Masks Work! …But not how the mask fanatics would have you believe

by The Naked Emperor

Masking is both a horrible, new normal phrase and a controversial topic. It was clear from quite early on that masks made little, if any difference, to the spread of Covid. However, the face nappies got politicised, resulting in strong opinions on every side. Even the behavioural scientists admitted (in the small print) that they didn’t work but, as was obvious to those paying attention, they were used as a psychological tool to divide people and create perpetual fear.

But of course masks work. I wear a mask when removing asbestos or cutting MDF. I wear a mask if there is the potential to inhale gases or chemicals. I would wear a mask if I was a fireman entering a burning building. I would wear a mask if fencing. I would wear a mask to make my skin lovely and soft (actually I wouldn’t, that was just added for comical effect – well maybe I would, once in a while). And I would certainly wear a mask if I was working with hazardous substances or biological agents.

The key is wearing the correct mask for the specific situation, advice that was completely ignored during the pandemic which almost certainly made things much worse. All arguments need nuance, something that has been severely lacking for quite some time.

Michael Woudenberg commented on my post about masks in Boston the other day, which led to me reading his post on masks. It is a fascinating article on an inflammatory subject and is reproduced below with Michael’s permission.

I like how he compares masks with seatbelts because they were often used by mask fanatics to try to persuade people to wear a mask “you wear a seatbelt don’t you, then why don’t you wear a mask”.

I also like this diagram he uses in another post which explains how everyone can think they are right whilst thinking that everyone else must be wrong. “Ironically, the true shape in the meme below is a wedge and that is exactly what is dividing the two sides of the debate”.

tldr: Michael argues that a lack of nuanced understanding of how masks work, which types are effective in different situations, and the psychology surrounding their use led to increased deaths in the US. The piece compares masks to seatbelts, with varying types suitable for specific situations and requires proper usage. It highlights that using masks improperly or using the wrong type of mask for a situation can be harmful, just like using the wrong type of seatbelt. The psychology of masks usage and risk compensation, where a false sense of security leads to riskier behaviour, also played a significant role in mismanaging the pandemic. Therefore, a more nuanced approach and understanding of masks were needed for better population-level outcomes.

Masks Do Work

Today’s topic has the singular goal of saving lives and when it comes to the past three years’ debates on masks, this requires a much more complex systems analysis than we’ve been offered. We’ll investigate what we missed in the binary debate on whether masks work or not and uncover the truth of how the science of masks, mask protocols, and our own psychology actually led to increased deaths in the US population. I want to clarify that I fully understand and appreciate the contentiousness of this discussion. I think it is critical to set aside our biases as we dig in so that next time, we can save more lives.

Introduction

The New York Times, not exactly the classic purveyor of this type of information, recently released an article titled The Mask Mandates Did Nothing. Will Any Lessons Be Learned? in which they shared:

The most rigorous and comprehensive analysis of scientific studies conducted on the efficacy of masks for reducing the spread of respiratory illnesses — including Covid-19 — was published late last month. Its conclusions, said Tom Jefferson, the Oxford epidemiologist who is its lead author, were unambiguous.

…“There is just no evidence that they” — masks — “make any difference,” “Full stop.”

While this might appear shocking, nigh heresy, in certain circles, to those of us who were studying the full system analysis on the topic it’s exactly as expected. The study goes on to clarify:

[T]he analysis does not prove that proper masks, properly worn, had no benefit at an individual level…

But when it comes to the population-level benefits of masking, the verdict is in: Mask mandates were a bust. (emphasis mine)

This is precisely what I had written about in early 2020 and formalized in a series of long-form Facebook posts in the summer of that year namely Masks do work! However because we couldn’t have the nuanced discussion about HOW masks work, and which masks work in which situations, we failed to achieve the Population-level benefits. This actually put more people at risk, while hobbling those that didn’t need them, and devolved the conversation to moral and political posturing helping no one.

This position put me in quite a bind in discussions as I got caught between both sides in what Eric Weinstein called the Quantum Superposition Problem where everything was forced into a false binary. To be clear, COVID was and is a wicked multi-variate problem where you should immediately flag any conversation that falls into a binary and nothing exemplifies this better than the masks.

 
The Science of Masks

Of course, masks work!  They work like seatbelts.  Few rational people would argue that seatbelts don’t work.  But we very quickly recognize that seat belts, like masks, come in a lot of varieties and uses.

• Lap belts – work well with tractors, certain UTVs, and slower-moving vehicles.
• 3-point seatbelts – standard in cars with moderate speeds and driving conditions
• 5-point harness: used in kids’ car seats and modest racing harnesses
• 6-point harness: one step up from 5-point, typically paired with a helmet
• HANS + 6 Point + Roll cage: used in NASCAR and F1 racing

 
Masks have a similar ranking:

1. Surgical masks: designed to prevent droplet contamination of open wounds.  They are a liquid, not a vapor barrier.  Critical to recognize is that surgical masks are used to avoid bacterial, not viral contamination (HEPA air filtration handles viral risk).  The Center for Disease Control (CDC) does not recommend using surgical masks for viral prevention.
2. Cloth masks: Slightly better than surgical but highly unregulated.  A good proxy may be the PM2.5 mask which has 2 cloth layers and a carbon filter that handles down to 2.5 microns. Viruses range in size from 0.02 to 0.25 microns and COVID-19 is 0.125 microns or 20x smaller than what the PM2.5 can filter. A dozen studies demonstrate effectively a null benefit in cloth masks preventing influenza transfer and therefore are only recommended for emergency use and are not to be worn constantly or as a replacement to a true virus mask as PPE.
3. N95 masks: Designed to filter down to 0.3 microns.  These work very well for bacteria as they are about 0.4 microns in diameter.  What this means is that COVID is still 2.4x smaller than what an N95 is designed to filter.
4. Powered Air Purifying Respirator (PAPR) masks: HEPA-filtered air with a rubber seal work very well for filtering viruses for the wearer but typically does not filter the exhaled air.
5. Level 4 Virology Lab equipment:  This is what members of the Wuhan lab would have worn to work with their coronavirus.  This is clearly what the experts believe works to stop a virus. They look like a space suit with positive pressure to ensure viruses cannot enter.

Each level of seatbelt or mask works for certain things and doesn’t work for others.  Also, like seatbelts, masks are not used only by themselves.  A lap belt in a tractor also has a roll bar.  A 6-point harness typically comes paired with a roll-cage and helmets.  Even our ubiquitous 3-point harnesses are coupled with airbags, crumple zones, and other safety mechanisms in our cars.  Similarly, a surgical mask is paired with a filtered ventilation system that draws the air up, and away from the patient, and other masks come with clear guidance of time, proximity, and human density.

A seatbelt also must be the right material and used properly.  Yes, a rope, tied to three points, can help but it also comes with its own risk.  Not wearing or sizing a seatbelt properly can result in injury.  You must have the proper material AND use it correctly to achieve the level of safety. What became very clear with the masks during COVID was that they required protocols that simply, were not followed. For a cloth mask to have any effectiveness, it needed the following protocol:

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