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Until a week or two ago, all I’d heard in a long time about masks indicated they were doing more harm than good. Sure, it made sense when we thought we might have a child-killer spreading through coughing. But then, even back in 2020, we starting hearing that Covid doesn’t hurt kids much. We also learned that the virus doesn’t spread much by coughing. It’s aerosolized; it spreads through infected people just breathing it out, and when they do it’s small enough to go both through and around cloth masks and regular surgical masks. And then Omicron came., replicating in the outer airways 70 times as fast as Delta, which was already a much faster-spreading virus than the original Covid.
There’s no stopping this thing with masks, which are not harmless in any case, and little to no slowing of it. Don’t trust me, of course. I’m a dang philosopher. Trust reliable sources on the internet–if you can find any. But does that count the New England Journal of Medicine? Some authors there say masks can at least prevent the spread of the virus.
Some Problems with the NEJM Article
Now there are any other problems with the article’s reasoning. It doesn’t stick to medical science, and spins its own supposed discoveries as a great way of fighting structural racism. It ignores the harm done by masks–the unhealthiness of breathing through sweaty face diapers, the developmental delays in small children who can’t see adults’ mouths when they’re trying to learn how to talk, the cruelty to asthmatics. It ignores the relative harmlessness of Omicron–generally ranging from mild cold to bad flu, and that’s only for the people who actually have symptoms. It ignores the fact that probably somewhere between 75 and 95 percent of us have had some kind of Covid by now anyway.
Basically, as it seems to me, there’s no awareness of the need to do any cost-benefit analysis. Nor of the superior abilities of people, who know their own situation better than centralized bureaucrats, to do their own analysis for their own dang selves.
Still, if there really is some actual evidence here that masks really do have the benefit of preventing some Covid infections, I would like to know that. My early-2020 optimism about masks has since given way to a deep pessimism about masks. Was I wrong then, or am I wrong now?
The Article’s Main Argument
So let’s look at the NEJM article’s argument for that conclusion. From what I can understand, these guys are comparing Boston schools without mask requirements and Boston schools with mask requirements and finding that during the April-June Omicron spike there were more positive Covid cases in the schools that lifted mask requirements.
Something like . . . 45/1,000 more people getting Covid over a space of 15 weeks.
This is illustrated in the article’s Figure 1, which shows higher Covid rates for the schools that dropped the mask mandates.
They conclude from this that the lack of masks is likely the reason these schools had more Omicron cases.
Ok. Seems to make sense. And, to their credit, they make some effort to rule out other possible causes–e.g., the schools that kept the mask mandates and had less Covid were also the ones that had worse “ventilation or filtration systems,” so when some schools had higher Covid rates it wasn’t because they had worse air systems.
But I’m kind of interested in something else: Figure 2. If I’m reading it properly, the same schools with the higher Covid rates after dropping mask requirements also had higher Covid rates during the December-January spike.
So this raises a darn big question: How are we supposed to know whether these schools were not just more prone to getting Covid for some reason not considered in the article? (There are plenty of possible explanations I can think of–something about their location, schoolkids’ parents’ jobs, or what a few clusters of first-graders sometimes do on the weekend–and many more I can’t even think of.) The reason they got even more Covid during the next Omicron spike is simply that the next version of Omicron was spreading even faster.
That was my initial, provisional concern with the article.
Other Problems with the Article
Apparent Dr. Vinay Prasad had some objections as well. Dr. Prasad says this study is not a randomized control trial; it’s just an observational study. But a randomized control trial is what we need. This would not be difficult, but Fauci is against it, and won’t fund it, and instead we’re funding these “observational studies that fit a certain narrative.”
That’s an important objection! Do you remember why they were saying back in 2020 that chloroquine didn’t have good science in its favor? It was because it didn’t have any randomized controlled studies–you know, the kind we still apparently don’t have for masks either.
Dr. Prasad recommends reading this piece on Substack by Dr. Tracy Beth Høeg. It’s a nice, detailed look at many things wrong with the NEJM piece. I don’t notice Høeg looking over my particular concern, but I am pleased that she, Dr. Prasad, and I are all worried about other causes of a difference in Covid rates that the article does not sufficiently rule out.
And golly–Dr. Høeg did a great job critiquing the NEJM article! Her article has some of the same concerns as Dr. Prasad. It also has this insight: The NEJM study assumes that Covid spread outside of school is caused by Covid spread inside school, and not vice versa. That’s a heckuvan assumption there. And Høeg links to some other studies that indicate little to no benefit of masks.
“Let Us Hear the Conclusion of the Whole Matter”
Not that I find all this easy to understand. But if I’m provisionally trusting someone, whom am I going to trust–the freethinker on Substack or the establishmentarians jabbering about structural racism and calling it medical science?
In short, the NEJM article notwithstanding, it is still perfectly reasonable to think that masks are not useful against Covid–that they are doing more harm than good. As far as I can tell, the available evidence still points to that conclusion.Published in