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After three years of a pandemic and millions of futile online arguments about whether mandatory masking is a good idea or not, we finally have a definitive scientific answer. Well, sort of.

It comes from Cochrane, a U.K.-based non-profit that publishes so-called “meta-analyses” (in essence, a study of studies) on everything from blood pressure medication to cognitive behavioural therapy and is widely regarded as the “gold standard” of evidence-based medicine. Its recently released analysis reviewed 78 studies to determine what impact mask wearing (and other physical interventions like hand washing) had on the spread of respiratory viruses, and it came to an unexpected conclusion: they don’t actually work.

The study’s own lead author, Oxford epidemiologist Tom Jefferson, didn’t exactly pull his punches in an interview with Australian doctor Maryanne Demasi. “There is just no evidence that they make any difference,” he said. “Full stop.” That holds, he said, even for fitted N95 masks in health-care settings. “It makes no difference — none of it.”

The actual study was much more cautious with its language, mind you. “Our confidence in these results is generally low to moderate for the subjective outcomes related to respiratory illness,” it said, which doesn’t exactly scream “slam dunk.” But for those who have increasingly defined themselves by their opposition to mandatory masking, this study is being treated like a triumphant vindication of their position — and weaponized accordingly.

New York Times columnist Bret Stephens wrote that “those skeptics who were furiously mocked as cranks and occasionally censored as ‘misinformers’ for opposing mandates were right. The mainstream experts and pundits who supported mandates were wrong. In a better world, it would behoove the latter group to acknowledge their error, along with its considerable physical, psychological, pedagogical and political costs.”

If there was an error on the part of masking advocates, it’s that they — OK, we — may have overstated the degree to which mask wearing could protect the general public. As Stephens notes in his column, “They may have created a false sense of safety — and thus permission to resume semi-normal life.” Given how desperate most people were for that form of permission, it’s not hard to see why they gravitated toward a potential solution like masking.

But according to a growing number of public health experts, there are some errors in the Cochrane study, as well. As Kelsey Piper wrote for Vox, only six of the 78 studies it analyzed were conducted during the COVID-19 pandemic, with most of the rest looking at flu transmission rates in normal conditions. Just two actually looked at the direct relationship between masking and COVID, and they were assessing the directive to wear masks, not whether people actually did it or not. “If telling people to wear masks doesn’t lead to reduced infections, it may be because masks just don’t work,” Piper said, “or it could be because people don’t wear masks when they’re told, or aren’t wearing them correctly.”

It’s almost certainly the latter, given what we already know about the efficacy of masking in a health-care setting. “We have fairly decent evidence that masks can protect the wearer,” Jennifer Nuzzo, an epidemiologist at Brown University, told The Atlantic’s Yasmin Tayag. “Where I think it sort of falls apart is relating that to the population level.”

The problem, in other words, may be less with the masks than the people wearing them. That’s hardly a smoking gun, much less one that vindicates or valorizes the people who refused to wear their masks throughout the pandemic. But it will make it even more difficult to get sufficient buy-in for public health measures in the future when the next pandemic arrives — something that’s merely a question of when, not if.

We're more than three years into a pandemic and the science around mandatory masking is as confused — and confusing — as ever. But one thing is certain: masking won't be the solution to the next pandemic. @maxfawcett writes for @NatObserver

It’s probably tempting to push back against some of the choices that the study’s authors made, and that’s something that other public health experts and researchers have tried to do. But in a world where more people turn to Joe Rogan for health-care advice than their actual doctor, this makes Sisyphus’s famous task look easy by comparison. “At this point, even the strongest possible evidence is unlikely to change some people’s behaviour, considering how politicized the mask debate has become,” Tayag writes.

Instead, public health officials should turn their attention to other solutions, whether that’s improving air quality in public spaces or developing new vaccines and antiviral drugs. Fighting the last war is a good way to lose the next one, and we’ve all spilled too much rhetorical blood on this particular battlefield already.

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The problem with Cochrane reviews is that they base their conclusions on the available evidence - without much regard to the quality or rigour of the studies. In other words, garbage in, garbage out. Publishing systematic reviews has become almost a cottage industry for epidemiologists. Most scientists like myself don't attach much faith to Cochrane reviews, certainly no gold standard.

As a scientist, IS there a "gold standard?"
I know that when I read this I felt the way Max probably did, where the most basic idea of wearing a layered barrier is now tossed to the wind? Even if you can appreciate that a lot of people didn't wear an effective mask OR wear it properly, SURELY it wasn't completely USELESS, which is what this guy sneeringly says, like HE'S the REAL scientist here. The fact that he "doesn't trust the media" either is a red flag, and correlates with the trivialization verging on outright denial of this even being the pandemic as designated by the WHO, so completely contradicting that esteemed group.
This is clearly a human trait, the tall poppy syndrome, as well as the irrational longing for "slam-dunk" solutions to complex problems. It explains the persistent lure of religion.

Tall poppy isn't a human trait, it's an enculturated trait.
Neither does it explain the lure of religion, though here is not the place to get into it.
Regarding science, something that talks simply about masking itself, without regard to the type of mask, the proper wearing, the "wash-wear" or wear-out cycle, that doesn't speak to specific illnesses, etc., is, I'm sorry, Just Not Science. It *passes* for science, just as much published science passes for science, but it simply isn't. Real Science depends on specificity, on accurate (and accurately recorded) observations/data, appropriate study design, accurately described materials (including cell cultures, some of which in common use are not what they are claimed to be -- I can dig out references, if anyone wants them), appropriately chosen subjects, and experiments carried through a long enough time-frame for real results (part of study design, but some well-designed studies are terminated early when they appear to be headed in the "wrong" direction for the study funder). That is all firmly established, by Real Science itself.
The meta-studies aren't just "garbage in, garbage out" ... many studies are well designed and carried through properly, with actually valid conclusions. But it always has to be remembered that apples only doesn't make a fruit salad, and fruit salad makes a lousey filling for apple pie.
It sounds like the study in question is mixing up not only apples and oranges, but enough fruits to make a very nice fruit salad.
That makes it not valid, as Science.
The same thing has been done by various "pressure groups," to create baseless public opinion, and sometimes to ruin careers ... numerous times I'm aware of, that kind of fell into my lap: I don't go seeking those things out.

Well said. Kudos!

You think it's NOT human nature to be jealous and vindictive; you think the tall poppy syndrome is LEARNED?
And wanting easy solutions to complex problems isn't in our nature either?
Can you think of a MORE simplistic solution than some god watching over us billions like our fathers did, who is of course male because religion is a set of man-made ideas, and is just "out there" somewhere? OR can you think of a MORE complex mystery than our uniquely self-conscious existence in the vast universe?

"It explains the persistent lure of religion."

LOL! Thinking of my long ago dearly departed mum here. She spent an entire life waiting for god to bless her, at the expense of most other aspects of her life, including building a career of some kind. Of course, she started from the fact there is no pension plan for housewives in our society. She eventually became her number one son's dependent. Now that he is in his 70s, he is very happy that his mum's religious sensibilities and financial management talent did not pass down.

No hell below us. Above us only sky. You reap what you sow. Those are wise words of independent thought.

Yay, my theme song as well, and the fact that we independent thinkers/atheists are the minority goes a long way toward explaining humanity's current perilous state.

Articles like this are adding to the confusion rather than clarifying the subject. I'm therefore surprised that the National Observer printed it. There should have been a foot note - similar to the first comment - that questioned the veracity of the notion that masks don't work. If an article like this rightly causes doubt about National Observer reporting, then is also opens a debate on the accuracy or validity on other reports published by the National Observer.
I'm waiting to see a follow up on this article. Leaving it as is will be detrimental to the reputation of the National Observer.

Thanks for this comment. I found this piece to be misleading and incorrect in many ways. It basically supports anti-maskers. I agree that there needs to be a follow up. My positive perspective about the author took a a major hit.

I have to agree with the other comments. This article doesn't help in the slightest. If anything it just gives more fuel to the rabid anti-maskers and science deniers. Personally, I think masks worked well and even if they just made us more aware of proximity to people and how airborne diseases spread, it played a role in saving some lives.

Thinking masks won't help in another pandemic is just lazy reporting. Like stay at home orders, masks, vaccinations and avoiding gatherings will always be an important part of preventing the spread of diseases. The fact our population can't do anything for the group vs the individual is what we are fighting here.

And hand washing ... you forgot handwashing!
The truth of the matter is that the vaccines aren't all that effective with seniors, and almost 40% of the Covid deaths in Canada were among seniors, who made up closer to 15% than to 20% of the Canadian population when Covid began to take off in Canada.
I may have had it very early in the epidemic. I don't usually "take shots" but the circumstances around Covid made it a whole new ballgame, and so I did.
I read not only the reportage of the science, but also the actual studies. It is appalling how much reportage does not reflect the conclusions of studies ... and also how conclusions in some studies are not warranted by the observations ... even where studies are well designed. If *I* can spot a glaring design flaw, it should be clear to reviewers ... you'd think.
A lot of "science," like plenty of the statements made by well-meaning "environmentalists" winds up being "bad" because of information being held and transmitted in tall and narrow silos.
There was an example on TV last night, when a woman with an "environmental perspective" spoke against construction of high residential towers; her points were all dead on. But when asked what would be environmentally sound, she mentioned that buildings should be constructed of wood, because that was "better for the environment" than other construction types. It seems to me she must have been unaware of the negative effect on the environment of cutting down many, many trees to build low-and-mid-rise apartments.
I don't know what the best solution would be, but I'm quite sure it's not chopping down more forests.

The first poor column by Max I've seen on here.

You need to read the links.

Perhaps invite David Fisman to rebut this.
Also: Wastewater study finds masks prevent COVID-19 in schools
https://www.healio.com/news/primary-care/20230222/wastewater-study-finds...

And, yes, improved ventilation in schools, workplaces and businesses would help, but first PHAC has to say definitively that COVID is airborne, then we need regulations. That would cost a lot of money ...

More here:
https://sciencebasedmedicine.org/masks-revisited/

"A recent Cochrane review, limited in scope and problematic in methodology, does not show that masks do not work, despite common misreporting.
Steven Novella on February 15, 2023 "

OK, last comment, I promise.
My knee-jerk reaction was to point out that this latest study is flawed and that there is evidence that mask mandates work. Of course, that's not Max's point.
His thesis seems to be that "we" have lost the (political) battle over mask mandates; we should wave the white flag and let the anti-maskers win.
I disagree that we should give up on mask mandates because the anti-maskers have politicized what should be an evidence-based public health policy decision. Giving up on mask mandates (in situations where they are shown to be effective) is what would undermine confidence in public health policies.
Why would we want to give up on a tool that has been shown to mitigate the spread of a pandemic?

Well said.

Amen. But during Covid, some of it just hasn't been.
When I go into indoor venues, I wear a very good and well-fitting mask, an Australian one that is very easy to breathe through and was tested as 99% effective in filtering out Covid viruses, for up to 12 hours of wear (continuous or otherwise). Even when damp they're far easier to breathe through than an N-95.
Very few employees and other customers mask at all, and some of them wear them draped loosely on their upper lips.
The interesting thing, though, is that people seem to have internalized physical distancing. For those who haven't, I don't hesitate to ask for space.

"... public health officials should turn their attention to other solutions, whether that’s improving air quality in public spaces or developing new vaccines and antiviral drugs. Fighting the last war is a good way to lose the next one, and we’ve all spilled too much rhetorical blood on this particular battlefield already." Max Fawcett
__________

This is fundamentally poor advice and inadequate analysis for a journalist. Dangerous, in fact, because it couches opinion as science. Masks are just as important as increasing the standards for indoor ventilation and continuing research into vaccines and anti-virals. They are part of the same package that protects the significant part of the population that has compromised immune systems and other susceptibilities. The majority may be vaccinated and relatively healthy, but they have no right to attempt to force uninformed opinions into the realm of professional public health policy just for their convenience.

Fawcett cites Joe Rogan as a key influencer of opinion, and now Fawcett practices nearly the same damned thing on this platform. Public advice on health science should be left to scientists with multiple levels of research backing their advice, not journalists or pollsters. I rank this with Fawcett's other flawed and poorly crafted opinions on CCUC and urbanism.

Don't agree? Then I challenge Fawcett (better yet, the most radical anti-mask convoyers) to take a maskless tour of the Level 5 viral research lab in Winnipeg where you have ebola, Marburg, TB, several kinds of SARs (including COVID-19 variants) and other deadly bugs kept alive for research into, among other things, new vaccines. These folks are not only double or possibly triple masked, they wear space suits pressurized with air that went through several micro filters and, I suspect, UV light treatment. A mask is a filter, and N95 masks are, according to most epidemiologists, still effective in the checkout line at Home Depot.

A member of my immediate family is immune compromised. COVID is still circulating all over the world. We know at least eight people who got COVID in the last three months, and the majority were unmasked on airplanes or public gatherings. Wearing masks indoors and in crowded outdoor occasions is now habitual for us and no big deal, though we now do not fly and avoid scheduled gatherings. It is no more inconvenient than putting on a pair of gloves on a cold winter day. To us, wearing one is the farthest thing from being a political statement. It's about staying alive, and avoiding the effects of long COVID.

A decision to take our masks off permanently will not be made on the opinion of any journalist, but on the professional published research of several top epidemiologists.

"Wearing masks indoors and in crowded outdoor occasions is now habitual for us and no big deal, though we now do not fly and avoid scheduled gatherings. It is no more inconvenient than putting on a pair of gloves on a cold winter day. To us, wearing one is the farthest thing from being a political statement. It's about staying alive, and avoiding the effects of long COVID.:"
Amen to that!
You don't need a PhD in molecular biology to understand that a filter that blocks viruses will prevent them from getting up your nose, or prevent you from exhaling them all over your neighbours. It is no coincidence that influenza infections were severely reduced during the time of mask mandates. And Rogan should certainly take the Ebola challenge.

Haha, agreed. And good point about there being no flu season.

So Max, you are saying we might as well give up on masking as a public health measure, because so many people don't believe it works, and there's so much pseudo-science out there to inspire folks to resist mask mandates, and because people use masks badly anyway, so what the heck. Is that about right? When the next Covid variant (let's imagine a deadlier one) comes down the pike, will your advice to Tam and Henry be, hey, just give up, that ship has sailed? This is a foolish, fuzzily constructed, short-sighted, irresponsible and damaging article.

I didn't read it that way because one of his links refutes the Cochrane guy effectively, but why is everyone so ready to attack the author's basic credibility as a journalist when he's mainly just exploring salient topics with fresh takes from more sources that they just don't bother reading?!
The thing with this Cochrane guy is interesting because it speaks to how easy it is to subvert a narrative, which may have been Max's point, and an instructive one even for us rightly smug progressives with the better and kinder narratives to keep us on our critical thinking toes, reminding us of our own susceptibility to confirmation bias. And as always it shows that there can absolutely be too much bloody information....
But we really should employ this tactic with all the conservatives who, despite being the primary and most avid authors/perpetrators of lies/DIS information, not to mention the most mean-spirited among us, have nonetheless somehow managed to co-opt FAR too many accepted political narratives. Like the one about THEM being the go-to guys for the economy, which is simply not true statistically but I just heard Naheed Nenshi this morning on CBC resignedly stating it anyway in the context of the upcoming provincial election, but he also missed an opportunity to insert the truth. CBC has supposedly garnered a "wider" audience by introducing uber right-wing nasty Jeremy Farkas to "debate" with Nenshi, so it couldn't have hurt....the truth should be stated whenever and wherever possible for one's own sanity if nothing else.
This Cochrane guy is clearly a senior type with an organization generally considered reputable who can be seen as having superior expertise, giving him more room to appropriate an alternative narrative that flies in the face of everything. But that doesn't mean he isn't mainly looking for attention and/or really needs to retire.....

Yes, Fawcett did link to a critique, but he also said, ""... public health officials should turn their attention to other solutions [than masks] ..." That is where he crossed the line into promoting the irresponsible notion that opinion = fact = policy.

The most important facts to me is this: my immune compromised wife gets COVID, she (i) dies, or (ii) gets long COVID, risking incapacitation. That means the only advice we'll ever take on this pandemic is from peer-reviewed and tested medical science, not from some journo in an online magazine citing controversial research and pollsters.

I hear you and empathize with your situation that a lot of older people share. But as far as dumping on Max Fawcett being the salient thing here, I insist it's petty and shallow, especially when people don't bother reading his links. What I took from his comment about public health officials looking elsewhere, I really think he was just displaying some of the yawning fatigue we all have now, not only with covid but with this whole misinformation/disinformation thing (we've never had so many new words for lying) but are also astounded at how glibly and shamelessly it's done, bringing that famous phrase "the banality of evil" to mind more clearly than ever before in most of our lives. And yet it is still believed, wholesale! It's disorienting, utterly exhausting, and truly dispiriting. So I took that comment to be a bit of throwing up of hands that I find myself doing more now than ever. Because "the centre is not holding," as Yeats said, a bizarro world has actually manifested, and it's quite terrifying to people who pay attention and have witnessed the transformation over time.
What should be the upside is that the right wing and religion, not at all unrelated, have been thoroughly outed as the red-handed culprits willing to run roughshod over the truth itself, despite it arguably being all we really have in our eggshell lives. "Truth is beauty, beauty truth...."
And this openly egregious act has been made exponential by "social media." It's aligned with the search for (now there's an engine for that) public/personal affirmation (you "believe"that too, right? Right?) but also for political power. The downside is that it's succeeded exponentially as well because many people simply lack any meaningful context for this unprecedented time we're living in, a time of "polycrises."

The "guy" isn't Cochrane; Cochrane is a database of generally widely accepted and generally good meta-reviews.
Much of Canada didn't have outbreaks of the first SARS virus. In Toronto, we did. One of the nurses couldn't find an N95 mask, which staff were required to wear when exposed to SARS patients, and so "double-masked" with a procedure mask: the blue or yellow ones one sees many wearing. FWIW, she died.
Covid was first identified in China as "a SARS-like pneumonia." The individual who discovered it was sent to jail for discussing it on a message board for doctors and researchers. It was in an English version of that site that I first came across mention of the ACE gene in connection with Covid. The researcher had used ACE-knockout mice to "calibrate" his studies, and they didn't get sick from the virus, while other strains all died. It was quite a while before the published science here even mentioned it.
I still question the advisability of using the spike protein, binding to ACE2 receptors, as a target for vaccines. It's not as though their functionality is negligible to human health and survival, or that they can be "done without" for a while, while they're busy with the virus or the vaccine. I expect that at least some of the long-term vaccine sequelae (and there are more than one might think: you have to go searching for the science, and be sensible about where you search). That's not to knock the vaccine: it's clearly been overall a good thing. But it's not been equally good for all people who've taken it.