In my villain origin story of how I became The Mask Bully discussion of masks with other Catholic women in a Facebook group, one of the things repeated (without solid evidence) is that masks don’t work.
It’s true that at the beginning of the pandemic, experts were hesitant to recommend masks due to limited data (among other reasons), but their recommendations changed as we had more data and evidence.
As Christians, we should respect scientific fact, even if it means we have to change our minds.
COVID is Serious
I know some people still question if COVID-19 is really all that bad. Here are some facts (with sources) about COVID-19.
- The novel coronavirus is highly contagious. 1, 2, 3
- The severity of COVID-19 can range from mild to severe. Most people experience mild symptoms. COVID can affect the entire body. 1, 2, 3, 4
- The elderly and people with pre-existing conditions are at higher risk. 1, 2, 3, 4
- But even young, healthy people can require hospitalization from COVID-19. 1, 2
- COVID-19 can have long-term impacts to health. 1, 2, 3, 4, 5, 6, 7
- COVID-19 is more harmful than the seasonal flu. 1, 2
- COVID-19 has killed over 2.9 million people as of 4/7/2021. 1
I also wrote a blog post on why the 99% survival claim is misleading and insensitive.
Masks Work
People can take several actions to reduce the transmission of the novel coronavirus, but for some reason, masking seems to be the most controversial.
Here are a number of science-based pieces that affirm that masks work. I put them in (approximate) order of publication date.
January 2021
JAMA typically has journals that are peer-reviewed though it seems that not everything put out by JAMA is peer-reviewed. They use legitimate science and strive to be unbiased. This article is a summary of the science with links to their sources.
Prior to the coronavirus disease 2019 (COVID-19) pandemic, the efficacy of community mask wearing to reduce the spread of respiratory infections was controversial because there were no solid relevant data to support their use. During the pandemic, the scientific evidence has increased. Compelling data now demonstrate that community mask wearing is an effective nonpharmacologic intervention to reduce the spread of this infection, especially as source control to prevent spread from infected persons, but also as protection to reduce wearers’ exposure to infection.
“Effectiveness of Mask Wearing to Control Community Spread of SARS-CoV-2” by John T. Brooks, MD and Jay C. Butler, MD (JAMA Insights), 2/10/2021
PNAS is a well-respected science journal. They published a narrative review.
The preponderance of evidence indicates that mask wearing reduces transmissibility per contact by reducing transmission of infected respiratory particles in both laboratory and clinical contexts. Public mask wearing is most effective at reducing spread of the virus when compliance is high.
“An evidence review of face masks against COVID-19” by eremy Howard, Austin Huang, Zhiyuan Li, Zeynep Tufekci, Vladimir Zdimal, Helene-Mari van der Westhuizen, Arne von Delft, Amy Price, Lex Fridman, Lei-Han Tang, Viola Tang, Gregory L. Watson, Christina E. Bax, Reshama Shaikh, Frederik Questier, Danny Hernandez, Larry F. Chu, Christina M. Ramirez, Anne W. Rimoin (PNAS), 1/26/2021
November 2020
The CDC has a fantastic summary about the efficacy of masks. There are links to sources to different studies, a number of them from peer-reviewed journals.
Masks are primarily intended to reduce the emission of virus-laden droplets (“source control”), which is especially relevant for asymptomatic or presymptomatic infected wearers who feel well and may be unaware of their infectiousness to others, and who are estimated to account for more than 50% of transmissions. Masks also help reduce inhalation of these droplets by the wearer (“filtration for personal protection”). The community benefit of masking for SARS-CoV-2 control is due to the combination of these effects; individual prevention benefit increases with increasing numbers of people using masks consistently and correctly…Multi-layer cloth masks can both block up to 50-70% of these fine droplets and particles and limit the forward spread of those that are not captured. Upwards of 80% blockage has been achieved in human experiments that have measured blocking of all respiratory droplets, with cloth masks in some studies performing on par with surgical masks as barriers for source control.
“Use of Cloth Masks to Control the Spread of SARS-CoV-2”, CDC, 11/20/2020
Your Local Epidemiologist wrote a summary back in November about the scientific evidence supporting mask-wearing.
Masks…work. And we have the scientific evidence to back it up. In fact, we have over 85 peer reviewed, scientific studies. 35 have been published in 2020 alone.
“Masks…work”, 11/5/2020
October 2020
Friendly Neighbor Epidemiologist wrote about whether or not masking helps the wearer.
It looks like masks play a big role in reducing the amount of virus you could be infected with and that is associated with how sick you become.
“𝐃𝐨 𝐦𝐚𝐬𝐤𝐬 𝐩𝐫𝐨𝐭𝐞𝐜𝐭 𝐦𝐞 𝐢𝐟 𝐨𝐭𝐡𝐞𝐫𝐬 𝐚𝐫𝐨𝐮𝐧𝐝 𝐦𝐞 𝐰𝐨𝐧’𝐭 𝐰𝐞𝐚𝐫 𝐨𝐧𝐞?”, 10/24/2020
She also published a great fact-checking article on the claim that the MMWR said masks don’t work and a post about the importance of masks/bipartisan science.
Nature published an interesting article back in October (keep in mind we have lots of additional data since it was published) about face masks while also acknowledging it can be confusing to look at all the information.
To be clear, the science supports using masks, with recent studies suggesting that they could save lives in different ways: research shows that they cut down the chances of both transmitting and catching the coronavirus, and some studies hint that masks might reduce the severity of infection if people do contract the disease.
“Face masks: what the data say” by Lynne Peeple (Nature), 10/6/2020
September 2020
Your Local Epidemiologist wrote a good piece about a hypothesis published in the New England Journal of Medicine.
The New England Journal of Medicine recently published another possible reason to wear a mask. This is NOT peer-reviewed science, it is an educated guess (hypothesis). Meaning the scientists used previous studies to make this guess. However, for the TOP medical journal (and I mean TOP) to publish a hypothesis means there is legitimate weight behind this guess.
What are they guessing? Universal mask wearing reduces the severity of COVID19 among those who do wear a mask.
“Need another reason to wear a mask?”, 9/13/2020
Friendly Neighbor Epidemiologist wrote about mask mandates in September.
Summer 2020
This is a meta-analysis published in a peer-reviewed journal.
“Conclusions: This study adds additional evidence of the enhanced protective value of masks, we stress that the use masks serve as an adjunctive method regarding the COVID-19 outbreak.”
“Efficacy of face mask in preventing respiratory virus transmission: A systematic review and meta-analysis” by Liang M, Gao L, Cheng C, Zhou Q, Uy JP, Heiner K, Sun C. (Travel Med Infect Dis.), Jul-Aug 2020
This is an article explaining a study done by Duke University. It primarily focuses on the results of the study while also giving some context to why masks work. It also has some quotes from experts.
Through all the ups and downs and uncertainty of the coronavirus (COVID-19) pandemic, one thing has become concrete: wearing a mask prevents the spread of the virus.
“New Study Highlights New Evidence That Masks Prevent Coronavirus Spread”, Cleveland Clinic, 8/28/2020
Friendly Neighbor Epidemiologist also shared a summary on the Duke study.
Here is an article that has a lot of research (with the sources linked within the article) and an interview with two experts.
But health experts say the evidence is clear that masks can help prevent the spread of COVID-19 and that the more people wearing masks, the better.
“Still Confused About Masks? Here’s the Science Behind How Face Masks Prevent Coronavirus” by Nina Bai (UCSF), 6/26/2020
Friendly Neighbor Epidemiologist was writing about the importance of masks since May 2020.
A study published in April and corrected in May 2020 said that surgical masks could help.
Surgical face masks significantly reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols, with a trend toward reduced detection of coronavirus RNA in respiratory droplets. Our results indicate that surgical face masks could prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals.
“Respiratory virus shedding in exhaled breath and efficacy of face masks” by Nancy H. L. Leung, Daniel K. W. Chu, Eunice Y. C. Shiu, Kwok-Hung Chan, James J. McDevitt, Benien J. P. Hau, Hui-Ling Yen, Yuguo Li, Dennis K. M. Ip, J. S. Malik Peiris, Wing-Hong Seto, Gabriel M. Leung, Donald K. Milton & Benjamin J. Cowling (Nature Medicine), 4/3/2020
As a note, when I say “masks work,” I am saying that my mask protects you and your mask protects me. Though my mask may protect me as well, it does not work as well as you wearing a mask.
A Note on Adherence
Some criticisms of the efficacy of wearing masks are about how people actually use them. Though this is certainly a valid concern, I think we need to differentiate between the efficacy when masks are used properly and how people actually use them.
I think an example some Catholic couples may relate to is NFP. We all know that if you follow your NFP method by the book, it will most likely work (though there absolutely are some cases of method failure). However, we know that following a method by the books can be challenging.
Let’s use a hypothetical scenario. Jane and John Doe are TTA. They use the Creighton Method. Jane and John’s practitioner taught them that to avoid pregnancy, they would need to wait to have intercourse until the end of the day on P+4. Jane and John decide to take a risk and have intercourse on P+2. Jane becomes pregnant.
The conversation following would not be whether or not Creighton is effective; it would be about the struggles with using it properly. The conversation would need to focus on how we could help John and Jane better use the Creighton Method.
It still is an absolutely valuable and necessary discussion, but there is a huge difference between “The Creighton Method doesn’t work” and “We’re struggling to make the Creighton Method work for us.”
When we look at concerns about how well masks work, we need to look into how to help people use their masks properly rather than avoiding masks altogether.
Note on Limits to Masks
All that being said, masking isn’t the magic solution to all of this. People should still follow guidelines from public health experts like social distancing, good hand hygiene, limiting outings, getting vaccinated, etc.
Additionally, it is important that we follow the instructions on how to wear masks properly so we can best protect ourselves and others.
But Past Studies Said…
I was told there are a lot of peer-reviewed studies pre-Coronavirus that discussed that masks were not effective, and are actually harmful. I’ll address the claims of harm this evening, but I did some digging in attempts to find these supposed articles.
I used Google Scholar and included things like masks, nonpharmaceutical interventions, and source control.
Based on the articles I read (and please feel free to comment with additional reputable sources for me to review), here are my thoughts/observations.
- They were studying different respiratory illnesses. Not all respiratory illnesses will be spread in the exact same way.
- A lot of them were based on households or healthcare settings rather than community spread.
- Masks were generally only recommended for those who were ill and/or in severe situations (except for health care workers who were typically advised to use masks). We now know that presymptomatic or asymptomatic spread is possible with COVID-19 which is why seemingly healthy people are encouraged to wear masks.
- One of the challenges is there are often layered approaches to nonpharmaceutical interventions (NPIs) so it isn’t always possible to isolate the effect of masking. However, some found that there was a benefit to combining masking with other NPIs.
- Another challenge is poor adherence to wearing masks during the studies.
- Several implied that the evidence for hand hygiene was also limited.
- Some recognized the potential for masks (or even found significant support) while others advised against it for the general public either due to lack of data supporting it or concerns about adherence.
Sources: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18
It seems that in most cases, they were asking for more data on the subject. Yes, pre-Coronavirus mask data is limited, but it doesn’t concretely prove that masks don’t work. In fact, some of the results should even be encouraging for the efficacy of masks.
But, as with all measures, we need to weigh the risks and benefits. The other part of the claim from the women is that masks are harmful. The Mask Bully will return tonight to address this concern.
