[vc_row content_placement=”top” row_space=”remove_padding_top”][vc_column][gva_block_heading subtitle=”The Effectiveness of Face Masks in Community Use”]This paper examines evidence regarding the use of face coverings to reduce transmission of Covid-19, particularly in relation to non-healthcare settings such as schools 

10 December 2021[/gva_block_heading][vc_column_text]

• Decades of research on surgical-type face masks (intended for short-term use to shield surgeons from the fluid spray) has failed to show they are effective in reducing viral transmission, neither protecting the wearer (as PPE) nor protecting others from the onward spread (as source control).
• Evidence cited to support community mask use is not ‘gold standard’ Randomised Controlled Trials but is selected from poor-quality laboratory/mechanistic studies (testing particles in lab conditions without real-world clinical trials) and observational studies (prone to bias and confounding factors).
• Masks have become a political tool, used to influence behaviour and show ‘something’ is being done. Governments and experts, under a pretence of objectivity, are misrepresenting the evidence for masks by cherry-picking low-quality observational studies to support preconceived opinions. Policymakers do not want to admit any uncertainty as they fear it will undermine their authority.
• Longstanding guidance that masks were not useful changed abruptly, not because of new evidence, but most likely as a tactical measure advised by government behavioural psychologists to:
  1. Increase the ‘perceived level of personal threat’ (SPI-B) using masks as a prominent symbol or ‘signal’ (Norway) of risk to remind people to comply with rules
  2. Empower people with actions they can take to reduce threat: for ‘reassurance’ (Dr Harries, Kate Green MP), to ‘alleviate anxiety’ (NEU), make people ‘feel safer’ (Unison)
  3. Emphasise duty to protect others, promote social approval, i.e. collectivism, ‘solidarity’ (WHO)

• Even those who believe masks could be an effective tool admit these drawbacks:

– Only beneficial if correctly handled and worn – rare, especially in long use and by children.

– Loose fit means there is leakage around gaps in the perimeter (glasses steam up).

– Filtration efficiency for small particles depends on the type of mask and manufacturing quality (e.g. cloth mask gaps 5000x size of viral particles, surgical mask pores 1000x their size).

– The benefit, if any, will be small: Norway concludes that 200k people would need to wear masks to prevent one new infection per week on the generous assumption of a 40% risk reduction.

• Harms from mask wearing, e.g. increased contamination risk, false sense of protection, and physical, hearing, psychological and social issues, are rarely considered and poorly reported (see Appendix).

[/vc_column_text][gva_block_heading align=”align-left” subtitle=”Peer-Reviewed Scientific Publications”][/gva_block_heading][vc_column_text]Besser R, Wood R, Fischhoff B, et al, ‘Rapid Expert Consultation on the Effectiveness of Fabric Masks for the COVID-19 Pandemic’, National Academies Press, 8 April 2020

“Conclusions: There are no studies of individuals wearing homemade fabric masks in the course of their typical activities. Therefore, we have only limited, indirect evidence regarding the effectiveness of such masks for protecting others, when made and worn by the general public on a regular basis. That evidence comes primarily from laboratory studies testing the effectiveness of different materials at capturing particles of different sizes.

The evidence from these laboratory filtration studies suggests that such fabric masks may reduce the transmission of larger respiratory droplets. There is little evidence regarding the transmission of small aerosolized particulates of the size potentially exhaled by asymptomatic or presymptomatic individuals with COVID-19. The extent of any protection will depend on how the masks are made and used. It will also depend on how mask use affects users’ other precautionary behaviours, including their use of better masks, when those become widely available. Those behavioural effects may undermine or enhance homemade fabric masks’ overall effect on public health. The current level of benefit, if any, is not possible to assess.”
https://www.nap.edu/read/25776/chapter/1[/vc_column_text][vc_column_text]Bowen L, ‘Does That Face Mask Really Protect You?’, Applied Biosafety, 2010

This study tested an N95 respirator, surgical face mask, dust mask and bandana and challenged saline aerosols.  The article confirms that the particle size range being tested in this study is larger than the actual geometric diameter of viral particles. The research goes on to show that “all three masks offer very little protection when compared to the N95, and wearing these face masks may produce a false sense of protection. All three masks performed poorly, with protective efficiencies less than 34% as compared to the N95 respirator that had a protective efficiency of nearly 90%. The results demonstrate that the use of these types of face masks may not provide as much protection as desired against inhaled aerosols.”
https://journals.sagepub.com/doi/pdf/10.1177/153567601001500204[/vc_column_text][vc_column_text]Bundgaard H, Bundgaard JS, et al, ‘Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers: A Randomized Controlled Trial’ (DANMASK-19), 18 November 2020

A study of over 4800 people over 2 months found that the recommendation to wear surgical masks to supplement other public health measures did not reduce the SARS-CoV-2 infection rate among wearers by a statistically significant amount.
https://www.acpjournals.org/doi/full/10.7326/M20-6817[/vc_column_text][vc_column_text]Da Zhou C, Sivathondan P, Handa A, ‘Unmasking the surgeons: the evidence base behind the use of facemasks in surgery’, J R Soc Med, 2015

This paper concludes that “overall there is a lack of substantial evidence to support claims that facemasks protect either patient or surgeon from infectious contamination.” Although the authors are examining masks in surgical use, the orthodoxies they uncover are worth considering in relation to non-healthcare settings: “Masks are a quintessential part of the surgical attire that has become so deeply ingrained in the public perception of the profession. However, even today, it remains unclear as to whether they confer any tangible benefits to surgical outcomes.” Interestingly, the report found that 20% of surgeons responding to a questionnaire wore a mask “for the sole purpose of respecting tradition” and “30% of responding surgeons felt that masks could make surgery more difficult by increasing breath condensation on spectacles, endoscopes and microscopes and thereby obscuring vision.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480558/[/vc_column_text][vc_column_text]Jefferson T, Del Mar CB, Dooley L, et al, ‘Physical interventions to interrupt or reduce the spread of respiratory viruses’, Cochrane Reviews, 20 November 2020 

Meta-analysis which included a total of 67 randomised trials found “Moderate certainty evidence that wearing a mask probably makes little or no difference to the outcome of [flu] compared to not wearing a mask… Harms were rarely measured and poorly reported…We are uncertain whether wearing masks or N95/P2 respirators helps to slow the spread of respiratory viruses. Hand hygiene programmes may help to slow the spread of respiratory viruses.”  ”
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub5/full[/vc_column_text][vc_column_text]MacIntyre CR, Seale H, Dung TC, et al, ‘A cluster randomised trial of cloth masks compared with medical masks in healthcare workers, BMJ Open, 22 April 2015 

“This study is the first RCT of cloth masks, and the results caution against the use of cloth masks. This is an important finding to inform occupational health and safety. Further research is needed to inform the widespread use of cloth masks globally.”

-Penetration of cloth masks by particles was 97% and medical masks 44%.
-Moisture retention, reuse of cloth masks and poor filtration may result in an increased risk of infection.
-The virus may survive on the surface of the face-masks.
-Self-contamination through repeated use and improper doffing is possible.
-A contaminated cloth mask may transfer pathogens from the mask to the bare hands of the wearer.

-Cloth masks should not be recommended for health care workers, particularly in high-risk situations, and guidelines need to be updated

Update from authors of RCT, 30 March 2020:
There have been a number of laboratory studies looking at the effectiveness of different types of cloth materials, single versus multiple layers and about the role that filters can play. However, none have been tested in a clinical trial for efficacy.”
https://bmjopen.bmj.com/content/5/4/e006577[/vc_column_text][vc_column_text]Xiao J, Shiu E, Gao H, Wong JY, Fong MW, Ryu S, Cowling, BJ, ‘Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Personal Protective and Environmental Measures’, Emerging Infectious Diseases, May 2020

This systematic review, which looked at literature from non-healthcare settings from 1946 to July 2018, “did not find evidence that surgical-type face masks are effective in reducing laboratory-confirmed influenza transmission, either when worn by infected persons (source control) or by persons in the general community to reduce their susceptibility.”
https://wwwnc.cdc.gov/eid/article/26/5/19-0994_article
[/vc_column_text][gva_block_heading align=”align-left” subtitle=”Scientific Publications/Communications (Awaiting Review or Pre-print or MedRxiv)”][/gva_block_heading][vc_column_text]Brosseau L and Sietsema M, ‘Masks-for-all for COVID-19 not based on sound data’, University of Minnesota Center for Infectious Disease Research, 1 April 2020 (addendum 16 July) 

“We do not recommend requiring the general public who do not have symptoms of COVID-19-like illness to routinely wear cloth or surgical masks because there is no scientific evidence they are effective in reducing the risk of SARS-CoV-2 transmission…Sweeping mask recommendations—as many have proposed—will not reduce SARS-CoV-2 transmission, as evidenced by the widespread practice of wearing such masks in Hubei province, China, before and during its mass COVID-19 transmission experience earlier this year. Our review of relevant studies indicates that cloth masks will be ineffective at preventing SARS-CoV-2 transmission, whether worn as source control or as PPE.”

Addendum 16 July:
“We agree that the data supporting the effectiveness of a cloth mask or face covering are very limited. We do, however, have data from laboratory studies that indicate cloth masks or face coverings offer very low filter collection efficiency for the smaller inhalable particles we believe are largely responsible for transmission, particularly from pre-or asymptomatic individuals who are not coughing or sneezing…Wearing a cloth mask or face covering could be better than doing nothing, but we simply don’t know at this point…In summary, though we support mask-wearing by the general public, we continue to conclude that cloth masks and face coverings are likely to have a limited impact on lowering COVID-19 transmission, because they have minimal ability to prevent the emission of small particles, offer limited personal protection with respect to small particle inhalation, and should not be recommended as a replacement for physical distancing or reducing time in enclosed spaces with many potentially infectious people.”
https://www.cidrap.umn.edu/news-perspective/2020/04/commentary-masks-all-covid-19-not-based-sound-data

[/vc_column_text][vc_column_text]Guerra Damian D., and Guerra, Daniel J., ‘Mask mandate and use efficacy for COVID-19 containment in US States’, MedRxiv, 7 August 2021

“Earlier mask mandates were not associated with lower total cases or lower maximum growth rates. Earlier mandates were weakly associated with lower minimum COVID-19 growth rates. Mask use predicted lower minimum but not lower maximum growth rates. Growth rates and total growth were comparable between US states in the first and last mask use quintiles during the Fall-Winter wave. These observations persisted for both natural logarithmic and fold growth models and when adjusting for differences in US state population density. We did not observe an association between mask mandates or use and reduced COVID-19 spread in US states.”
https://www.medrxiv.org/content/10.1101/2021.05.18.21257385v2[/vc_column_text][vc_column_text]Heneghan C and Jefferson T, ‘COVID 19 – Masks on or off?’, Oxford Centre for Evidence-Based Medicine, 23 July 2020 

“Evidence from 14 trials on the use of masks vs. no masks was disappointing: it showed no effect in either healthcare workers or in community settings...It is often more difficult to breathe while wearing masks (particularly respirator masks), which can exacerbate other health issues. An overview of 84 articles found that protective facemasks also negatively impact respiratory and dermal mechanisms of human thermoregulation, making it hard for many to wear constantly. Thinking you’re protected, means you may put yourself at higher risk…A mask can become dirty with excessive moisture, and contaminated with airborne pathogens. And because your voice is muffled; individuals may have to get closer to people, particularly the elderly, to hear from you.”
https://www.cebm.net/covid-19/covid-19-masks-on-or-off/[/vc_column_text][vc_column_text]Martin G, Hanna E. and Dingwall R, ‘Face masks for the public during Covid-19: an appeal for caution in policy’, Institute for Allied Health Sciences Research, 23 April 2020 

“The evidence is not sufficiently strong to support widespread use of facemasks as a protective measure against COVID19,” and that “masks alone have no significant effect in interrupting the spread of [influenza-like illnesses …] or influenza…The very weak evidence for face masks should be reiterated. Although some important studies followed the outbreak of SARS-Cov-19 in the 2000s, by and large, the quality and clarity of the evidence base for face masks as a means of reducing transmission is disappointing. Few studies examine the use of face masks in community settings; those that do find no evidence of reduced transmission compared with no face masks.”
https://dora.dmu.ac.uk/handle/2086/19526[/vc_column_text][gva_block_heading align=”align-left” subtitle=”Government/Institutional Communication (Most Recent First)”][/gva_block_heading][vc_column_text]Oral Evidence Accountability Hearings, House of Commons Education Committee, 1 December 2021 

Department of Education Minister for Children and Families, Will Quince: “At the moment there is very limited evidence as to the efficacy of masks in educational settings”
https://committees.parliament.uk/oralevidence/3098/pdf/

 

House of Commons, Debate on ‘Covid-19 Update’, 29 November 2021

The Health Secretary admits there is uncertainty as to the efficacy of face coverings.
Sir Desmond Swayne MP: “Over the last few months there has been a useful control experiment on face coverings, given the different policies pursued in Scotland and England. What estimate has the Secretary of State made of the result? It is mumbo-jumbo, isn’t it?”
Health Secretary Sajid Javid: “If my right hon. A friend is suggesting that there are mixed views on the efficacy of face coverings in helping to fight the pandemic, he would be right, but I would point him to UK work by Public Health England – published, if I remember correctly, last month – referring to a number of reports setting out how in certain settings face coverings could help.” [Note Professor Dingwall criticises the UKHSA (previously PHE) report to which Javid is referring in his article below, ‘COVID-19, Face Masks and Research Integrity’]
https://hansard.parliament.uk/Commons/2021-11-29/debates/D925097E-3B2F-4E65-9AD0-BEA5A41911AC/Covid-19Update?highlight=mumbo%20jumbo#contribution-68598E08-88A3-4259-A65E-4B86C47522F7

 

‘Evidence for Community Cloth Face Masking to Limit the Spread of SARS‐CoV-2: A Critical
Review’ (working paper no. 64), Cato, 8 November 2021

“Evidence of facemask efficacy is based primarily on observational studies that are subject to confounding and on mechanistic studies that rely on surrogate endpoints (such as droplet dispersion) as proxies for disease transmission. The available clinical evidence of face mask efficacy is of low quality and the best available clinical evidence has mostly failed to show efficacy, with fourteen of sixteen identified randomized controlled trials comparing face masks to no mask controls failing to find statistically significant benefit in the intent‐to‐treat populations. Of sixteen quantitative meta‐analyses, eight were critical as to whether the evidence supports a public recommendation of masks, and the remaining eight supported a public mask intervention on limited evidence primarily on the basis of the precautionary principle.’
https://www.cato.org/working-paper/evidence-community-cloth-face-masking-limit-spread-sars-cov-2-critical-review

 

The role of face coverings in mitigating the transmission of SARS-CoV-2’, UK Health Security Agency, 14 October 2021

“The evidence on the effectiveness of face coverings to reduce transmission of SARS-CoV-2 is still limited, largely due to the low level of evidence provided by the studies available (which are largely observational, and not always peer-reviewed) and by the differences between studies in terms of methods and settings. Factors such as types of face coverings, mask fit, and compliance with face-covering policies may also impact on their effectiveness, especially in the context of airborne transmission.” Despite this admission of the low level of evidence, this government report goes on to say that the weak evidence actually does suggest that face coverings are effective in reducing transmission of SARS-CoV-2 in both healthcare and community settings. See Professor Dingwall’s criticism of this conclusion below in his article, ‘COVID-19, Masks and Magical Thinking’ from 25 October 2021.
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1033268/Respiratory_Evidence_Panel_Evidence_Overview.pdf

 

‘Efficacy of face masks as source control and respiratory protection against transmission of SARS-CoV-2’, Norwegian Defence Research Establishment, 25 June 2021

“Medical and community face masks do not typically fulfil the performance requirements that apply to respiratory protection devices. The reason for this is twofold. First, medical and community face masks are loose-fit devices prone to gap leakages around the perimeter. Therefore, a substantial fraction of the respiratory droplets may bypass the filtering layer of the mask. Second, the filtration efficiency for very small droplets is highly variable for medical and community face masks. This finding is not surprising, since the intended use for medical face masks as a personal protective device is limited to direct transmission via splashes and sprays.”
https://www.ffi.no/publikasjoner/arkiv/efficacy-of-face-masks-as-source-control-and-respiratory-protection-against-transmission-of-sars-cov-2

 

Talk Radio Interview of Kate Green by Julia Hartley-Brewer, 9 June 2021

Shadow Education Secretary, Labour MP Kate Green, supports teaching unions calls for the reintroduction of masks in schools, since “It will provide reassurance…My view is that on their own they won’t make anything more than a very marginal if any difference”.
https://twitter.com/talkRADIO/status/1402528417539633154?s=20

 

‘Face coverings in schools make staff feel safer’, Unison website, 25 May 2021 (accessed 7/12/21)

The perceived safety of adults is listed by the UK’s largest union as an important reason for the government to keep its advice on school children wearing masks in classrooms: “The introduction of face coverings in schools have [sic] made school support staff feel safer…Seven in ten (71%) teaching, learning and special needs assistants, administrators, lunchtime supervisors and facility staff in England believe face coverings in secondary schools are an important safety measure. More than six in ten (63%) say face coverings make them feel safer at work, according to a recent UNISON survey…[Lifting this measure] could undermine the morale of staff, who see face coverings as an important protection at work. These findings are being sent to the government to inform its review of face coverings as a safety measure in schools and highlight the risk of removing them, particularly from classrooms”.
https://www.unison.org.uk/news/2021/03/face-coverings-schools-make-staff-feel-safer%E2%80%8B/

 

UK Government response to petition ‘End all requirements to wear face coverings immediately’, 11 May 2021

The Government indicates that a purpose of the introduction of masks is to reassure an anxious public: “As footfall increases, we want to give people more confidence to shop safely and enhance protections for those who work in shops. The British Retail Consortium has said that together with other social distancing measures, face coverings can make shoppers feel even more confident about returning to the high street.”
https://petition.parliament.uk/petitions/581316

 

‘End of face masks in the classroom as Boris Johnson defies unions’, Telegraph, 6 May 2021

Kevin Courtney, joint general secretary of the National Education Union (NEU), said that masks were an important “psychological reminder” for teenagers that “there is still something to be concerned about”.
https://www.telegraph.co.uk/politics/2021/05/06/exclusive-end-masks-classroom-boris-johnson-defies-unions/

 

Letter to Education Secretary Gavin Williamson from NEU, 4 May 2021

NEU (National Education Union) letter, co-signed by numerous members of ‘zero covid’ lobby group ‘Independent Sage’, says that removing guidance for school children to wear face masks in classrooms would cause its members anxiety: “any relaxation of mask use would cause great anxiety among the staff and students at greater risk”.
https://neu.org.uk/media/15416/view

 

‘Government transparency and accountability during Covid 19: The data underpinning decisions’, UK House of Commons, 15 March 2021

This document quotes Cambridge University professor David Spiegelhalter on why the Government may overstate claims about the effectiveness of covid mitigations such as face masks to the public: “An anxiety that many communicators have about admitting uncertainty is that, if we admit we do not quite know what the benefits of face masks are and things like that, maybe people will not want to wear them, maybe people will not obey the rules. That can lead people to overclaim their confidence in the conclusions they are making.”
https://committees.parliament.uk/publications/5076/documents/50285/default/

 

National Institute for Public Health and the Environment (Netherlands), ‘Non-medical face masks’, accessed 1 March 2021

“It seems likely that face masks help prevent infecting others, but only to a limited extent…It will not be possible to state with certainty within the short term whether face masks do or do not have an additional effect.”
https://www.rivm.nl/en/novel-coronavirus-covid-19/face-masks-and-gloves

 

Swedish Public Health Agency, ‘Munskyddsanvändning i samhället utanför vård- och omsorg’ (‘The use of face masks in the community outside healthcare settings’), accessed 1 March 2021

[Translated from Swedish by UsforThem] 

“Evidence supporting the use of face masks in the community is weak compared to other measures which are already in place to reduce the spread of covid-19. However, there are some situations where the Swedish Health Authority considers face masks to be of value as a complement to other measures.”

“Children do not need to wear face masks. This is because it is difficult for children to handle and wear face masks properly, and because children are not driving the spread of infection and do not transmit in the same way as adults.”
https://www.folkhalsomyndigheten.se/smittskydd-beredskap/utbrott/aktuella-utbrott/covid-19/om-sjukdomen-och-smittspridning/smittspridning/munskydd/

 

European Centre for Disease Prevention and Control, ‘Using face masks in the community: first update – Effectiveness in reducing transmission of COVID-19’, 15 February 2021
“The role of face masks in the control and prevention of COVID-19 remains an issue of debate. Prior to COVID-19, most studies assessing the effectiveness of face masks as a protective measure in the community came from studies on influenza, which provided little evidence to support their use. The evidence regarding the effectiveness of medical face masks for the prevention of COVID-19 in the community is compatible with a small to moderate protective effect, but there are still significant uncertainties about the size of this effect. Evidence for the effectiveness of non-medical face masks, face shields/visors and respirators in the community is scarce and of very low certainty. Additional high-quality studies are needed to assess the relevance of the use of medical face masks in the COVID-19 pandemic.”
https://www.ecdc.europa.eu/en/publications-data/using-face-masks-community-reducing-covid-19-transmission

 

World Health Organization, ‘Mask use in the context of Covid-19, Interim Guidance’, 1 December 2020

The WHO recommends the use of masks despite the weak evidence base: “Evidence on the protective effect of mask use in community settings: At present there is only limited and inconsistent scientific evidence to support the effectiveness of masking of healthy people in the community to prevent infection with respiratory viruses, including SARS-CoV-2.”
https://apps.who.int/iris/bitstream/handle/10665/337199/WHO-2019-nCov-IPC_Masks-2020.5-eng.pdf?sequence=1&isAllowed=y

Why did the WHO change its advice in June 2020 from previously recommending against healthy people wearing masks in public? As revealed by BBC Newsnight’s medical correspondent Deborah Cohen in July 2020, the WHO’s change of advice on masks was primarily ‘due to political lobbying’ rather than scientific rationale:

‘Wales treats shoppers as adults on masks – but for how long?’, Gary Oliver, Conservative Woman, 31 July 2020

“We had been told by various sources WHO committee reviewing the evidence had not backed masks but they recommended them due to political lobbying. This point was put to WHO who did not deny. We said some people think we should not wait for RCTs before putting policies in place.” Deborah Cohen on Twitter (@deb_cohen, tweet now deleted) 12 July 2020
https://www.conservativewoman.co.uk/wales-treats-shoppers-as-adults-on-masks-but-for-how-long/

Norwegian Institute of Public Health, ‘Face mask and visor use by the general public’, Published 29 October 2020/Updated 01 December 2021

Face masks also have a signal effect, and can act as a reminder of the risk of transmission in society.”
https://www.fhi.no/en/op/novel-coronavirus-facts-advice/facts-and-general-advice/munnbind-i-befolkningen/?term=&h=1

‘Evidence on face coverings is not very strong” says Jenny Harries’, Metro, 29 August 2020 

Deputy Chief Medical Officer Dr Jenny Harries: “The evidence on face coverings is not very strong in either direction…At the moment the evidence is pretty stable, but it can be very reassuring in those enclosed environments for children and for teachers as well, to know that people are taking precautions.”
https://metro.co.uk/2020/08/29/evidence-face-coverings-not-strong-says-jenny-harries-13194494/

 

Sick Kids, The Hospital for Sick Children (Canada), ‘COVID-19: Guidance for School Reopening’, 29 July 2020

“Non-medical masks may reduce transmission from individuals who are shedding the virus. However, the extent of this benefit is unknown (especially in children) and would only be potentially beneficial if done properly. In fact, if worn incorrectly, it could lead to increased risk of infection and it is not practical for a child to wear a mask properly for the duration of a school day”.
https://www.sickkids.ca/PDFs/About-SickKids/81407-COVID19-Recommendations-for-School-Reopening-SickKids.pdf

 

‘Face masks in all public places under consideration’, Telegraph, 14 July 2020

Health Secretary Matt Hancock suggested that making face coverings mandatory in shops and supermarkets was primarily for economic reasons, saying the British Retail Consortium had said they made shoppers “more confident about returning”
https://www.telegraph.co.uk/politics/2020/07/14/face-coverings-public-places-consideration/

 

Iversen BG, Vestrheim DF, Flottorp S, Denison E, Oxman AD, ‘Should individuals in the community without respiratory symptoms wear facemasks to reduce the spread of COVID-19?’, Norwegian Institute of Public Health, June 2020

“There is no reliable evidence of the effectiveness of non-medical facemasks in community settings. There is likely to be substantial variation in effectiveness between products. However, there is only limited evidence from laboratory studies of potential differences in effectiveness when different products are used in the community. Given the low prevalence of COVID-19 currently, even if facemasks are assumed to be effective, the difference in infection rates between using facemasks and not using facemasks would be small. Assuming that 20% of people infectious with SARS-CoV-2 do not have symptoms, and assuming a risk reduction of 40% for wearing facemask, 200 000 people would need to wear facemasks to prevent one new infection per week in the current epidemiological situation.”
https://www.fhi.no/globalassets/dokumenterfiler/rapporter/2020/should-individuals-in-the-community-without-respiratory-symptoms-wear-facemasks-to-reduce-the-spread-of-covid-19-report-2020.pdf

UK ministers and Government scientific experts, ‘UK Government U-turns on face mask advice by making them mandatory’, The Telegraph, 4 June 2020  

Two-minute compilation of video clips showing UK Government ministers and experts saying face masks are not necessary, before the Government changed its stance on this policy.
https://www.youtube.com/watch?v=HHGtyH0SYsc

 

‘Options for increasing adherence to social distancing measures’, SPI-B, 22 March 2020

This paper by the Government’s SAGE behavioural science sub-group SPI-B (Scientific Pandemic Influenza Group on Behaviour) discusses ways to increase adherence to social distancing measures. Masks are not mentioned, but are clearly a main part of SPI-B’s strategy presented to politicians, underpinning the administration’s altered advice on masks, which were mandated on public transport on 15 June 2020. The paper states: “A substantial number of people still do not feel sufficiently personally threatened…The perceived level of personal threat needs to be increased among those who are complacent, using hard-hitting emotional messaging. To be effective this must also empower people by making clear the actions they can take to reduce the threat… Messaging needs to emphasise and explain the duty to protect others… Communication strategies should provide social approval for desired behaviours and promote social approval within the community…Consideration should be given to enacting legislation, with community involvement, to compel key social distancing measures”.
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/882722/25-options-for-increasing-adherence-to-social-distancing-measures-22032020.pdf

 

‘Coronavirus: Face masks could increase risk of infection, medical chief warns’, Independent, 12 March 2020 (accessed 1 March 2021)

Jenny Harries, Deputy Chief Medical Officer, said masks could “actually trap the virus” and cause the person wearing it to breathe it in. “For the average member of the public walking down a street, it is not a good idea” to wear a face mask in the hope of preventing infection.

Jake Dunning, head of emerging infections and zoonoses (infectious disease spread between humans and animals) at Public Health England: there is “very little evidence of a widespread benefit” from wearing them. “Face masks must be worn correctly, changed frequently, removed properly, disposed of safely and used in combination with good universal hygiene behaviour in order for them to be effective.”
https://www.independent.co.uk/news/health/coronavirus-news-face-masks-increase-risk-infection-doctor-jenny-harries-a9396811.html

 

Coronavirus: Chief medical officer tells public not to wear masks, Independent, 4 March 2020

Before the Government advice changed on mask-wearing, England’s Chief Medical Officer Professor Chris Whitty said: “In terms of wearing a mask, our advice is clear: that wearing a mask if you don’t have an infection reduces the risk almost not at all. So we do not advise that.”
https://www.independent.co.uk/news/uk/home-news/coronavirus-uk-news-professor-chris-whitty-no-masks-advice-a9374086.html[/vc_column_text][gva_block_heading align=”align-left” subtitle=”Statements by Experts (Most Recent First)”][/gva_block_heading][vc_column_text]‘COVID-19, Face Masks and Research Integrity’, Robert Dingwall, Social Science Space, 30 November 2021

Professor Dingwall of Nottingham Trent University, School of Social Sciences, and government advisor indicates that due to the “fragile evidence base” for the value of face masks in community settings, when he sees “respected biomedical scientists being quoted as flatly asserting that ‘face masks work to control transmission of COVID-19”, he likens this to a case where research is “presented to policymakers as objective but was designed to generate results supportive of the sponsors’ prior value positions”. Dingwall suggests that the UK Health Security Agency is guilty of this kind of bias – “exaggerated claims about the effectiveness of masks” – based on their November 2021 evidence review, by “concluding that a pile-up of weak observational studies somehow equates to stronger evidence, rather than a greater volume of low-quality evidence”.
https://www.socialsciencespace.com/2021/11/covid-19-face-masks-and-research-integrity/

 

‘Face masks unlikely to halt omicron variant’s spread, warns scientist’, Telegraph, 29 November 2021

Jim Naismith, director of the Rosalind Franklin Institute and professor of structural biology at the University of Oxford, said mask mandates had done little to prevent the spread of the delta variant in Scotland and were unlikely to stop omicron. Scotland kept its mask mandates in shops, public transport, schools and hospitality after easing restrictions in the summer, but in the autumn saw rises in cases similar to those of England, which had lifted most mask rules. “The Office for National Statistics survey results on prevalence shows that the Scottish and English approach to masking, although formally different since July, has made no meaningful difference to delta. In both countries, very high levels of prevalence have continued for months. Thus the new changes announced [masks reintroduced in England in schools, shops and public transport] are unlikely to have much of an impact if omicron does indeed spread rapidly.”
https://www.telegraph.co.uk/news/2021/11/29/face-masks-unlikely-halt-omicron-variants-spread-warns-scientist/

‘COVID-19, Masks and Magical Thinking’, Robert Dingwall, Social Science Space, 25 October 2021

Professor Dingwall writes: “The bitter controversy over the use of masks or face coverings in community settings that has erupted in the USA and can also be seen in the UK and mainland Europe has many of the characteristics of the contest between magic and science. Advocates of masks have struggled to demonstrate a causal connection between face covering and the transmission of the SARS-COV-2 virus. Their critics might well be forgiven for claiming that mask mandates are based on magical thinking and questioning whether the power of the state should be used to enforce this.” Dingwall goes on to criticise a 14 October evidence review by the UK Health Security Agency in which the authors “strove to defend the case for face masks” despite not being able to identify “a clear, evidence-based benefit from face masks in the community.”
https://www.socialsciencespace.com/2021/10/covid-19-masks-and-magical-thinking/

 

‘Cloth face masks are ‘comfort blankets’ that do little to curb Covid spread, Scientist warns’, Telegraph, 17 July 2021 

Interview with Dr Colin Axon, Brunel University Engineering lecturer and Government advisor on ventilation. Axon said the public need to be offered a wider view of the science behind face masks, rather than the “partial view” of information being pushed by medics over their effectiveness, saying some cloth masks have gaps which are invisible to the naked eye, but are 5,000 times the size of viral covid particles. “The small sizes are not easily understood but an imperfect analogy would be to imagine marbles fired at builders’ scaffolding, some might hit a pole and rebound, but obviously most will fly through. Masks can catch droplets and sputum from a cough but what is important is that SARS CoV-2 is predominantly distributed by tiny aerosols. A Covid viral particle is around 100 nanometres, material gaps in blue surgical masks are up to 1,000 times that size, cloth mask gaps can be 5,000 times the size. Not everyone carrying covid is coughing, but they are still breathing, those aerosols escape masks and will render the mask ineffective.”

“The public were demanding something must be done, they got masks, it is just a comfort blanket. But now it is entrenched, and we are entrenching bad behaviour. All around the world you can look at mask mandates and superimpose on infection rates, you cannot see that mask mandates made any effect whatsoever. The best thing you can say about any mask is that any positive effect they do have is too small to be measured.”
https://www.telegraph.co.uk/news/2021/07/17/cloth-face-masks-comfort-blankets-do-little-curb-covid-spread/

 

“Mandatory Masking of School Children is a Bad Idea”, Neeraj Sood and Jay Bhattacharya, Uni. of Southern California Schaeffer Center for Health Policy & Economics website, 16 July 2021

“The benefits of masks in preventing serious illness or death from COVID-19 among children are infinitesimally small. At the same time they are disruptive to learning and communicating in classrooms. A Centers for Disease Control and Prevention study estimated that mask mandates in schools are associated with a roughly 20% reduction in COVID-19 incidence though the effect estimate was statistically indistinguishable from zero. Let’s take the 20% effect at face value and do the math. Last month, about 5,000 school age children in California were diagnosed with COVID-19, which means 1,000 infections would have been prevented if all school kids wore masks.  Given the survival rate among children, mask mandates might prevent one child death in the coming school year, a tiny fraction of the approximately 900 deaths of children 5 to 17 years old in 2019. If the aim is to save children’s lives, other interventions – like enhanced pool safety – would be much more effective. At the same time, the long-term harm to kids from masking is potentially enormous.”
https://healthpolicy.usc.edu/article/mandatory-masking-of-school-children-is-a-bad-idea/

 

A State of Fear: How the UK government weaponised fear during the Covid-19 pandemic, Laura Dodsworth, 16 May 2021

Author Laura Dodsworth interviews Educational Psychologist Gavin Morgan, a member of government advisory group SPI-B (Scientific Pandemic Influenza Group on Behaviour, comprising several behavioural psychologists and at least three members of the ‘Independent Sage’ covid elimination strategy lobby), who said that some members of the group like masks because they convey a message of ‘solidarity’. Dodsworth explains, “In other words, there is a behavioural science reason for wearing masks, to increase a sense of collectivism. This is a feeling favoured by the psychologists that is entirely unrelated to the scientific evidence regarding transmission. Essentially, they want us to feel like we are ‘in it together’”.

Furthermore, Sociology Professor Robert Dingwall explained to Dodsworth that one reason masks had been introduced was that they are “a symbolic reminder that people are dangerous, the world is dangerous, and you might feel safer at home. They create a sense of threat and danger, and that social interaction might be something to be anxious about. So mandating mask can feed the fear…[They were designed to] make people compliant.”

 

McCartney M, ‘We need better evidence on non-drug interventions for covid-19’, BMJ, 28 August 2020 

“There are large gaps in our knowledge and without clear evidence, on the use of cloth masks in the community we may be wearing false reassurance. Observation of the use of face coverings, in real life, finds that they are commonly worn incorrectly. Nor have we considered enough about the broader societal impact. “
https://blogs.bmj.com/bmj/2020/08/28/margaret-mccartney-we-need-better-evidence-on-non-drug-interventions-for-covid-19/

‘How are schools preparing to re-open in September?’, Interview with Professor Russell Viner (President of the Royal College of Paediatrics and Child Health), BBC Newsnight, 24 August 2020

“The evidence on masks is very unclear. And, actually, I think that’s in one sense, potentially going beyond the evidence we have. There are lots of concerns about mask wearing for children, particularly younger children. Because they touch their face, they are constantly worried about the mask, it actually could, potentially, spread the virus more.”
https://twitter.com/BBCNewsnight/status/1298336872201158657?s=20
https://www.itv.com/news/2020-08-24/keep-masks-in-schools-option-under-review-urges-education-union

‘Special Committee on CV-19 Response debate’, Irish Parliament, 13 August 2020 

Oxford Professor of Evidence-Based Medicine Carl Heneghan states in testimony to the Irish Parliament that “the evidence comparing cloth masks to surgical masks or the N95s shows clearly that cloth masks are worse and may actually increase the risk of infection. Therefore, that is why they are not recommended in hospitals or in health professional settings” and that uncertainty surrounding masks has divided opinion: 

“That is why we end up with people proposing them more and more. They say people should put them on in schools, pubs and shops. However, there is no clear evidence. They use observational data to inform their decision. If one looks at what has happened in the UK, for instance, it put masks in on 24 July. They were supposed to reduce the risk of infection by 40% over the next two weeks. In fact, infections detected have gone up. In effect, people are not looking at the evidence.

When Norway looked at this, it said that at low circulation, the public health consequences were so minimal that it was not clear they worked and, even if they did work, it reckoned about 200,000 people would have to wear a mask fully for a week to prevent one infection. That is how one has to think about uncertainty. If one is going to put a policy in place, that is fine. 

What one cannot do, however, is say it is evidence-based because when people talk about the evidence, they have again cherry-picked low-quality, observational evidence to suit the argument. However, they have not picked further observational evidence. For instance, if one puts masks in, what is one expecting to happen to the case definitions and the reductions in the next two to four weeks to show it was a worthwhile policy to enact?”
https://www.oireachtas.ie/en/debates/debate/special_committee_on_covid_19_response/2020-08-13/4/
https://www.youtube.com/watch?v=QNI2ocgosgA

‘WHO Director-General’s opening remarks at the media briefing on COVID-19’, WHO website (accessed 7/12/21), 3 August 2020

WHO director Dr Tedros Adhanom Ghebreyesus remarked, “the mask has come to represent solidarity…By wearing a mask, you’re sending a powerful message to those around you that we are all in this together”.
https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—3-august-2020

 

‘Oxford epidemiologists: suppression strategy is not viable’: Unherd Interview with Oxford’s Tom Jefferson and Carl Heneghan, 18 July 2020

Tom Jefferson: “Aside from people who are exposed on the frontlines, there is no evidence that masks make any difference, but what’s even more extraordinary is the uncertainty: we don’t know if these things make any difference…. We should have done randomised control trials in February, March and April but not anymore because viral circulation is low and we will need a huge number of enrollees to show whether there was any difference”.

Carl Heneghan: “By all means, people can wear masks but they can’t say it’s an evidence-based decision… there is a real separation between an evidence-based decision and the opaque term that ‘we are being led by the science’, which isn’t the evidence”
https://unherd.com/thepost/oxford-epidemiologists-suppression-strategy-is-not-viable/

‘Coronavirus: Why have masks become such a battleground?’, BBC Newsnight, 14 July 2020

Oxford Professor Carl Heneghan pointed out that there was little evidence from randomised control trials showing masks were effective and it was odd for the Government to be mandating a public health measure that isn’t based on RCT evidence. He also said that if masks are used repeatedly, rather than disposed of daily, someone with a viral infection can re-infect themselves when they put the mask back on. Heneghan says, “Unfortunately, when things feel right, when they’re ‘common sense’, they still have the equal chance of harming you as opposed to benefitting you. Let’s be clear, the high quality trial evidence for cloth masks suggests they increase your rates of re-infection.”
https://twitter.com/PhilipWatson_/status/1299850554320072706?s=20

 

Professor Robert Dingwall (School of Social Sciences, Nottingham Trent University) commented to Newsnight, “It doesn’t matter whether something is effective or not, the demand is that governments do something. And what we’re seeing here I think is latching on to the idea that masks are something that a government can do – which is cheap, which is symbolic, but is which is probably not particularly effective.”
https://www.bbc.co.uk/programmes/m000kqzq  

 

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This section is an excerpt from another paper by UsforThem which notes the potential harms of children wearing masks in educational settings, focusing on the following four aspects:

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Impediment to children learning effectively

• Communication made more difficult, reducing empathy and understanding, and increasing detachment and anxiety

• Poor learning environment created by effects including increased irritability, headaches, difficulty concentrating, reduced happiness, reluctance to go to school, malaise, impaired learning, drowsiness or fatigue

No evidence presented to explain why Government changed its advice

 

Physical harms

• Eye problems
• Skin and ear problems
• Headaches
• Respiratory and heart problems

Increase in contamination 

• Microbial contamination on masks, even when used correctly, increases when used by non-medical personnel
• Risk goes up with the length of time a mask is worn

Psychological and social harms

• Rise in reports of anxiety, behavioural changes and sleep disorders in children – particularly acute in pupils with SEN
• Concerns about reduced social cohesion through issues around recognition and connections, stigmatisation

 

Follow the below link to read this paper in full, or write us at hello@usforthem.co.uk for a copy:

https://usforthem.co.uk/resources/potential-harms-of-face-coverings-in-schools/

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