Mask Mandates Aren’t Working As Promised

Doug Badger and Norbert Michel December 27, 2020 26 min read Download Report

SUMMARY A surge in COVID-19 cases in the United States and Europe has prompted calls for a national mask mandate here in America. Advocates of government edicts have asserted that these would bring the pandemic “under control” in a matter of weeks. The authors of this Backgrounder found that 97 of the 100 counties with the most confirmed cases had mask mandates. Nor did a national mask mandate prevent a surge in Italy. These findings do not deny the efficacy of mask-wearing, nor should they discourage the practice. Instead, they point to the inadequacy of public health strategies that rely too heavily on lockdowns and mask mandates. Governments should undertake more effective interventions, such as specifically protecting nursing home residents, enabling nationwide screening through use of rapid self-tests, and establishing voluntary isolation centers where infected people can recover, rather than exposing their families to infection.

KEY TAKEAWAYS

1. While mask-wearing can help to reduce transmission of COVID-19, data show that mask mandates in the U.S. and other countries did not prevent a surge of cases.
2. During the U.S. surge in the fall, 97 of the 100 counties with the most confirmed cases had either a county-level mask mandate, a state-level mandate, or both.
3. Governments should take more effective steps, such as protecting nursing home residents and approving rapid self-tests for widespread at-home testing.

A surge in COVID-19 cases in the United States and Europe has prompted calls for a national mask mandate here in America. Advocates of government edicts have asserted that these would bring the pandemic “under control” in a matter of weeks.

Public health officials here and throughout most of the world believe that mask-wearing has some value in reducing the rate at which the pandemic spreads. Accepting this premise, however, does not necessarily lead to the conclusion that government mask mandates will bring the contagion under control.

This Backgrounder examines the effects of mask mandates in the U.S. and Italy. While there is no national mask mandate in the U.S., many states and counties have imposed them. We (the authors) find that, of the 25 counties reporting the highest numbers of new cases during this latest surge, 21 had mask mandates in place since at least July.

Italy does have a national mask mandate that is backed by fines of up to 1,000 euros for non-compliance. We find that the mandate did not prevent a surge in cases in Italy that began in October, peaked in mid-November, and had not yet subsided in mid-December.

These findings do not deny the efficacy of mask-wearing per se. Nor should they discourage the practice.

Instead, they point to the inadequacy of public health strategies that rely predominantly on lockdowns and mask mandates. Governments should undertake more effective interventions. These include adopting better measures to protect nursing home residents, enabling nationwide screening through the widespread use of rapid self-tests, and establishing voluntary isolation centers where infected people can recover, rather than exposing their families to infection.

The Value of Masks

Mask-wearing has become a highly politicized practice in the U.S. Some detractors consider it an emblem of social submission. Others, such as Centers for Disease Control and Prevention (CDC) Director Robert Redfield, see masks as the best way to get the pandemic under control: “I think if we could get everybody to wear a mask now,” Redfield said in July, “I think in four, six, eight weeks, we could bring this epidemic under control.

Mask-wearing has thus inspired both enthusiasm and revulsion that likely exaggerates its significance.

The CDC in general is a bit more tempered about mask-wearing than its Director. While the CDC has changed its guidance on masks numerous times throughout the pandemic, the agency’s recommendation (as of November 20) endorses mask-wearing both to reduce the risk of infecting others and to protect uninfected people from the contagion.

The discussion of CDC guidance on mask-wearing represents claims that the agency made as of November 20, 2020. As noted, the agency changes its views frequently, and likely will continue to do so.

The CDC and other public health authorities in the U.S. and abroad have been trying to determine the relative efficacy of mask-wearing for two different, though related, purposes. The first is “source control”—meaning the extent to which wearing a mask prevents an infected individual from spreading the virus. The second is “protection”—meaning the extent to which wearing a mask protects an uninfected individual from contracting the virus.

The CDC has, for many months, believed that masks have “source control” value. More specifically, it advises that “multi-layer cloth masks block release of exhaled respiratory particles into the environment.”
Ibid.

According to this theory, by reducing the speed and volume of droplets that an infected person releases into the environment, masks help to protect the uninfected from the infected.

Since November 20, 2020, the CDC has also asserted that masks provide some protection for uninfected people who wear them: “Cloth mask materials can also reduce wearers’ exposure to infectious droplets through filtration.”
Ibid.

The CDC bases its mask guidance on “experimental and epidemiological data,” rather than controlled studies

Experimental data is collected, for example, by squirting an aerosol through a cloth mask and measuring how far particles travel. Epidemiological studies or, as the CDC calls them, “real world” data, generally involve case studies of transmission.

In perhaps the most famous of these, two St. Louis hairstylists who had COVID-19 wore masks while they continued to service customers. They saw 139 clients over eight days. Of those, 67 consented to follow-up testing. None of those 67 tested positive for COVID-19.7

The CDC assigns great weight to this study.

One drawback of these studies is that they lack a control group. Danish researchers recently published the only controlled study of mask-wearing. It tests the hypothesis that wearing a mask protects uninfected people.

The researchers conducted the study, in which 6,000 Danes participated, in spring 2020, before Denmark instituted a mask mandate. The control group followed existing social distancing guidelines but did not wear masks. Researchers provided the experimental group with high-quality surgical masks with a filtration rate of 98 percent and instructed participants to wear them outside their homes.

Those who completed the study underwent COVID-19 tests one month later. Researchers found that 1.8 percent of those in the mask-wearing group tested positive, while 2.1 percent of the control group did. The results were not statistically significant. The researchers concluded that mask-wearing is compatible with a range of outcomes—from a 46 percent reduction in infections to a 23 percent increase.

Although the Annals of Internal Medicine published the study on November 18, the CDC did not cite it in its November 20 revised mask guidance. The Danish study casts doubt on the CDC’s advice about the protective value of masks.

In sum, some studies support the source control value of masks, though none of those studies are controlled. Source control benefits also align with common sense: A face-covering will reduce the speed and distance that an infected person’s droplets travel. The prevention value of masks is less well attested, and the only controlled study of the hypothesis contradicts it.

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