Source: Our Essay in Extermination (a doctor's response to Prohibition era alcohol poisonings)
Science is an input into public policy, not an output providing a ready-made prescription for public policy. Our society is impossibly complex. If the chaos principle applies in the physical world, how much more so does it apply in the social world?
Even if masks were as effective as the CDC now claims (which far exceeds the more nuanced efficacy claims of other health authorities), there would still be an argument to be made for discontinuing their use.
Masks have been pitched as a no-cost intervention. The logic goes, since there is no cost to masks ("it's just a mask"), even if the evidence for their effectiveness is weak or mixed, their use should be continued based on the precautionary principle. That the use of masks has no downsides has been taken a priori. There is, of course, a cost to everything, no matter how seemingly innocuous. Prior to 2020, medicine had started to come to terms with this, noting that even bed-rest during pregnancy--the most seemingly innocuous of all interventions--could cause serious harms, and was no longer recommended. The tension around masks alone, is proof that there are indeed costs associated with their usage.
Despite this, while the CDC has spent millions of dollars funding research to "prove" masks work since March of 2020, it has spent not one red cent trying to understand if there are any harms associated with masks. During the height of the pandemic, perhaps we didn't want to ask that question. Masks were seen by many--including doctors--as a way of getting people back to work, even if they were known to be ineffective. Now that we have three vaccines, and multiple therapeutics, I think we can--and must--ask those questions. For example:
Are masks healthy to be worn for long periods of time, or during strenuous activity? Only one study has been done assessing this. The results suggested not.
What is the impact on children's development of being masked in school and other activities? On having their peers masked? Does it impact socialization? Does it increase anxiety? Does it increase hostility to others?
Do masks impact children's learning?
Will masks and the isolation and alienation they engender increase suicides? Nearly 3,000 kids die from suicide in a normal year --dwarfing the number who die from all respiratory viruses combined--especially COVID.
Are masks being used by teachers as disciplinary tools ? Are those tools being applied unevenly? Answer, yes: All the time, ALL.THE.TIME.
Are there health risks associated with inhaling small fibers from masks?
Have there been any studies to show if masks incubate pathogens? Yes, there have been, and the results were not encouraging. Since the start of the COVID-19 pandemic, however, not one study has looked at this, especially not when applied to children. A group of parents in Florida submitted their masks to a protein lab, and found the masks harbored scores of dangerous pathogens. Having smelled my kids' masks I have no doubt of these results. The question is, does this result in disease? If so, does it for children, or might it for people with weaker immune systems? All of these are questions that our current mask mania makes impossible to even ask, much less answer. Back in 1918, doctors did come to believe that the masks made the pandemic more deadly.
If masking requirements are predicated on a child's vaccination status, what is the impact of having minority children whose parents are more vaccine-hesitant masked, while their white counterparts are not?
If masks were effective in reducing disease (I am very skeptical of that), the result would necessarily be depressed exposure to disease, likely resulting in hypersensitivity and worse disease when ultimately exposed to airborne pathogens (e.g. similar to children reared in hypoallergenic environments becoming hyper-allergenic ).
Do masks decrease desire to work in-person, and in teams? What impact does that have on mentorship, advancement, cohesion, and productivity?
Does widespread mask-wearing create anxiety about illness in the populace? (Yes, see below).
Does mask-wearing decrease desire to engage publicly in commercial, cultural or civic activities, either due to a dislike of wearing masks, or due to fear of exposure to disease?
What is the impact of employers forcing employees against their will to mask, in order to stay healthy? Is this not treating an employee like a piece of machinery that needs to be maintained, rather than an individual who can make their own health decisions?
What are the social dynamics of some professions being masked (e.g. servers), while their clients are not?
Will masking in certain professions but not in others decrease interest in masked professions?
Will people be more likely to drive drunk, because they do not want to be forced to wear a mask in a taxi or Uber?
Will people be less likely to take public transportation due to mask requirements (or the fear of illness that masks instill?)
Will people be less likely to go to the doctors because they dislike wearing masks, or fear becoming infected while receiving medical care?
Will over-stated claims of masks encourage people to go to work while sick? (This happens routinely in Japan).
Will over-stated claims of masks encourage high-risk people to engage in risky behavior? For example, how many at-risk hairstylists or clients considered themselves safe because both parties were masked (this actually happened to my step-mother, who contracted COVID)? How many at-risk people choose to wear masks, rather than get vaccinated?
My basic thought, is that humans are an extremely successful species. It seems that evolution has favored our being a hyper-social species. We have evolved to be around one another, to share our germs, to work together, to interact. The last 20 months has been an attempt to improve upon that evolution. From a science perspective, I am always wary of such attempts. I am especially wary when the "technology" being applied is literally medieval.
While Dr. Walensky makes the wild claim about 80% efficacy for masks, even the rosiest real-world data come no where close to that number. Even the (in)famous Bangladesh mask study, which the author claims "proves" masks work, and claimed to be the most important piece of epidemiological research of the pandemic, showed a an absolute decrease in disease incidence of just 0.07%. Sure, it was technically a 10% relative decrease, but the absolute decrease in disease prevalence was miniscule. Not 1% miniscule. LESS THAN ONE-TENTH of 1 percent miniscule. This is the study cited as the "nail in the coffin" for the mask debate. Yet even this vanishingly small effect is undermined by the study's manifold flaws, including: no actual baseline; not being a randomized controlled trial of mask effectiveness, but rather of interventions geared towards increasing mask wearing; not being peer-reviewed; and on, and on.
Source: NBER working paper
Even so, let's pretend this is the most perfect of perfect studies showing without a shadow of a doubt that if 40% of the population wore masks, we would guarantee that 0.07% fewer people would contract COVID (that's less than 1 in 1000). With so many potential harms gone completely unstudied, if even one of them turned out to be true in even the smallest degree, it would almost certainly wipe out all potential benefit. (Some will already be starting in with "Just imagine if it were 100%? It could reduce it by 0.18%!"--OK, fine. That's 2 cases in 1000.)
In Prohibition, we have an example of how well-intentioned policies--with far more convincing mechanisms of actions than those of masks--can go awry due to a panoply of unintended consequences. Like masks and vaccine mandates, Prohibition was considered to be "settled science," its social benefits so certain as to render any criticism literally "of the devil" (sound familiar?). (Though it's probably worth noting that masks were considered "settled" in the opposite direction until March of 2020).
Excerpt 1
Source: The Brownstone Institute
The excerpt above calls to mind many researchers today, who acknowledge that their research shows no utility from masks, but who, nonetheless, feel compelled to add "masks are still an important tool" at the end of their papers (or be drummed out of academia (Hi, Emily)). Sadly, their attempts to lift mask mandates, while insisting on mask effectiveness have been equally as ineffective as those who tried to argue against Prohibition based on its unintended consequences, but still insisting on alcohol's diabolical origins.
As we have seen with masks, once Prohibition was enacted, group think ensued.
Excerpt 2
Source: The Brownstone Institute
Once the policy was in place--and it was originally a very popular one--group think devolved into an echo chamber. It didn't take long for the consequences of the policy to begin to come to fruition. Unfortunately, the fruits were tainted and rotten. Where crime was expected to decrease, instead it increased, spawning not just extensive organized crime networks, but wide-ranging distrust of the law and law enforcement. Not surprisingly, the response to the failure of such an absolutist and coercive policy was more absolutism and more coercion, served up here as pure propaganda.
Except 3
Source: Research published by The Brownstone Institute
Not seeing the results they expected from strong enforcement and coercive propaganda, the U.S. government literally turned to poisoning. Since the beginning of the 1900s, industrial alcohol--which was not taxed--had been "denatured," or made unpalatable, to protect the tax revenues from normal liquor. In 1926, frustrated with bootleggers undermining compliance by taking industrial alcohol and "re-naturing" it, the Coolidge administration decided to make the denaturing more potent, adding wood alcohol (methanol), which turned it from unpalatable to lethal. When dozens died from poisoned alcohol in NYC over the course of a few days, the architects of this policy were up-front and unrepentant about these actions, calling the victims "deliberate suicides." They were certain that the "greater good" was being served by dissuading the compliant, and punishing those who chose to flout the laws (once again, this sounds eerily familiar to our current clime, where politicians are trying to coerce vaccination by refusing medical care to unvaccinated people).
Except 4
Source: UNZ
When we hear about moonshine killing people, it was this denaturing process implemented--and tuned for lethality--by the U.S. Government that was responsible. Nor did it kill a small number. It is estimated that ~10,000 Americans were killed due to government-poisoned alcohol between 1926 and 1933, when Prohibition ended. Population-adjusted, that is equivalent to approximately 35,000 people today. It also more than off-set any potential lives saved due to decreases in cirrhosis (which had actually plummeted before Prohibition was instituted). A physician at the time described the practice as "Our Noble Experiment--in Extermination," and argues persuasively that the non-acute poisoning deaths far out-numbered the acute poisoning deaths (the 10k mentioned above).
With such an egregious example of the potential magnitude of unintended consequences looming so large in our national consciousness, we must not make the same mistakes with masks (or vaccine mandates). While the CDC and NIH won't investigate, fund, or publish any research that could suggest harms from masks, data is available that is strongly suggestive that many of the potential harms above are already coming to pass.
During the six months of peak masking (between November 2020 and May 2021), while there was no correlation with COVID deaths/million, there was a very strong negative correlation between masking and access to in-person school, as well as masking and high levels of unemployment. Coloring reflects whether a state went for Biden or Trump. The point here is that masking has unquestionably been politicized. Unfortunately, none of the benefits ever seem to come to fruition, which leaves the states that have embraced masking with only the harms.
Figure 1
While these are certainly the gravest potential harms, they are not the only ones. Below we see--not surprisingly--that masks are also linked to fear of illness, a significantly lower likelihood of spending time with others, and feelings of isolation.
Figure 2
Sadly, none of these behaviors translated into any health benefits. In addition to seeing no health benefit in the cumulative numbers, nor is there any association when looking at cases and deaths in the weeks subsequent. This is the cases both for masking, and for spending time with others in doors.
Figure 3
A more rigorous analysis also found no association with masking rates or mandates and case growth. What makes this particular analysis so important, is that it looked at case growth during surges, which helps to reduce the impact of seasonality (something which, if you are not familiar with yet, you will be soon, as cases spike in the highly-vaccinated northeast, while they continue to plummet in the slightly less-vaccinated south).
Excerpt 5
Source: https://escipub.com/irjph-2021-08-1005/
Our state of Massachusetts, which ranked at the top of mask compliance for this period, rating never less than 98% compliance, likewise suffered some of the worst outcomes when it came to access to education and unemployment.
During the 2020/21 school year, Massachusetts had the 10th-lowest access to full-time in-person education. Usually such differences are trivial, but this year they were not. The states with the highest in-person education had the normal 40 weeks+ of 100% in-person school. In Massachusetts, our average was 9 weeks. That means the average Florida child, who had access to 40 weeks of 100% in-person education, received 4x the amount of in-person education as the average Massachusetts child (click on the map below to access an interactive dashboard). Note, much of the reporting on access to education, has focused on ANY access to in-person education, the map below shows access to full-time in-person education. This is an important distinction, because through the beginning of March 2021, less than 5% of Massachusetts students had access to full-time in-person learning, though 68% had access to some in-person learning through hybrid learning, that was generally no more than 2-4 hours per week.
Figure 2
Source: www.burbio.com, weekly access to hybrid, 100% in-person, or virtual learning by school district.
The picture is no better from an employment perspective. From March 2020 through September of 2021, Massachusetts had the 7th highest pandemic unemployment average--9.1%, more than 3-fold our pre-pandemic unemployment rate of 2.8%. In September, our unemployment rose to 5.2%, giving us the dubious distinction of being the only state whose unemployment rate increased, and once again pushing our unemployment rate above the national average.
Figure 3
Source: www.bls.gov
With all of these harms, our COVID death rate here in Massachusetts remains in the top 10, despite having one of the youngest, healthiest and wealthiest populations in the United States.
We have suffered all of the costs, and yet garnered no benefit.
Worse still, these policies are a betrayal of our values. There is no question that the people of Massachusetts care deeply about equality, and improving the lot of the most disadvantaged within our communities. Unfortunately, high unemployment and limited access to education do not impact communities evenly. Quite the opposite.
The graphs below show access to education by race in "Trump" versus "Biden" states. If access to education is an indication of racism, this is perhaps a bit inverted from what we typically expect... Is it any wonder that African-Americans now homeschool their children at higher rates than any other race--16%?
Figure 4
In an indication of just how politicized masks have become, there is nothing that correlates more highly with masking, than BLM support. Given the correlation with masking, and these extremely negative outcomes of low in-person schooling, and high unemployment, both of which hit communities of color hardest, this is somewhat perplexing. This is likely explained by the media's lack of curiosity--and hence coverage--about any potential negative consequences from our various mitigation measures, especially masking. Indeed, rather than investigating potential harms caused by pandemic policies, the media has acted not just as a megaphone for those government policies, but as their chief explainers, and defenders.
Figure 5
When it comes to unemployment, vaccination has not changed the game. The same pattern persists. The Biden administration has claimed repeatedly that we need to have vaccine mandates in order to get the economy back on line. The data tell a different story. The states with the highest vaccination rates, are the same that had the highest masking rates. Unemployment remains significantly higher (55%) in the 10 most vaccinated states (workforce 38 million), and the least vaccinated states (workforce, 39.8 million, 17 states). This difference translates to nearly 900,000 additional people unemployed in those states, vs. the least vaccinated states. But the incremental unemployment is where things look worst. The least vaccinated states have 284,000 more people unemployed than pre-pandemic. The 10 most vaccinated have more than 1.1 million incremental unemployed. In Massachusetts, prior to the pandemic, we had roughly 100,000 people unemployed. We have nearly doubled that, forcing an additional 84,000 people onto the unemployment rolls.
Table 1
Source: www.bls.gov
There will be some who argue that we must continue to have these policies in place, and especially masking, in order to protect minorities, that that is why masking is so tightly correlated with BLM support. Once again, the story the data tell is literally the opposite.
When we look at all-cause mortality, we see that the lockdowns--recommended by public health officials--far from reducing deaths caused massive spikes in deaths across all races, but particularly amongst minorities, and particularly in the places where those lockdowns were strongest, i.e. the Northeast.
Figure 6
As interesting as the chart above is, comparing Florida (one of the least restrictive states across all measures--notably making mask mandates unenforceable) and California (one of the most restrictive and most highly masked), the contrast is even sharper. What makes this comparison interesting is that California and Florida have somewhat similar seasonal trends, though California's big surge is in the winter. Regardless, we see that while Florida had restrictions in place, deaths by race diverged, favoring whites (i.e. whites died at lower rates), just like California. When restrictions were removed, and mask mandates made unenforceable, deaths across all races decreased, but most importantly, differences completely disappeared.
Figure 7
More than that though, when we compare all-cause excess death between California and Florida, we see that through September, 2021, Florida has a smaller increase in excess death than California, both on an absolute basis, and on an age-adjusted basis. Florida saw 15.7% excess death un-adjusted, and 11.3% age-adjusted, where California had 18.9% excess death un-adjusted, and 15.4% age-adjusted. Given that this period includes Florida's summer surge (which from last year's seasonal trends we know is larger than California's summer COVID season), but not California's expected 2021-22 winter surge, this trend is likely to become more pronounced, and more in Florida's favor.
Public health officials have been arguing since the beginning of the pandemic that the difference in deaths of minorities is due to "long-standing systemic racism." But the fact that the discrepancies at national and state levels decrease or go away all together when restrictions lift shows us that these discrepancies were not due to any long-standing problem, but due specifically to lockdowns and harsh restrictions.
In May of 2020, I did an analysis where I compared cumulative case rates in Boston by zip code to education rates. The results are rather stunning. There is a strong negative correlation with case rates and education levels.
Figure 8
Sources:
1) Boston neighborhood infection data, provided by the Boston Public Health Commission as of May 18, 2020.
2) Population, demographic, education info, United States Census, American Community Survey 5-year estimates. Extracted for each Zip code using Wolfram Alpha.
3) Analysis, Emily Burns, detailed version available here.
This becomes especially
More than systemic racism being in play, what we see is a "protect the rich, infect the poor," dynamic. This is particularly apparent when we see East Boston (predominantly white) in the position second to the right. To the extent that there was systemic racism in action, I believe it was in the assumption that minorities would suffer worse outcomes, crafting policies that unwittingly guaranteed those results, and then assuming the results were caused by long-standing problems rather than the policies just implemented.
Testing is supposed to favor whiter neighborhoods, so in theory these discrepancies would be magnified, if those discrepancies were remedied (and indeed we see that with seroprevalence data).
Seroprevalence data supports the data above. Below we see that as of July of 2020, Black and Hispanic people in Massachusetts were 6-7 times more likely to be infected than white people, and twice as likely as Asians. Blacks and Hispanics died at higher rates during the first wave of the pandemic because the were infected at higher rates during that period (and subsequently), due to policies that implicitly favored the wealthy, work-from-home class, that is more often than not, white.
Figure 9
Source: https://covid.cdc.gov/covid-data-tracker/#nationwide-blood-donor-seroprevalence
These policies were bad in and of themselves, and were not recommended either by any existing pandemic plan, or epidemiological best practices. However, the differences in mortality by race--which on closer inspection appear to be due to the lockdown policies themselves driving the infection disproportionately to these races--were then used as justification for keeping schools closed. This was especially true in inner-city areas, where children were 100% virtual for the longest time. As was seen above, schools closures hit minority communities harder, thus adding injury to injury.
This is how unintended consequences work. In this case, the goal became to stop the virus, because the impacts of the virus were expected to be worse in some communities than others. But the result of this well-intentioned policy was to make things far worse in those exact communities, than had the virus had run its natural course. It is impossible to look at these curves of excess deaths, and see that when these harsh measures are removed, race-based discrepancies disappear, and deaths overall decrease, and not conclude that like Prohibition, we made every problem we sought to fix worse, not better, with these draconian policies.
While lockdowns were the initial driver, for more than a year, masks have remained the only meaningful mitigation measure. It is not linked to improved outcomes, but it is linked to harms.
Given so many harms, so unevenly distributed, and such weak evidence of benefits, how can we possibly continue to recommend masks?
And yet, there are many in the public health community (Frieden, Fauci, Gottlieb, Walensky) who are vocally advocating for maintaining mask mandates now, as well as for wearing masks during flu season, and even simply in crowded spaces into perpetuity. There is, as ever, no thought for consequences, though we have a glimmer of what those consequences might look like.
Excerpt 6
Source: NBC News, Megan Ranney, MD MPH
When it comes to public policy, science is not a map to be followed, it is a tool to be used. Just as any tool, it can be mis-used. Public policy must be evaluated on its outcomes. From this lens, the mitigation measures put in place have been abject failures. Further, they were not part of the plan. They were in fact explicitly counter-indicated in those plans. Naturally, the authors of these measures are not keen to acknowledge this. So they are mis-using science once again, using it now as a shield to deflect criticism of their policies. The media, which is supposed to act as our watch dog, calling out government mis-steps and holding the powerful to account, appear instead to be acting as the guard dog for both. This leaves us with only one option: the people. We the people must vote the politicians out out of office who supported, and continue to support, these destructive policies, which includes, but is certainly not limited to mask mandates.
"The facts demand our attention and arouse our consternation. Such catastrophes demand investigation and an official accounting; [ .... ] No less do they demand the attention of the judicious public, which must here face its duty or find a despicable refuge in ignorance."
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