Now the punchline: This is not new news. In fact it was known in 1981 and all of the trial participants were trained medical professionals. No person in the common public can be expected to do as well as a trained doctor or nurse in this regard, yet even among them they were unable to demonstrate benefit.
I pointed this out -- that masks are mere performative theater, much like the common white coat a doctor wears, and have zero to do with infection transmission. We've known this factually for FORTY YEARS.
You do, right?
If so you recognize the hierarchy of evidence when it comes to poorly-understood subjects.
And let's be clear on this: If a subject is well-understood then the outcomes are deterministic. You don't have a "percentage" change, a thing either is or is not, and its repeated every time. Almost nothing in medicine meets this standard; ergo, virtually everything is poorly understood.
The hierarchy looks like this, from worst to best:
- Study-of-one -- a single person, a single trial of a thing, and an alleged result.
- Notch trial on one -- The best "one person" can do; you start, get a baseline, do a thing which you hope is all you changed, record results and then withdraw the thing you changed and see if you go back to the baseline. This is best evidence for a single person, and is wildly better than a "study of one", but it suffers from the fact that you are distinct.
- Anecdotes or "case studies" of lots of people -- Not much better than a Study of One as its very hard to control for all the externalities. It is in fact worse most of the time than a single person notch trial, but it is often all we have. Retrospective studies are all in this category as it is almost impossible to control for confounding factors.
- Random trial, open -- Everyone knows if, for example, you have a mask on or not. Therefore a "random controlled trial" is random and controlled, but not blind. This has serious bias problems and unfortunately the next type is often demoted to this, although almost nobody ever admits it.
- Random, double-blind trial -- The thing being tried is matched against a placebo or other known intervention, but nobody knows which person got which. This obviously only works if the trial and control are not able to be distinguished by the person giving it or the person getting it. This is often not true even though claimed to be true; an infamous version of this happened during the AZT trials for HIV in that the pills had a taste that was distinguishable from placebo. Oops. However, if blinding can be maintained this is pretty good evidence, because nobody knows which person to apply the bias to if they want to. The problems come in the implementation; if there is a financial interest in the outcome by the people running the trial gaming it suddenly becomes both expected and very profitable, and thus you can never trust such an analysis if the entity running it has a financial interest other than if it fails! Oops.
- Meta-analysis of many random controlled trials of either of the above -- These are the best evidence, particularly when they debunk a claim. Again, the reason they're only dispositive when they disprove a claim is that typically there is a financial interest among the trial operators in success, so if you find "success" its questionable. But if you find no success that you can accept as fact, as the bias was running the other way.
Cochrane runs these sorts of meta-analysis as their primary line of work. They do God's work in this regard in that they debunk a lot of what was otherwise accepted, and every one of those instances is very valid. Anyone arguing against a debunked position they have analyzed has an enormous burden of proof before them.
Well, here we are with masks. And not just any masks -- all masks, including N95s.
We included 12 trials (10 cluster4;RCTs) comparing medical/surgical masks versus no masks to prevent the spread of viral respiratory illness (two trials with healthcare workers and 10 in the community). Wearing masks in the community probably makes little or no difference to the outcome of influenza4;like illness (ILI)/COVID4;19 like illness compared to not wearing masks (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.84 to 1.09; 9 trials, 276,917 participants; moderate4;certainty evidence. Wearing masks in the community probably makes little or no difference to the outcome of laboratory4;confirmed influenza/SARS4;CoV4;2 compared to not wearing masks (RR 1.01, 95% CI 0.72 to 1.42; 6 trials, 13,919 participants; moderate4;certainty evidence).
In short: They don't work, and the meta-analysis was against RCTs, which are two up the chain, not one because its obvious if you're wearing a mask or not.
Nonetheless this is conclusive.
But... it gets worse.
The use of a N95/P2 respirators compared to medical/surgical masks probably makes little or no difference for the objective and more precise outcome of laboratory4;confirmed influenza infection (RR 1.10, 95% CI 0.90 to 1.34; 5 trials, 8407 participants; moderate4;certainty evidence). Restricting pooling to healthcare workers made no difference to the overall findings.
....
One previously reported ongoing RCT has now been published and observed that medical/surgical masks were non4;inferior to N95 respirators in a large study of 1009 healthcare workers in four countries providing direct care to COVID4;19 patients.
Not only do masks not work but N95s don't work either, even among properly-trained medical workers. If a medical worker, who has been trained and knows the proper protocol for donning, doffing and time-in-use restrictions, can't get superior results with an N95 the common person in the public has no chance of doing so.
There is good news. Well, sort of.
Comparing hand hygiene interventions with controls (i.e. no intervention), there was a 14% relative reduction in the number of people with ARIs in the hand hygiene group (RR 0.86, 95% CI 0.81 to 0.90; 9 trials, 52,105 participants; moderate4;certainty evidence), suggesting a probable benefit. In absolute terms this benefit would result in a reduction from 380 events per 1000 people to 327 per 1000 people (95% CI 308 to 342).
Here's the problem with this: hand "hygiene" likely is mostly about hand washing. Why? The next couple of sentences:
When considering the more strictly defined outcomes of ILI and laboratory4;confirmed influenza, the estimates of effect for ILI (RR 0.94, 95% CI 0.81 to 1.09; 11 trials, 34,503 participants; low4;certainty evidence), and laboratory4;confirmed influenza (RR 0.91, 95% CI 0.63 to 1.30; 8 trials, 8332 participants; low4;certainty evidence), suggest the intervention made little or no difference.
Note, however, that hospitals have largely-replaced the "hand washing station" in each patient's room with the use of "hand sanitizers." That's a problem and a confounder that may be responsible for the heterogenous outcomes. We don't know, but what we do know is that "sanitizer" is more convenient and faster, thus it has become preferred. Is that at the cost of infections? We don't know.
This result is consistent with the known exponential nature of respiratory viral (really, all viral) infections. Unlike bacterial infections which replicate in a binary fashion (1 becomes 2, then 4, etc.) viruses typically produce thousands or more of their copies per infected cell. That is, it doesn't progress "1, 2, 4" it progresses "1, 500, 250,000...."
Thus once you reach minimum infective dose you're screwed and the likely outcome is not expected to change. Many people say otherwise but the data in this regard is conclusive.
Now the punchline: This is not new news. In fact it was known in 1981 and all of the trial participants were trained medical professionals. No person in the common public can be expected to do as well as a trained doctor or nurse in this regard, yet even among them they were unable to demonstrate benefit.
I pointed this out -- that masks are mere performative theater, much like the common white coat a doctor wears, and have zero to do with infection transmission. We've known this factually for FORTY YEARS.
Those who insist otherwise in the medical or any other field need to be destroyed.
It's time to be done with the lies when it comes to this sort of crap. Three years on is three years too many.
Anyone attempting another mask mandate deserves everything they get.
