But whatever the reason, mask mandates were a fool’s errand from the start. They may have created a false sense of safety — and thus permission to resume semi-normal life. They did almost nothing to advance safety itself. The Cochrane report ought to be the final nail in this particular coffin.
There’s a final lesson. The last justification for masks is that, even if they proved to be ineffective, they seemed like a relatively low-cost, intuitively effective way of doing something against the virus in the early days of the pandemic. But “do something” is not science, and it shouldn’t have been public policy. And the people who had the courage to say as much deserved to be listened to, not treated with contempt. They may not ever get the apology they deserve, but vindication ought to be enough.
Jefferson and his colleagues also looked at the evidence for social distancing, hand washing, and sanitising/sterilising surfaces — in total, 78 randomised trials with over 610,000 participants.
Jefferson doesn’t grant many interviews with journalists — he doesn’t trust the media. But since we worked together at Cochrane a few years ago, he decided to let his guard down with me.
Interestingly, 12 trials in the review, ten in the community and two among healthcare workers, found that wearing masks in the community probably makes little or no difference to influenza-like or Covid-19-like illness transmission. Equally, the review found that masks had no effect on laboratory-confirmed influenza or SARS-CoV-2 outcomes. Five other trials showed no difference between one type of mask over another.
There is uncertainty about the effects of face masks. The low to moderate certainty of evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect. The pooled results of RCTs did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection. Hand hygiene is likely to modestly reduce the burden of respiratory illness, and although this effect was also present when ILI and laboratory‐confirmed influenza were analysed separately, it was not found to be a significant difference for the latter two outcomes. Harms associated with physical interventions were under‐investigated.
SARS-Cov-2 is a more stable virus than influenza. Trillions of replications have thrown up a handful of variants of concern, clustering around a small set of mutations. These variants are worth monitoring but the vaccines effectively prevent them causing serious illness. There is a theoretical risk of a more dangerous variant but it does not seem more likely than a shift in the influenza virus. If it were to occur, we could now manage it with short-term measures and rapid vaccine modification.
…Vaccination protects the vaccinated. It helps protect others but it means that we take no greater risk in the autumn of 2020 than in the autumn of 2019. Interventions should be proportionate to that – which means that most cannot be justified.
Some are worth retaining, like improved hygiene in public places or greater readiness to stay at home with respiratory symptoms. It is probably a good idea to invest further in the search for effective antiviral therapies. Promoting better population health through diet and exercise is always a good thing. But it is time for a bonfire of face masks and the despatch of lateral flow tests to landfill.
For a virus that spreads via airborne transmission of aerosols—something scientists have known for many months, though it took the World Health Organization until the end of April to update its guidance—these plastic barriers between diners were always a confusing addition. Think of the particles that disperse through the air when someone smokes a cigarette. A plastic barrier wouldn’t prevent you from smelling that cigarette and breathing some of that same air.