Other than during my time working as a nurse I had never seen anyone wearing a surgical face mask and, even then, it was only in operating theatres and by the surgeons and scrub nurses who were hovering directly over the patient. Of course, I saw builders with dust masks and had worn a respirator during the First Gulf War when we feared that Saddam Hussein was going to send chemical or biological weapons over the border into Saudi Arabia. But these were sealed fitted masks with valves; surgical masks were simply strips of material which left gaps at the sides.
My next encounter with surgical face masks was in 2003. I had the misfortune to be working in Hong Kong in the precise week that the first cases of SARS were identified. My hotel was coterminous with the shopping centre where the first case was identified. I was only there for one week but before I left people began appearing wearing surgical face masks. These flimsy types of disposable masks are meant for only very short term use in situations where droplets may move from the clinician to the patient or vice versa.
I asked senior clinical colleagues there what the evidence was that these were effective at preventing the spread of a respiratory infection and they confirmed, as I suspected, that there was no evidence for their effectiveness. I returned to Hong Kong the year after SARS, by which time the epidemic was over, but people were still wearing surgical face masks. My most recent visit was in 2019 and they were still very much in evidence.
I was also in Wuhan when COVID-19 was first identified. However, it was still being covered up by the authorities when I left, and I returned to the U.K. to find out that I had left an epidemic behind me. I told people I had travelled extensively on public transport, eaten in crowded restaurants and worked out in a gym yet, miraculously, I was still alive. But within days of my return, I saw my Chinese colleagues were all wearing surgical face masks and urging me at the end of each WeChat session to “wear a mask”. How we laughed at their stupidity. That would never happen here where we had a propensity to rely on evidence and were not driven by the ‘you have to be seen to be doing something’ mentality. How wrong I was.
There were serious discussions here and across the rest of the Western world about whether we should be wearing surgical face masks in public. People who knew how to find and assess evidence checked reliable sources such as the Cochrane Collaboration, the international gold standard organisation for assessing evidence. We found exactly what we expected to find, that there was no substantial evidence in favour of the use of surgical face masks, even in situations for which they were designed. We were also encouraged that the WHO in Geneva and the CDC in the USA were not advocating the routine wearing of surgical face masks.
Then, within a few weeks of the declaration that there was a global pandemic we were being instructed to wear face coverings in enclosed public spaces and those face coverings could include disposable surgical masks or even just a strip of cloth. The evidence for the former was threadbare and the evidence for the latter was non-existent. Some countries took things to extremes, and if the Covid faint-hearts and lockdown fanatics had been permitted, we would have gone further in the United Kingdom. Thus, for example, Spain and Hong Kong insisted on face coverings out of doors, something for which absolutely no evidence had been or has since been produced. Other countries such as Italy and Austria mandated that disposable surgical masks and cloth strips were not to be permitted and only masks of a higher standard (FP2 and N95) were to be worn. While there is evidence that these are effective in clinical situations when properly fitted and when sufficient supplies are available for renewal every few hours, there is no evidence that these are effective when worn in everyday circumstances by the public.
So, what happened and what is the evidence for face masks now that the COVID-19 pandemic appears to be receding? Both books which stimulated this article consider the issue of evidence but from different perspectives. Only Unmasked considers the origins of the change in policy regarding face masks that led to such a widespread change in practice. Of course, we will never know precisely what led to the international change in heart about face masks. The people behind the change such as Dr. Anthony Fauci, Chief Medical Advisor to the President of United States, are accountable, it seems, to no one. Fauci was initially vocally opposed to the widespread wearing of face masks declaring that they were “unlikely” to be effective and that there was “no reason” to be walking around wearing them. But very early in the pandemic he changed his mind and, in line (some would say “lockstep”) with the rest of the influential health bodies in the world, he began recommending face masks. When questioned about this he “admitted” to the “noble lie” of not having recommended face masks initially to protect supplies for those who needed them on the “front line” of clinical practice. Ian Miller, who is based in the United States, explores Fauci’s thinking throughout the process of face mask implementation from his denials that they were needed through saying that disposable surgical face masks would also be a waste of time to his ultimate recommendations for face coverings. As a result, these became mandated in some states, but not in others.
The fact that face masks, and other non-pharmaceutical interventions (including social distancing and economic lockdowns) were not universally mandated across the United States and the sheer longevity of the COVID-19 pandemic provided an excellent series of natural experiments and forms the bulk of Unmasked. Miller meticulously assesses the evidence across the United States and internationally by comparing states, counties and countries with draconian COVID-19 restrictions against those without. His basic unit of analysis is the comparison of mask mandates with no mandates against the prevalence of reported COVID-19 infections. For example, he looks across time at the prevalence of reported COVID-19 infections for the whole of the United States and indicates in the graph the points at which mask mandates were introduced. He also plots individual states with the same data and compares, within states, those counties with mandates against those without and does the same for states and whole countries. There is no need to dwell on the specific outcomes which can be summed up as follows: there is absolutely no evidence that face masks were effective in controlling the spread of COVID-19.
Hector Drummond does not concern himself with the origins of The Face Mask Cult which forms the title for his book. He opens with two chapters on face mask FAQs and covers here almost every question that is thrown at the face-mask sceptic, addressing each with evidence-based responses. The second of these chapters revolves around the ‘precautionary principle’ argument whereby even people who are prepared to accept that the evidence for wearing face masks is flimsy will still advocate them on a ‘better safe than sorry’ basis. However, there are definite disadvantages to wearing a face covering and even some dangers. Nevertheless, Drummond takes a balanced approach to the harms and is careful not to undermine his arguments by exaggerating them.
The remainder of the book considers the various reports that proliferated in support of wearing face masks from august bodies such as the Royal Society and the University of Oxford. These reports were very influential and those of us who expressed mask scepticism became deluged with these whenever we expressed our views. I was glad to see Drummond analyse these non-peer-reviewed, demonstrably biased and scientifically weak publications. However, it was not only in these reports that the science was deficient. The final, extensive chapter of The Face Mask Cult dissects the individual studies published to date and exposes the bias inherent in many, the misinterpretation and misrepresentation of data and the subsequent misuse of these studies. In the case of the rigorous Danish mask study which failed to support mask wearing, presumably to avoid rejection the authors were forced to add a conclusion that contradicted the findings. The book is a catalogue rather than a textbook, thus there is no index and no inclusion of issues beyond the studies in question. I would have valued some consideration of, for example, publication bias whereby studies that did not fit the COVID-19 narrative were suppressed.
Nothing in either of these excellent books should surprise us given all else that went on throughout the COVID-19 pandemic. This is not the place to rehearse these things, but it is to the credit of both volumes that they confine themselves to the specific issue of face masks and do not stray into other areas of non-pharmaceutical interventions. However, the legacy of the COVID-19 pandemic looks ever more like a trail of destruction – the destruction of society, the economy, health services, mental health and even science itself. The unpalatability of the findings related to masks is enhanced for lockdowns by the fact that, as is increasingly being shown, they were similarly ineffective but with the added insult that they were positively harmful. Notwithstanding all the above, the most remarkable aspect of the COVID-19 pandemic for which I have yet to see an adequate explanation is that people complied.
Source: The Great Face Mask Con – The Daily Sceptic