Public Health Measures like Mask Mandates Lead to Unintended and Unpredictable OutcomesTags Bureaucracy and RegulationHealth
After months and months of covid tyranny, nearly forty states and many more localities continue to push mandatory mask wearing in the US. Shortly after his inauguration, President Joe Biden signed a set of executive orders that require mask wearing on all federal lands, as well as in airports, buses, and trains. This brand of state paternalism should be cause for much concern—not only because it infringes on man’s natural rights, but also because the state has proven incapable at making people any safer. In fact, it has invariably made them less safe.
Mask Efficacy: “Settled Science”?
The chorus of technocrats and corporate media repeatedly pushes the same line—that the benefits of mandatory mask orders are “settled science.” In defense of their claims, they’ll often cite a litany of peer-reviewed epidemiological studies, with the intent of shutting down all further discussion. However, most of the studies they reference fail to decouple important variables or don’t analyze masks outside a laboratory setting, so their alleged “facts,” in short, don’t prove much of anything. The debate around mask efficacy is actually far more nuanced. In fact, a lot of the more relevant studies suggest that most masks may be only marginally beneficial in slowing the spread of covid.
A 2017 meta-analysis studying mitigation tactics against pandemic influenza found that “facemask [sic] use was not significantly protective” overall, but “that regular hand hygiene was” (emphasis added). Since covid is, like influenza, a viral respiratory illness, this finding may be relevant to the present pandemic. Still, masks are not homogenous, and the efficacy of masks may hinge, in large part, on the type being considered.
For instance, repeated studies have indicated that makeshift masks, such as bandanas, may be only slightly effective in preventing particle intake. Researchers recommend that they only be used as a “last resort,” even though they’ve been very common during the present pandemic. Some other types of masks don’t fare too much better in the literature. According to one study, cloth masks are “only marginally beneficial in protecting individuals from particles<2.5 μm” like SARS-CoV-2 (the virus responsible for the covid disease). In a commentary on the available data, Drs. Lisa Brosseau and Margaret Sietsema wrote that “cloth masks exhibit very low filter efficiency” and should not be used by either healthcare workers or the general public.
There’s similar pessimism to be had about surgical masks as well. Unfortunately, neither of the two studies that looked at surgical mask use in nonmedical settings was able to formally conclude anything. Both urged further research, although neither did find a statistically significant benefit to the masks. Actually, several studies have found that even in a medical setting surgical masks are ineffective at preventing the infection of patient wounds and protecting healthcare workers. Beyond surgical masks, though, the “gold standard” for valetudinarians has been N95 respirators. A pair of studies conducted in 2017 concluded that N95s may be more protective than surgical masks (though a more recent study found no significant difference between the two). In any case, N95s are almost always unfitted and worn improperly in general public use, even by the admission of the CDC, which casts doubt on their alleged superiority.
Masks and Nothing Else
A systematic review published by Cambridge University Press contained the following nugget: “[A]ny mask, no matter how efficient at filtration or how good the seal, will have minimal effect if it is not used in conjunction with other preventative measures, such as isolation of infected cases, immunization, good respiratory etiquette, and regular hand hygiene.” Nonetheless, throughout the covid crisis, the efficacy of mask wearing has been widely exaggerated by public health authorities, to the exclusion of other mitigation tactics. CDC director Robert Redfield, for example, has called them “the most powerful public health tool” and “our best defense.” Misleading rhetoric of this sort has caused many to treat masks as cure-all talismans that allow them to continue an otherwise regular course of activity. Once masked up, they assume, there is little risk of transmission, even when in close quarters with others. Of course, research has repeatedly shown this assumption to be false.
What may account for this behavior, at least in part, is a phenomenon called risk compensation, which is “[t]he adjustment of individual behaviour in response to perceived changes in risk,” per the definition from Segen’s Medical Dictionary. Whenever an individual believes himself to be more “insulated” from danger, he can afford to be more haphazard and hence often exerts less effort toward being “safe.” As a result of wearing masks, many people reduce the practice of other safety strategies, like social distancing and hand hygiene. Due to the government’s mask mandates, then, people may be contracting the virus in far greater numbers than they otherwise would have (including those who are elderly and immunocompromised).
This looks to be exactly what’s been happening all around the world, including in the US. A self-report survey on covid mitigation practices was conducted in the US between April and June 2020, when fears were still ramping up and governors issued their initial mask orders. Overall mask use predictably increased during the period, but all other mitigation practices dropped. A study led by doctors from Yale University found that “the representative American in states that have face mask mandates spent 20–30 minutes less time at home, and increase[d] visits to a number of commercial locations, following the mandate.” The high case rates of many well-masked polities, like Los Angeles County, help to reinforce the study’s findings.
Chart after chart of data from various states and localities shows that the introduction of mask mandates has repeatedly failed to induce a reduction in covid cases. In many instances, case levels have only risen higher in the weeks following the imposition of mandates. A comprehensive analysis conducted by Rational Ground found that states with mandatory mask orders had, on average, twenty-seven cases per hundred thousand people per day, whereas those without had only seventeen, even after researchers accounted for a fourteen-day period of viral transmission.
If mandatory masking is really the linchpin of America's covid response, as Redfield and other officials have claimed, why does the data fail to show any public health benefit? A team of infectious disease experts—including some from Harvard Medical School—proffered the following answer in a recent paper: “Focusing on universal masking alone may, paradoxically, lead to more transmission of Covid-19 if it diverts attention from implementing more fundamental infection-control measures.” That observation should be far from controversial. Even in its current guidelines, the World Health Organization (WHO) warns that masks may provoke a “false sense of security leading potentially to reduced adherence to well recognized preventive measures such as physical distancing and hand hygiene,” as well as increased “risk-taking behaviours.” Yet mask orders have continued to be defended, extended, and enforced.
In fact, some mask orders have, by their very letter, explicitly played into the mentality of risk compensation and exacerbated its effects. Massachusetts’s order, which has been in effect since May 6, is one such example, requiring that “any person…who…does not maintain a distance of approximately six feet from every other person shall cover their mouth and nose with a mask or cloth face covering.” It’s an either-or imperative: either practice social distancing or wear a mask—though in reality substituting one behavior for the other may come with dire consequences. The authors of the Yale study comment, “Since the reproductive rate of [SARS-CoV-2], the pathogen that causes COVID-19[,] is hovering right around one, such substitution behavior could be the difference between controlling the epidemic and a resurgence of cases.” Let that sink in: the very mandates intended to “slow the spread” may have been among the primary factors driving the virus’s propagation.
Recently, Dr. Anthony Fauci fawningly praised the practice of wearing two masks as “common sense.” But according to some physicians, this practice may only add a very marginal level of protection, and there has never been a single scientific study conducted to measure its efficacy. Perhaps, under the impression that double masking is a “silver bullet,” many will feel even more comfortable eschewing other mitigation strategies—all at a time when covid may be becoming more infectious.
All that raises the question: If the mask mandates have produced so many unpredictable and inefficient results, what should have been done instead? To this, there can be no single answer, because it’s impossible for any authority to centrally plan public health. The risk of contracting covid varies from place to place and person to person, based on the extent of community spread and the types of activities an individual engages in. A one-size-fits-all approach, like the mask mandates, is then liable to end in failure. The information required to assess each situation and make the proper decisions is diffused throughout society; no one authority has all the answers. What should have been done, then, was to let people confer with their families, friends, and physicians to find the solutions that work best for them. Businesses, too, should have been free to craft their own policies to keep customers and workers safe. That means that freedom and property rights were the only prudent path—not state paternalism. Such freedom could have taken all sorts of different forms, with different solutions working for different people and businesses at different places and times, allowing personal insight and flexibility to drive society’s covid response. After all, following the knowledge of civil society is the only way to secure health and freedom; reliance on government has only engendered a diminution of both.