I have been studying developments in the COVID-19 pandemic since the day it started to gain attention.
Having read a number of original studies on the effectiveness of face masks to control viral infections, I have come to the conclusion that strong beliefs win out over scientific reasoning. Researchers present their own strong beliefs as evidence to guide leaders into forcing entire populations to cover their faces with cloth.
What follows is an illustration what I am talking about, where I critique a well known study of studies on face masks.
A Study of Studies
In 2020, a group of researchers at Brigham Young University (BYU) claimed to have done a study that clears up the confusion about wearing face masks to combat COVID-19:
Benjamin W. Abbott , Mitchell Greenhalgh, S. Isaac St. Clair, Jonas Bush (2020). Making Sense of the Research on COVID-19 and Masks, [a Brigham Young University research study].
Abbott and Greenhalgh cite nine of their many references to support the following key assertion from their executive summary:
- There is now convincing evidence from multiple controlled experiments and field observations that wearing masks reduces the transmission of COVID-19 for healthcare workers and the public. Most of this evidence is COVID-19 specific and has emerged in the past few months.
Below, I list each of the authors’ nine pivotal references, and then I comment briefly on why each fails to substantiate their key assertion. Getting to the root of deception requires such a rigid approach.
I am, by no means, suggesting that the researchers had any intent to deceive. Rather, I am pointing out how public deception can be rooted in self deception that materializes, within good intentions, to grossly misguide society.
BYU Supporting Reference 1.
Brooks, J. T., Butler, J. C. & Redfield, R. R. (2020). Universal Masking to Prevent SARS-CoV-2 Transmission—The Time Is Now, JAMA, doi:10.1001/jama.2020.13107.
This reference is an editorial in the Journal of the American Medical Association, where Brooks, Butler and Redfield were promoting another article in the same issue. Interestingly, Brooks, Butler and Redfield wrote [referring to the authors whose article they were editorializing about]:
- The authors rightly note that other community-wide and hospital-specific interventions may have contributed to their observation, including the statewide declaration of emergency (March 10), new hospital policies to restrict visitors (March 12) and elective procedures (March 14), statewide school closures and hospital restrictions on business travel and on-site working (March 16), local public transportation reductions (March 17), issuance of statewide stay-at-home orders (March 24), and automation of screening and testing (March 30). Nonetheless, it was only after the universal masking policy had been in operation for approximately a week that the temporal trend in positivity of SARS-CoV-2 testing among HCWs declined (as shown in the Figure in the report by Wang et al).
Pay careful attention to the six other mitigating actions, introduced during the same time as face masks:
- statewide declaration of emergency
- new hospital policies to restrict visitors and elective procedures
- statewide school closures and hospital restrictions on business travel and on-site working
- local public transportation reductions
- issuance of statewide stay-at-home orders
- automation of screening and testing.
Any one, any combination, or all of these collectively could have caused the observed pattern, or none of the measures could have caused the observed pattern.
Notice also that only one week serves as the time frame for judging a mask effect. Even if an effect of masks could be separated from the other mitigating actions, a week is an extraordinarily short period to use in judging whether any measure, let alone masks, had an effect.
The minimum incubation period for the virus is two weeks, and so the one week assumption for mask effectiveness does not take account of possible infections that would have required a minimum of two weeks to become apparent.
Consequently, this reference is a reference to the authors’ faith, NOT a reference to actual evidence.
BYU Supporting Reference 2.
Howard, J. et al. (2020). Face Masks Against COVID-19: An Evidence Review. Preprints (In Review), doi:10.20944/preprints202004.0203.v1.
This study, if anything, points to the lack of high-quality evidence supporting mass mask use, going to great lengths to sculpt faith into the appearance of policy-level information. The lead author, a University of San Francisco data scientist, is also founder of the activist organization, Masks4All, where he has led a letter-writing campaign to state governors strongly advising them to enforce statewide face-mask mandates.
Nowhere do I see that this study makes any attempt to assess proper mask use, which would seem to be necessary in order to establish that all people using masks have done so at the same level of skill.
Nowhere do I see any discussion of data quality – how different countries or regions might have had different definitions of a case, or whether definitions of a case were (or were not) consistent and the same for all countries at all times of the various studies, or even if the process of assigning cause of death to COVID-19 was consistent, where such information was used.
Consequently, I do not see how any strong conclusions can be drawn about mask use, without clear conclusions about how many people using masks actually use them correctly, in circumstances where data inconsistency might exist as well. The mere visual appearance of a mask on a face does not constitute proper use -- it does not constitute proper quantification of any effect of the mask.
This speaks to the grave flaw in national mask mandates – these mandates enforce only a superficial appearance, and they do not enforce proper use, which would be highly impractical. This is why all such studies correlate the appearance of mask use with the appearance of infection reduction. Mere appearance of two variables together does not constitute causation of one by the other. The observed reduction in infection could be nothing more than a downturn in the trend of infection, where the virus is running its natural course, which just happens to coincide with the time at which governments decide to mandate masks.
This is precisely the trend that I have observed in my own state, where the highest single-day death toll attributed to COVID-19 occurred seven weeks after a statewide mask mandate went into effect, which is more than three virus incubation periods for the mandate to start showing an effect [graph shown below].
North Carolina Daily New COVID Deaths After Statewide Face Mask Mandate
BYU Supporting Reference 3.
Cheng, K. K., Lam, T. H. & Leung, C. C. (2020). Wearing Face Masks in the Community During the COVID-19 Pandemic: Altruism and Solidarity. The Lancet 0,
This study is yet another appeal to faith, disguised as a presentation of evidence. The authors state:
- … absence of evidence of effectiveness from clinical trials on mass masking should not be equated with evidence of ineffectiveness.
Absence of evidence also should not be equated with hope for effectiveness that substitutes for evidence of effectiveness. No matter how someone tries to confuse rational thinking, the evidence on which to base an intimately invasive law dictating a society-changing behavior does not exist.
The authors go on to state:
- Dismissing a low-cost intervention such as mass masking as ineffective because there is no evidence of effectiveness in clinical trials is in our view potentially harmful.
This is a statement of belief. The opposing belief (shared by many) is that dismissing individual differences and individual judgment, as if all people are threats by default, is socially, psychologically, and economically damaging to the point of being criminal.
BYU Supporting Reference 4.
Wang, X., Ferro, E. G., Zhou, G., Hashimoto, D. & Bhatt, D. L. (2020). Association Between Universal Masking in a Health Care System and SARS-CoV-2 Positivity Among Health Care Workers. JAMA, doi:10.1001/jama.2020.12897.
Here we have yet another study that clearly points to possible confounding factors and limitations, but then dismisses these factors in favor of asserting faith in masks as the underlying cause of infection reduction. The authors of this study also dismiss the possibility of randomized trials, without any reasonable explanation.
BYU Supporting Reference 5.
Hendrix, M. J. (2020). 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. MMWR Morb Mortal Wkly Rep 69 (a CDC publication).
This study is overly presumptive. The degree of uncertainty in its claims are reflected in the cautious use of language. Even part of the title is a give away to the presumptuousness of this study – Absence of Apparent Transmission ….
Like other such researchers, the researchers in this study are engaging in faith-based conclusions and recommendations appended to their own statements of uncertainty about the facts. This is flimsy evidence, therefore, and not fit for driving serious policy decisions that invade personal freedoms and remove intelligent adult judgments about intimate bodily spaces.
BYU Supporting Reference 6.
Abaluck, J. et al. (2020). The Case for Universal Cloth Mask Adoption and Policies to Increase Supply of Medical Masks for Health Workers, SSRN (a pre-print service) doi:10.2139/ssrn.3567438.
Like many others, this study relies on mechanistic coughing experiments in unrealistic laboratory settings and on comparisons of countries for which there is no consideration for data consistency or data quality from country to country.
It is another weak-evidence study not fit for policy-level information that alters basic societal habits on a mass scale.
BYU Supporting Reference 7.
Tam, V. C., Tam, S. Y., Poon, W. K., Law, H. K. W. & Lee, S. W. (2020). A Reality Check on the Use of Face Masks during the COVID-19 Outbreak in Hong Kong, EClinicalMedicine 22, 100356.
This was a letter in an online website published by The Lancet, in which the writers do little more than express an opinion, making a strong appeal to tradition as justification for using face masks, with no reference whatsoever to studies of any kind that test the effectiveness of such masks. In fact, these authors state quite clearly that widespread incorrect use of face masks prevails in regions where the tradition of mask wearing is long established – this is their reality check writ large.
It is actually one of the better articles documenting massive failure of people to handle and care for masks properly -- a deeper problem of enforcement that is seldom discussed and simply avoided, because enforcing proper handling and use would be impossible.
The impossibility of enforcing proper use is why mass masking mandates are absurdly pretentious displays of government force that give a false appearance of effective action. Mass masking mandates fabricate the false appearance that leaders are in control of a problem, and they fabricate a look that eases public anxiety.
Brigham Young University is being pretentious and inept to cite this reference as evidence for what it claims in its study on face masks.
BYU Supporting Reference 8.
Kenyon, C. (2020). Widespread Use of Face Masks in Public May Slow the Spread of SARS CoV-2: an Ecological Study, MedRxiv (a preprint service) http://medrxiv.org/lookup/doi/10.1101/2020.03.31.20048652 doi:10.1101/2020.03.31.20048652
Again, another weak study tries to compare different countries, where there is little consideration of data quality and data consistency, and little consideration of actual human compliance in proper use. The authors, readily state:
- Whilst these results are susceptible to residual confounding, they do provide ecological level support to the individual level studies that found face mask usage to reduce the transmission and acquisition of respiratory viral infections.
How is this not a contradictory statement? This is typical doublespeak for studies claiming to find evidence of face-mask effectiveness – they say one thing in part of the sentence and then contradict it by saying something opposite in the next part of the sentence.
BYU Supporting Reference 9.
Greenhalgh, T., Schmid, M. B., Czypionka, T., Bassler, D. & Gruer, L. (2020). Face Masks for the Public during the COVID-19 Crisis. BMJ 369.
This study is an elaborate exercise in ignoring lack of evidence, in favor of very narrowly invoking the precautionary principle. The authors bring up again what appears to be a go-to claim by researchers who give the appearance of presenting evidence, when they actually fail to present evidence, and often present the very contradiction to their own favored claim within their study:
- … absence of evidence is not evidence of absence.
Again, we must ask what is it that competent policy making should rely on? – evidence? – or hope that evidence might be forthcoming in its current absence?
Do we make society-changing policies that invade personal bodily space on the basis of hope, faith, trust in that which does not yet exist? Do we make society-changing policies that destroy economic lives, risk individual freedoms, and cause massive collateral cultural damage on the basis of hope, faith, or trust? The rational answer to these questions is no.
The claim here is that absence of evidence of universal face mask effectiveness is not evidence of absence of universal face mask effectiveness. The fact is, however, that the best evidence is precisely this lack of evidence itself. Confusing rational thinking by rearranging language is a distraction from the reality, which is that major life decisions for all of society should be based on current evidence, NOT on faith in future evidence that does not now exist.
The BYU study of studies, thus, impresses me as little more than a manifesto on faith in faith.