. Compared with N95 or FFP2 respirators, which have very low particle penetration rates (~5%), surgical and similar masks exhibit higher and more variable penetration rates (~30 to 70%) ( 2 , 3 ). Given the large number of particles emitted upon respiration and especially upon sneezing or coughing ( 4 ), the number of respiratory particles that may penetrate masks is substantial, which is one of the main reasons for doubts about their efficacy in preventing infections. Moreover, randomized clinical trials have shown inconsistent or inconclusive results, with some studies reporting only a marginal benefit or no effect of mask use ( 5 , 6 ). Thus, surgical and similar masks are often considered to be ineffective. On the other hand, observational data show that regions or facilities with a higher percentage of the population wearing masks have better control of COVID-19 ( 7 9 ). So how are we to explain these contrasting results and apparent inconsistencies?

In this work, we develop a quantitative model of airborne virus exposure that can explain these contrasting results and provide a basis for quantifying the efficacy of face masks. We show that mask efficacy strongly depends on airborne virus abundance. On the basis of direct measurements of SARS-CoV-2 in air samples and population-level infection probabilities, we find that the virus abundance in most environments is sufficiently low for masks to be effective in reducing airborne transmission.

When people see images or videos of millions of respiratory particles exhaled by talking or coughing, they may be afraid that simple masks with limited filtration efficiency (e.g., 30 to 70%) cannot really protect them from inhaling these particles. However, as only few respiratory particles contain viruses and most environments are in a virus-limited regime, wearing masks can keep the number of inhaled viruses in a low- P inf regime and can explain the observed efficacy of face masks in preventing the spread of COVID-19. However, unfavorable conditions and the large variability of viral loads may lead to a virus-rich regime in certain indoor environments, such as medical centers treating COVID-19 patients. In such environments, high-efficiency masks and additional protective measures like efficient ventilation should be used to keep the infection risk low. The nonlinear dependence of mask efficacy on airborne virus concentration—i.e., the higher mask efficacy at lower virus abundance—also highlights the importance of combining masks with other preventive measures. Effective ventilation and social distancing will reduce ambient virus concentrations and increase the effectiveness of face masks in containing the virus transmission. Moreover, high compliance and correct use of masks is important to ensure the effectiveness of universal masking in reducing the reproduction number for COVID-19 (supplementary text, section S7.3, and fig. S11) ( 20 ).

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Thanks for the link. I did read the quoted part, but maybe I’m too sleepy and missed this part of the discussion: isn’t the main reason we’re masking up to protect others from us? I thought the general impression for about a year has been that masks are fairly good at limiting how much virus the infected people spread out, but less effective at limiting how much virus we breathe in.

I’m not sure if I should read that article as saying “Actually, masks protect the wearer better than we thought,” or if it’s making another point in that debate.

Yeah, I thought about that when I read the paper too (full disclosure: I read the first half and skimmed the rest for reading later, because I had other 3 a.m. stuff to do).

But I think your question is addressed in Fig. 3, if a little non-obviously. In Fig. 3A, the further the colored lines are from the gray 1:1 line means a greater reduction in infection probability due to mask wearing, for infected people wearing masks (red line), susceptible people wearing masks (yellow line), and both wearing masks (blue line).

Figure 3B shows the difference a bit more clearly, where the y axis is reduction in infection (higher equals better) and the x axis is probability of infection without masks from 0 to 1 (I think this can also be considered as essentially “atmospheric viral load”, where the right side is guaranteed infection). So this plot seems to indicate that surgical masks are very effective (ca. 90% reduction in infection probability when both groups are wearing masks, 80% when the plague carriers are wearing masks, and 75% when uninfected people are wearing masks) in the low atmospheric viral load regime, but that effectiveness falls off dramatically at high virus concentrations/unmasked infection probabilities. In other words, in a hospital or Wanhua tea house with a lot of infected people expelling the plague, surgical masks aren’t sufficient (or, indeed, very helpful judging from that plot).

Panels C and D show the same thing for N95/FFP2 masks.

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Thanks for the explanation. So for me at least this comes as good news. I’ve been operating with the assumption that my mask helps protects others from me, if I’m infected, but doesn’t do much for me, if they’re infected. (And if we’re in enclosed spaces for a long time we’re all doomed anyway. Um there’s a bit of poetic license in that.) But my mask may also be more beneficial for me than I realized.

Caveat of ideal mask wearing, which I’m surely far from, etc etc.

End result of no change in behavior on my part except for fewer nasty thoughts towards the nearby unmasked along the lines of “I’m wearing this stupid thing to protect YOU, you stupid sh*t, and the least you can do is do the same.” Mask wearing becomes a bit more about self-interest.

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Another quote from the article:

More-advanced masks and other protective equipment are required in potentially virus-rich indoor environments

This definitely raises some doubts whether Taiwan’s strategy of mostly using plain surgical masks for potentially highly exposed workers (quarantine hotel staff, quarantine taxi drivers, airport personnel, …) is really adequate.

I don’t know about hospitals and doctors - but those should definitely wear N95 masks and not just surgical ones!

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Finally there is a study conducted in Bangladesh which focuses on how effective masks are against covid. They encouraged people to voluntarily wear masks and provided those for free.

We Did the Research: Masks Work, and You Should Choose a Surgical Mask

Masks, especially surgical ones, substantially reduce the risk of getting Covid-19. Getting more people to wear them — through mandates or strategies like handing out masks at churches and other public events — could save thousands of lives each day globally and hundreds each day in the United States.

While this may seem like common sense more than 18 months into the pandemic, early studies on masking had raised important questions. Mask mandates appeared to reduce Covid-19 cases, but was this because of masking, or because people in places with mask mandates would have become more careful even without them? Because of this uncertainty, some governments and public health agencies were hesitant to recommend them. That’s why we ran one of the largest and most sophisticated studies of mask wearing, using the “gold standard” of research design, a randomized controlled trial, to evaluate whether communities where more people wear masks have fewer cases of Covid-19.

Many people live in countries where vaccines are not yet widely available. Even in the United States, vaccines are available but used unevenly, and the weekly death rate from Covid-19 remains high. In both of these environments, masks are a critical and inexpensive tool in the fight against the coronavirus.

Our research, which is currently undergoing peer review, was conducted with 340,000 adults in 600 villages in Bangladesh and tested many different strategies to get people to wear masks.

Our research team settled on distributing masks directly to people’s homes and in crowded public places like mosques and markets. We provided information on why mask wearing was important, and involved religious and community leaders in that messaging. Finally, we had residents in each village politely ask anyone not wearing a mask to put one on, and give masks to whoever needed one.

While not everyone agreed to mask up, mask wearing increased by about 30 percentage points among the adults who were encouraged to do so. This change led to a 9 percent reduction in Covid-19 overall. In communities where we promoted surgical mask use, Covid-19 cases dropped by 11 percent.

Our study did not measure the effect of universal mask wearing but the effect of a voluntary mask program. It resulted in an increase to four in 10 people using a mask from one in 10 people masking — a large rise in use, but still far from perfect. If everyone wore masks, the reductions in Covid-19 cases would most likely have been substantially larger.

People over age 50 benefited most, especially in communities where we distributed surgical masks. In these communities, Covid-19 cases fell by 23 percent for people aged 50 to 60 and by 35 percent for people over age 60. Our study does not suggest that only older people need to wear masks, but rather that widespread community mask wearing reduces Covid-19 risk, especially for older people.

Let us put this in concrete terms. Our best estimate is that every 600 people who wear surgical masks in public areas prevent an average of one death per year given recent death rates in the United States. Think of a church with 600 members. If a congregation learned that it could save the life of a member, would everyone agree to wear surgical masks in indoor, public areas for the next year?

We also tested the filtration of surgical masks that had been worn, crumpled up in pockets and purses, and washed with soap and water up to 10 times. These masks still prevented more virus particles from passing through than typical cloth masks. Masks with even better filtration or fit than surgical masks, such as KF94 or KN95 masks, may provide even stronger protection than surgical masks if worn properly.

The bottom line is masks work, and higher quality masks most likely work better at preventing Covid-19. If you have the ability to choose between a cloth and a surgical mask, go with surgical. But the best mask is one that a person will actually wear and wear correctly.

Mask wearing need not be permanent. More surgical masks in high-risk areas today can mean less need for masks tomorrow, preventing many deaths along the way. In places where mask mandates are not feasible or possible, softer alternatives — like a greeter handing out masks at a mall entrance — can be remarkably effective. Our research suggests that if handed a mask and asked politely to please wear one, many people will do so. Not everyone will, but not everyone needs to for lives to be saved.

Mr. Abaluck is a professor of economics at the Yale University School of Management. Ms. Kwong is an assistant professor in environmental health sciences at the University of California, Berkeley School of Public Health. Dr. Luby is a professor of medicine in the infectious diseases division at Stanford University.

Source

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