How the "masks work" claim is propped up

Chapter from Expired

Given the new clamouring for masking for flu I thought I would share the chapter of Expired that explains why masks do not and cannot work and why some people think otherwise.

Book can be bought here.

BELIEF TEN: MASKS REDUCE TRANSMISSION

Surgical masks are not intended to provide protection against infectious aerosols. There is a common misperception amongst workers and employers that surgical masks will protect against aerosols. Health and Safety Executive, 2008^[1]

If social distancing was sufficient to handle the larger than a grapefruit sized droplets, could mask wearing deal with those that were smaller? When there is political pressure because something must be done, then mask wearing has the feel of something that might work and the public wanted something that could work. If the infected could be persuaded to wear something to filter out droplets then could the virus be controlled? The answer, according to public health officials across the world in spring 2020 was a resounding ‘no’.

On 11th March 2020, Professor Chris Whitty, Chief medical Officer said, “In terms of wearing a mask, our advice is clear: that wearing a mask if you don’t have an infection reduces the risk almost not at all. So we do not advise that.” [2] Dr Jenny Harries, England’s Deputy Chief Medical Officer summarised the position in an interview with the Prime Minister saying, “it’s really not a good idea and doesn’t help,” and “in some ways you may actually risk catching the disease rather than preventing it.” [3] Fauci said, “There’s no reason to be walking around with a mask. When you’re in the middle of an outbreak, wearing a mask might make people feel a little bit better and it might even block a droplet, but it’s not providing the perfect protection that people think that it is. And, often, there are unintended consequences – people keep fiddling with the mask and they keep touching their face.” [4]

A review of all the medical literature on the subject, with an international authorship, was published in 2020. It showed no clear reduction from mask wearing in seasonal influenza, which was the most similar virus to use as a measure.[5] The Cochrane Collaboration, who are a well-respected international authority on collating medical evidence stated that surgical and medical grade masks made no difference as to how many people caught a flu-like viral illness.[6] That was the starting point. However, from summer 2020, every authority did a lockstep u-turn and masks were promoted as an essential, sometimes mandatory intervention that would save lives.

HOW WAS MASK WEARING JUSTIFIED?

The evidence that was presented by SAGE at the time of the U-turn were two reports from groups both convened by the Royal Society. The first report from Data Evaluation and Learning for Viral Epidemics or DELVE, reasoned thus, “40%-80% of infections occur from individuals without symptoms… Droplets from infected individuals are a major mode of transmission… Face masks reduce droplet dispersal.” [7]

A single paper from an international group of scientists in January 2021 presented a good summary of the justifications used to bring in masking.[8] Firstly, they claimed there were no randomised controlled trials of masking to prevent covid transmission but did cite a study showing reduced community transmission. The Czech Republic was cited as a country where masking was introduced early and kept covid at bay. As there were no other population studies they heavily relied on laboratory mechanical studies and modelling. Each of these studies were scientific analyses that appeared to show a benefit from masking. We will come back to the problems with the studies but first let’s look at the broader picture.

HOLES IN MASKS

Many scientists spoke out when masks were introduced saying that the holes in the fabric were too large to stop the spread of a virus.[9] Individual virus aerosols are a similar size to tobacco smoke particles and, similarly, fill the air. If someone sent you into a smoke-filled room wearing a cloth mask and you could smell tobacco, then you could also breathe in the virus (and exhale it back into the room). The holes in the fabric were so large it would be like trying to protect a double decker bus from grapefruit and lentils being thrown at it by using badminton or even tennis rackets with no strings in.

Dr Colin Axon, a former adviser to SAGE, said masks were just “comfort blankets… an imperfect analogy would be to imagine marbles fired at builders’ scaffolding, some might hit a pole and rebound but obviously most will fly through.” [10]

Mask proponents objected to this view saying that the cloth holes were more like tunnels. The holes were large but were deep and a proportion of aerosols would hit the sides and not progress further. The very largest droplets would be stopped anyway and that, alone, might have reduced spread. Maria Van Kerkhove, technical lead of covid response at WHO said, “We have evidence now that if this is done properly it can provide a barrier… for potentially infectious droplets.” ^[11]

Here were two conflicting hypothetical positions. When there is more than one prediction of what may happen, the way to find which is right is to test it with an experiment. There was no shortage of real world evidence of neighbouring regions with and without mandates to compare their covid rates.

Ian Miller, author of Unmasked: The Global Failure of COVID Mask Mandates, carried out a comprehensive analysis of the USA.[12] He plotted the cases over time in areas with mask mandates against neighbouring areas where no mandate was introduced. In every case the covid trajectory in the masked state perfectly tracked the one in the neighbouring state. Without labels no-one could tell from his graphs which state wore masks. Where there was a slight difference it was the masked state which fared worse. There was not a single example where the masked region fared better, (even thanks only to chance), that the pro-maskers could use to push masking. This whole population measure is the one that matters. The results were in, from the real world, and the masks did not work. No amount of hypothetical ideas about how they could work or even evidence that they do reduce droplets is of any relevance when in the real world there was no impact on spread. However, because the authorities ignored this data and continued pushing masks, the majority continued to wrongly believe they did work.

BIOLOGICAL MASKS

Let’s return to the land of giants and see what happens to an inhaled aerosol. The infectious source has left behind a cloud of droplets, or perhaps they wafted out of the window of someone who was sick in bed. Those larger than a grapefruit (100 microns) would have fallen to the ground but for every one the size of a grapefruit or larger there are thousands that were smaller.[13] The droplets smaller than a grapefruit have evaporated and shrunk in size and are suspended in the air. The majority of virus was in those droplets smaller than a lentil (five microns) so remained in the air.[14] A second giant now walks by, hoovering up air into his bus sized nostrils. Those droplets that remain larger than a lentil are deposited in the nose and throat.[15] The remainder flows down through the trachea, into the branching bronchi and down into the lung.

Any that land in the airway will hit a layer of mucus. Zooming in to the mucus reveals tiny holes the size of the virus, acting like a biological sieve.[16] The final layer of mucus, protecting the cells, has no holes big enough for the virus to fit through and the virus becomes entrapped.[17] The mucus is then swept along by hair cells on the surface of the airway, which waft the mucus upwards creating a slow moving stream that reaches the throat and is swallowed into the acid of the stomach killing the viruses and bacteria. In order to start an infection the virus must break through the mucus to reach the cells.[18] In order to do that it must, ultimately, leave the aerosol it travelled in to be small enough. Even then, the rate at which a virus can cross the mucus barrier is slower than the rate at which mucus is swept away. Therefore, other factors must contribute to allow entry. One theory is that characteristic bacterial infections, which often cause infections alongside viral infections such as influenza and SARS-CoV-2, are not coincidental. These bacteria have mechanisms for crossing the mucus barrier and virus can hitchhike on these bacteria in order to penetrate the mucus.[19]

The mucus lining of the respiratory tract creates a natural barrier far superior to any mask. Wearing a mask is much the same as wearing a hearing aid in your ear designed to alert you to any dangerous noises. There is already a finely tuned system for dealing with that problem which is far superior. All the focus on cloth masks has distracted from the much more important, unanswered question of why some people’s mucus layer fails and what can be done about that.

Because the aerosols trapped in mask fabric will keep evaporating and shrinking, they may be closer in size to sand than lentils, in the giant analogy, when they reach the mask. Most aerosols will be channelled with the flow of the air. Those that become stuck on the fabric will not just disappear. Instead, the person wearing the mask continues to breathe through the mask. The virus can be absorbed into aerosols in the exhaled breath which the wearer or others may inhale later. On contact with the mask, the liquid surrounding the virus may be absorbed, freeing the virus to travel alone into the respiratory tract.[20] The idea that viruses would sit obediently on the fabric waiting for laundry day was a fantasy.

Everyone can agree that a mask would reduce the volume of what was expelled in a sneeze or cough in a similar way to a tissue or handkerchief. How many people would honestly keep their mask on to sneeze into and then continue wearing it? Even if they did, would they create new aerosols as they breathed over the trapped droplets? Either way, with every breath smaller aerosols would penetrate the mask and enter the air. The major problem though was that the vast majority of the virus in the air would have originated from maskless sick people in their homes who could have been some distance away.

WHY DO WE SEE NO IMPACT FROM MASKING?

As anyone who has worn a mask will know, the premise above about holes and tunnels is ridiculous anyway. The vast majority of air taken in and exhaled enters and leaves by gaping holes at the sides and top of the mask. In theory this could have helped reduce person to person transmission, as larger droplets would be directed away when two people were facing each other, reducing spread. It would not have helped hairdressers however, who stood behind the vents of their client’s mandatory masks or school children who sat alongside their neighbours’ vents. Because air was mostly redirected the only real impact of masking was to reduce the spread of large droplets during close face to face contact. In theory such a reduction could have reduced spread to some degree but in practice it did not. There was no impact on real world data on infection trajectories. In fact the similarity of speed of transmission between areas where droplets are stopped by masks and those where they are not is a further indication that aerosols drive spread.

As the evidence on the size of aerosols that contained the virus came to light, there should have been a change of position on masks. As John Maynard Keynes said, “When my information changes, I change my mind.” The open letter to the CDC about aerosol transmission by the physicists and other scientists we met in Belief 1: Covid only spreads through close contact, was sent in July 2020. The consequence of this information could have been to acknowledge that the virus was airborne, that close contact was not the prime mode of transmission and that there was little that could be done to prevent aerosols from the sick filling the air. It could, however, have led to a change in hospital policy of stopping masking, returning bed capacity to normal and installing air filters. An announcement to that effect at that time would have been politically difficult and it has only become harder since.

Instead, an utterly illogical position was taken. There seemed to be a strong desire to ‘do something’ about aerosol transmission and the only idea out there was masking. Trish Greenhalgh, Professor of Primary Care at Oxford University, was a key proponent of masking on the basis that, “Even limited protection could prevent some transmission of covid-19 and save lives.”[21] Taking this approach meant that proof of a meaningful difference was no longer the bar for intervention. A hypothetical idea about what might work coupled with an aim of preventing even a single death meant that the entire world could be asked or forced to mask.

Mask proponents eventually cottoned on to the literal gaping hole in their reasoning and started to advocate for tighter fitting masks. In February 2021, New York City’s Mask to the Max campaign included recommendations for everyone over the age of two to wear snug masks by wearing a cloth mask over a disposable mask; a nose wire; a mask fitter or brace or to “knot the ear loops and fold or tuck extra material,” in an attempt to create a tighter seal.[22] Trish Greenhalgh had been a vocal advocate of masking with some extreme suggestions. She went from suggesting people wear panty liners[23] in their masks (which have an unbreathable waterproof plastic layer) to advocating for wearing a pair of nylon tights over the head to improve the fit.[24]

However, by December 2021, she was insisting only high quality medical grade masks would work, not cloth masks saying, “Breathing, coughing, talking generate aerosols. So EVERYONE needs high-grade masks” ^[25] and “that droplet theatre won’t cut the mustard” [26] before begging Elon Musk to buy enough to supply the world, “If you did that, you’d be very popular and it could end the pandemic.” [27] Leana Wen, one of CNN’s favourite high priests said, in a most patronising way, “Cloth masks are not appropriate for this pandemic. It’s not appropriate for Omicron. It was not appropriate for Delta, Alpha or any of the previous variants either because we’re dealing with something that’s airborne.” [28]

Calls to wear close fitting medical grade masks have increased since that time and the US administration had 750 million such masks in storage by January 2022.[29] These masks are meant to have a sealed fit and have very small holes (20 microns in diameter or around an inch in the giant analogy). However, they do not work through mechanical filtering but through static electricity which traps small particles in the fabric. Good quality masks filter 95 percent of particles three times the size of the virus. No-one knows the exact percentage for particles the size of the virus and there is disagreement about the true filtration ability for larger particles with estimates of between 54[30] and 85 percent[31] rather than 95 percent.

Again, there was a hypothesis that medical grade masks could make a difference where regular masks failed. The experiment to test that hypothesis was carried out by Germany and Austria which both mandated medical grade masks. Despite these mandates there was no difference in case numbers compared to neighbouring countries. Perhaps this is surprising given that medical grade masks are clearly superior to cloth masks. However, in the real world they do not make an impact. There was no need to rerun this experiment after Germany[32] and Austria did that for us in 2021. However, since then Japan, South Korea and Hong Kong have confirmed their findings. By 29th November 2022, a randomised trial showed that healthcare workers given N95 masks had similar infection rates to those wearing surgical masks i.e. they did not work.[33]

There are at least five reasons which could explain why medical grade mask mandates did not work. The issues are where the air enters, what happens to aerosols either trapped in the fabric or later when the mask is removed, how SARS-CoV-2 spreads and who is emitting the virus.

WHERE THE AIR ENTERS

Air enters and leaves through sometimes barely perceptible gaps in the sides. These vary in size with movement of the face. Pushing a medical grade mask onto the face to improve the seal results in a clear increase in difficulty breathing demonstrating that the air normally enters through gaps in an inadequate seal. Think about how hard it is to maintain even a large, tightly fitting, rubber seal on a snorkel mask. Given that aerosols containing virus are so small perhaps the recommendation should have been for Hazmat suits and personal oxygen tanks. Such bulky equipment probably could have protected from the virus, but only when worn.

WHAT HAPPENS TO AEROSOLS TRAPPED IN THE FABRIC

An aerosol that is trapped in the filter will continue to evaporate as it is breathed over. The liquid portion will shrink as this happens until virus particles themselves could be released. Ultimately, it is the smallest aerosols that cause infection as larger ones cannot penetrate the respiratory mucus layers.

WHEN THE MASK IS REMOVED

One study showed that the highest levels of virus in a hospital could be found in the room where protective equipment was removed.[34] Having carefully collected virus in the filtering mask, on removing the mask, healthcare workers would unwittingly fill the air around them with virus, while imagining this air away from their patients was safe. It is a bit like thinking that wearing a snorkel to swim in the sea would stop you getting salty.

HOW SARS-COV-2 SPREADS

If you are still left wondering if medical grade masks are worth wearing, remember that SARS-CoV-2 can also spread via the surface of the eye anyway.[35] If it turns out that touching contaminated objects led to significant spread, masks would achieve nothing.

WHO IS EMITTING THE VIRUS.

The most crucial point is that no-one can wear medical grade masks all the time. Remember that each infected person emits 72 million infectious particles overnight when there is no UV light to cleanse the air. Even if a mask could protect you for a few hours a day, what about the rest of the time?

HOLES IN THE EVIDENCE

Let’s take another look at the single paper that listed the justifications for the introduction of masks. Their first claim of there being no randomised controlled trials at the time for covid was invalid as they totally ignored a Danish randomised controlled trial showing no statistically significant difference in infection rates between the masked and unmasked.[36]

The one study they cited which overclaimed about a reduction in community transmission was a Chinese study. The Chinese produced huge volumes of academic papers on SARS-CoV-2 in early 2020. Of all the papers on respiratory virus infections in March 2020 produced by the UK, USA and China, two thirds were Chinese. In the twelve months prior to that only four in ten had been Chinese and it was a full year before that ratio returned to normal. From April 2020, the Chinese Communist Party mandated that all scientific literature on covid must be approved by the Chinese Ministry of Science and Technology or Ministry of Education before publication.[37] Microbiology professor, Sarah Cobey said, “it would be very problematic if results from China were being filtered or suppressed for reasons other than quality.” [38] This political interference means that all Chinese scientific publications should be regarded sceptically and with consideration around the motivations of the Chinese Communist Party. The fact that China reported fewer than 250 covid deaths over the two year period from 17th April 2020 should also be treated with the scepticism it deserves. In fact, no reliance should be placed on official Chinese Communist Party data.

Those justifying masking cited the Czech Republic as an example of masking working. The Czech Republic had made masks compulsory in public from March 2020 and, as with all of Eastern Europe, were relatively spared from covid in spring 2020. The hypothesis that they had hit on the solution that prevented spread was proved erroneous in autumn 2020 when Eastern Europe as a whole, and the Czech Republic in particular, were hit hard with covid. Since February 2021, the Czech Republic became and has remained one of the hardest hit countries in Europe for covid deaths.

The use of hypothetical modelling studies to support masking were based on assumptions at the outset about the impact that mask wearing would have at a population level.[39] The results of that impact were graphed and then the paper concluded that mask wearing would be worthwhile. These modelling studies were entirely works of fiction using circular logic.

For a short time in October 2020, the real world evidence appeared to support the modelling studies. A paper was published showing that masked states in the US had lower case rates.[40] The paper was withdrawn in November 2020 because the rates had rocketed in those same masked states.[41] Looking back after a few more months it was clear that masks ‘worked’ in the summer and stopped ‘working’ in autumn and winter.[42]

The justification for mask wearing also heavily relied on laboratory studies in which aerosols were synthesised using tubing to demonstrate protection from masks. The unrealistic base assumption was that two people would be in close proximity, face to face while one coughed or sneezed directly at the other. Measurements of mask effectiveness in such a scenario were taken with a machine called the Gesundheit, named after the German phrase for wishing someone good health after they sneeze.

Hector Drummond wrote a superb summary of the evidence around mask wearing and its manipulation in The Face Mask Cult.[43] He points out that only the front of a person’s face enters the collection cone. Any breath that escapes at the sides of the mask is not measured. Even allowing for this misfiring, the claim from a key experimental study showed that, when unmasked, nine out of ten people emitted fine particles and this fell to only eight out of ten with masking.[44] There was no evidence that such a reduction, even if genuine, would have a real world impact. He also points out that one in six of the participants had more measurable virus in the cone with the mask on than without it, a point the authors failed to mention.

SHODDY EVIDENCE

Hector Drummond goes on to expose how the UK authorities have created their own perpetual motion engine for evidence on masks. An original paper from SAGE stated that “Face coverings are likely to reduce transmission through all routes by partially reducing emission of and or exposure to the full range of aerosol and droplets that carry the virus.” [45] Note the lack of claim about the extent of any reduction. This paper referenced another government paper which referenced another government paper and so on in a chain. The fourth paper had become more bold saying “Promoting high levels of wearing face coverings or face masks can potentially reduce transmission through all transmission routes especially via close range and long range airborne transmission (high confidence).” [46] Where was this high confidence from? The reference used for that claim was the original paper that made the much lesser claim. The claims had spiralled into more and more confident assertions without the addition of any further evidence.

Hector Drummond also did a deep dive into the references used for a face mask report from The Royal Society, from June 2020, ‘Face masks and coverings for the general public: Behavioural knowledge, effectiveness of cloth coverings and public messaging’.[47] Their entire meta-analysis was based on four Chinese reports having excluded a randomised controlled trial which showed no benefit. Of these, two showed a minor effect of masking, one showed a negative effect and the other showed a dramatic difference. The latter study was of healthcare workers treating SARS-1 patients and claimed that eight out of ten unmasked healthcare workers were infected compared to only two out of ten who were masked. The original paper is only available in Chinese, only one author is listed along with an affiliation and he appears to be a state employee, there was no randomisation and participants reported their mask use in retrospect (i.e. those who became infected might then report that they had not always worn masks much after all). The fact that these results have never been replicated anywhere else did not seem to cause the Royal Society any concern.

The second Royal Society report in May 2020 was the DELVE report which proposed masking to stop droplets.[48] Dr Antonio Lazzarino from the Department of Epidemiology and Public Health at UCL said about the DELVE report, “That is a non-systematic review of anecdotal and non-clinical studies. The evidence we need before we implement public interventions involving billions of people, must come ideally from randomised controlled trials at population level or at least from observational follow-up studies with comparison groups. This will allow us to quantify the positive and negative effects of wearing masks. Based on what we now know about the dynamics of transmission and the pathophysiology of covid-19, the negative effects of wearing masks outweigh the positive.” [49]

As well as the justifications used by the UK above, the CDC in the USA chose an odd paper as their second most important piece of evidence on their website when introducing masking.[50] It was a report of a covid outbreak in a Missouri hairdressers, Great Clips.

It starts, as most papers do with an introduction on background scientific knowledge of the area. This said, “Consistent and correct use of cloth face coverings is recommended to reduce the spread of SARS-CoV-2.” That does not sound anything like a scientific review of the evidence base.

The paper reports on one hairdresser who had what were described as ‘covid symptoms’, tested positive and spread covid to four close contacts. A second hairdresser had ‘respiratory symptoms’ and tested positive but none of her close contacts developed covid. No further details were given as to what the symptoms were but it is worth noting that this was in the second week of May 2020, only a week after their five week lockdown ended. No-one would have been keen to cough in public. If someone started coughing at work they would surely be sent home, especially in a job where masks had been thought necessary to reassure the clients. There is no elaboration on what the ‘covid symptoms’ were but it is odd that a cough was not mentioned. Coughing or not, the air in the hairdressers may have contained SARS-CoV-2.

There were 139 clients who were exposed while the first hairdresser was symptomatic. (They ignored clients from her presymptomatic phase). The public health authorities tracked them all down, interviewed them and made them quarantine for a fortnight. A quarter of the clients had had respiratory symptoms in the preceding three months unrelated to covid. With that background rate, we would expect five of them to have these symptoms, unrelated to covid, in the following two week period, even if there was no covid. Robin Trotman, a local infectious disease doctor predicted five to ten covid cases among the clients in addition.[51]

Public health officials contacted the clients during quarantine to ask if they had developed symptoms which would have meant a longer quarantine period. Not one of them had a single symptom, which either proves that masks are a panacea or that people do not like extensions to their house arrest. It is worth appreciating what the atmosphere was like at the time. Only a couple of weeks earlier headlines said, “900 Missouri residents who ‘snitched’ on lockdown rule-breakers fear retaliation after details leaked online.” ^[52] These were people whose names and addresses had been released in public, alongside reports they made of their neighbours breaching regulations, thanks to local freedom of information law. Even with no intention of leaving the house when unwell, with a heightened awareness of snitching neighbours, it might be best not to draw attention to any issues. The final indication of how keen the clients were to cooperate with public health authorities comes from the fact that half of them refused covid testing when offered it. The ones that were tested had negative results.

What is particularly egregious is that the CDC used this as prime evidence when there was no control group. The City Journal article, Do masks work? demolished this study concluding “Nobody has any idea how many people, if any, would have been infected had no masks been worn in the salon. Late last year, at a gym in Virginia in which people apparently did not wear masks most of the time, a trainer tested positive for the coronavirus. As CNN reported, the gym contacted everyone whom the trainer had coached before getting sick – 50 members in all – “but not one member developed symptoms.” Clearly, this doesn’t prove that not wearing masks prevents transmission.” [53]

One final point, is that the study took place in Springfield, Green County, Missouri. Like the other states in the central band of the USA there may have simply not been a seasonal trigger. Green County was relatively spared in spring 2020 with only thirteen patients in hospital at the spring 2020 peak compared to over 230 in the subsequent peaks in December 2020, July 2021 and January 2022.[54] Missouri was part of a central band of US states from Montana and Minnesota down to Oklahoma and Arkansas which were relatively spared in spring 2020 but not spared thereafter.

Why on earth was the CDC using this paper as the second reference for the effectiveness of masks?

Proving something works which does work is relatively easy. Proving that something does not work is much harder. When something has no impact, it may still be possible to measure an effect by chance some of the time. Only by including the times when it had a negative effect, can you see that averaging all the evidence out shows it achieved nothing. Singling out individual studies of apparent benefit is not an adequate way to prove the case because there will be other studies where there was no benefit. Yet, the CDC did just that, with a study that was effectively an anecdote of an outbreak at Great Clips, to justify the introduction of masks.

Another time woeful evidence was used to support masking policy happened in England. Public Health England carried out a study of covid rates in schools with or without masks.[55] They showed that schools with masks had higher covid rates. Their excuse was that those schools had introduced them because they had more covid. That should have led to a better designed experiment but instead led to modelling of the data to show what they believed the results would have been had covid rates been equal. This was not just a slight adjustment but an inversion of the results. Even their fictional claim was only that masked schools had 0.6 percent fewer covid absences than unmasked schools. That data was used to push the policy to introduce masking in UK schools.

Interestingly, Jenny Harries England’s Deputy Chief Medical Officer, who has said masking was not a good idea was not particularly persuaded by the evidence. She said in Aug 2021, “The evidence on face coverings is not very strong in either direction… but it can be very reassuring in those enclosed environments.” [56] However, by July 2022 she was totally contradicting her position in March 2020 saying, “we want people to take sensible precautionary advice like… wearing a face covering if you’re going into enclosed, poorly ventilated spaces. If I’ve got any respiratory infection it’s a good thing to do, and I think it’s a new lesson for the country.” [57] The damage such flip-flopping does to public confidence in health messaging is the real negative here.

In February 2022, the Cochrane Collaboration, the world centre for collating evidence on medical matters, finally published Thomas Jefferson’s updated summary of the evidence on masking showing “little to no difference.” [58] The first review of the evidence was delayed by seven months until November 2020 due to “unexplained editorial decisions” such that mask mandates were already in place.[59] Public health officials and others in positions of authority continued to undermine themselves by dismissing this comprehensive analysis and continuing to insist that masking worked and in USA continuing with mandates even for toddlers.

In March 2023, there was a further twist. Karla Soares-Weiser, the Editor-in-Chief of the Cochrane Collaboration published an apology regarding the review without having consulted the authors.[60] The lead author, Thomas Jefferson complained that “Cochrane has thrown its own researchers under the bus again,” adding, “I think Soares-Weiser has made a colossal mistake. It sends the message that Cochrane can be pressured by reporters to change their reviews. People might think, if they don’t like what they read in a Cochrane review because it contradicts their dogma, then they can compel Cochrane to change the review. It has set a dangerous precedent.” ^[61]

Masking has been supported by government policy documents, Royal Society reports and laboratory and modelling studies. However, even a relatively superficial dig into the scientific real world evidence shows these documents have a foundation of dust. It was hope and politics which drove masking not scientific evidence.

THE EVIDENCE MANIPULATION TRIAD

EXTRAPOLATE

Laboratory and modelling studies were extrapolated as the basis to justify the introduction of masks and anecdotal evidence, like the Great Clips story, was used as if it was solid evidence.

EXCUSE

Public Health England claimed the reduced covid rates in schools without masks were because they were at lower underlying risk of covid.

When masks did not prove effective, it was said not enough people were wearing them or they were not wearing them properly or for long enough.

Another common excuse was that people had let their guard down because of overconfidence around safety provided by the masks. (Even though evidence shows people give mask wearers a wider berth than the unmasked).[62]

EXCLUDE

Real world evidence was ignored and experts trying to explain how masking could not work were silenced on social media.

TOP THREE MYTHS

1. Stopping droplet transmission at close distance would reduce spread

2. A small decrease in transmission in a fraction of interactions would have a measurable impact overall

3. Medical grade masks work where cloth masks do not

https://www.amazon.co.uk/Spiked-Shot-Dark-Covid-Autopsy/dp/1739344723/ref=tmm_pap_swatch_0

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[1] Health and Safety Laboratory. (2008). Evaluating the protection afforded by surgical masks against influenza bioaerosols Gross protection of surgical masks compared to filtering facepiece respirators. Health and Safety Executive. https://www.hse.gov.uk/research/rrpdf/rr619.pdf

[2] Sullivan, R. (2020, March 4). Don’t wear face masks in response to coronavirus, says Chief Medical Officer. The Independent. https://www.independent.co.uk/news/uk/home-news/coronavirus-uk-news-professor-chris-whitty-no-masks-advice-a9374086.html

[3] UK Prime Minister. (2020, March 11). PM DCMO Q&A On Coronavirus. Dr Jenny Harries, Deputy Chief Medical Officer, came into Downing Street to answer some of the most commonly asked questions on Coronavirus. Facebook. https://www.facebook.com/watch/?v=486465015562901

[4] Reuters Staff. (2020, October 8). Fact check: Outdated video of Fauci saying “there’s no reason to be walking around with a mask”. Reuters.com. https://www.reuters.com/article/uk-factcheck-fauci-outdated-video-masks-idUSKBN26T2TR

[5] Jefferson, T. et al.(2020). Physical interventions to interrupt or reduce the spread of respiratory viruses. The Cochrane Database of Systematic Reviews, 11(11), CD006207. https://doi.org/10.1002/14651858.CD006207.pub5

[6] Cochrane. (2020, November 20). Do physical measures such as hand-washing or wearing masks stop or slow down the spread of respiratory viruses? Cochrane.org . https://www.cochrane.org/CD006207/ARI_do-physical-measures-such-hand-washing-or-wearing-masks-stop-or-slow-down-spread-respiratory-viruses

[7] DELVE group. (2020, May 4). DELVE Group publishes evidence paper on the use of face masks in tackling coronavirus (covid-19) pandemic. Royal Society. https://royalsociety.org/news/2020/05/delve-group-publishes-evidence-paper-on-use-of-face-masks

[8] Howard, J. (2021, January 11). An evidence review of face masks against COVID-19. Perspective: Biological Sciences 118(4): e2014564118. https://doi.org/10.1073/pnas.2014564118

[9] Gregory, A. (2020, May 4). Scientists divided over report recommending widespread use of face masks. The Independent. https://www.independent.co.uk/news/health/coronavirus-face-masks-effective-work-study-royal-society-research-uk-a9498796.html

[10] Stoneman, J. (2021, July 17). Cloth face masks are “comfort blankets” that do little to curb Covid spread, scientist warns. The Telegraph. https://www.telegraph.co.uk/news/2021/07/17/cloth-face-masks-comfort-blankets-do-little-curb-covid-spread

[11] Kelland, K. (2020, June 5). Wear masks in public says WHO, in update of COVID-19 advice. Reuters.com. https://www.reuters.com/article/us-health-coronavirus-who-masks-idUSKBN23C27Y

[12] Miller, I. (2022). Unmasked: The global failure of COVID mask mandates. Post Hill Press.

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[22] NYC Health. (2021, February 18). Mask to the max – Health Department updates mask guidance. NYC.gov. https://www.nyc.gov/site/doh/about/press/pr2021/mask-to-the-max-guidance.page?emci=9f1c5a08-d777-eb11-9889-00155d43c992&emdi=b2298eff-7d78-eb11-85aa-00155d43c992&ceid=4092309

[23] Greenhalgh, T. (2021, January 18). Exactly what I do … @trishgreenhalghh, Twitter.

[24] Greenhalgh, T. (2021, July 11). Two tricks to improve the fit of a medical mask. @trishgreenhalghh, Twitter.

[25] Greenhalgh, T. (2021, December 24). Canada officially junks the “aerosol generating medical procedure…”. @trishgreenhalghh, Twitter.

[26] Greenhalgh, T. (2022, January 8). Narrator: we could a) wear better masks (FFP2/N95 minimum)… @trishgreenhalghh, Twitter.

[27] Greenhalgh, T. (2021, December 25). Dear @elonmusk …. @trishgreenhalghh, Twitter.

[28] The Post Millennial. (2021, December 28). Cloth masks are “not appropriate for this pandemic” says CNN medical expert Leana Wen. @TPostMillenial, Twitter.

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[29] Egan, L. and Przybyla, H. (2022, January 19). White House says it will distribute 400 million free N95 masks to protect against Omicron. NBC News. https://www.nbcnews.com/politics/white-house/white-house-says-it-will-distribute-400-million-free-n95-n1287672

[30] Rengasamy S, Miller A, Eimer BC, Shaffer RE. Filtration Performance of FDA-Cleared Surgical Masks. J Int Soc Respir Prot. 2009 Spring-Summer;26(3):54-70. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7357397/

[31] American Chemical Society. “A replaceable, more efficient filter for N95 masks.” ScienceDaily. ScienceDaily, 21 May 2020. www.sciencedaily.com/releases/2020/05/200521124646.htm

[32] Miller, I. (2022b, January 31). As many experts move the goalposts from cloth masks to N95’s, it’s important to point out that the states in Germany with N95 mandates are actually doing WORSE …. @ianmSC,Twitter.

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[33] Loeb, M. et al. (2022). Medical masks versus N95 respirators for preventing COVID-19 among health care workers: A randomized trial. Annals of Internal Medicine, 175(12), 1629–1638. https://doi.org/10.7326/M22-1966

[34] Loh, M. M. et al. (2023) Measurement of SARS-CoV-2 in air and on surfaces in Scottish hospitals, Journal of Hospital Infection (133, 1-7) https://doi.org/10.1016/j.jhin.2022.11.019

[35] Dawood A. A. (2021). Transmission of SARS CoV-2 virus through the ocular mucosa worth taking precautions Vacunas (English Edition), 22(1), 56–57. https://doi.org/10.1016/j.vacune.2021.01.007

[36] Bundgaard, H. et al. (2021, March). Effectiveness of adding a mask recommendation to other public health measures to prevent SARS-CoV-2 infection in Danish mask wearers: A randomized controlled trial. Annals of Internal Medicine. 174(3), 335–343. https://doi.org/10.7326/M20-6817

[37] Silver, A. and Cyranoski, D. (2020, April 15). China is tightening its grip on Coronavirus research. Nature, News. https://www.nature.com/articles/d41586-020-01108-y

[38] Quoted in ibid.

[39] Eikenberry, S. E. (2020). To mask or not to mask: Modeling the potential for face mask use by the general public to curtail the COVID-19 pandemic. Infectious Disease Modelling, 5, 293–308. https://doi.org/10.1016/j.idm.2020.04.001

[40] Adjodah, D. et al. (2020, October 23). Decrease in hospitalizations for COVID-19 after mask mandates in 1083 U.S. Counties. MedRxiv (Preprint). https://doi.org/10.1101/2020.10.21.20208728

[41] Adjodah, D. et al. (2020, November 4). Decrease in hospitalizations for COVID-19 after mask mandates in 1083 U.S. Counties. MedRxiv (Withdrawn). https://www.medrxiv.org/content/10.1101/2020.10.21.20208728v2

[42] Guerra, D. D. and Guerra, D. J. (2021). Mask mandate and use efficacy in state-level COVID-19 containment. MedXriv. https://doi.org/10.1101/2021.05.18.21257385

[43] Drummond, H. (2022). The Face Mask Cult. CantusHead Books.

[44] Milton, D. K. et al. (2013). Influenza virus aerosols in human exhaled breath: Particle size, culturability, and effect of surgical masks. PLOS Pathogens, 9(3), e1003205. https://doi.org/10.1371/journal.ppat.1003205

[45] Scientific Advisory Group for Emergencies. (2022, May 13). SPI-B, SPI-M and EMG: Considerations for potential impact of plan b measures, 13 October 2021. Gov.uk. https://www.gov.uk/government/publications/spi-b-spi-m-and-emg-considerations-for-potential-impact-of-plan-b-measures-13-october-2021/spi-b-spi-m-and-emg-considerations-for-potential-impact-of-plan-b-measures-13-october-2021

[46] New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) and the Environmental and Modelling group (EMG). (2021, October 13 updated November 26). EMG-Nervtag update on transmission and environmental and behavioural mitigation strategies, including in the context of Delta. Gov.uk. Retrieved January 31, 2023, from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1036475/S1395_EMG-Nervtag_Update_on_Transmission_and_Environmental_and_Behavioural_Mitigation_Strategies__including_in_the_context_of_Delta.pdf

[47] Mills, M., Rahal, C. and Akimova, E. prepared for The Royal Society SET-C Group. (2020, June 26). Face masks and coverings for the general public: Behavioural knowledge, effectiveness of cloth coverings and public messaging. https://royalsociety.org/-/media/policy/projects/set-c/set-c-facemasks.pdf

[48] DELVE group. (2020, May 4). DELVE Group publishes evidence paper on the use of face masks in tackling coronavirus (covid-19) pandemic. Royal Society. https://royalsociety.org/news/2020/05/delve-group-publishes-evidence-paper-on-use-of-face-masks

[49] Quoted in Davis, N. (2020, May 4). Report on face masks’ effectiveness for covid-19 divides scientists. The Guardian. https://www.theguardian.com/world/2020/may/04/scientists-disagree-over-face-masks-effect-on-covid-19

[50] Hendrix M.J., et al. (2020, July 17) Absence of apparent transmission of SARS-CoV-2 from two stylists after exposure at a hair salon with a universal face covering policy – Springfield, Missouri, May 2020. Morbidity and Mortality Weekly Report 2020, 69: 930-932. http://dx.doi.org/10.15585/mmwr.mm6928e2

[51] Frankel, T. C. (2020. June 17). The outbreak that didn’t happen: Masks credited with preventing coronavirus spread inside Missouri hair salon. The Washington Post. https://www.washingtonpost.com/business/2020/06/17/masks-salons-missouri

[52] Spocchia, G. (2020, May 4). 900 Missouri residents who “snitched” on lockdown rule-breakers fear retaliation after details leaked online. The Independent. https://www.independent.co.uk/news/world/americas/us-politics/coronavirus-missouri-lockdown-breakers-details-online-st-louis-county-a9497271.html

[53] Anderson, J. H. (2021, August 11). Do masks work? City Journal. https://www.city-journal.org/do-masks-work-a-review-of-the-evidence

[54] Springfield Greene County Health (n.d.). https://www.springfieldmo.gov/5147/Recovery-Dashboard

[55] Department of Education. (2022). Evidence summary: Coronavirus (COVID-19) and the use of face coverings in education settings. Gov.uk. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1055639/Evidence_summary_-_face_coverings.pdf

[56] 10 Downing Street. (2020, August 28). PM Boris Johnson and Deputy Chief Medical Officer Dr Jenny Harries host a back to school Q&A. YouTube.

[57] Sunday Morning. (2022, July 3). ‘Sunday Morning’ - 03/07/2022. BBC iPlayer. https://www.bbc.co.uk/iplayer/episode/m00190q6/sunday-morning-03072022

[58] Jefferson, T. et al. (2023). Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database of Systematic Reviews. Cochrane.library.com. https://doi.org/10.1002/14651858.CD006207.pub6

[59] Heneghan, C., & Jefferson, T. (2023, February 3). Do Mask Mandates Work? A Look at the Evidence. The Spectator. https://www.spectator.co.uk/article/do-mask-mandates-work

[60] Statement on ‘Physical interventions to interrupt or reduce the spread of respiratory viruses’ review https://www.cochrane.org/news/statement-physical-interventions-interrupt-or-reduce-spread-respiratory-viruses-review

[61] Desami, Maryanne (2023, March 15) Did Cochrane sacrifice its researchers to appease critics? https://maryannedemasi.substack.com/p/breaking-did-cochrane-sacrifice-its

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