Masks are one of the most cost-efficient tools to slow the spread of COVID-19, not “one of the biggest scams ever perpetuated on this country,” as Brian Baker asserts in his Dec. 2 column, “The Great American Mask Scam.”
First of all, anecdotal evidence is a poor foundation for policymaking. Calls to “look around” and witness the failures of masks at preventing the spread of the coronavirus are illogical. They assume that no other factors matter. Failing to adhere to prevention measures doesn’t matter. Gathering in groups doesn’t matter. A lack of hand-washing or mask-wearing doesn’t matter. According to this line of thinking, if masks worked, then COVID-19 cases would decrease. COVID-19 cases are increasing; therefore, masks do not work. This is not sound reasoning. Other factors contribute to the spike in cases.
Secondly, Baker cites six studies in support of the notion that masks do not work. These are important to consider and should bring humility to politicians requiring mask-wearing, but this isn’t the whole story. In the realm of public policy, you can’t cherry-pick the studies that support your position. Unless you make clear why your studies should be accepted and the contrary ones rejected, you should take the academic literature as whole. And when the full span of the available evidence is taken into account, a very different picture emerges.
At worst, the evidence is mixed. At best, the evidence supports the use of masks as an effective tool to fight against the spread of COVID-19.
A meta-analysis of 172 observational coronavirus studies across 16 countries — 38 of which specifically studied the use of face masks — found that the use of a face mask was associated with a large reduction in the risk of infection (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142-9/fulltext).
A large systemic review of 67 studies concluded that mask-wearing is a low-cost intervention with the “most consistent and comprehensive supportive evidence,” (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6993921/).
A review of 31 clinical trials suggests that “wearing face masks can be slightly protective against primary infection from casual community contact, and modestly protective against household infections when both infected and uninfected members wear facemasks,” (https://www.medrxiv.org/content/10.1101/2020.04.01.20049528v1).
Another examination of six case-control studies found that wearing a mask was associated with a significantly reduced risk of COVID-19 infection, with an especially prominent effect for health care workers (https://www.medrxiv.org/content/10.1101/2020.10.16.20214171v1).
The breadth of the evidence supports masks as an effective tool to combat the spread of the coronavirus. To make the case that masks are ineffective, opponents need to explain why the studies showing no effects are more accurate than those showing positive effects. Baker doesn’t do this.
To be fair, support for mask-wearing is based on observational and epidemiological studies, not randomized controlled trials (RCT) — the gold standard of research. But this would be an unrealistic — and perhaps unethical — expectation to have. An RCT would require that some members of a community wear masks, while others do not. In other words, members of the control group would be required to not wear masks, potentially putting them and those around them in increased danger. Is the additional evidence regarding mask efficacy worth the possibility of more people getting infected? We have other sources of evidence that can inform our decision-making besides RCTS.
The World Health Organization recommends wearing masks. The Centers for Disease Control recommends wearing masks. If the evidence is mixed but there’s a possibility that masks may help save lives and livelihoods, why not give them the benefit of the doubt? The upside outweighs the minimal cost.
Baker takes aim at the wrong target when he calls mask mandates a scam. A critique of stay-at-home orders or forced business shutdowns is far more warranted than an attack on masks. Wearing a mask is something everyone can get behind; it’s one of the least-costly tools we have to protect each other.