Masks Don't Kill People. COVID Does.
Masks Don't Kill People. COVID Does.
Let's unpack & completely dismantle this irrational fear of masking safety measures that have not only kept an already bad pandemic from getting worse, but have also kept the economy going
Publisher’s Riff
As of this writing, a renewed political front in the war against responsible pandemic response is forming: it's the return of the Anti-Maskers. It's largely White, overwhelmingly middle-class or the type of demographic that's in a position to access vaccine and vaccine "boosters," take the time off work to access it and activate the couple of days sick leave to recover from it.
Think this is an exaggeration? Let's take a look at YouGov/Economist polling on the matter as it breaks mask sentiments down by race in February and in March …
When asked if they support indoor "mask mandates" back in mid-February, an average 44 percent of White respondents - nearly half - said that they did not support the safety measures to contain COVID, the largest anti-masking demographic surveyed. Just 19 percent of Black respondents said they opposed it and 27 percent of Latino respondents the same. These are enormous racial disparities in who is opposing mask measures and who is not.
By end of March, YouGov registered a 4 point increase to 48 percent in White opposition to mask measures - still mostly among White men. However, opposition among Black folks stayed steady at 19 percent. Opposition did rise among Latino respondents to 34 percent. Interestingly enough, income may also dictate or drive masking sentiment: each poll between February and March shows individuals with incomes above 100K or more are also the most likely to oppose a mask measure compared to individuals who make less than 100K or who make less than 50K. More than likely, the chasm between income mindset on masks is indicative of those who are in frontline jobs that require more human interaction and, thus, more exposure to COVID infection ... and those who are not.
By April, Whites are also, overwhelmingly, the most likely to "never" wear a mask compared to Black respondents, just 10 percent of whom claimed to have never worn a mask.
Losing Minds
So, as race (and, in many ways, subtle racism) is driving the visceral reaction to so-called "mask mandates," communities in major urban centers like Philadelphia are losing their minds over the issue. In fact, some businesses are suing the city over it. As of last week, Philadelphia became the first major city to re-institute it's once indoor masking requirements, a move by its Public Health Commissioner that's been widely blasted and ridiculed by anti-masking commentators (see this Philadelphia Citizen piece here) and others calling themselves public health professionals ...
It was a bold and noble move by the city's relatively new Public Health Commissioner, Dr. Cheryl Bettigole (who, unlike Dr. Wen, has an "MPH" or Masters in Public Health). First, what responsible public health official wouldn’t be alarmed by a 50 percent rise in cases. Yet, something else Bettigole, in stark contrast to her disgraced predecessor, was more than likely looking at. She has a lot more sensitivity to racial health "disparities" in the city and the systemic trends that have created those gaps. Bettigole looked at the majority Black population in Philadelphia and may have noticed something unsettling: the Black population, compared to all other groups, is still the least vaccinated and it is the most infected, hospitalized and dying from COVID. Just an average 54 percent of Black Philadelphia residents between the ages of 5-65+ are fully vaccinated, with only 20 percent of Black 5-11 year olds vaccinated. Yet, White, Latino and Asian vaccination rates are comfortably higher at 62 percent, 66 percent (each still shy of the 75% "herd immunity" threshold) and 86 percent (touchdown), respectively. See below ...
It's even worse for booster shots, which will become essential in warding off ugly future variants. Just 29 percent of Latino and 32 percent of Black Philadelphia residents between the ages of 18-65+ are boosted compared to 38 percent of Whites and 50 percent of Asians.
Black residents, also, continue being the hardest hit by COVID in Philadelphia …
Hence, when we dig deeper into the numbers, we can understand more of Bettigole's reasoning for more caution: the city's most vulnerable and poorest residents, which includes those most likely forced to work lower-wage jobs that require "frontline" or face-to-face human interaction labor, are the city's most harmed by COVID. For a variety of reasons, the most low-wealth Black residents, especially, are not getting vaccinated - and access problems are much more prevalent than hesitancy, as evidenced in a recent Boston University School of Public Health study of Massachusetts vaccine data ...
As vaccinations were rolled out across the country last year to combat COVID-19, public health experts raised concerns about low uptake in communities of color, based on historic distrust with the health care system. But a new study of vaccination data in Massachusetts has found that educational level is a much stronger predictor than race, and could find no evidence that vaccine hesitancy played a role in people’s decisions. “Although ‘vaccine hesitancy’ dominates media coverage, in fact, language barriers, lack of regular health providers, absence of paid time off to get vaccinated and recover, and lack of trust in the health system all play a role in undermining vaccine coverage,” noted the team of researchers from Boston University’s School of Public Health and the city’s Public Health Commission.
Such adamant opposition to masking ignores the continued public health threat to Black residents in a city like Philadelphia. If you’re more concerned about masking than you are about the health and safety of Black residents, that makes you, well, anti-Black. What happened to all that concern for “essential” and “frontline” workers from the dark shutdown days of 2020? Oh, turns out, society found out they were largely Black, Brown, poor and barely living off unlivable wages and lack of healthcare. Everyone went back to business as usual.
Where is the Threat?
What’s missing in the irrational push to remove mask safety measures is that it defies one simple fact: the pandemic didn’t go anywhere. COVID hasn’t disappeared. But, what makes it more irrational is that opposition to masks seems as energetic and fevered as opposition to the real killer: COVID itself. It’s as if a large slice of the American public, mostly White, has determined masks are a threat or that they’re somewhat lethal. Hence, the bigger question is: What is the opposition to masking measures based on? Is it data or is it, simply, fatigue from inconvenience?
An even more important question for Anti-Maskers appears: Is there any research or study or data suggesting masks are dangerous or that they kill people? We haven’t found any. What we do find is research concluding that masks, when used, are an enormously successful tool against COVID infection. As a June 2021 peer-reviewed PLOS ONE-published analysis of U.S. states and counties shows, we would have actually seen a much larger share of infections, hospitalizations and deaths without masks ….
We show that mask mandates are associated with a statistically significant decrease in new cases (-3.55 per 100K), deaths (-0.13 per 100K), and the proportion of hospital admissions (-2.38 percentage points) up to 40 days after the introduction of mask mandates both at the state and county level. These effects are large, corresponding to 14% of the highest recorded number of cases, 13% of deaths, and 7% of admission proportion. We also find that mask mandates are linked to a 23.4 percentage point increase in mask adherence in four diverse states. Given the recent lifting of mandates, we estimate that the ending of mask mandates in these states is associated with a decrease of -3.19 percentage points in mask adherence and 12 per 100K (13% of the highest recorded number) of daily new cases with no significant effect on hospitalizations and deaths. Lastly, using a large novel survey dataset of 847 thousand responses in 69 countries, we introduce the novel results that community mask adherence and community attitudes towards masks are associated with a reduction in COVID-19 cases and deaths.
Imagine how many more lives would have been saved if we were expanded masking and just followed directions the entire time. The International Monetary Fund followed up with an August 2021 regression analysis showing that mask mandates do, in fact, save lives …
We find a significant and substantial effect—mask mandates reduced new weekly COVID-19 cases, hospital admissions, and deaths by 55, 11 and 0.7 per 100,000 inhabitants on average. Crucially, we find that the effect of mask mandates depends on the attitudes toward mask wearing at the county level, with larger effects in counties more positively inclined towards mask wearing. Our results imply that mandates saved 87,000 lives through December 19, 2020, while a nationwide mandate could have saved 58,000 additional lives.
A later February 2022 University of Penn study showed a similar pattern: masked counties show fewer incidents of infection than unmasked counties …
On average, the daily case incidence per 100,000 people in masked counties compared with unmasked counties declined by 23 percent at four weeks, 33 percent at six weeks, and 16 percent across six weeks postintervention. The beneficial effect varied across regions of different population densities and political leanings. The most concentrated effects of masking mandates were seen in urban counties; the benefit of the mandates was potentially stronger within Republican-leaning counties. Although benefits were not equally distributed in all regions, masking mandates conferred benefit in reducing community case incidence during an early period of the COVID-19 pandemic.
Despite the intense political backlash from many parents over “mask mandates” in schools, the evidence is awfully clear on the effectiveness of the very simple COVID-suppression tool, as well: masks dramatically reduce infection among students. As an independent Duke University study of 61 school districts in 9 states found …
In total, the team recorded more than 40,000 infections acquired in the community (36,000 among students) and about 3,100 infections acquired in school (2,800 among students). Compared to optional masking, mandatory masking was associated with a 72% reduction of in-school COVID-19 cases. School districts with mandatory masking had 7.3 cases of in-school infection for every 100 community-acquired cases. Districts with optional masking had 26.4 cases of in-school infection for every 100 community-acquired cases. The results were similar when the researchers adjusted for district size and weeks of reporting data.
That study was just released in March. So, where exactly is the threat coming from? What is the threat of masking? Is there something in the material? Anti-Maskers will have heavily relied upon this oft-cited piece by an infectious-disease scientist and (wait for it) a veterinarian and an emergency medical doctor in The Atlantic from January 2022. But, again, what exact threat are they looking for? Did they find a large sample of K-12 students being poisoned by masks? Were kids dying from masks or heading into emergency rooms? No.
The exercise ends up becoming a waste of time. Those findings from three authors in The Atlantic in January are completely debunked by the Duke University study just dropped in March. Even when the argument is made that masks in schools impede study or communication in the classroom, or that they interfere with learning, there’s plenty of evidence refuting even that …
“But we do have this human experiment that’s been going on with kids wearing masks at school, and we know that we haven’t seen those fears of health risks realized,” says Theresa Guilbert, a pediatric pulmonologist who is a member of the American Academy of Pediatrics Section on Pulmonary and Sleep Medicine.
She and other experts say most evidence suggests that masking doesn’t harm children—and that it benefits them in more ways than one. Not only do masks protect kids from COVID-19 and other respiratory diseases, but studies show that schools with mask policies in place are more likely to stay open, which decades of research show is particularly critical for kids’ mental health and development.
We find an abundance of peer-reviewed and irrefutable research showing how much masks reduce infection, save lives and help decrease school closures. There are even studies showing how much mask measures boost the economy - which is common sense: of course they do: fewer living people means fewer consumers buying products and services; more confident consumers who are not afraid of going in and out of stores means more shoppers. More indoor mask measures mean more safe spaces … and, well, what shopper doesn’t want a safe, healthy space to go into?
What does happen is that we keep coming up short - how about not at all - when we try looking for research concluding otherwise. More importantly, we’re still stumped: Where is the research showing masks are killing people - especially in the same way that COVID does? Show us the maskless response strategy for pandemic that works and we’ll stop asking.
What’s important in this conversation is that we need to, first, base critical public health decisions on science, not sentiment or inconvenience. Of course masks can be highly annoying and sometimes inconvenient - especially if you leave them at home or we run into supply chain issues. But, most of us would rather choose inconvenience over hospitalization and death. In addition, how about choosing inconvenience over inadvertently causing infectious harm and potential hospitalization and death to others in the community who haven’t been vaccinated, yet? That is, of course, a moral consideration. But, it’s also a practical and economic problem for the average Anti-Masker, too: fewer vaccinated people without exposure to fewer masked people = fewer workers at the storefront to help consumers and keep businesses afloat. Last we checked, businesses can’t operate with no workers. More people unvaccinated who could have otherwise been saved by continued masking measures, until they get vaccinated, suddenly become a greater strain on medical systems and a preventable social cost. Everyone loses.
We shouldn’t be getting mad at “mask mandates.” We need to get mad at the situation that requires them in the first place. Anti-Maskers and communities at large need to focus on getting as many people as possible vaccinated so they wouldn’t have to worry about wearing masks to being with.