We are now fully two years into this pandemic and the controversy of masks in preventing the spread of COVID-19 continues to rage. Right or wrong, like vaccines and lockdowns, masks use adherence have been a flashpoint dividing the political right and left during the pandemic. It may have taken several months, but those on the right and left of the spectrum seem to have adopted mask wearing (or the lack thereof) as a symbol of political allegiance, the evidence be damned!
I can only imagine the type of hand-wringing that is going on at the Centers for Disease Control (CDC), National Institutes of Health (NIH), and American Medical Association (AMA). I do not envy these people. They must feel like they are tiptoeing through a field of landmines when considering public health policy. At least, that’s how I would feel if I were presiding over one of these institutions. The gut wrenching feeling and dread of considering whether we made the right decision would be hanging over me as I consider all different sorts of perspectives on how to tackle the COVID problem at hand.
Considering the preface above, and as a practicing medical doctor, I do respect these organizations for what they do, the guidance they give, and clarity to help me in my medical practice are invaluable, and I thank them for that. I don’t believe there is some underlying ulterior motive by these organizations. I do believe these organizations are occupied by many men and women who are trying really hard to do the right thing for all of us to minimize death and disease.
Having said that, and again, with the deepest respect for them, it makes it quite difficult to support some policy decisions which are supposedly based on scientific evidence. For example, 1. How well do masks work in reducing COVID hospitalizations and death and 2. Are the results statistically significant and actually meaningful? After spending the past year and a half reviewing randomized controlled trials, observational trials, meta analyses, and systematic reviews on the subject, I’ve come to the 2 conclusions about masks wearing and its effect on COVID:
There you have in a nutshell folks. Looking at the available data, wearing a mask reduces COVID transmission by around a 10-15% margin. However, and much more importantly, is that this 10-15% reduction does not create a statistically significant difference in hospital and mortality outcomes. So while proponents of mask wearing can state confidently that wearing the mask reduces transmission, proponents of evidence based medicine (like me) can claim that the end result of that mask wearing is not meaningfully different than no mask wearing.
This is completely different from, say, outcomes for vaccinated vs. unvaccinated. There is clear and compelling evidence that COVID vaccines save lives. Period. Some other caveats to consider that affect transmission, and not seemingly discussed by these organizations include: What type of mask? How clean or dirty is it? How many times have I reused it? How many times did I take it off during the day? Do I lose all protection the moment that I take it off? Is avoid infection at all costs worth it? Do you see how incredibly complicated this becomes? Vaccines are easy because you can’t take off a vaccine. You can’t wash it or get it dirty. You get the jab and that’s it. It’s a whole lot easier to track than mask use. I personally find the mask conundrum interesting because in December 2020 I was hospitalized for COVID. It was during a time that I was highly compliant with wearing a mask everywhere I went. I still got it. I’m glad I survived it.
So in the end, there really isn’t any clinically significant evidence to support any sort of mask mandate in the general population of people with no symptoms (unless you are feeling personally ill–then it makes sense). Why the CDC and NIH are still recommending masks despite these findings is beyond me. Since they continue to advise mask use, perhaps they should tackle lowering the speed limit, or outlawing alcohol to reduce motor vehicle related deaths, since these actions would have more impact on death than mask mandates would.