I think by now, everyone knows that masks are of limited utility - if any
That won't stop some people swearing by them, and of some places mandating them no matter what
The Mask has become an identity - ranging from "I DON'T WANNA DIE" person to the "I care SO much"
This is no longer a matter of science of efficacy - seriously if the mask worked it would have worked by now. Its a psycho-political-cultural matter now. Time to move on.
Thank you for this interesting analysis, and for highlighting the potentially confounding affect a modulation of fear that is independent of that induced by wearing a mask.
When reading the Bangladesh trial, I did wonder why this wasn’t a potential confounder here, too, but you didn’t seem to comment on it (or maybe you did, but I missed it - apologies if this was the case!). The arm that received the mask in the Bangladesh trial also received “… information about the importance of mask-wearing”. I would have thought that, in a well designed RCT, the intervention should be presented identically - and neutrally - to both arms: i.e. “We are doing this trial as we do not currently have high quality information as to whether or not masks are effective”. Presenting information about “the importance of wearing mask-wearing” seems to pre-judge the outcome, and presenting this only to the mask-wearing group might be expected to increase the level of fear in this group. As such, it is not clear to me that the significant increase in physical distancing shown by the study can necessarily be entirely attributed fear / apprehension that is secondary to mask wearing (and so be legitimately included as an effect of mask-wearing effect) rather than secondary to fear / apprehension due to the instruction that mask wearing is important: an instruction that was given only to the mask-wearing participants (i.e. if you don’t wear a mask you are at risk). The true effect size of masking is still then somewhat uncertain, but could presumably be less than that found in the study.
Of course, compliance with the intervention in the Bangladesh study is “important”, and this should rightly be communicated to participants. However, better instruction would be “It is important you wear your mask as we have instructed, so that the results of the trial [either positive OR negative] are valid”, rather than “mask wearing is important [i.e. mask wearing is effective]”. Strictly, even this modified instruction creates a potential asymmetry - much better would be to have the non-intervention arm also actively instructed to NOT wear masks, so that identical instructions (and, presumably, identical levels of non-mask induced fear) are given to both groups: “It is important you wear / do not wear your mask as we have instructed, so that the results of the trial are valid”.
It's clear why we must have these mask studies. Authorities decided masks might be helpful and if people stayed apart somewhat that too might be helpful. Fear was everywhere and people demanded relief so authorities declared, let's try this. Prior data suggested that the policy was likely not very effective but they required it anyway. Along came push-back "show me". So we get studies, generally fudged to prove the point, except being full of holes.
Industrial physicists know certain masks do work to PROTECT the WEARER. They really do study that and make sure those workers are protected. Those masks cost a lot, much more than any consumer would pay. They are tested routinely because leakage can cause harm, sometimes great harm, even death. No fooling around with that safety. Someone WILL be held accountable and workers depend on mask safety.
The public health authorities nicely confound industrial, expensive masks with surgical or cloth masks is delusional, yet they did it anyway. They had to do something and maybe masks might help and they do, but they are not materially effective except by altering behavior. Those that believe masks don't help refuse to alter their behavior, alas. Hence the studies arrive to convince them. Of course, the studies don't convince, perhaps not even for those that did the study if they were honest. What a supreme waste of effort.
OTOH we know that distancing works. Stay away from crowded places preferably don't go out with others at all. If you must go out as many must, what can you do? The public might have been helped to be reminded of getting an adequate amount of a helpful Vitamin D. Beyond that the public might be helped to be told to gargle after exposures with a solution known to kill pathogens, like diluted Betadine, along with a bit in the nose via a swab. Apparently the authorities worry more about the public's ability to take the proper amounts or do proper dilution than they are about getting infected. We are not even sure if a bit of alkaline water via baking soda might help, as was known in years before many medications. Seems like a very easy RCT for old time remedies should researchers want a more useful area to investigate.
This is a helpful review, thank you for your assessment of the limitations. I do find it heartening that the analysis for this paper seems much better designed than some of the deeply flawed studies that get cited by mask advocates.
I wonder whether the results of this paper could at least serve as a plausible upper bound of mask mandate effectiveness. That is to say, at best, pre-Omicron, in urban areas, mask mandates reduced cases by at best 20-35%. I greatly doubt the effectiveness is that high, but it would be nice if we could at least establish public consensus that it's certainly not any higher than that.
I think by now, everyone knows that masks are of limited utility - if any
That won't stop some people swearing by them, and of some places mandating them no matter what
The Mask has become an identity - ranging from "I DON'T WANNA DIE" person to the "I care SO much"
This is no longer a matter of science of efficacy - seriously if the mask worked it would have worked by now. Its a psycho-political-cultural matter now. Time to move on.
Thank you for this interesting analysis, and for highlighting the potentially confounding affect a modulation of fear that is independent of that induced by wearing a mask.
When reading the Bangladesh trial, I did wonder why this wasn’t a potential confounder here, too, but you didn’t seem to comment on it (or maybe you did, but I missed it - apologies if this was the case!). The arm that received the mask in the Bangladesh trial also received “… information about the importance of mask-wearing”. I would have thought that, in a well designed RCT, the intervention should be presented identically - and neutrally - to both arms: i.e. “We are doing this trial as we do not currently have high quality information as to whether or not masks are effective”. Presenting information about “the importance of wearing mask-wearing” seems to pre-judge the outcome, and presenting this only to the mask-wearing group might be expected to increase the level of fear in this group. As such, it is not clear to me that the significant increase in physical distancing shown by the study can necessarily be entirely attributed fear / apprehension that is secondary to mask wearing (and so be legitimately included as an effect of mask-wearing effect) rather than secondary to fear / apprehension due to the instruction that mask wearing is important: an instruction that was given only to the mask-wearing participants (i.e. if you don’t wear a mask you are at risk). The true effect size of masking is still then somewhat uncertain, but could presumably be less than that found in the study.
Of course, compliance with the intervention in the Bangladesh study is “important”, and this should rightly be communicated to participants. However, better instruction would be “It is important you wear your mask as we have instructed, so that the results of the trial [either positive OR negative] are valid”, rather than “mask wearing is important [i.e. mask wearing is effective]”. Strictly, even this modified instruction creates a potential asymmetry - much better would be to have the non-intervention arm also actively instructed to NOT wear masks, so that identical instructions (and, presumably, identical levels of non-mask induced fear) are given to both groups: “It is important you wear / do not wear your mask as we have instructed, so that the results of the trial are valid”.
Brandolinis Law at work. How exhausting.
Best comment. Lol
It's clear why we must have these mask studies. Authorities decided masks might be helpful and if people stayed apart somewhat that too might be helpful. Fear was everywhere and people demanded relief so authorities declared, let's try this. Prior data suggested that the policy was likely not very effective but they required it anyway. Along came push-back "show me". So we get studies, generally fudged to prove the point, except being full of holes.
Industrial physicists know certain masks do work to PROTECT the WEARER. They really do study that and make sure those workers are protected. Those masks cost a lot, much more than any consumer would pay. They are tested routinely because leakage can cause harm, sometimes great harm, even death. No fooling around with that safety. Someone WILL be held accountable and workers depend on mask safety.
The public health authorities nicely confound industrial, expensive masks with surgical or cloth masks is delusional, yet they did it anyway. They had to do something and maybe masks might help and they do, but they are not materially effective except by altering behavior. Those that believe masks don't help refuse to alter their behavior, alas. Hence the studies arrive to convince them. Of course, the studies don't convince, perhaps not even for those that did the study if they were honest. What a supreme waste of effort.
OTOH we know that distancing works. Stay away from crowded places preferably don't go out with others at all. If you must go out as many must, what can you do? The public might have been helped to be reminded of getting an adequate amount of a helpful Vitamin D. Beyond that the public might be helped to be told to gargle after exposures with a solution known to kill pathogens, like diluted Betadine, along with a bit in the nose via a swab. Apparently the authorities worry more about the public's ability to take the proper amounts or do proper dilution than they are about getting infected. We are not even sure if a bit of alkaline water via baking soda might help, as was known in years before many medications. Seems like a very easy RCT for old time remedies should researchers want a more useful area to investigate.
This is a helpful review, thank you for your assessment of the limitations. I do find it heartening that the analysis for this paper seems much better designed than some of the deeply flawed studies that get cited by mask advocates.
I wonder whether the results of this paper could at least serve as a plausible upper bound of mask mandate effectiveness. That is to say, at best, pre-Omicron, in urban areas, mask mandates reduced cases by at best 20-35%. I greatly doubt the effectiveness is that high, but it would be nice if we could at least establish public consensus that it's certainly not any higher than that.