One has to ask.....if masks work so well, why did places like NYC have another huge spike in cases where the population is obsessed with wearing masks.
And you would think that controlled facilities like nursing homes would have nearly zero cases. Employees are masked full time while mingling with patients and most of these facilities did not allow guests.
This study simply doesn’t pass the smell test when compared to the body of evidence. Do we really believe that masks reduced the omicron wave in NYC by 50%? Surely we’d see evidence of 50% higher waves in places without masks, right? Why didn’t DANMASK find any effect if it was adequately-powered for the effect size that we see in this study? The list goes on.
It requires a total suspension of disbelief that is almost Trumpian in nature—Vinay hits the nail on the head when he says that this study creates room for people to seek “alternative facts.”
I have to take issue with your use of the word "controlled" there. I work in a nursing home and nobody wears a mask correctly. I'm surprised that this point isnt being made with this study, Wallensky's congressional testimony, and the Cochrane paper; namely, nobody wears the masks correctly and they take them down all the time and thats probably whats accounting for the "masks dont work" headlines. It's not that masks dont work (its obvious that they filter some virus) and thus have to reduce the risk somewhat, right?
Vinay, I am a surgeon with a degree in epidemiology. I highly respect your opinions and often listen to Plenary Session and read your substack. I also frequently share your work with family, friends and colleagues. BUT!! You must start proofreading your work. You have at least a dozen errors in the piece above. It is unprofessional and degrades your ability to effectively communicate via the written word. If you don't have time to proofread every sentence you write before hitting 'send' or 'publish' then pay someone to do it for you.
Sad, but true. I am a hematologist with boards in Microbiology...seems useful for reviewing Covid-related stuff. I have offered to copy edit (I am a long time journal editor/reviewer) Vinay's stuff but he has not taken me up on it (I would be glad to do it for free -- the volume is low and the importance is high.) He should.
I brought up the same issue a few posts back. Dr. Prasad's content is so great that I would hate for people to discredit or ignore it because of typos or lack of proofreading in general.
When I read blog posts or articles my skeptic-meter goes up a notch once I start seeing mistakes.
The CDC is a political organisation. Perhaps there is Still some real science being done there but, really, they don't dare stray from their messaging. I mean all we hear about in the news is how the CDC admits that its "messaging" is off. Not that it is an antiquated and incredibly flawed agency which has been thrust into the forefront and whos "guidelines" are having an outsized impact on millions of lives... nope, we get "messaging"
There are some decent people there. That fact that VAERS is still available and still gives a HUGE danger to these vaccines says that to me. I'm betting some people raised a ruckus to keep it that way, in spite of the desires of the utterly corrupt senior management.
Vinay, despite Teddy Truther's (sheesh) comments below, this is a solid analysis. What people need to also add to the mix when they consider this are the dozens (even more, likely) of RCTs involving masking for influenza which is essentially the same particle size (about 100nm) as SARS-COV-2. Every one of these shows no tangible mask value; in fact, there has never been a shred of evidence that masks help, even with all the wishful thinking over the years. As you noted, Fauci clearly knows this -- the science got discarded for politics early on and, sadly, masking was just one of many areas where science was discarded.
(If you want a second area, the fact that everyone is ignoring the recent Hopkins study on the virtually zero value of lockdowns compared to their enormous cost is another stark reminder that The Narrative is far more important to those who think they are our COVID masters than the truth.)
Anyone, but apparently especially our political masters, can continue to do studies until they get the result they want. (The best real life example I recall is a toothpaste add that said "4 out of 5 dentists recommend our toothpaste". How did they do this? The asked groups of five dentists the question until they found a group of five that came out that way. We get EXACTLY the same behavior from CDC/FDA. The toothpaste example was for marketing; sadly, so is anything coming out of the three letter organizations. 100% political; 0% scientific. In fact, as you point out, it has a negative scientific effect because it demonstrates to anyone sane that they are lying to purpose. This causes an erosion of trust that is death to the success of public health efforts.
Even without RCTs, there is a natural experiment that has been going on for two years that has compelling data: the comparison of states with no masks and those with mask mandates. (Other geopolitical entities show the same results.) Over any reasonable time (CDC always cherry picks -- see toothpaste example above) the data from this real-world experiment shows NO difference between masks and no ,masks. It is not hard to discern. While imperfect, the law-of-large-numbers takes out many of the confounders and if there were ANY signal one would see SOMETHING. There is just no there, there (If you want to see endless documentary evidence of this, read Ian MIller's just published book Unmasked. More charts/statistics than are needed for any reasonable observer to understand we have been had.)
In short, of course there should have been RCTs. But the CDC has always known, based on the numerous influenza RCTs done before COVID (including on N95 masks) that masks have zero value for practical purposes and that is what studies would have shown. And that is WITHOUT factoring in the negative consequences of masks which are legion, especially in children.
I am glad you have gotten beyond the "bioplausible" distraction -- lots of things that are starkly untrue are plausible (geocentricity always comes to mind). It is up to people with an audience to point that out, and I applaud you for stepping up to do so.
Many thanks for having the courage that most of the medical community lacks. I fear for science and our profession.
Ian Miller (https://ianmsc.substack.com/ and https://twitter.com/ianmSC) has been presenting data since the beginning using his comparison charts to illustrate the ineffectiveness of efforts to mitigate spread. Containment does work but containment was lost in early days. Then we have various PPE some with better effectiveness than others. Of course we can have fully protective PPE against pathogens, but those have not yet been created for widespread public use. Even the N95 mask becomes intolerable except for the dedicated health worker who must. I even see some health care workers using the expensive respirators with p100 filters, at least they are more comfortable to wear while scaring patients.
The mask battle is hard to abandon because it does not involve protection, it's a social signal, a talisman of sorts. It became even less scientific when it became political. Some say it increases awareness, others say it reinforces fear. The social scientists of the future will look back at all of these well documented controversies with interest. They existed back in 1918 as history reveals. Science has moved on and the RCT will never happen. Until then the comparatives of Ian Miller are useful.
As I have promoted in some other stacks, Ian has also written an excellent book called Unmasked. It is an inexpensive paperback and I recommend everyone get a copy if you have any interest in learning how silly the masking is and has always been.
“ if at first you don’t succeed, try two more times until your failure is statistically significant. “ Too bad this is no longer a tired joke amongst our top public institutions, looking at you CDC.
I’ve lost faith in public health after my biopsy was delayed 7 months in Seattle “to slow the spread.” I moved to ID, received a biopsy and immediate 3rd surgery for skin cancer removal. Had I stayed, I wouldn’t be typing this. Thousands to millions of these stories. 💔 Thank you for your work & measured thinking.
Compelling analysis. I saw this headline a few days ago, and I’m not in the medical field, but immediately recognized it was not a good study due to the fact that it was a self reported survey. You pointed out earlier in the analysis of the daycare study that self reported surveys are a fundamental flaw.
So tired of feeling like I’m living in an insane asylum. Will they ever stop with this junk or are we doomed to be having to do battle against this borderline propaganda from here on out ??
Thank you for doing such a great job objectively analyzing these “studies”.
It's comically obvious at this point that the CDC knows the masks they've asked people to wear for 1.5 years are ineffective and is twisting itself in knots to publish sophistic analyses to enable people (particularly the most devout) to avoid the painful conclusion that the masks might have been completely unnecessary or - worse - served other purposes.
People I know who mask up even when alone outside will always tell me one of three things:
1) "Why is it so hard to wear a mask, especially when it could protect others?"
But I've already had omicron (tested positive over the holidays; only had congestion, sore throat, and minor body aches) and boosters are available to anyone who wants that extra protection. On top of that I'm not stopping anyone else from wearing a mask, double-masking, distancing from unmasked people, etc. (The number of people who mask up then willingly cram themselves together still boggles my mind.)
2) "What's wrong with other people wearing a mask all the time, even if it's outdoors?"
I think it's a sign that people still aren't able to move on. It's sunny and a warm 80 degrees out here in Los Angeles, and yet nearly half of the people at the park (young, old, and in-between) are masked up. There's the occasional double-masked person walking alone outside. Even back in summer 2021 when the mask mandate was briefly lifted in LA, I was usually the only person not wearing a mask indoors despite the wide availability of vaccines. (Remember at that time the message was transmission couldn't occur or was extremely rare if you got the jab.)
3) "If it helps, what's the harm?"
If wearing a mask increases your protection by 1% or even 0.1%, technically that does "help". However, is it worth mandating an entire population wear a mask for such meager gains? By that logic, why not mandate masks forever in indoor settings? Wouldn't that prevent transmission of cold and flu viruses? With omicron as mild as it is, if we take the current masking fanaticism to its logical conclusion we might as well mask every winter or all the time.
Feb 6, 2022·edited Feb 6, 2022Liked by Vinay Prasad
The slide says "compared people with similar characteristics (e.g., vaccination)". But this is not evident from the paper, which merely says (in notes to Table 3, from which the slide data come): "Models included matching strata defined by the week of SARS-CoV-2 testing." It seems it would be difficult to account for the characteristics that seem associated with testing positive (ethnicity, reasons for testing, vaccination) and still have power with such small samples? Does the slide simply misrepresent what is done in the paper?
Update: I answered my own question in the replies below. Still struggling to make sense of the results however.
I find it hard to believe that the people wearing N95/KN95 respirators after September 2021 were not fully vaccinated, whether it be doing so "all, most, [or] some … of the time." (Unless of course these are people who can't take vaccines, which would seem important to note.)
If they're all vaccinated, the 83% reduction in risk compared to no mask comes from comparing the 31 respirator users (10 positive, 21 negative) with those among the 35 non-mask-wearers (24 positive, 11 negative) who were vaccinated. Given that most responders over the sample period were unvaccinated (though sample period is long), how many people are we talking about? If we assume (generously) that all the 11 negatives were vaccinated, then given the effectiveness of vaccines alone, we wouldn't expect a lot of people in the "no mask, positive test, fully vaccinated" cell.
Putting aside bad science, this reporting of results is terrible (though perhaps the norm for such studies).
Note that paper says "interviewers attempted to enroll one control-participant … and matched the case-participant by age group, sex, and state region." But nothing about matching by vaccination status that I can see.
Also "Adjusted models accounted for self-reported COVID-19 vaccination status (fully vaccinated with ≥2 doses of BNT162b2 [Pfizer-BioNTech] or mRNA-1273 [Moderna] or 1 dose of Ad.26.COV2.S [Janssen (Johnson & Johnson)] vaccine >14 days before testing versus zero doses), household income, race/ethnicity, age, sex, state region, and county population density."
This is not my field, so I find the excessively abbreviated reporting of results a little foreign.
This "study" is so bad, so terribly poor in quality, that it's almost certain this was intentional.
The question now, is this just the CDC exploiting Brandolini's Law - forcing intelligent people to get disproportionately distracted refuting this bullshit, or, is this some sort of Stockholm Syndrome signal - the distressed employees of the CDC winking at us, giving us a sign, they realize they are forced to churn out such bullshit, so they went all in to produce the most incredible piece of bullshit and alert us they want out?
I agree the conclusions being circulated on Twitter are overstated and overhyped. But your critiques are overheated and hold the study to a standard it was not designed to meet (sidebar: your implicit argument that each individual context/setting must have its own cluster RCT for each layer of a NPI strategy is not a serious one. Public health is not oncology, where single drug substitutions in chemotherapy regimens of specific risk cohorts of specific cancers all get their own Phase III trial).
What this data says is "Lower reported rates of masking are among the cohort of behaviors and environmental factors associated with a increased likelihood of acquiring SARS-CoV2 infection in an indoor setting." Does this establish masking as a monocausal explanation? No. Does it point towards voluntary adherence towards layered NPI measures as being associated with individual protection against infection? Yes.
The substantial critiques of the study are #3 (the difference may be due to reporting bias after the outcome is known) and the fact that the environmental factors associated with protection may reflect demographic and not behavioral factors (people more likely to test negative may be wealthier and thus spend time in communal indoor settings that are less crowded and have better ventilation, and also be able to minimize exposures outside of communal settings - living in single family homes, etc.)
Everything else is just yelling at this study for not being a RCT. Which of course, it isn't.
Thank you for this! And for fighting for kids.
One has to ask.....if masks work so well, why did places like NYC have another huge spike in cases where the population is obsessed with wearing masks.
And you would think that controlled facilities like nursing homes would have nearly zero cases. Employees are masked full time while mingling with patients and most of these facilities did not allow guests.
This study simply doesn’t pass the smell test when compared to the body of evidence. Do we really believe that masks reduced the omicron wave in NYC by 50%? Surely we’d see evidence of 50% higher waves in places without masks, right? Why didn’t DANMASK find any effect if it was adequately-powered for the effect size that we see in this study? The list goes on.
It requires a total suspension of disbelief that is almost Trumpian in nature—Vinay hits the nail on the head when he says that this study creates room for people to seek “alternative facts.”
Trump was a genius compared to Biden. I seriously doubt Trump would have issued jab mandates.
Agreed
I have to take issue with your use of the word "controlled" there. I work in a nursing home and nobody wears a mask correctly. I'm surprised that this point isnt being made with this study, Wallensky's congressional testimony, and the Cochrane paper; namely, nobody wears the masks correctly and they take them down all the time and thats probably whats accounting for the "masks dont work" headlines. It's not that masks dont work (its obvious that they filter some virus) and thus have to reduce the risk somewhat, right?
Vinay, I am a surgeon with a degree in epidemiology. I highly respect your opinions and often listen to Plenary Session and read your substack. I also frequently share your work with family, friends and colleagues. BUT!! You must start proofreading your work. You have at least a dozen errors in the piece above. It is unprofessional and degrades your ability to effectively communicate via the written word. If you don't have time to proofread every sentence you write before hitting 'send' or 'publish' then pay someone to do it for you.
Sad, but true. I am a hematologist with boards in Microbiology...seems useful for reviewing Covid-related stuff. I have offered to copy edit (I am a long time journal editor/reviewer) Vinay's stuff but he has not taken me up on it (I would be glad to do it for free -- the volume is low and the importance is high.) He should.
I brought up the same issue a few posts back. Dr. Prasad's content is so great that I would hate for people to discredit or ignore it because of typos or lack of proofreading in general.
When I read blog posts or articles my skeptic-meter goes up a notch once I start seeing mistakes.
I agree. I had to reread some parts to decipher the intent.
The CDC is a political organisation. Perhaps there is Still some real science being done there but, really, they don't dare stray from their messaging. I mean all we hear about in the news is how the CDC admits that its "messaging" is off. Not that it is an antiquated and incredibly flawed agency which has been thrust into the forefront and whos "guidelines" are having an outsized impact on millions of lives... nope, we get "messaging"
Any real science is squelched, atleast from the public, until it can be manipulated beyond recognition.
My guess is this is preamble for indefinite masking. If you start with this endpoint in mind, their behavior becomes very clear
There are some decent people there. That fact that VAERS is still available and still gives a HUGE danger to these vaccines says that to me. I'm betting some people raised a ruckus to keep it that way, in spite of the desires of the utterly corrupt senior management.
Walensky is a a disgrace.
"HUGE danger *signal* ..." Duh.
Vinay, despite Teddy Truther's (sheesh) comments below, this is a solid analysis. What people need to also add to the mix when they consider this are the dozens (even more, likely) of RCTs involving masking for influenza which is essentially the same particle size (about 100nm) as SARS-COV-2. Every one of these shows no tangible mask value; in fact, there has never been a shred of evidence that masks help, even with all the wishful thinking over the years. As you noted, Fauci clearly knows this -- the science got discarded for politics early on and, sadly, masking was just one of many areas where science was discarded.
(If you want a second area, the fact that everyone is ignoring the recent Hopkins study on the virtually zero value of lockdowns compared to their enormous cost is another stark reminder that The Narrative is far more important to those who think they are our COVID masters than the truth.)
Anyone, but apparently especially our political masters, can continue to do studies until they get the result they want. (The best real life example I recall is a toothpaste add that said "4 out of 5 dentists recommend our toothpaste". How did they do this? The asked groups of five dentists the question until they found a group of five that came out that way. We get EXACTLY the same behavior from CDC/FDA. The toothpaste example was for marketing; sadly, so is anything coming out of the three letter organizations. 100% political; 0% scientific. In fact, as you point out, it has a negative scientific effect because it demonstrates to anyone sane that they are lying to purpose. This causes an erosion of trust that is death to the success of public health efforts.
Even without RCTs, there is a natural experiment that has been going on for two years that has compelling data: the comparison of states with no masks and those with mask mandates. (Other geopolitical entities show the same results.) Over any reasonable time (CDC always cherry picks -- see toothpaste example above) the data from this real-world experiment shows NO difference between masks and no ,masks. It is not hard to discern. While imperfect, the law-of-large-numbers takes out many of the confounders and if there were ANY signal one would see SOMETHING. There is just no there, there (If you want to see endless documentary evidence of this, read Ian MIller's just published book Unmasked. More charts/statistics than are needed for any reasonable observer to understand we have been had.)
In short, of course there should have been RCTs. But the CDC has always known, based on the numerous influenza RCTs done before COVID (including on N95 masks) that masks have zero value for practical purposes and that is what studies would have shown. And that is WITHOUT factoring in the negative consequences of masks which are legion, especially in children.
I am glad you have gotten beyond the "bioplausible" distraction -- lots of things that are starkly untrue are plausible (geocentricity always comes to mind). It is up to people with an audience to point that out, and I applaud you for stepping up to do so.
Many thanks for having the courage that most of the medical community lacks. I fear for science and our profession.
Ian Miller (https://ianmsc.substack.com/ and https://twitter.com/ianmSC) has been presenting data since the beginning using his comparison charts to illustrate the ineffectiveness of efforts to mitigate spread. Containment does work but containment was lost in early days. Then we have various PPE some with better effectiveness than others. Of course we can have fully protective PPE against pathogens, but those have not yet been created for widespread public use. Even the N95 mask becomes intolerable except for the dedicated health worker who must. I even see some health care workers using the expensive respirators with p100 filters, at least they are more comfortable to wear while scaring patients.
The mask battle is hard to abandon because it does not involve protection, it's a social signal, a talisman of sorts. It became even less scientific when it became political. Some say it increases awareness, others say it reinforces fear. The social scientists of the future will look back at all of these well documented controversies with interest. They existed back in 1918 as history reveals. Science has moved on and the RCT will never happen. Until then the comparatives of Ian Miller are useful.
As I have promoted in some other stacks, Ian has also written an excellent book called Unmasked. It is an inexpensive paperback and I recommend everyone get a copy if you have any interest in learning how silly the masking is and has always been.
Thanks! Just ordered his book. Look forward to reading it.
As soon as I read the MMWR on masks I waited patiently for your response to it. Thank-you for your work.
“ if at first you don’t succeed, try two more times until your failure is statistically significant. “ Too bad this is no longer a tired joke amongst our top public institutions, looking at you CDC.
I’ve lost faith in public health after my biopsy was delayed 7 months in Seattle “to slow the spread.” I moved to ID, received a biopsy and immediate 3rd surgery for skin cancer removal. Had I stayed, I wouldn’t be typing this. Thousands to millions of these stories. 💔 Thank you for your work & measured thinking.
Compelling analysis. I saw this headline a few days ago, and I’m not in the medical field, but immediately recognized it was not a good study due to the fact that it was a self reported survey. You pointed out earlier in the analysis of the daycare study that self reported surveys are a fundamental flaw.
So tired of feeling like I’m living in an insane asylum. Will they ever stop with this junk or are we doomed to be having to do battle against this borderline propaganda from here on out ??
Thank you for doing such a great job objectively analyzing these “studies”.
It's comically obvious at this point that the CDC knows the masks they've asked people to wear for 1.5 years are ineffective and is twisting itself in knots to publish sophistic analyses to enable people (particularly the most devout) to avoid the painful conclusion that the masks might have been completely unnecessary or - worse - served other purposes.
My family takes everything CDC publishes as gospel. It’s tearing us apart.
Thank you for using your platform to shine light on what amounts to profound dishonesty dressed as “science”.
People I know who mask up even when alone outside will always tell me one of three things:
1) "Why is it so hard to wear a mask, especially when it could protect others?"
But I've already had omicron (tested positive over the holidays; only had congestion, sore throat, and minor body aches) and boosters are available to anyone who wants that extra protection. On top of that I'm not stopping anyone else from wearing a mask, double-masking, distancing from unmasked people, etc. (The number of people who mask up then willingly cram themselves together still boggles my mind.)
2) "What's wrong with other people wearing a mask all the time, even if it's outdoors?"
I think it's a sign that people still aren't able to move on. It's sunny and a warm 80 degrees out here in Los Angeles, and yet nearly half of the people at the park (young, old, and in-between) are masked up. There's the occasional double-masked person walking alone outside. Even back in summer 2021 when the mask mandate was briefly lifted in LA, I was usually the only person not wearing a mask indoors despite the wide availability of vaccines. (Remember at that time the message was transmission couldn't occur or was extremely rare if you got the jab.)
3) "If it helps, what's the harm?"
If wearing a mask increases your protection by 1% or even 0.1%, technically that does "help". However, is it worth mandating an entire population wear a mask for such meager gains? By that logic, why not mandate masks forever in indoor settings? Wouldn't that prevent transmission of cold and flu viruses? With omicron as mild as it is, if we take the current masking fanaticism to its logical conclusion we might as well mask every winter or all the time.
(Now excuse me while I step off my soapbox.)
The slide says "compared people with similar characteristics (e.g., vaccination)". But this is not evident from the paper, which merely says (in notes to Table 3, from which the slide data come): "Models included matching strata defined by the week of SARS-CoV-2 testing." It seems it would be difficult to account for the characteristics that seem associated with testing positive (ethnicity, reasons for testing, vaccination) and still have power with such small samples? Does the slide simply misrepresent what is done in the paper?
Update: I answered my own question in the replies below. Still struggling to make sense of the results however.
I find it hard to believe that the people wearing N95/KN95 respirators after September 2021 were not fully vaccinated, whether it be doing so "all, most, [or] some … of the time." (Unless of course these are people who can't take vaccines, which would seem important to note.)
If they're all vaccinated, the 83% reduction in risk compared to no mask comes from comparing the 31 respirator users (10 positive, 21 negative) with those among the 35 non-mask-wearers (24 positive, 11 negative) who were vaccinated. Given that most responders over the sample period were unvaccinated (though sample period is long), how many people are we talking about? If we assume (generously) that all the 11 negatives were vaccinated, then given the effectiveness of vaccines alone, we wouldn't expect a lot of people in the "no mask, positive test, fully vaccinated" cell.
Putting aside bad science, this reporting of results is terrible (though perhaps the norm for such studies).
Note that paper says "interviewers attempted to enroll one control-participant … and matched the case-participant by age group, sex, and state region." But nothing about matching by vaccination status that I can see.
Also "Adjusted models accounted for self-reported COVID-19 vaccination status (fully vaccinated with ≥2 doses of BNT162b2 [Pfizer-BioNTech] or mRNA-1273 [Moderna] or 1 dose of Ad.26.COV2.S [Janssen (Johnson & Johnson)] vaccine >14 days before testing versus zero doses), household income, race/ethnicity, age, sex, state region, and county population density."
This is not my field, so I find the excessively abbreviated reporting of results a little foreign.
This "study" is so bad, so terribly poor in quality, that it's almost certain this was intentional.
The question now, is this just the CDC exploiting Brandolini's Law - forcing intelligent people to get disproportionately distracted refuting this bullshit, or, is this some sort of Stockholm Syndrome signal - the distressed employees of the CDC winking at us, giving us a sign, they realize they are forced to churn out such bullshit, so they went all in to produce the most incredible piece of bullshit and alert us they want out?
I agree the conclusions being circulated on Twitter are overstated and overhyped. But your critiques are overheated and hold the study to a standard it was not designed to meet (sidebar: your implicit argument that each individual context/setting must have its own cluster RCT for each layer of a NPI strategy is not a serious one. Public health is not oncology, where single drug substitutions in chemotherapy regimens of specific risk cohorts of specific cancers all get their own Phase III trial).
What this data says is "Lower reported rates of masking are among the cohort of behaviors and environmental factors associated with a increased likelihood of acquiring SARS-CoV2 infection in an indoor setting." Does this establish masking as a monocausal explanation? No. Does it point towards voluntary adherence towards layered NPI measures as being associated with individual protection against infection? Yes.
Extracting oneself from living is what reduces exposure to risk, not their NPIs.
The substantial critiques of the study are #3 (the difference may be due to reporting bias after the outcome is known) and the fact that the environmental factors associated with protection may reflect demographic and not behavioral factors (people more likely to test negative may be wealthier and thus spend time in communal indoor settings that are less crowded and have better ventilation, and also be able to minimize exposures outside of communal settings - living in single family homes, etc.)
Everything else is just yelling at this study for not being a RCT. Which of course, it isn't.