An analysis of studies pertaining to masks from 1978 to 2023 | Hacker News Reader

An analysis of studies pertaining to masks from 1978 to 2023

medrxiv.org

48 pointsohshit199 comments

> 77 studies, all published after 2019... 23/77 (29.9%) assessed mask effectiveness, with 11/77 (14.3%) being statistically significant, but 58/77 (75.3%) stated masks were effective. Of these, 41/58 (70.7%) used causal language. Only one mannequin study used causal language appropriately (1.3%). 72/77 (93.5%) pertained to SARS-CoV-2 alone. None cited randomized data. 1/77 (1.3%) cited conflicting evidence.

Bit hard to follow here since the talk about "studies that didn't actually study it" seems like a valid critique of study quality but not of mask effectiveness. (But where does the 1978 year in the title come from?)

Seems like of 23 studies, 11 of them found statistically significant evidence of improvement; only 1 saw conflicting evidence.

Sounds like room for further study and investigation but possibly suggestive of differences in mask quality, correct usage, etc, so deeper dives would certainly be interesting.

Obviously in some situations and disciplines nobody questions the value of quality masks, so the "it can't possibly be effective" crowd seems even more unjustified than the "it's effective [even if just 11 out of 23 of the studies said so]" crowd.

> study quality

And even more specifically, quality of studies (re)published by a single journal, albeit an important one.

"Are masks effective" is the completely wrong question, anyway. The question should be "how effective are masks?"

Preferably, "How effective are masks against X under Y circumstance?"

In relation to Covid, I think it's likely masks reduced transmission. But, under normal social environments, did they reduce it by 5% or by 50%? It makes a big policy difference. It seems that studies are coalescing around masks having a 'real but small' effect, but I get it's a hard thing to study.

> did they reduce it by 5% or by 50%

Either one would cause a dramatic reduction on the (exponential) virus spread.

For the actual policy, it shouldn't make a difference. It had feedback mechanisms anyway, because the conditions always change.

Well, no. It makes a big difference:

1) If the exponent is >1, it doesn't make much difference. Everyone will catch "it," for whatever disease.

2) It makes sense to have interventions prioritized by ROI

3) Many interventions are individual, and there is no exponent. Should I, as a [doctor / immuno-compromised-individual / patient / etc.] wear a mask?

> It makes sense to have interventions prioritized by ROI

The thing about masks is that the investment is minimal. Those 5% are still an incredibly large number that makes it a non-brainier.

If it decreases another order of magnitude, it may need some analysis. The OP has a point, but it's way beyond the plausibility window.

As an individual I would not wear a mask to reduce infection risk by 5%. If it’s more like 90% then that’s something.

But those who are the most likely to be affected i.e. older and vulnerable people would.

So in fact whether you wear one or not is far less relevant.

You misunderstand the utility of masks, where it is significantly more an infected wearer of the mask who protects others by their wearing. So, being infections before you have symptoms is the problem, which is why people should - as is standard in Japan, for example - wear masks in public whenever they feel unwell or feel a 'cold' coming on.

Masking during a pandemic is never just about individual risk. Collective action has an exponential effect on prevalence, so the real risk goes down by far more than 5%.

Not taking action to reduce risk of illness or death is irrational.

There's a trade-off between doing things you enjoy (or don't enjoy) and the risk of death, and it's a personal trade-off, not something that can be assessed rationally.

First-world thinking.

A quality mask costs around $1. Per-capita GDP is about $33 per day worldwide. Or put another way, with 8 billion people in the world, a mask a day runs around $3 trillion annually.

The world is interconnected.

I like masks since, aside from viruses, they filter pollution and allergens. I feel a lot better post-2020. However, universal HEPA filters and covid masks are very much for the rich.

Don't masks have to be swapped way more than once per day to reach the perscribed efficiency? More like once every 30 minutes?

No. I've been using N95s since the start of the pandemic and have spent a fair amount of time learning about them, e.g., reading the written material that comes with the box of masks, and I've never seen that kind of recommendation. The written materials say things like, "throw the mask away as soon as it becomes stained or discolored."

I use each of my masks for probably at least 10 hours before throwing it away, and I've never gotten covid except once (in Jan or Feb 2020) before I started wearing masks (in fact, before anyone in my country -- the US -- knew about covid).

(I have to write "probably" because I don't actually keep written records of how long I have each mask on. I rarely have one on for more than an hour at a time.)

I've used mainly 3M 8511 masks.

The most important distinction between mask models is that some models have valves / vents and some do not.

Hospitals use ones without valves. The lack of a valve means that the part of the mask that filters the air gets a lot more damp than it would if a value were present (because exhaled air is damp) which might drastically reduce how long the mask will last, so that might be why some hospitals instruct their employees to use a new mask for each new patient contact.

> The most important distinction between mask models is that some models have valves / vents and some do not.

The most important distinctions also include:

1) Fit. This matters a lot.

2) Nano versus electrostatic technology.

3) Filtration level. "N95" advertised isn't always 95% in reality, and some are 99+%.

4) Impedance to airflow

#4 is more than just comfort it determines how much air goes around the mask.

> The written materials say things like, "throw the mask away as soon as it becomes stained or discolored."

For some N95 masks, that's because they assume you are using it to block out particles that will accumulate on the mask, like paint droplets or sawdust or whatever.

In contrast, breath is mostly water vapor, and COVID-19 particles have a short-enough half-life that you can probably rotate between masks and be pretty safe.

30 minutes? Definitely not.

More than once per day? It's complicated. There are two designs:

- Electrostatic masks work well so long as the mask remains charged (those are the 3M N95 ones). Efficiency drops as they become moist, especially. However, for good ones, even after extended use, it's still surprisingly high.

- Nano masks basically work forever. The initial efficiency is lower than electrostatic, but remains pretty good for longer than I'd want to use one.

For real-world use, I really prefer nano. Unless you're much more careful than I am, enough air leaks around the mask that I'm not sure there's a big difference between 99%, 95%, or even 80% filtration.

And the numbers are extremely conservative too -- they look at filtration around a few hundred nanometers, which is the worst-case. Most diseases come in on much larger droplets.

One thing which tends to be under-emphasized is that it's not binary. Viral load is important. A single virus particle probably won't cause an infection (it probably won't infect a cell, and if it does, your innate immune system will probably flush it). If it does cause an infection, your adaptive immune system has a lot of time to react, so it probably won't be a bad one.

This is even more true for pollution and allergens.

For my purposes, I find nano masks to be the right bang-for-the-buck. They're much more breathable too. And they handle environmentals like rain or sweat better.

The Asians are right; living in a big city, I've felt better since 2020, with masks, air quality monitors, and HEPA filters everywhere. I get sick less often, have milder seasonal allergies, and just generally do better.

On a related note, other aspects of air quality matter too: CO2 levels, humidity, etc.

> dramatic reduction on the (exponential) virus spread.

Check your assumptions, please!

If you are comparing e^(kt) to e^(0.5 kt), sure, they’re very different. But Covid didn’t spread like that at all. It grew exponentially-ish until the fraction infected was no longer negligible, and then the dynamics changed dramatically, as they must have. After all, you can’t have 1 million times the entire population infected after a couple years.

> I think it's likely masks reduced transmission

And your belief is based on what?

Common sense? Restricting exhalation to reduce transmission of airborne disease? Have you never been taught to cover your mouth when you sneeze or cough?

Like it would be remarkable if it did nothing. THAT would be a blockbuster result.

The thing worth studying is if the effect is worth the trouble or not. It could be worth doing or it could effectively be a waste of time due to whatever other factor.

Many people have been taught to say "Bless you!" when somebody sneezed too, would it also surprise you that it doesn't affect any airborne virus?

Aye, that brings up another issue. What exactly does “airborne” mean? The assumption early on was that Covid was not airborne, and required droplets of a certain size, though I think that changed over time.

We might never know this about COVID as further studying it can only uncover more malfeasance at this point, but traditional airborne stuff like smallpox or measles won't be affected by a dirty bandana on one's mouth or, even, over the nose.

Common sense says if you put your hand over your mouth and breath out you will be able to. That says the pressure is overcoming the blockage.

The other way round is far more difficult.

If you leak then you are wasting your time because in a static air environment you’ll delay the critical level build up by a few minutes at most.

Medicine doesn’t like aerosolisation because it sounds too much like miasmia theory.

So we have too much focus on droplets and fomites.

Fundamentally this should have been sorted with a properly designed trial with the correct protocol of sufficient size to answer the question. Given what was on the line why has it not been done?

> Fundamentally this should have been sorted with a properly designed trial with the correct protocol of sufficient size to answer the question. Given what was on the line why has it not been done?

That's an interesting question but if you're suggesting it implies something either direction: why?

Obviously there are a LOT of politicians and people strongly interested in a "masks are useless" position.

But it's not just that the "masks are useful" people have failed to satisfy you.

It's also that the "masks are not useful" crowd has not published a conclusive study of their own.

So it's not convincing to me that the truth is anything other than "masks have varying effectiveness, though the supply-chain-crunch plain-cloth-mask world of 2020 wasn't the ideal type of mask."

Do you have reason to believe an N95 isn't effective? What about a P99? (In the world of media I consume, these types of masks vs cloth masks are things that were widely discussed, along with PM2.5 etc. So the "it was presented as black and white" crowd seems just uniformed of their own volition, maybe watching too much partisan media who had an interest in presenting the issue in a one-sided manner.)

https://journals.aps.org/rmp/abstract/10.1103/RevModPhys.95.... is one article that provides some insight. It describes the nature of viral particles exhaled in different activities, and explains how effective different masks are at preventing these particles from being inhaled.

Separately, I was surprised to see that OP's article looked at studies starting in 1978, since modern electrostatic filtering masks were only patented in 1995--so I'm not sure how meaningful it is to lump studies on older mask technologies in with modern masks.

Another question most of these studies fail to ask is what is the effectiveness of each type of mask? An N95 mask is going to have a big difference in efficacy vs a surgical mask without a seal.

Another issue is that most of these studies are just surveys. Did participants actually use their masks for x hours? Did they use their masks correctly?

It's probably more addressing the "it can't possibly be ineffective" crowd.

>But where does the 1978 year in the title come from?

This seems to come from the fact that although MMWR has been in publication since 1978, 100% of papers they have published on the topic has been in the past 3.5 years.

Actually the authors interpretation is very different if you read the very next sectio (“Conclusions”):

> “Conclusions and Relevance MMWR publications pertaining to masks drew positive conclusions about mask effectiveness over 75% of the time despite only 30% testing masks and <15% having statistically significant results. No studies were randomized, yet over half drew causal conclusions. The level of evidence generated was low and the conclusions drawn were most often unsupported by the data. Our findings raise concern about the reliability of the journal for informing health policy.”

I watch Dr Prasad on YouTube and he is pretty interesting IMO. He’s an oncologist but spends a lot of time analyzing medical studies.

With language like that, there's no way to not see this as a hit piece.

Yea, a hit piece on bad science

Yes, I noted that the authors are largely focused on study quality vs actual conclusions about which sorts of masks are what level of effective.

And critiquing sloppy science is very necessary. But it's being extended by many to be "masks not useful, full stop" despite largely being about "most studies suck." And the phrasings chosen by the authors make it look like that mis-read/extension is an effect they desire.

> But where does the 1978 year in the title come from?

Was curious about that too — it’s a slightly unfortunate headline:

> Our search, spanning the years 1978 to 2023, identified 83 MMWR published studies on PubMed, all of which were published after 2019.

In 2020, I wanted to understand the issue better, so I followed all the links from my government website to any research regarding masks.

My government had first stated that wearing masks by the public was not effective and wearing them was actually very selfish and stupid, because masks were needed by the medical professionals.

The marrative then took a 180 turn, and then same officials said that masks were effective and not wearing masks was selfish and stupid. They also admitted to lying about the effectiveness of masks before, claiming they wanted save masks for the medical professionals.

The only research I could find through links from these government health policy organizations was a meta analysis on the European CDC website, stating that the evidence was inconclusive but masks should be worn anyway. The recommendation of the organization did not follow from their own research.

So seeing that the policy had already been based on admitted lies about the research, and that even current research at the time by the organization itself could not support the recommendation, I had to come to a conclusion that mask recommendations were a very political issue.

Then I went to read on the methdologies on how the effectiveness can is measured. The general scientific consensus before COVID appreared to be that using masks even by the surgeons did not reduce the risk of tramitting disaease from the surgeon to the patient, but still all surgeons thoughy that it was a good idea to use them.

The narrative “at least it prevents droplets from reaching and infecting others” actually relies in the assumption that we know the transmission mechanism for the specific disease.

We did not know it at the time for COVID, and I believe we still do not know it conclusively.

Some research has been done on the effectiveness of masks on diseases that are transmitted via aerosols. The surprising finding was that although the mask catches the droplets, the mask does not ultimately keep them but the droplets are vaporized in the process, and many of them are turned into aerosols. So using masks actually may increase the transmission for disases that are transmitted through aerosolic particles.

Respirators are effective down to 300nm - aerosolized viruses are larger than this, around 1uM and larger.

> Respirators are effective down to 300nm

Not exactly. For most filter media, ~300nm is the “most penetrating particle size”. The mask is more effective below that.

Most people were using masks that did not prevent aerosolic viruses. Government mandates did not require use of respirators in most countries.

Furthermore, research I was mentioning found that while the droplets are blocked by the mask, some of them end up in the clothes, suggesting some droplets fall of the mask.

There were some videos that showed the effect.

I am not saying that respirators do not work. I am saying that public policy was not backed by science and in some cases scientific papers were published that appeared to be politically motivated, which caused pulic to lose trust in both the public health policy organizations and to some extent also in science.

Please note:

1. surgical masks are pretty ineffective, but N95 and better masks are very effective, subject to proper use and quality control

2. Mask research and experience pre-COVID in the West was not widely understood by non-experts even in the medical field. Which led to all sorts of doctors with huge egos getting onto Youtube and misinforming people with their poor grasp of science and studies. (Most doctors are not medical sceientists, but artisans).

3. Then look at the huge number of studies since 2020 and you will find that indeed when a study looks at the correct masks ued properly, they work as intended. the biggest problem is the meatsack using the masks, because most of them are not diligent or kind enough to use them.

4. We should allow scientists and medical practitioners to make a mistake, and own up to it to make 180 degree u-turns. This means ghey are using data and experience to update their beliefs, which is good science.

Yes, people do not follow instructions. Policies should take that into account, and not be vbsed on unscientific overly optimistic beliefs about human behavior.

People would follow instructions better if they believed them to be based on facts. People were pressured to appear to follow instructions. That does not work well.

I don’t criticize making mistakes. I am criticizing lying to the public and using social pressure to force people to follow policies that are known to be ineffective.

One of the single most frustrating things about Covid was the way media coverage almost entirely ignored the 100 years of studies on the varying effectiveness of various types of masks against various threats. Every bit of media attention on masks that I read treated it like it was some new cutting-edge area of research, when nothing could be further from the truth. "Effectiveness of masks" is a very deep and nuanced subject, but unfortunately most talking heads don't seem interested in nuance.

It also seemed very American/Euro-centric how it was treated as some kind of novel idea that no one had ever tried before. Meanwhile in most East Asian countries it's been common courtesy for ages to wear a mask during cold/flu season.

From a US perspective it was much worse than that. People seemed to 1) divide into two groups: you like the idea of masks, or you hate the idea of masks. Then 2) invent reasons to justify that position. The media simply followed along with this, providing pseudo-justification for one position or the other depending on political color. Disclosure: I liked the idea of avoiding breathing pathogens on other people, and I loved 2 years not catching any cold or flu. It has been really unpleasant to once again be having back-to-back colds every time I travel by plane.

Why do you not just wear a mask on a plane? It's pretty effective for Covid-19 and presumably all other airborne vectors even if you take it off for the meals. https://www.mdpi.com/1660-4601/21/6/654

Thanks for that link! That’s very interesting. I’ve been assuming that catching something on a flight was most likely due to fomites, based on airline assurances that their HEPA filters and ventilation design worked properly.

Obviously it's better for everyone to wear a mask in confined spaces so the random sick person(s) are not spreading out stuff everywhere, but I am making the major assumption here that just doing your part by yourself helps you in particular.

Further muddying the waters (with an ethics quagmire) were health officials who intentionally misled the public in an attempt to protect supplies of masks for medical workers during the PPE shortages that characterized the first months of the pandemic[1].

[1]https://slate.com/technology/2021/07/noble-lies-covid-fauci-...

Where I live in SW Missouri during 2020 most of my neighbors refused to wear masks and 72% were infected in that 1st year. Among those who did wear them less than half wore the properly. Most of those I saw wearing them did not cover their nose. I guess that was their way of protesting against the local mandate to wear them.

So there is really no way to analyze the effectiveness of masks if you simply ask "did you wear a mask?" and "did you get infected with Covid?".

I can say that my wife and I did wear masks and we did not get infected with covid. And that we bought a box of N95 grade masks as soon as those were available, which was around the beginning of 2021. We both wore them until the vaccines were available, and we've both got the jab and booster shots as recommended.

The last statistic given by the County here was over a year ago and it said that 78% of the residents had been infected with covid and around 450 were killed by it. That's pretty close to 1 in 100 who live here. Most of those killed by it here were elderly and in nursing homes that 1st year.

I started working with my father customizing cars when I was 14 years old in 1973 and from the very start I wore both paper masks and respirators with filters and way back then I took a lot guff from guys who considered that to be unmanly, so even back then there was a stigma involved with wearing those.

Back then I figured it was a "macho man" thing, but during covid women here also refused to wear them, or wear them properly, and they would sneer at me too when I was wearing one in a store.

I'm not a sociologist but this is something that deserves being studied.

> I can say that my wife and I did wear masks and we did not get infected with covid.

When did you stop?

I have been wearing N95s everywhere since the pandemic began and I don't think I've been infected yet, but according to the wastewater data, it seems the virus is still very prevalent in population.

In fact, it seems another wave is building right now.

I know many people who wore N95 masks all the time who were infected. More than once too.

I really don't know what to make of that. I can say we did make a point to keep a distance from others, changed our masks pretty often, and we both used hand sanitizer when we were out in public spaces, so it's possible that made a difference.

We were both in our 60s when this crud began, the low end of the high risk group, so could be were more cautious than most.

I think it’s hard to tell with all of the variables involved. I tried to stay away from crowded indoor locations. I wore masks when they were required and wasn’t infected.

I’m sure that the aggregate of cautious behavior by people who are willing to wear masks is responsible for at least some of the perceived effectiveness.

My wife and I also have worn masks a lot - but we also tend to avoid crowded indoor events almost entirely now, and use hand sanitizer whenever we leave a public place. We were also quick to get each of our vaccinations.

Wearing a mask is more effective at preventing you from spreading virus particles if you’re infected than it is at preventing you from being infected.

True, but mostly because it lacks specifics.

Wearing a N95 mask correctly and washing your hands consistently is _quite_ effective at protecting you (and others).

Wearing a nonsense cloth mask, not terribly well fitted, protects you a little bit but mostly protects others some.

In between those it varies.

Nothing does much if you're not washing your hands before touching your face.

People also ignore that initial viral load can be a lot lower from masks (depending) even if you do get infected, which can help with severity.

Your comment does read like 'My grandma has smoked 20 a day all her life and she's still alive at 90'. statistics do not preclude people from being luckier or unluckier than the average.

Yes and you sound like those commenters who post "correlation does not imply causation" as a response to everything without disproving causation.

I don't think they sound like that at all

> disproving causation

If the sequence is: 1- study that shows correlation between X and Y 2- someone says "X causes Y" referencing the study

then it is appropriate to point out that correlation does not imply causation. X may cause Y but you can't claim it based on the correlation study only. The burden of proof is on you. Nobody needs to disprove causation here.

We stopped wearing masks after about a month after our 1st vaccination. We've both kept up on those vaxxes since. I work from home so I'm so I'm rarely in crowds but my wife works at a resort and interacts with folks from all over and she's still not been infected.

One of our adult daughters refused to get vaxxed and came to visit for Christmas in 2022 and just 5 days after she arrived she got sick af here. She was in bed for 5 days. Her 2 children, who were 15 and 11 years old and not vaxxed didn't come down with any symptoms at all though and they stayed very close to her.

That same daughter has been infected 2 or 3 times since then and is now dealing with "long covid" issues.

I expect we will see another wave soon as well. People will be gathering and sharing it again. That happened last year and nothing much has changed since aside from the severity of infections, and that probably had do so with natural immunity from prior infections, and folks are still dying from it.

The vaxxes have worked for us though so we'll keep up on them.

I like your comment because it doesn't necessarily make any direct attributions, while covering some breadth and depth of your observed social environment and the regional stats.

Growing up in skateboarding and bmx, there was a similar anti-helmet anti-pad sort of sentiment, perhaps a similar sort of anti-authority culture.

I have two shots, no boosters, and selectively wear a mask when a situation seems to call for it, and haven't yet tested positive, but I figure it's fairly likely I will eventually, or have and just haven't tested positive. Many many people I know have got it by this point, unless they're particularly isolated, as would be true in the general population.

My impression is that many vocal people vehemently picked one extreme take or the other, likely in opposition to each other.

I wore it in the outdoors for like a week, and then on transit and in cafes etc.. I never felt particularly strongly one way or another, and still don't, but just as tiring as hearing anti-mask people go on their rants were my interactions with people who clearly wanted to be seen wearing it more than they actually believed it to be useful, along with those who were/are adamant that not wearing a mask meant you're trying to kill people.

For example, doing outdoor sports without a mask, and then putting one on to post a video on Instagram, or finding a way to bring up covid long after 2021 for the purpose of trying to bait a conflicting opinion out and subsequently beating that horse to death.

Getting stuck in any of those situations/conversations was perhaps most convincing in that I should continue not really being concerned with the opinions of others, quite the opposite of being persuaded to either wear or not wear a mask. Getting both sides of it, somewhat regularly, indicated to me that everyone has some inane axe to grind and mostly just wants someone to listen.

What I'll remember most about the pandemic was how much pointless and tiresome division it brought forth, how unhealthy the reaction was for me personally in terms of shutting everything down, and just hoping none of the vulnerable members of my family succumbed to it. The only thing I'd do differently in retrospect would be to have engaged those people less, because it never made the day any better, and good days were tough to come by.

Most of those here didn't wear a mask. When the local mandate to wear them was imposed that just pissed people off here and I got scowled at when wearing them but I refused to react to it and that's as far as it ever went.

I never reacted any different at all to those who were not wearing them. I understood early on wearing those masks were not for my protection and I really did not want to infect anyone.

The N95 masks were a way to protect myself and others at the same time so I kept up with when they'd become available and got them as soon as I could, and made a point to use them, and we gave quite a few to others. My wife brought them to where she works and handed them out. They'd been wearing cloth masks there up until then.

You're spot on about the division. Like I said, I took a lot of guff early on for wearing a mask here. Honestly, I think no small reason that stopped happening here is because so many got infected here and after dealing with it themselves they settled down on shitting on those wearing masks or getting vaxxed.

I see a few people wearing a mask when I go to the big box stores in town now and no one pays any attention to it.

> You're spot on about the division. Like I said, I took a lot of guff early on for wearing a mask here. Honestly, I think no small reason that stopped happening here is because so many got infected here and after dealing with it themselves they settled down on shitting on those wearing masks or getting vaxxed.

> I see a few people wearing a mask when I go to the big box stores in town now and no one pays any attention to it.

I think something to this effect happens quite frequently in a bunch of different domains. Some level of emotional intensity, hype, or posturing one way or the other, until we settle on something more reasonable, with only a few still holding onto a pitchfork or whatever, it's an optimization problem.

I do have a suspicion though that these extremes will re-surface if it happens again soon, rather than be more moderate, and I hope I'm wrong because it's exhausting. At the very least I hope people and local governments remember which part of their conduct wasn't evidently helpful to the people they ostensibly serve or want to be around, but some portion of the population will be encountering that for the first time.

Based on various interactions I had during and after, I'm cautious about the people I spend time with now, because sometimes I'll get the subtle feeling that even though there haven't *yet* been extremely polarizing opinions about some inane issue, I feel like I can sense when a person is susceptible to being extremely sensitive toward something I'm not.

I think people need a break from their phones and Internet tbh.

One of the often not talked about problems is that lots of masks were terrible and the quality in general was very variable.

There are some really great ones, and there are plenty that are quite difficult to breathe through. The N95 standard for breathability would pass some pretty bad ones.

Most places sold all sorts of badly quality controlled masks and it was a crapshoot what you got. And less breathable didn’t necessarily mean better protection.

Plenty would also collapse onto your mouth or not etc.

Some people definitely had a nicer time than others with them.

There is also no good study showing that parachutes prevent death when falling from an airplane. The best we have is observational "evidence" where there are many uncontrolled variables, such as people whose parachutes failed (but they may be unlucky or careless in other ways, or incompetent fallers). And then speculative physics models involving rates of acceleration and energy transfer, which can hardly be assumed to carry over to the real world in the absence of a proper large-scale randomized test.

>parachutes

Very easy and simple demonstration though. With a high confidence value.

Whether masks make a 1% or 0.07653 difference or whatever is very difficult.

It’s very tough to do a good double-blind parachute RCT.

https://www.bmj.com/content/363/bmj.k5094

....which, again, you don't need to do, because the effect size of parachutes is enormous. You must do them when the effect size is measured in single-digit percent (or less, as in the case of mask mandates).

You're not making a responsive argument to the parent.

how do you get an "effect size" or "confidence interval" without a properly controlled trial? I could claim that the "effect size" of umbrellas leading to rain is absolutely enormous, billions of gallons of it drop from the sky! You parachute believers are really something else.

The same reason that the argument is parroted by unserious people in "arguments" like the one above: some things are obvious. I don't need an RCT of dynamite to know that it is deadly.

If we do not allow exceptions for the obvious, our intellectual rigidity becomes a liability.

Exceptions for "obvious" stuff should be temporary. If a thing is so obvious and relevant to your life, then there should be mountains of anecdotal and scientific evidence proving the idea. Remember, lots of ideas seemed obvious at one time or another and turned out to be disastrously wrong.

I have it on good authority from the mask-questioning community that double-blind RCTs are the only valid tests. We should also prove Koch's postulates on aeroplane falls, just to make sure.

Your comment is amusing and biting! Sadly, with and irony are not particularly valued on HN. Direct clear expressions are preferable for the expected neurotypes of this pseudo-community.

If I had to choose, I'd choose a bias toward double-blind RCTs than the parade of obviously biased nonsense used to justify mask mandates.

Pseudoscience and sloppy thinking have a well-established constituency, and need no additional support.

For an up to date meta-analysis, see Masks and respirators for prevention of respiratory infections: a state of the science review (2024, Clinical Microbiology Reviews)

https://journals.asm.org/doi/10.1128/cmr.00124-23

Thank you, I hadn't seen this yet, and it's a legitiately well-researched piece by medical scientists with methodological expertise and communicative clarity, which is not always the case.

I confess the criticism of randomized control trials (RCTs) in the previous paper hit me the wrong way. Anyone that tries to build a case against RCTs has a pretty heavy hill to climb. There are weaknesses, of course, but it is by far the strongest method we know of at the moment for things where you can't isolate all other factors.

That said, I also confess that I look forward to a time we aren't seeing writers seeming to just take pot shots at each other. I get that talking past each other is a common problem in life, it still sucks that it has seemed to dominate so much discourse recently.

An individual can wear a proper mask in the proper manner and be VERY protected from infectious agents.

Effects at a population level, with many uneducated and unmotivated individuals wearing a random assortment of unfitted headgear is MUCH MUCH harder to discern.

Studying disease spread at the level of rigor that this paper anticipates is very difficult, would never get sufficient funding, and would never pass a review board.

If the only possible way to get a mask to work is to apply it in perfect laboratory conditions, it's useless. Imagine if seat belts were that hard to use.

If masks were so effective, there would be good data somewhere out of like hundreds of studies done on them over decades. The truth seems to be that masks help somewhat with some pathogens spread by droplets, but airborne viruses can't be stopped by any commonly accessible mask. Even if the mask somehow works, an infectious agent can get in through your eyes. If you are facing a very deadly virus, you better have more than just a N-95. I don't care if you tape the damn thing to your face or double up, it won't be enough.

You are using a perfection fallacy, or black-and-white thinking here. That a significant number of ordinary peopple do not mask well or do not have / know of the correct mask to use doesn not make the masks or the process ineffective.

It's not a fallacy. You're saying that masks work and if they don't you're just doing it wrong. Under what conditions, exactly, would you accept that masks don't work or are so unwieldy and ineffective as to be impractical? People wore masks over many years, and studied it, and found no conclusive evidence that they're worth it. Your argument is basically a No True Scotsman. If it didn't work for those mask wearers, they weren't True Mask Wearers and their masks were No True Masks. Nevermind that the masks were available, people did in fact wear them, and wearing a mask is simple (and it's supposed to be very simple). If a study was performed, it was No True Study, especially if it concluded that masks aren't worth it.

It feels like we're in a cloud of mud here.

> Under what conditions, exactly, would you accept that masks don't work or are so unwieldy and ineffective as to be impractical?

I accept that as more of the following items are true, masking is less effective:

1. Wearers are unmotivated - if you don't want to wear a mask properly, you won't.

2. Wearers are uneducated - if a person has not been trained to fit a mask properly, AND to CHECK that fit, the mask will be less effective.

3. Masks of the proper standard and fit are unavailable. If a person cannot get a mask that fits them and meets standards, then masking will be ineffective. (This includes price)

4. Masks are too uncomfortable. Uncomfortable masks are very demotivating. Proper fit includes comfort; However the proper fit is not always the most comfortable. This dilemma is the reason that motivation is required. (If this feels like a paradox, consider human fitness - people who are more fit are more comfortable in their bodies, but sweating can be very uncomfortable)

5 + Anything that can affect any of the items above, including political or religious objections. (Basically this one brings in the whole universe)

---

I've been accused of being a nihilist when I say things like the following, but I would call it being realistic:

The universe does not owe you proof, and especially does not owe you satisfying proof in the form you seek.

The linked study DOES NOT show that masks are ineffective.

The linked study DOES show that prior studies are UNSATISFYING.

My original comment attempts to address this:

> > Studying disease spread at the level of rigor that this paper anticipates is very difficult, would never get sufficient funding, and would never pass a review board.

I also do not have satisfying proof that a mask mandate has beneficial effects at a population level.

However I am personally satisfied that: Well fitted masks of the proper standard, worn by motivated and educated people, will reduce both pathogen ingress and egress.

So, you think people are too stupid or unwilling to wear a mask that authorities promised was beneficial, despite years of practice and constant browbeating. Of course I don't deny that unwilling/unmotivated people exist, but that should not preclude the generation of a convincing study somewhere in the whole world. It should at least be possible to collect data in healthcare facilities where masks were strictly imposed.

>The linked study DOES NOT show that masks are ineffective.

Right, it is a survey arguing that existing positive studies are inadequate to show benefits from masking.

>The universe does not owe you proof, and especially does not owe you satisfying proof in the form you seek.

The universe might not owe it to me to make things evident. However, people who want to argue with me do owe me proof. Especially when the outcome is a major imposition on my personal autonomy, and they have failed to collect adequate evidence over decades. We can argue that masks sound like they ought to do something for various particular scenarios, but that is a far cry from proving they are worth the time and effort to implement. Are they worth using in a room full of people who are eating and conversing without masks? Certainly not, even if they do work to some extent.

Please take care with my words. I never said stupid.

It's implied. Masks are an extremely simple thing, and you're suggesting that masks can't be tested because people can't figure it out, instead of blaming the masks themselves for not being effective or easy to apply. We call people who can't figure out simple things stupid (though perhaps not to their faces lol). I don't believe people who don't wear masks "properly" are uneducated. They don't care, because they know that the whole ritual is pointless. They don't care to fight it, and just want to conform the minimum amount to be left alone.

It should be blindingly obvious that a mask, any sort of mask, on a sick, coughing person acts to limit the quantity of infected sputum put into the air. Confusion arises on the right in particular because those guys simply cannot understand why they would wear a mask if the benefit is chiefly to other people.

I really wish it were first clarified in these discussions whether we are talking about benefit to the wearer or benefit to people around the wearer. The distinction appears to be completely absent both in the article and in the comments here on HN.

> the conclusions drawn were most often unsupported by the data

This is damning. What’s the purpose of an allegedly-scientific paper if it draws conclusions not supported by the data? It’s no better than an opinion column.

This is a unreviewed preprint from politically active anti-mask advocates per their disclosures. It’s hard to take it seriously on the cover because they have a bias well articulated (and they have received compensation for) against masking long before they did this paper. I’d rather see it post peer review when taking such a stark conclusion in contrast with generally accepted public health science, yet is totally in line with their political stances they’re paid to propagate.

The authors were very publicly biased against masks before this paper. It's hard to take it objectively.

Sure, but on the other other hand, it might be difficult to expect someone who really believes in masks to try to prove they don't work. Or, to publish their data if they find that masks don't work(because they believe they have some flaw in their logic, or they think there are social benefits to mask wearing not covered in their study, etc).

The people that believe in masks should be the ones testing if they work. The situation you are describing is a messed-up environment that puts politics above science.

The people that don't believe masks work should be busy testing something they believe in.

Believing masks to be slightly effective at preventing airborne illnesses seems like a pretty common sense default viewpoint though. No barrier provides no benefit, a completely impermeable barrier like wearing a fish tank on your head would provide 100% benefit. So it makes sense that a partially permeable barrier would provide some benefit.

Most anti-maskers say "masks don't work" without trying to understand that masks are not a 100% solution, and nothing in life is. But even if a mask is 50% effective (not a scientifically proven number, just an example), I'll take that mitigation over 0% of not wearing a mask (not a random number, wearing no mask actually provides no protection at all), every single time.

But surely the amount matters. What if it’s only 1% better?

>> The situation you are describing is a messed-up environment that puts politics above science.

This has been going on for a while and just came into sharp focus during the pandemic. Its horrifying to think science is now so politically based that any study that contradicts what the gov is telling you is somehow suppressed because they know better? Do you remember when the Canadian Health Minister said people should ignore any information that isn't coming directly from the government?

Our dystopian future arrived during the pandemic and science went from using a rigorous established methodology to allowing the government to tell us that science is now decided as a popularity contest like a survey. "99% of doctors recommend the vaccine so you should trust "the science" and get it or you're going to kill your grandma!"

> Do you remember when the Canadian Health Minister said people should ignore any information that isn't coming directly from the government?

On that environment, with several groups spreading lies everywhere, and with a public health issue that couldn't possibly turn into a political hot topic, that statement made a lot of sense. That is not suppression of scientific speech. (Suppression of scientific speed happened a lot less than popular press manipulation. Still happened, though.)

Personally, I am much more afraid about how people managed to turn covid into a political hot topic.

There was suppression of speech as well. For example, doctors were fired for publicly stating facts backed by research that turned iut to be more accurate than the offivial narrative.

I remember how in Ontario the actual science, pardon me, the Science Advisory Table, was some meeting that absolutely could not be public and Science™ only occurred in the back room secret meetings, with the Premier coming out once in a while to give updates, telephone-game style

Why? You think only people who are negative towards a specific issue may have bias? Or that it is impossible that they are negative based on some experience or hunch or non-conclusive indication, rather than political bias? Do tou understand that being negative vs. positive is just about framing the question?

When was the last time you got out to spend months of your life and of the people around you intent on trying something that you expected not to work?

Science advances by both negative and positive results. So for a researcher, negative results are also “expected to work”. Furthermore, scientific ideal is that researchers are neutral towards the results. Does not always happen, of course.

Absolutely none of this has ever been objective, or even based in reality, let alone evidence, so I find it hard to care.

The issue was never about masks, but of two highly-polarized groups (few of them having any real knowledge on the subject) dehumanizing the other under color of Science™.

It was purposefully misunderstanding and sloganizing Science™ into simplistic, unscientific statements like "Masks work" and "Masks don't work" [for what? for whom? etc]. Objective science isn't sold as bumper stickers and lapel pins on Etsy.

It ignored completely and purposefully the two extremely basic and fundamentally different modes of operation: protecting the wearer from inhaling Bad Things (Masks Don't Work) and protecting people other than the mask wearer from what the mask-wearer is exhaling (Masks Work).

The Science™ on this hasn't really changed in any meaningful way, and the whole subject is tiresome. People who can't think past Mask Good or Mask Bad might think otherwise, but their opinions are perhaps even less valuable than this study.

Besides, if you're not a physician or have a PhD in maskology, how could you possibly begin to evaluate this evidence anyway? It's so very complicated and technical, see. You should be Trusting The Experts™.

Except the experts are mostly objective. However, the waters have been muddied in the public's view by anti-maskers, like anti-vaxxers. This is a real catastrophe of the pandemic.

Background from one of the authors: https://twitter.com/TracyBethHoeg/status/1709371816479952993.

Timely, we are about to enter a new election cycle.

Masks won't have an influence on this election. Gaza will. Nobody will vote for the man who's currently causing a genocide to be committed.

I live in a place where masking isn’t a big deal, people wore masks all the time before covid if they felt sick to prevent transmission. During covid, our rates were quite low, and the rates of countries like Japan where they mask routinely were lower.

How do “anti-maskers” (for lack of a better term) explain this? If masks only work for 5 or 10 percent reduction, then it still helps and with little downside.

I don’t understand what’s so bad about wearing a mask, other than wanting to buck the system trying to tell you what to do.

I don’t understand why you’d look at someone with a mask on and judge them today, even, as you don’t know their story or what their health is like.

I think the problem with the mask discussion is both sides over represent what the other side is saying. Proponents likely don't view it as a panacea, just as opponents probably could be convinced it is a good idea to try.

To be clear, there were and are people that are in the extremes. People having meltdowns over being asked to wear a mask did happen. And that doesn't make sense.

However, it also takes rather high confidence to think that masks were meaningful impacts on school transmission. And getting either side that is invested in a position here to discuss with the others is difficult. I'm not clear why.

So, people will talk over each other and not actually engage with the discussion, but the weakest form of the discussion that they can dominate.

For myself, I don't understand it, either. Agreed that masking was not a big deal. But, literally everyone I knew that made a big deal of masking all of the time were the most likely people I knew to have covid. Usually several times in the year. It made literally no sense. (My guess is they were the most likely to test all of the time, and odds are high they had a few false positives?)

Now, as indicated by my comment on schools, I also think it was pointless to try and get preschools and such with masking policies. Happy to be shown I'm wrong on that, but the messaging around kids and covid was abysmal.

Preschool’s probably hopeless, but I happened to get to see a somewhat-nice (doctors and fancy lawyers send their kids there) local private elementary and a bunch of local public elementaries handle Covid.

The public schools re-opened later and had terrible transmission rates the whole first year. Kids and teachers were sick constantly. Masking was nominally mandated but compliance in all grades was terrible, mostly due to attitudes from and modeling at home (i.e. their parents were chin-maskers who complained about masking a ton at home in front of their kids) and then social effects of having quite a few like that, causing even more to mask poorly. Kids routinely came to school with fevers and got everyone sick with what always seemed to turn out to be yet more goddamn covid.

The private school opened sooner, but had very-good air purifiers in every room that ran whenever possible (too loud when class actively working) and practically perfect masking. Kids didn’t come to school sick. Despite re-opening sooner, they did a ton better. Any extra costs were more than made up by not having to pay for as many substitute days. Even first graders and kindergarteners masked decently well—because their parents did, and didn’t complain constantly about masking and talk about how it’s pointless and watch media complaining about masking in front of their kids. The parents’ attitudes made most of the difference as far as masking goes.

I'd wager that opening sooner versus later is almost certainly more pertinent than you realize there. It is comical how rapidly families get sick when they first start something like preschool. The longer it has been since they were exposed, the more rapidly they get sick.

That said, I'm happy to see data backing this. Last time I recall the claim getting looked at, it didn't have anything actionable. Private school was something like 1/20th the size of typical public schools and the numbers were inline with what you would expect for such a smaller population.

Our kids in public similarly saw a ton of reported cases. Around here, though, masking compliance was pretty good. I'm still finding stashes of masks we had in convenient locations for when we were out.

>I don’t understand what’s so bad about wearing a mask, other than wanting to buck the system trying to tell you what to do.

Mostly this. I like eating ice cream. If someone told me to eat ice cream or they would shoot me in the face, I would resent it.

I much prefer to be offered ice cream, or asked politely to have some.

What about vaccinations? I’m talking about for mumps and stuff, things we should all agree are necessary. Those are more invasive yet we accept them today as a requirement for most of society.

I just don’t understand (cause I’m autistic I think) that if you think a mask might help, but it was mandatory anyways, why you would get angry then versus if they asked politely and you did it. Is that your ego or something? I totally don’t understand, but like I said, around here it was the exception for someone to not wear a mask, and those who didn’t had good reasons and were very careful to shop when less people were around and stuff like that. We care about each other where I live.

Happy to explain further, but first I need to know more about what you can relate to.

How do you feel about the ice cream analogy? Would you just be happy for the opportunity to eat ice cream and not be bothered by the gun to your head?

I guess maybe I just won’t get it, it seems like nothing, to me, to wear a mask if requested, so I don’t get the push back. Do you feel like it’s being too submissive or something? I prefer explanations of how you feel and what your internal dialogue is when a mask is mandatory at, say, the grocer. Vaccinations are a decent corollary but those are riskier than an N95 by far, so it’s not perfect. Wearing a mask basically costs nothing, IMO, unless you’re a very specific case where it’s harmful.

I would say this is false analogy fallacy.

You might be surprised at how many Americans feel the analogy is quite accurate.

Is this person a lawful agent of a legitimate government? Is the ice cream policy reasonably connected to some compelling government interest, like public health?

The degree to which people think these factors matter is likely a deciding characteristic in their response.

How do those people feel about wearing pants at the point of a gun?

It makes them see red.

If that's true, they're uncharacteristically quiet about it!

Do you expect anyone to follow any rules?

what do you mean.

Exactly what I asked.

The mask thing was all theater and political logrolling. Beyond it being anti-science, three other concerning factors:

* It decreased trust in government by backing a policy that most now understand wasn't science-based.

* It increased the partisan divide in the country for no benefit by encouraging people on both sides to label those on the other side as "nutters."

* It probably caused some amount of real harm by causing people to think that, if they wore a mask, they were protected. This probably meant some elderly and immunocompromised people put themselves at risk when they could have avoided the risk by staying outdoors.

The most embarrassing part is that it started off by declaring that the science was against masks, and silencing all dissenters; then moved to declaring the effectiveness of masks, demanding their universal use, and silencing all dissenters.

The problem is with the official silencing, not with masks. You can't even figure out whether masks work when you can't trust any of the sources of information to not be some sort of partisan religious police. The hydroxychloroquine fraud being published in the Lancet is something that political, wedge issue science will never recover from. It was like an awful sequel to the Wakefield incident, and a one-two death blow to the general acceptance of vaccines writ large. Now people will just believe the studies that their political party tells them to believe.

Yes, these are all valid points. One question would be, given that masks likely have little effect, what should governments do? My view would be they should not encourage such an intervention, as it lowers faith in institutions, which is most of what your second paragraph is pointing out.

Why do you think that suggesting to wear a mask during a global pandemic was "all theater"?

If you had to go into an ebola ward, and someone handed you a mask, would you really refuse to wear it?

Where I live (Alameda County, California), people were required by law to wear a mask outdoors when within 30 feet of another person. This was not merely a "suggestion" and it was enforced.

My decision about ebola would be based on whether masks are effective or not. I haven't researched the topic.

We're far, far beyond the point where we have to question or wonder if wearing an air filter in an infectious disease ward will decrease your chances of catching the disease. Maybe you personally really don't know, but maybe you're being willfully ignorant, I don't know you.

If you refused to wear the mask, the very serious and educated people at the door of the ebola ward would likely refuse you entry to the ebola ward, which is probably all for the better anyway.

In every public place I visited during the pandemic, the official rules stated you could leave your mask down if you were eating or drinking. This included two of the largest hospitals in Colorado. In bars and restaurants you only had to wear a mask if you were standing up, and at all other times you were allowed to eat, drink, laugh and talk unmasked. On airplanes everyone unmasked while eating meals.

If masking was truly primarily about stopping the spread of a highly contagious airborne virus, why were the rules designed and applied to allow people to spend so much time in confined spaces unmasked?

The original comment claimed that the suggestion to wear a mask was "all theater" during a pandemic, because masks don't actually protect people.

The proposition was "wearing a mask is all theater", but your comment is explaining how not wearing a mask in particular situations was theater.

Wearing the mask is not theater, it's an effective mitigation.

Taking the mask off in an enclosed space and pretending you're safe is the theater part, but that isn't what OP was talking about.

Like the OP, I'm just pointing out that the masking requirements set out by governments and institutions at all levels were highly theatrical in nature, and I gave some concrete examples. Do you disagree? For example, the requirement by local governments to wear masks in restaurants only while standing... Do you think that had any practical "non-theatric" value?

You're throwing in a truly decadent load of assumptions in a few short words before you make your points. Just because you can craft rhetoric that is tiring to untangle does not mean it has any merit.

People should try to find interventions that work. If masks worked reliably, and there were evidence behind that, I'd be a big supporter.

There is _better_ evidence around N95 masks in hospital settings. But that's not the typical masking situation. At my kids' school, everyone wore surgical masks. It's pretty easy to demonstrate that virons pass through and around those masks with relative ease.

> If masks worked reliably, and there were evidence behind that, I'd be a big supporter.

Masks do work reliably, and there is plenty of evidence behind that. Maybe you only trust biased sources that say otherwise, I don't know, but your comment is pretty much calling N95 masks snake oil, and that's nonsense.

> The mask thing was all theater and political logrolling

And yet every government around the world from all political persuasions pushed for mask wearing.

Wonder how you reconcile this with your intellectually lazy and factually baseless "this was all for partisan reasons" rhetoric.

You're very close to understanding hegemony.

You would have to be completely ignorant of world affairs to think all of the countries in the world act in unison.

... Sweden enters the chat.

The Party told you to reject the evidence of your eyes and ears. It was their final, most essential command.

Pretty sure Sweden didn't ban mask, you could still use them.

This is the correct way to do science

A superb example of poor science in practice!!!!!!!!!

This study did not receive any funding. I wonder why?

Conclusions and Relevance:

MMWR publications pertaining to masks drew positive conclusions about mask effectiveness over 75% of the time despite only 30% testing masks and <15% having statistically significant results.

No studies were randomized, yet over half drew causal conclusions.

The level of evidence generated was low and the conclusions drawn were most often unsupported by the data. Our findings raise concern about the reliability of the journal for informing health policy.

So many people still wearing masks in their cars while driving alone.

> So many people still wearing masks in their cars while driving alone.

Many of them do it because they have various degrees of social anxiety, not because they are afraid of the 'Rona.

Why would that be relevant to their behavior while alone?

If you can see them wearing a mask while driving, are they really alone?

Unless your windows are tinted way past the legal limit, you aren't really alone when driving.

>This study did not receive any funding. I wonder why?

You don't need funding to do a literature review.

A bit like you don't need funding to write software.

> So many people still wearing masks in their cars while driving alone.

Where do you live that you see this regularly?

Don't think it's happening in southern California.

It would have been an excellent idea in Southern California not that long ago — a good mask massively reduces PM2.5, and PM2.5, especially on So Cal freeways, was quite high.

Cabin air filters, which are in many if not most modern cars, should already have removed the particulates already.

“Should have” is, at best, wishful thinking. In air filtration, a good rule of thumb is that, if an actual quantitative spec isn’t given, then the filter doesn’t filter. I’ve seen this with expensive commercial systems with stamped plans, I’ve seen it with very fancy European IAQ systems, and I’ve seen it with cars. Seriously, go look for a stated spec for a cabin air filter, which you generally won’t find, then drive on a freeway, bring a PM2.5 meter, and compare windows open to windows closed.

I live in Minneapolis - I see it all the time. Several times a day in fact. I still see people in outside settings wearing them as well. By now, if I see a person wearing one my only two thoughts are: a) this is an act of virtue signaling (Minneapolis is a VERY progressive city) or b) you are immunocompromised and or wearing it for medical or health reasons.

Since both of these are on opposite ends of the spectrum, I just hope its for medical reasons and being cautious as opposed to the former and get one with my day.

Don’t forget option C: in cold, dry weather, a disposable mask can be an impressive comfort improvement. And you can throw it away when it gets disgusting. They often outperform balaclavas.

Or option D: allergies. A well fitted disposable mask removes allergens, at least until it collects so many that it starts triggering allergies all by itself. Achoo!

I discovered option D during covid and it's like a superpower. I have allergies even through double dosing OTC medicine, but a good mask does wonders for me in spring.

I still see people wearing N95 masks. Bizarre. Often progressive-looking people in their mid 20's and 30's.

What about it is bizarre?

Living in perpetual paranoia and fear?

I haven't had a respiratory illness since N95s were a little more normalized. I don't wear one when I'm walking around, but I keep them handy for flights and public transit.

It's fucking great, I haven't had so much as a runny nose in nearly half a decade.

Studies are not really the right way to test mask effectiveness end-to-end. The physics of filters is well known. What you'd want to do is study humans to see how they're actually wearing the masks and what kind, and then use physics and infection modelling to see what that means for spread and health.

Trying to do a study that measures mask effectiveness in humans is just too noisy/messy or immoral, or both.

The physics of filters is well-known, but how many virus particles does it take to infect a person? Can you smell anything through your mask? If you can, you'll probably be infected if you're anywhere near an infected person. By the way, you also absorb virus particles through your eyes. So trying to rely on the primitive filters you'd actually wear is silly. The effect of masks is so minimal, in my estimation, it's worse than nothing. Then we have to address the stupidity of people thinking that it's mandatory to wear a mask in a restaurant but only until you sit. Then the virus stops completely as you eat. The truth is, by the time we got to that stage, the virus was not a significant threat. The mask mandates were purely performative at that point, and we were seriously at risk of being in that stage forever because of power-tripping politicians.

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