Masks: the questions people should be asking

 Niall McCrae, freelance journalist

Kevin Corbett, healthcare consultant

Amidst the current coronavirus epidemic, suddenly it has become a social norm in Western society to wear a face covering. How did this dramatic transformation arise - is it motivated by science, collective spirit or mere compliance?

Covid-19 is the name given to a disease attributed to the genetic viral sequence SARS-CoV-2 (severe acute respiratory syndrome coronavirus; the first outbreak was in 2002).  In an effort to curtail the contagion, the British government made wearing of masks mandatory on public transport in July 2020. This was extended to shops in September, and in October to pubs and restaurants (except when seated). Since schools reopened in September, many teachers and pupils are wearing masks, despite no legal requirement. Masks have generally proliferated, with people choosing to wear them whenever they are outdoors.  

There is much debate about the effectiveness of facial coverings to prevent infection. But as masks are expected to be worn throughout the coming winter season, will they also protect people from influenza?

As we will explain, a ‘yes’ or ‘no’ answer to this question is elusive. Despite widespread mask-wearing, incidence and mortality of influenza is currently at normal levels for autumn. In England and Wales, deaths from influenza and pneumonia have exceeded those from Covid-19 continually since June. From 20th June to 4 September 20836 death certificates stated influenza or pneumonia compared with 6302 mentioning Covid-19. Influenza mortality is lower in summer; it is now increasing as expected in line with annual trends.

The Office for National Statistics (8 October 2020) reported an exceptionally low number of influenza deaths from January to August 2020, a period when most people did not cover their faces. In England and Wales there were 48,168 reported deaths due to Covid-19, 13,619 due to pneumonia and 394 from influenza. It is highly likely, however, that many more died from influenza, as Public Health England data show that the annual average of deaths in England from this disease in winter seasons 2014-2015 to 2017-2018 was 16156 (ranging from 11875 to 28330). It is also probable that a high proportion of Covid-19 fatalities were misdiagnosed: many were not tested for Covid-19, and false positives are a major problem with the widely-used test (which was not designed for diagnosing infectious disease).  Although SARS-Cov-2 is known as a ‘novel coronavirus’, the associated disease Covid-19 has no distinct symptoms and may easily be mistaken for influenza or vice versa.

For a wearer to believe that a mask protects people from coronavirus but not flu is equally dubious. Both types of virus are microbes of potential aerosol transmission. A mask may guard against droplet infection from other people coughing, but an airborne upper respiratory tract epidemic is so pervasive that people [the ‘host’ in immunological terms] living in normal social conditions rely on their immune systems to thwart adverse bacteria and viruses.  As accepted by leading virologists, the relationship between host, viruses and symptoms is not fully understood.  Fortunately, a high proportion of people appear to exhibit immunity, and a high proportion of people testing positive for SARS-CoV-2 are asymptomatic. The size of the pores in masks exceeds that of particles thought to comprise SARS-CoV-2, possibly explaining the demonstrable lack of efficacy in randomised controlled trials of masks.

In the journal Emerging Infectious Diseases, a World Health Organisation working group on interventions for an influenza pandemic stated:

WHO has recommended that mask use by the public should be based on risk, including frequency of exposure and closeness of contact with potentially infectious persons; routine mask use in public places should be permitted but not required.

The authors noted the observation of a medical officer in Alberta in Canada that cases increased after mandating of masks during the Spanish flu pandemic in 1918. The order was subsequently ridiculed. Although that paper was published in 2006, scientific evidence has not really changed since then. At the peak of the Covid-19 pandemic, authorities advised against universal mask use. Interviewed on the US television series Sixty Minutes (8 March 2020), Anthony Fauci, a leading member of the US government’s Coronavirus Task Force, said: -

 People should not be walking around with masks. There is no reason for wearing a mask.

Fauci believed that masks should be reserved for healthcare workers and infected patients. Jenny Harries, deputy chief medical officer to the British government, stated in March 2020 that masks do more harm than good, because wearers repeatedly touch their faces, and the virus is likely to be trapped in the mask thereby increasing the risk of inhalation.

A rapid review of the effectiveness of masks by the Royal Society and the British Academy, which persuaded the UK government to promote mask-wearing, explicitly stated a lack of robust RCT evidence for prevention of aerosol transmission.  A rather biased article in Nature (6 October 2020), which included plenty of anecdotal reports but limited scientific research to support its argument in favour of masks, nonetheless accepted that the evidence was inconclusive. Author Lynne Peeples noted that studies finding masks to be ineffective had been retracted from journals; this has been a troubling trend of censorial group-think. Indeed, the new mask orthodoxy has entailed disciplinary proceedings, as in the disciplinary investigation by New York University into Professor Crispin Miller for simply encouraging students to critically review research on mask efficacy.

So, contrary to the scientific evidence, governmental health advice has drastically changed, but like other Covid-19 policies, mask enforcement is now more of a political than a scientific decision. John Lee, retired pathologist and lockdown sceptic, said on TalkRadio (28 September 2020): -

We have politicians doping amateur science and scientists doing amateur politics. Mix the two together and it’s an awful brew.

We concur, and suggest that people should be routinely asked about their expectations of masks: Will it protect them from influenza? Either an affirmative or negative response would expose faulty thinking: masks do not appear to prevent flu, and a belief that such a permeable barrier stops coronaviruses only is scientifically baseless.  

Editorial note: articles in JAN interactive are not reviewed and are published at the discretion of the Editor-in-Chief. We welcome replies, rejoinders, comments and debate on all entries provided they are not offensive or personal and these will be published on JAN interactive.