You should mask in 2023 exactly as often as you masked in 2017

We learned nothing during the pandemic

Pre-pandemic, there was no evidence masking in public slowed the spread of colds and flu. Cloth and surgical masks in the community was considered at best useless. That is why Fauci initially went on 60 minutes and said not to do it. Later, when he advised cloth masking, is when he started lying.

For doctors walking into the room of a person coughing up blood from tuberculosis, it is plausible that wearing a tight fitting, fit tested n95 mask for a short time can temporarily prevent you from infection (that you are not likely to encounter elsewhere). Yet, pre pandemic, it was also out of the question that any person could sustain doing this in the community. We did not advise wearing an n95 in a grocery store during flu season, and this remains untested.

During COVID19 pandemic, here is what we learned. We learned surgical masks were non-inferior to n95s in an RCT of healthcare workers. We also learned giving people a box of surgical masks in Denmark failed to reduce rates of COVID19. We learned that cloth masks didn’t work in rural Bangladesh, but surgical masks did, but further information revealed a major problem of concealment bias in that trial, thin events, and the entire conclusion is, at best, unreliable.

The biggest thing we learned was that with enough time ~100% of people will get COVID, and most will get it many times over.

For this reason: you should not mask any harder in 2023 than 2017. Why?

1. Because no new evidence emerged justifying masking

2. The totality of the evidence fails to find benefit (in medicine this is usually when we say it ‘doesn’t work’)

3. You will get COVID anyway, many times over

Some people have written to me saying they mask in grocery stores to prevent their loved ones from getting even a cold. I would contend that is absolutely unproven. If you want to do that, you should have done it in 2017 b/c the high quality evidence is the same: absent.

I am not sure this is actually the reason you are doing it. I think you have tacitly accepted the fact that masks work, which you should not have without well done RCTs. That is the real motivation for your behavior. You cannot entertain the idea that no one can sustain tight fitting masks in all situations, and very likely, over 30 or 90 or 180 days, you will get sick (the same number of times) whether or not you mask when you remember.

Others say: that immunocompromised people have to still wear n95 masks. I draw a distinction between transiently immunocompromised and permanently immunocompromised, and reiterate my view that for the latter it makes no sense. You have to find a way to live for the rest of your life, and you will get colds if you interact with anyone.

Some say: masking trials lack equipoise or are unethical. These people are totally wrong and lack understanding of medicine. Equipoise exists the moment different nations have different policies.

Some say the correct masking trial is to randomize people to wear masks or nothing and then expose then to the virus (a so called challenge trial)— they then dismiss this as unethical. But, not so fast.

It is entirely reasonable to ask college kids to spend a weekend in a house, and randomize them to different mask advice and then actually challenge them over the course of the weekend, and see if the mask advice helps. Over an entire weekend, I have a guess what will happen.

If you prefer not to use a challenge design you can assign different mask advice to dorms, or community clusters, and follow them. Either way, trials are beyond possible. They are necessary.

Finally, some say: what is the harm? If you want to mask, mask. Leave them alone. By that logic, we should also be quiet about people who swallow useless supplements and vitamins. Those are also useless, but there is some obligation to tell people the truth. Additionally, I don’t think masking is harmless. The more zealots who remain in society, the more likely they will again force toddlers to mask, which is a net harm intervention, and the more likely they will again force us sensible people to mask. They still force me at work.

Instead of spending money on paid sick leave, and universal health care, liberals have squandered their social capital on masking advice, which is nonsensical and unproven. They are no better than the misinformed people they mock. It is just different misinformation.