[ConorSheehan1]

Great article but I have a critique:

It's odd to put the introduction of hand washing at hospitals in 1800s Vienna and doubt over mask effectiveness against the spread of covid19 in the same category. They seem like opposites to me.

Sure they're both going against the scientific consensus of the time but there are some key differences.

In both cases, people don't want to change their behavior, but questioning masks is on the side of doing nothing.

There are no downsides to wearing a mask. When there's a new disease and we're not sure how to slow it's progress, but we have something that might help with no downside i.e. mask wearing, might as well try it right? And in retrospect it's pretty clear it was effective.

During the pandemic, I'd rather see scientists coming up with new more effective measures than squabbling over whether the existing measures are effective.

[mike_hearn]

There are no downsides to wearing a mask.

They cost money and require effort. Therefore, there are downsides.

Defining a set of actions as literally cost free is a logical fallacy. Nothing is ever cost free. The moment you do this you're obliged to engage in that action 24/7 for the rest of your life, immediately and indefinitely, as any possible benefit would justify doing it - even imagined benefits that exist only in the realm of future hypotheticals. Worse, once someone makes this error, they start to believe everyone else is irrational because why would they not engage in this completely downside-free behavior too?

it's pretty clear it was effective.

The article mentions the Cochrane Review which rigorously concluded the opposite. However you don't need a meta-study. Community masking was justified on the claim that it would create a downward inflection in the case numbers. Go to ourworldindata and select COVID case graphs for a few countries you're not familiar with, then try to figure out when they imposed or removed mask mandates by searching for the inflections. You won't be able to because no such inflections were ever created. So mask mandates had no impact when judged by their own (stated) goals.

[shiftingleft]

> The article mentions the Cochrane Review which rigorously concluded the opposite.

Do you mean this one?

"Many commentators have claimed that a recently-updated Cochrane Review shows that 'masks don't work', which is an inaccurate and misleading interpretation.

It would be accurate to say that the review examined whether interventions to promote mask wearing help to slow the spread of respiratory viruses, and that the results were inconclusive. Given the limitations in the primary evidence, the review is not able to address the question of whether mask-wearing itself reduces people's risk of contracting or spreading respiratory viruses."

https://www.cochrane.org/news/statement-physical-interventio...

[mike_hearn]

Yes, that one. From the "We need scientific dissidents" article this thread is about:

When Tom Jefferson and his group published a report saying “We are uncertain whether wearing masks or N95/P2 respirators helps to slow the spread of respiratory viruses based on the studies we assessed,” the editor in chief of Cochrane apologized for the wording, even though subsequent surveys showed the language was standard for Cochrane given the nature of the evidence.

The incoherent attempt at walking back the study findings by Cochrane administration is the type of problem the article is discussing. It came after a pressure campaign by a social media influencer [1] and the New York Times [2], not due to any actual problem with the review (which AFAIK remains unaltered).

The actual study authors stand by their conclusions. But consider something else: the statement on their website is nonsensical, asserting that it's wrong to accept the null hypothesis in this case despite a large multi-study failure to find significant results. But that's not how science works. You start by assuming the null (community masking/mandates don't work), and then try to disprove it. If you can't then you stick with the initial belief that there's nothing there, you don't assert that anything failing to find what you want is "inconclusive" - that's starting from a conclusion and working backwards.

[1] https://twitter.com/thackerpd/status/1644306405942255617?s=2...

[2] https://dailysceptic.org/2023/04/13/the-new-york-times-is-su...

[lukeschlather]

The thing is people elide the correct conclusion of that study to "masks don't work" which is not what the study says, and it is actually a hypothesis that has been roundly disproven... there are numerous studies showing the efficacy of mask wearing for preventing the spread of infectious diseases. They apologized for the wording for a good reason, which is that people took it out of context to suggest something that is not only not what the study said but contradicts a variety of other research.

[brabel]

This is a hard one... the parent commenter mentioned that there should be some indication about when people were told to wear masks in the charts that show the spread of the virus in at least some countries. That's difficult to see anywhere... the study you link to says that they were simply unable to show whether masks are effective because of "the high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies".

Let me give a little anecdote about that... Brazil was one of the worst affected countries, despite having made it mandatory to wear masks. Sweden, on the other hand, only made it mandatory to wear masks in a few very limited situations (e.g. public transport), and even then, only after the pandemic was already dying down, much later than most countries. And Sweden seems to have had a below OECD average rate of deaths due to the pandemic.

I know it's a difficult comparison to make: Sweden's healthcare system is likely more "competent" than Brazil's (because it can afford much more, but both have free or nearly free healthcare available to everyone) and people in Sweden tended to be less skeptical of the virus (personal experience, not sure this can be shown by data) - that makes a big difference as people in Brazil would often wear a mask just because they were forced to, and hence wore it incorrectly and didn't really try hard to make it effective, while in Sweden people did it by their own accord (for the longest time, Sweden only recommended to wear, but did not make the mask mandatory) and were much more likely to have done their research about how to better make use of the mask to avoid getting infected.

Also, it has been shown that most deaths in Sweden occurred early on, among the elderly living in nursing homes where employees (who are almost always foreigners with a very different culture and hence, I suggest, less likely to properly wear masks and follow government recommendations to contain the spread of the virus, like completely avoiding meeting people who are not living in the same household) were the main source of infections - so if you take that into account, the fact that people in Sweden were mostly not wearing masks at all for most of the pandemic should show that, at the very least, wearing masks was not the most effective way to keep the virus under control.

My takeaway is that masks may help, but only if you actually believe it will help and take sufficient care to wear a proper mask and do it properly... and that other measures, like voluntary social distancing, turned out to have been more effective than just wearing masks.

[Tao3300]

> foreigners with a very different culture and hence, I suggest, less likely to properly wear masks

What does culture or nation of origin have to do with being able to wear a mask properly?

[depressedpanda]

The answer is right there in the quote you decided to cut short for some reason.

Culturally, Swedes trust their government a lot more than people do in other countries.

[kubb]

Not only that, but the mechanism of respiratory transmission is so widely known, that the use of masks to reduce it is an idea soundly backed by an accepted theoretical framework.

When Covid started I stopped getting sick in the winter. Before the pandemic I had gotten sick at least twice per year with some virus: sore throat, fatigue, sneezing, all that. It started again when the measures were relaxed. Of course this doesn't qualify as evidence for mask effectiveness, but I wonder if anyone had the same experience as me?

[wozniacki]

Solely addressing the mask use part of your reply, I've found that it greatly helped reduce the number of times I fell ill ( even mildly ) from things you list like colds, coughs, sore throats & fatigue.

I can't believe that there are no substantial studies that have studied the ability of consumer grade surgical masks ( and/or N95s) in preventing common illnesses, very reliably when used regularly.

Why aren't these things conclusively studied, beyond any degree of doubt?

[kubb]

Most likely because it's hard to orgainze a controlled, large-scale trial, and there are many variables that influence real-world outcomes, and the measurement of the mask variable is not accurate based solely on historical real-world data.

[depressedpanda]

Yes.

I used to get really bad colds 3-5 times a year, for as long back as I can remember (afaik, I never got Covid, though). Now, it's been longer than a year since I last got sick.

However, I only wore a mask when forced to, as mask usage was generally only recommended and almost never mandatory during the pandemic.

Rather than masks, I think the most likely reason is that people who get sick nowadays are much more likely to stay at home, and probably also that everyone washes their hands more often.

[Thiez]

Many had the same experience, including those who went without masks. I imagine social distancing + people self-quaranteening for all of those symptoms you mention can explain most of it.

[VK538FY]

I experienced very little illness, winter or otherwise, during the coronacrisis. I had two fevers that lasted on average 4 days. I had a case of mild bronchitis that lasted 3 or 4 weeks. On average, I tend to have more cold/flu/rinopharyngitis in normal winters and often a bit of bronchitis. I'm a light smoker. I wore a fake mask poorly when I was forced to. I took a number of parapharmaceutical prophylatics like zinc, vitamins C and D and quercetine. Regular intense sport but less overall physical activity. Diet with tons of animal fat and a fair amount of cooked vegetables. Drank surely too much alcohol. No vaccines or medical procedures except regular dental care. I worked from home 60% of the time but literally jumped on every opportunity to socialize with like minded people. If I had to bet real money: the rather favourable outcome was due mostly to home office and the reduced stress.

[mypastself]

I don’t know. It can be difficult to breathe for some people, it can be itchy, hot, build up bacteria, fog up glasses… you also have to carry enough of them wherever you go. So it’s not exactly doing nothing.

[alfnor]

"Babies are on average interacting with fewer people (and seeing fewer faces because of masking) than they did before the pandemic." https://www.health.harvard.edu/blog/pandemic-challenges-may-...

[skrebbel]

> There are no downsides to wearing a mask.

I’ll never understand why people keep repeating this. I know multiple people who seriously struggled with the mask. Ranging from basic stuff such as “it fogs up my glasses so I can’t see well and it gives me a headache” all the way to “I get a panic attack if I wear one for longer than 5 minutes”.

These people all pretty much stayed in the house for as long as the mask mandates lasted. That’s a long time to look at the same four walls!

[arrozconcosas]

And for kids to not see each others faces, honestly even adults, has implications for communication and empathy you have for others. You are “anonymous” in your mask. For kids it really impacts development for them not to see each other.

[almostnormal]

There's downsides to wearing pants, too. Nonetheless almost everyone is wearing them.

[sneed-oil]

Maybe because to them the upsides are more important than the downsides, including because it would be illegal to go out without pants in their country. I don't think wearing clothes should be required by law.

[metalspot]

> There are no downsides to wearing a mask

this is objectively false. it is generally accepted in the scientific community that wearing masks for an extended period of time is dangerous and leads to respiratory illnesses.

[wddkcs]

There's also little if any evidence masks were effective at stopping spread. Maybe in idealized conditions, but the mandated use likely did nothing.

[jacob171714]

No, n95 and better masks have been proven conclusively to protect against it. If your mask isn't fitted right it wont work obviously and surgical masks are not effective. If you are going to be in a poorly ventilated space with someone for an extended period of time an n99 may be better. But otherwise n95s are very effective.

[wddkcs]

I'm not familiar with any country that mandated or adequately supplies n95s to their citizens.

There's a the question of whether masks can be effective (even without a study, common sense says they are against a respiratory virus) vs. the question of whether they are effective, given actual use.

There's a good argument that idealized use of masks would have been beneficial, but actual use was likely neutral, or even counter productive (caused more unintended harms than prevented infections).

[jabradoodle]

Source?

[barbacoa]

https://www.city-journal.org/article/approximately-zero

I suspect this is the study being mentioned.

Keep in mind this is at slowing population level spread. On an individual level masking may be different.

The idea is that covid is so contagious in unexposed population that any precautions against spread are futile.

[jabradoodle]

I think your mistaking which comment I replied to.

[fzeroracer]

No it isn't.

[sneed-oil]

> There are no downsides to wearing a mask.

Besides the obvious effort required and the monetary costs, as somebody who wears glasses and commutes by bike and train I can name a couple others. After biking to the train station my breath is heavier than normal, and having to put a mask on when entering the train made my glasses fog up, so I would usually wear it under the nose (even those with a valve, because they still made it hard to breathe after biking, although a little easier). Otherwise I would be unable to use my phone nor laptop and I would have nothing to do for most of the commute. My glasses would also fog up when entering indoors locations during the winter, so I would have to clean my glasses and mess around with the mask to make the air come out from the bottom. There's also no clear upside for me given that I rarely get sick, the last time I had a fever was in 2022 and the time before that was 2017.

[nradov]

There is no reliable evidence that the masks most people used were effective. For the most part it was a waste. The notion that we should do something just because it might help is ridiculous. I'm certainly not willing to put up with that nonsense.

https://doi.org/10.1002/14651858.CD006207.pub6

[defrost]

The conclusion to that paper is telling:

    The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions. 

aka: We can't decide whether masks (or other interventions, including hand washing, etc) worked as all the examples we looked at were a clusterfuck of many people pulling in opposite directions preventing any clear conclusion from being drawn.

     Harms associated with physical interventions were under‐investigated.

Sufficient clean data is lacking.

Further:

    There is a need for large, well‐designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, as well as the impact of adherence on effectiveness, especially in those most at risk 

ie. They don't believe the matter is settled by any means.

The most interesting part is the selection criteria.

Looking at the section Characteristics of included studies it appears some effort was made to trawl two decades of global trials in order to find those least likely to have any good conclusion.

Many of the trials look at the effectiveness of low level encouragement to try an intervention at a time and low location with relatively low risks, leading to intermittent uptake and noisy data.

[RandomLensman]

Do you reject most medical treatment then as it usually only has some probably of success (it might work, but need not)? What about seat belts? Presumably your position is a lot more nuance than your wording?

[Tao3300]

I think you just missed the nuance.

GP said "the masks most people wore", which is not to say all masks, but rather suggesting that the majority of masks that real people were really using and how they used them amounted to nothing.

> What about seat belts?

If it helps (though I never met an analogy that wasn't rotten on the inside once dissected in debate) an inadequate or improperly worn seatbelt can be more dangerous.

[EVa5I7bHFq9mnYK]

There are downsides. Face recognition is not as reliable with masks on.

[mensetmanusman]

If you don’t think there are any downsides to wearing masks, you probably don’t have children and maybe you haven’t tried to speak to people with masks on :)

[Tao3300]

The best was showing ID while masked. Yes, I have sunglasses, long hair, and a face mask; the short haired fellow in the picture is absolutely me.

[salmonellaeater]

> There are no downsides to wearing a mask.

You can't see people's full facial expressions. I wouldn't be surprised if the toddlers in daycare during 2020-2021 end up with deficits in social perception. For adults who already have a hard time inferring other people's emotions, masks make it worse.

You can't identify people as well if they're wearing a mask.

Aerobic exercise and hard physical labor are difficult or impossible wearing a mask (try breathing through a mask once it's saturated with sweat, blocking the airflow).

It fogs up glasses.

I'm sure there are others, but you get the point. Wearing masks has real downsides that need to weighed against the protection they offer.

[exodust]

> There are no downsides to wearing a mask

Except for wearing a mask, which is inherently a downside compared with not wearing a mask.

Pollution. Disposable masks litter the streets and end up in waterways.

When masks are mandated in general settings, workplaces and anywhere usually unmasked, there are downsides. Even in aged care, the faces of visiting family and friends are now obscured. Residents in many cases would not see the unmasked faces of their own family again.

[jacob171714]

Washing your hands is an inherent downside to washing your hands. Its tedious, annoying, and many people get dry skin or are allergic to commonly used scented soaps. There is no evidence that that how regular people wash there hands is effective.

[exodust]

Washing your hands doesn't require your hands remain soaped up as you go about your day. "Washing hands" takes a few seconds, then it's over. Your analogy doesn't work.

Nobody knows you washed your hands 2 minutes ago, but everyone knows you put a mask on 2 minutes ago because your face is covered, and your words are muffled.