Masking the Science Revisited – A Look Back

Dr. John Powell and I wrote this blog in February 2021. COVID was a year old. Our blog was up for scarcely a week when someone complained to regional executives at Common Spirit in Tacoma. Those administrators asked MMC CEO Kelly Morgan to have us remove it. Kelly messaged me with the email thread asking for my help.

My initial instinct, which involved gesturing with my third finger, was tempered by the pending $45 million master facility plan request that MMC was actively negotiating with Common Spirit. So, I took it down. That is how a partnership works. That’s how suppression works. Ironically, the most difficult time to speak is often when it is most needed.

Times have changed, but the facts remain the same. Dr. Paul Alexander, an epidemiologist trained at Oxford, John’s Hopkins, and McMaster’s Department of Health research, a former WHO consultant and Senior Advisor to the US Department of HHS for COVID-19, reviewed over 170 comparative studies on masking in December 2021, concluding that masking had no impact on controlling the transmission of the COVID-19 virus.

In January 2023, Cochrane researchers reached the same conclusion in a 300-page paper. Two RCTs of masks were conducted during the COVID-19 pandemic. In fact, the ineffectiveness of masks had already been highlighted in a previous Cochrane review published in December 2020. Real-world data, along with ecological evidence from countries such as Spain, Italy, and Japan, have repeatedly supported this conclusion.

Truth should matter. It didn’t.

So, this is John and I tilting at windmills. One more thing that hasn’t changed.

Masking the Science  2020

We have purposely avoided directly confronting the issue of masks because it is such a sensitive and politically charged issue. Like waving a red flag in front of a bull, the topic elicits strong emotions that overwhelm reason. 

We wear masks in the hospital and don N95 masks, gowns, and gloves when we see a patient known to have COVID-19.  Masks are used for source control when patients are admitted with various infectious respiratory diseases. After the visit, we dispensed the gown and gloves and changed into our regular surgical masks to continue patient rounds. In public, we wear cloth masks to comply with executive orders and as a courtesy to others who feel afraid and uncomfortable. Like most of you, we rarely wash our masks; we stick them in our pockets, pick them out of the glove compartment, or off the floorboard when needed.

In truth, we wish masks worked. If they did, it would be a cheap and easy way to control the spread of COVID-19. The idea that masks protect not only their wearer but also those around them seems noble. We wish masks worked because citizens are spending billions of dollars on them.

We wish masks worked because most Americans wear them now. Telling them it was unnecessary will not make them happy. We wish masks worked because they have become a symbol of virtue and social responsibility. Anyone who doubts their utility is personally attacked, as though they don’t believe the viral pandemic is real or don’t care about those who die from it.

We wish masks worked because they distract from other important Covid related issues - such as school closings, lack of access for non-COVID related illness, increased expression of mental illness, elderly people dying alone, missed youth experiences, substance abuse, suicides, increased poverty and homelessness, suppression of free speech, censorship of science, disruption of supply chains, government agencies oppression of small businesses,  restriction of religious gatherings, travel disruptions, isolation protocols, honoring modeling over actual data, unnecessary quarantines, lockdowns, ineffective contact tracing, and a global harm of the economy that will disproportionately impact the working class, vulnerable and poor.

We wish masks worked.  

But they don’t.

At least, not the cloth and surgical masks you see in the public arena. They litter the landscape and waterways. They are difficult for people with disabilities and small children. It promotes natural germaphobe tendencies and indoctrinates the young to view their fellow humans as a sack of germs.

Many randomized controlled trials (RCTs) and meta-analyses of previous studies have shown that masks do not work to prevent influenza-like illnesses or respiratory illnesses transmitted by droplets and aerosol particles—such as COVID-19. This knowledge was the basis for the WHO and CDC's recommendation against the public wearing masks in the spring of 2020. Authorities and experts repeated it at every level.

Dr. Jerome Adams, the Surgeon General, tweeted, “Seriously people – STOP BUYING MASKS! They are NOT effective in preventing the public from catching Coronavirus.”

Dr. Anthony Fauci told 60 Minutes, “There’s no reason to be walking around with a mask”. 

In April, the New England Journal of Medicine wrote: “we know that wearing a mask outside of health care facilities offers little, if any protection from infection”.

What changed?  Well, it wasn’t the science.

All studies are not equal. The gold standard of medical evidence is derived from randomized controlled studies. Studies evaluating the viral exposure of mice in cages covered with mask material versus caged mice without a mask cover do not seem to translate well to the human world, where hands are used.

A new drug, medical product, or procedure would never be approved based on this type of evidence.

Logic argues against mask effectiveness. The size differential between viral particles or droplets expelled from the human respiratory tract compared to the filter size of surgical or cloth masks is substantial.  If you read the fine print on most consumer masks, you will read a statement such as this: “not intended for medical purposes and has not been tested to reduce the transmission of disease”. 

The best studies are outcome-based and measure patient-oriented evidence that matters.  A pharmaceutical company may demonstrate that its statin drug significantly reduces cholesterol, and scientific studies can establish a correlation between cholesterol levels and the risk of heart disease. The obvious premise is that lowering cholesterol reduces the likelihood of heart attacks.

Except it doesn’t—at least not for primary prevention in patients without preexisting vascular disease. That is why you must do the study. Does the intervention work in real-world conditions?

In August, Pew Research reported that 85% of Americans said they wore masks in public all or most of the time. If this is so, and if masks are effective, why has the incidence of SARS-CoV-2 increased so rapidly?

 Why is there not a favorable correlation between mask usage and disease transmission in countries and states with different mask policies?

 If masks and lockdowns work, why don’t they work? 

The graph below shows the daily number of deaths per million in the UK, France, Spain, Italy, and Sweden from March to December.  The number to the right reflects the percentage of the population that reports wearing a mask in public spaces. 

Sweden has the lowest number of deaths per million in this comparison, despite only 7.7% of the surveyed population reporting that they wear a mask.   For those who argue that Norway, Denmark, and Finland have lower mortality rates than Sweden, they would be correct. However, these countries also have significantly lower mask use rates compared to other European countries (less than 50%).  Masks have been oversold as a solution.

Dr. Anders Tegnell, Sweden’s state epidemiologist, said, " Face masks are an easy solution, and I’m deeply distrustful of easy solutions to complex problems.” He was right. Sweden now (1/23/2021) has fewer deaths per million people (1086) than the United States (1284). In fact, they have a lower death rate than 30 of our states.

History is replete with examples of how politics or religion meddle with science, adversely impacting solutions. Dr. Martin Kulldorff has argued against widespread public mask mandates from the beginning. He is a professor at Harvard Medical School and a leader in disease surveillance methods and the management of infectious disease outbreaks. He describes the current pandemic policy of COVID lockdowns and mask use in this way: “After 300 years, the Age of Enlightenment has come to an end.” 

At this point, many do not need an expert opinion to trust their own intuition and eyes, which tell them that masks are not working.  Everyone wants to mitigate the transmission of the virus, but we should focus on what works.

So, why are we poking this tiger - this mask issue now?

Wearing a mask is a simple thing to do.

Can’t you just shut up and wear the damn mask?

We can’t.  Because…...

Because there is widespread hysteria, and many innocent people are caught up in it.

Because it’s an irrational and divisive policy when unity is required more than ever.

Because evidence should matter. Fear and panic should not prevail over actual evidence, even when many powerful institutions have invested considerable political capital in promoting the wrong policy. 

Because in 2019, if we saw a father struggling to muzzle a terrified, crying 2-year-old child on a plane with a cloth, we would report them to authorities for child abuse.  In 2021, we kick the whole family off the plane unless the father succeeds.

Because a young man with autism, unable to tolerate the mask on his face, is publicly shamed.

Because the masks offer a false sense of security and may adversely impact more important public health mitigation measures.

Because our local high school cross-country teams should not be running the trails wearing masks.

Because the Oregon Board of Medicine suspended the license of a physician who spoke out against this policy. Suppressing and even punishing disagreement with state orthodoxy is being justified in the name of a science that doesn’t exist.

Because one of the greatest losses during this pandemic will prove to be the erosion of credibility among organizations that we previously held in high regard. Organizations such as the CDC, WHO, and Public Health. Institutions that rely on retaining the trust of citizens will lose that trust.

Because it is increasingly apparent that the basis for the mask mandate is not medical but political.

We wish masks worked.

We wished we didn’t have to fight about them.

But they don’t.

And we do.

Tim Powell MD

John Powell MD