Imagine if I wrote a paper advocating that everyone wore a rabbit's foot to protect from car accidents, and then a year later I published a paper showing an absolute reduction in car accidents by .0009. Would the Washington Post call this "the nail in the coffin that rabbit foots work?" Or instead would you expect some rigorous skepticism?
What they hell happened to science?
The author of Bangladesh Mask Study, Jason Abaluck, previously authored "The Case for Universal Cloth Mask Adoption and Policies to Increase Supply of Medical Masks for Health Workers" on 4/6/2020 - https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3567438 which concludes:
"The economic case for universal mask wearing is convincing and urgent, but the moral
need to provide adequate equipment to frontline healthcare workers is an even higher
imperative. Enacting policies to increase medical mask production, and concurrently
encouraging the widespread production and use of cloth masks can achieve both
objectives. Public officials should encourage and support universal cloth mask adoption
immediately."
Is it possible that because he started the Bangladesh Mask study already convinced of the conclusion, that masks work, this may have created subconscious bias in his design, gathering of data, and synthesis of results?
Look how his co-authors framed the minimal efficacy findings in their study when given the chance to summarize their findings in the Washington Post.:
(this is typically paywalled but I used the gift option to bypass that)
"We conducted the largest study on masks and covid-19: They work"
Hilarious experts include: "We now have the results, and the answer to both questions is an emphatic yes."..."The results were striking."...."We found that surgical masks averted 1 in 3 symptomatic infections among those aged 60 and older."...."Masks may have even greater potential than our study was able to demonstrate."...."Our study showed conclusively that masks are a cost-effective way to reduce infections and demonstrated that a mask-promotion strategy can work."
Note they didn't bother to point out they found cloth masks didn't work, but instead data-drudged their way to the "1 in 3 cases averted over the age of 60" without a second glance at the ridiculousness of that statement.
The press uncritically regurgitated the hype without ever reading the actual study.
Nature: "Face masks for COVID pass their largest test yet"
"“This really should be the end of the debate,” says Ashley Styczynski, an infectious-disease researcher at Stanford University in California and a co-author of the preprint describing the trial. The research “takes things a step further in terms of scientific rigour”, says Deepak Bhatt, a medical researcher at Harvard Medical School in Boston, Massachusetts, who has published research on masking."
WebMD: "Large Study Confirms Masks Work to Limit COVID-19 Spread"
Former Director of the CDC Tom Friedman: "Masks work. A new study of more than 340,000 adults across Bangladesh found that the more people wore masks, the less spread of Covid there was"
Masking proved you were a good person and likely voted Democrat. Once Trump avoided the mask, it became an instrument of faith that the bad guys avoid masks because they want everybody to die. From then on, mask deniers were shunned in society. No studies needed but there were a bunch where only benefit was found. Sure.
I have spent many hundreds of hours trawling through the data for this study (https://gitlab.com/emily-crawford/bd-mask-rct). According to that data, some individuals were given a serology test at endline despite being "asymptomatic" (that is, not meeting the study criteria for COVID-19 symptoms, which are based on the WHO definition of a probable COVID-19 case). I am not sure whether or not these individuals were randomly selected.
Out of 2375 asymptomatic individuals tested in the control group, 449 were seropositive (18.9%).
Out of 2987 asymptomatic individuals tested in the intervention group, 543 were seropositive (18.2%).
This is a smaller effect size (3.8%) than the one seen in the study, which is already on the edge of statistical significance.
Also notably, the percentage of symptomatic individuals who tested seropositive is 29.9%. So symptomatic individuals were more likely to test seropositive than asymptomatic individuals, but not by as much as one would expect or hope (especially given the authors' claim that they ran the symptom surveys in order to cut down on the number of blood tests they would need to perform to find seropositive results). This is one of many indicators that the symptom survey is unreliable.
We must keep in mind that the surveys themselves are fraught with problems. A researcher went to each enrolled household, asked "has anyone in your household experienced any of these symptoms in the past four weeks?", and read out a list of 11 symptoms. That list of symptoms doesn't even match what's reported in the Science paper. (Here is the full script: https://docs.google.com/document/d/14li6x3Wg0INClpBfuTzhFcALqC6aFyNtYc9DjVurcv0/edit.) This is a far cry from meeting any reasonable standard for COVID-19 diagnosis, including the one used by the FDA for vaccine trials (https://www.fda.gov/media/142143/download).
There has never been any confusion. Vinay is always just too kind. There have been many studies over many years on influenza (same size, for practical purposes, as SARS-COV-2) that show that masking makes NO difference. None of the areas that masked did any better than those who did not. (Check the Ian Miller Substack if you want more detail on actual usage results.)
This has always been a public "health" fraud to see how many people would comply to something known to be wrong. Sadly, they proved almost all will follow blindly, even when the promulgators change their minds for no reason in the middle and continuously ignore all evidence.
Most of us in the field discounted the Bangladesh "study" long ago -- there are many other confounders besides what Vinay has noted, and the result effect was so small as to be irrelevant in any case...as RWE shows.
All very sad. This was the initial lie that allowed all the other lies to pile on. It is why masking is important to debunk.
Can you explain why wearing a surgical mask does not make any difference in transmission ? Not worn properly ? Not worn 24/7 ? It is counter intuitive and needs an explanation, no ?
Honestly I find it more counterintuitive to believe they WOULD make a difference. If wearing a mask could prevent *getting sick* with any real reliability society would have figured this out at some point in the last 4000 years. Instead the pre-2020 consensus was largely against it. And no, Asian mask culture was neither as widespread as some claim nor about disease prevention so much as various other social motivations to the extent it existed at all.
Maybe the virus particles are too small. Maybe they escape out the sides and top along with fogged up glasses. Maybe even a few people not wearing them properly and not at all times is all it takes to eliminate all community-wide effectiveness for a highly contagious airborne virus. Maybe we don't understand the transmission dynamics.
Most interventions don't work. It is surprising and welcome when they do. It is not surprising that masks are in the first category.
So we must conclude that wearing surgical mask during a surgical procedure is useless ? I think in fact that it has been suggested in the litterature. The duration of the surgery seems to be more important.
Others are more qualified to reply but it is my strong understanding that surgical masks are intended to prevent bacterial infection of a wide open wound and also things like blood splatter. I doubt any surgeon prior to 2020 would say they were to prevent respiratory viruses. More generally it is odd to believe a practice used in a hospital operating room would have any applicability to, like, a kindergarten class.
Maybe the utility of the surgical mask is more to protect the surgeon.
Veterinarians in Belgium have (or had) to perform lots of caesarians because they have (had) a majority of Bleu Blanc cows. I do not know if it is still the case, but some years ago they would summarily wash their hands, no gloves, no mask but boy were they quick to open and close the abdomen !!! They had the same rate of infection as the vet faculty where my husband worked as a vet.
I will chime in on the question of efficacy in the operating room. Aside from the risk of the surgery itself, and the risk from the anesthesia, the next largest risk is getting a bacterial infection at the wound site. Before we "discovered" germ theory, created antibiotics, and realized the importance of achieving asepsis in the OR, many routine surgeries were still death sentences. In our quest to reduce the odds of infection, we created the scrub process which included wearing a surgical mask.
The purpose of the mask was NOT to reduce odds of passing a virus to the patient. We know this because the surgeon would never wear his or her mask pre or post op when checking on the patient. It was solely worn within the OR.
The theory was that small drops of spittle may spray out while talking or breathing, possibly containing bacteria, which may be sputtered from the mouth of the surgeon while they are leaning over close to the open site on the patient, which might increase odds of an infection at the wound.
Through dispassionate research, we never actually found the mask to make a difference, and often found it may make things worse [citations at the bottom].
Why then if we knew they didn't make a difference did surgeons continue to wear them?
The simplest explanation is that the surgical mask, like a double Windsor knotted tie on a lawyer, conveys a sense of seriousness. When the mask is on it conveys to the team in the OR it's a serious matter and scrub practices are in place.
________________________
"These results indicate that the use of face masks might be reconsidered. Masks may be used to protect the operating team from drops of infected blood and from airborne infections, but have not been proven to protect the patient operated by a healthy operating team."
"This study provides strong evidence for the identification that Surgical Masks as source of bacterial contamination during operative procedures, which should be a cause for alarm and attention in the prevention of surgical site infection in clinical practice."
Dr VP doesn't answer questions in the comments. I will tell you that if you look at surgical masks, there are gaps around the nose and at the cheeks. Those gaps are enough to allow transmission to happen. Covid virus is very small particles, not droplets, thus they are like smoke, they go where ever the wind blows, in this case, your breath. Remember all of those people who complained about their glasses fogging up when they wore a mask? That fog is their breath, breath that contains airborne particles such as covid virus, flu viruses or cold viruses.. 2nd, surgical masks were designed to prevent the wearer from spitting into patients, not to prevent airborne particles from entering or leaving the wearer.
It's only counterintuitive because we aren't very good at relating very very small things to one another.
If I told you that wrapping a chain link fence section around yourself would protect you from gunfire, your mind is instantly able to call "bullshit".
It's a bit tougher understanding that invisible things (virions) can pass through other invisible things (micropores in masks) because we can't actually see them.
Covid at 1:31, the size of micropore of n95 roughly equally to chloroplast at 2:29, the size of micropore in surgical mask close neron at 3:23. Alternatively, if we scaled a covid virion to 1 foot, then a n95 micropore is 90 feet, surgical mask would be 700 feet, and cloth mask 16,400 feet.
I know what you mean. It does seem intuitive that a mask, of any kind, would stop at least some of the virus particles from escaping -- and that seems to be the position of everyone I know who believes in the efficacy of masking. That said, one day I happened to observe a young man, wearing a surgical mask, vaping outside Walmart. He pulled his mask down to inhale and then put it back on. When he exhaled, the smoke/steam flowed easily out of the top, bottom, and sides of his mask. Apparently the air you exhale (and inhale) will find the easiest path in/out of the mask and the virus is along for the ride.
Imagine if I wrote a paper advocating that everyone wore a rabbit's foot to protect from car accidents, and then a year later I published a paper showing an absolute reduction in car accidents by .0009. Would the Washington Post call this "the nail in the coffin that rabbit foots work?" Or instead would you expect some rigorous skepticism?
What they hell happened to science?
The author of Bangladesh Mask Study, Jason Abaluck, previously authored "The Case for Universal Cloth Mask Adoption and Policies to Increase Supply of Medical Masks for Health Workers" on 4/6/2020 - https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3567438 which concludes:
"The economic case for universal mask wearing is convincing and urgent, but the moral
need to provide adequate equipment to frontline healthcare workers is an even higher
imperative. Enacting policies to increase medical mask production, and concurrently
encouraging the widespread production and use of cloth masks can achieve both
objectives. Public officials should encourage and support universal cloth mask adoption
immediately."
Is it possible that because he started the Bangladesh Mask study already convinced of the conclusion, that masks work, this may have created subconscious bias in his design, gathering of data, and synthesis of results?
Look how his co-authors framed the minimal efficacy findings in their study when given the chance to summarize their findings in the Washington Post.:
(this is typically paywalled but I used the gift option to bypass that)
"We conducted the largest study on masks and covid-19: They work"
https://wapo.st/3DAYmPQ
Hilarious experts include: "We now have the results, and the answer to both questions is an emphatic yes."..."The results were striking."...."We found that surgical masks averted 1 in 3 symptomatic infections among those aged 60 and older."...."Masks may have even greater potential than our study was able to demonstrate."...."Our study showed conclusively that masks are a cost-effective way to reduce infections and demonstrated that a mask-promotion strategy can work."
Note they didn't bother to point out they found cloth masks didn't work, but instead data-drudged their way to the "1 in 3 cases averted over the age of 60" without a second glance at the ridiculousness of that statement.
The press uncritically regurgitated the hype without ever reading the actual study.
Nature: "Face masks for COVID pass their largest test yet"
https://www.nature.com/articles/d41586-021-02457-y
"“This really should be the end of the debate,” says Ashley Styczynski, an infectious-disease researcher at Stanford University in California and a co-author of the preprint describing the trial. The research “takes things a step further in terms of scientific rigour”, says Deepak Bhatt, a medical researcher at Harvard Medical School in Boston, Massachusetts, who has published research on masking."
WebMD: "Large Study Confirms Masks Work to Limit COVID-19 Spread"
https://www.webmd.com/lung/news/20210907/masks-limit-covid-spread-study
Former Director of the CDC Tom Friedman: "Masks work. A new study of more than 340,000 adults across Bangladesh found that the more people wore masks, the less spread of Covid there was"
https://twitter.com/DrTomFrieden/status/1434901885106876416
LiveScience: "Huge, gold-standard study shows unequivocally that surgical masks work to reduce coronavirus spread"
https://www.livescience.com/randomized-trial-shows-surgical-masks-work-curbing-covid.html
"Results from a massive study in Bangladesh unequivocally show that surgical masks reduce the spread of SARS-CoV-2, scientists say. "
HOW??!! How can science be in such a state of disarray where we are so easily fooled? How can journalists covering science fall for such nonsense?
Why did it a bad cat to debunk this and not The New York Times or Nature or The Lancet?
https://boriquagato.substack.com/p/bangladesh-mask-study-do-not-believe
We are going to look at this as a mini-dark age.
Masking proved you were a good person and likely voted Democrat. Once Trump avoided the mask, it became an instrument of faith that the bad guys avoid masks because they want everybody to die. From then on, mask deniers were shunned in society. No studies needed but there were a bunch where only benefit was found. Sure.
I have spent many hundreds of hours trawling through the data for this study (https://gitlab.com/emily-crawford/bd-mask-rct). According to that data, some individuals were given a serology test at endline despite being "asymptomatic" (that is, not meeting the study criteria for COVID-19 symptoms, which are based on the WHO definition of a probable COVID-19 case). I am not sure whether or not these individuals were randomly selected.
Out of 2375 asymptomatic individuals tested in the control group, 449 were seropositive (18.9%).
Out of 2987 asymptomatic individuals tested in the intervention group, 543 were seropositive (18.2%).
This is a smaller effect size (3.8%) than the one seen in the study, which is already on the edge of statistical significance.
Also notably, the percentage of symptomatic individuals who tested seropositive is 29.9%. So symptomatic individuals were more likely to test seropositive than asymptomatic individuals, but not by as much as one would expect or hope (especially given the authors' claim that they ran the symptom surveys in order to cut down on the number of blood tests they would need to perform to find seropositive results). This is one of many indicators that the symptom survey is unreliable.
We must keep in mind that the surveys themselves are fraught with problems. A researcher went to each enrolled household, asked "has anyone in your household experienced any of these symptoms in the past four weeks?", and read out a list of 11 symptoms. That list of symptoms doesn't even match what's reported in the Science paper. (Here is the full script: https://docs.google.com/document/d/14li6x3Wg0INClpBfuTzhFcALqC6aFyNtYc9DjVurcv0/edit.) This is a far cry from meeting any reasonable standard for COVID-19 diagnosis, including the one used by the FDA for vaccine trials (https://www.fda.gov/media/142143/download).
Sorry, by 29.9% I meant 23.0%, so it's even worse than I said.
"I have spent many hundreds of hours trawling through the data for this study (https://gitlab.com/emily-crawford/bd-mask-rct)."
I think you just earned us renaming "Brandolini's Law" into "Mitchells Law".
Well done.
Even more confusion over the impact and protection offered by cloth and surgical masks.
There has never been any confusion. Vinay is always just too kind. There have been many studies over many years on influenza (same size, for practical purposes, as SARS-COV-2) that show that masking makes NO difference. None of the areas that masked did any better than those who did not. (Check the Ian Miller Substack if you want more detail on actual usage results.)
This has always been a public "health" fraud to see how many people would comply to something known to be wrong. Sadly, they proved almost all will follow blindly, even when the promulgators change their minds for no reason in the middle and continuously ignore all evidence.
Most of us in the field discounted the Bangladesh "study" long ago -- there are many other confounders besides what Vinay has noted, and the result effect was so small as to be irrelevant in any case...as RWE shows.
All very sad. This was the initial lie that allowed all the other lies to pile on. It is why masking is important to debunk.
Thank you for all these precious detailed info !
Can you explain why wearing a surgical mask does not make any difference in transmission ? Not worn properly ? Not worn 24/7 ? It is counter intuitive and needs an explanation, no ?
Honestly I find it more counterintuitive to believe they WOULD make a difference. If wearing a mask could prevent *getting sick* with any real reliability society would have figured this out at some point in the last 4000 years. Instead the pre-2020 consensus was largely against it. And no, Asian mask culture was neither as widespread as some claim nor about disease prevention so much as various other social motivations to the extent it existed at all.
Maybe the virus particles are too small. Maybe they escape out the sides and top along with fogged up glasses. Maybe even a few people not wearing them properly and not at all times is all it takes to eliminate all community-wide effectiveness for a highly contagious airborne virus. Maybe we don't understand the transmission dynamics.
Most interventions don't work. It is surprising and welcome when they do. It is not surprising that masks are in the first category.
So we must conclude that wearing surgical mask during a surgical procedure is useless ? I think in fact that it has been suggested in the litterature. The duration of the surgery seems to be more important.
Others are more qualified to reply but it is my strong understanding that surgical masks are intended to prevent bacterial infection of a wide open wound and also things like blood splatter. I doubt any surgeon prior to 2020 would say they were to prevent respiratory viruses. More generally it is odd to believe a practice used in a hospital operating room would have any applicability to, like, a kindergarten class.
Right.
I try to play the devil's advocate.
Maybe the utility of the surgical mask is more to protect the surgeon.
Veterinarians in Belgium have (or had) to perform lots of caesarians because they have (had) a majority of Bleu Blanc cows. I do not know if it is still the case, but some years ago they would summarily wash their hands, no gloves, no mask but boy were they quick to open and close the abdomen !!! They had the same rate of infection as the vet faculty where my husband worked as a vet.
I will chime in on the question of efficacy in the operating room. Aside from the risk of the surgery itself, and the risk from the anesthesia, the next largest risk is getting a bacterial infection at the wound site. Before we "discovered" germ theory, created antibiotics, and realized the importance of achieving asepsis in the OR, many routine surgeries were still death sentences. In our quest to reduce the odds of infection, we created the scrub process which included wearing a surgical mask.
The purpose of the mask was NOT to reduce odds of passing a virus to the patient. We know this because the surgeon would never wear his or her mask pre or post op when checking on the patient. It was solely worn within the OR.
The theory was that small drops of spittle may spray out while talking or breathing, possibly containing bacteria, which may be sputtered from the mouth of the surgeon while they are leaning over close to the open site on the patient, which might increase odds of an infection at the wound.
Through dispassionate research, we never actually found the mask to make a difference, and often found it may make things worse [citations at the bottom].
Why then if we knew they didn't make a difference did surgeons continue to wear them?
The simplest explanation is that the surgical mask, like a double Windsor knotted tie on a lawyer, conveys a sense of seriousness. When the mask is on it conveys to the team in the OR it's a serious matter and scrub practices are in place.
________________________
"These results indicate that the use of face masks might be reconsidered. Masks may be used to protect the operating team from drops of infected blood and from airborne infections, but have not been proven to protect the patient operated by a healthy operating team."
https://link.springer.com/article/10.1007/BF01658736
"This study provides strong evidence for the identification that Surgical Masks as source of bacterial contamination during operative procedures, which should be a cause for alarm and attention in the prevention of surgical site infection in clinical practice."
https://www.sciencedirect.com/science/article/pii/S2214031X18300809
"No masks were worn in one operating theatre for 6 months. There was no increase in the incidence of wound infection."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2493952/
Dr VP doesn't answer questions in the comments. I will tell you that if you look at surgical masks, there are gaps around the nose and at the cheeks. Those gaps are enough to allow transmission to happen. Covid virus is very small particles, not droplets, thus they are like smoke, they go where ever the wind blows, in this case, your breath. Remember all of those people who complained about their glasses fogging up when they wore a mask? That fog is their breath, breath that contains airborne particles such as covid virus, flu viruses or cold viruses.. 2nd, surgical masks were designed to prevent the wearer from spitting into patients, not to prevent airborne particles from entering or leaving the wearer.
It's only counterintuitive because we aren't very good at relating very very small things to one another.
If I told you that wrapping a chain link fence section around yourself would protect you from gunfire, your mind is instantly able to call "bullshit".
It's a bit tougher understanding that invisible things (virions) can pass through other invisible things (micropores in masks) because we can't actually see them.
Perhaps watching this youtube video https://www.youtube.com/watch?v=k0l1kLt917A might help? It shows the scale of very very small things to one another. It's very cool.
Covid at 1:31, the size of micropore of n95 roughly equally to chloroplast at 2:29, the size of micropore in surgical mask close neron at 3:23. Alternatively, if we scaled a covid virion to 1 foot, then a n95 micropore is 90 feet, surgical mask would be 700 feet, and cloth mask 16,400 feet.
I know what you mean. It does seem intuitive that a mask, of any kind, would stop at least some of the virus particles from escaping -- and that seems to be the position of everyone I know who believes in the efficacy of masking. That said, one day I happened to observe a young man, wearing a surgical mask, vaping outside Walmart. He pulled his mask down to inhale and then put it back on. When he exhaled, the smoke/steam flowed easily out of the top, bottom, and sides of his mask. Apparently the air you exhale (and inhale) will find the easiest path in/out of the mask and the virus is along for the ride.
Another instance of in vitro and in vivo (real world !) gap :-)
I mean, we only found viruses in the first place because something smaller than bacteria was somehow penetrating porcelain water filters in the 1890s.
Which we named "Filter passing viruses".
To believe that porous masks would outperform ceramic is remarkable.
https://en.wikipedia.org/wiki/Chamberland_filter