Since I think it has some bearing on discussions we’ve been having here, I’m going to reproduce this Wall Street Journal op-ed from Joseph A. Ladapo of UCLA’s medical school in its entirety:
A hallmark of Covid-19 pandemic policy has been the failure of political leaders and health officials to anticipate the unintended consequences of their actions. This tendency has haunted many decisions, from lockdowns that triggered enormous unemployment and increased alcohol and drug abuse, to school closures that are widening educational disparities between rich and poor families. Mask mandates may also have unintended consequences that outweigh the benefits.
First, consider how the debate has evolved and the underlying scientific evidence. Several randomized trials of community or household masking have been completed. Most have shown that wearing a mask has little or no effect on respiratory virus transmission, according to a review published earlier this year in Emerging Infectious Diseases, the Centers for Disease Control and Prevention’s journal. In March, when Anthony Fauci said, “wearing a mask might make people feel a little bit better” but “it’s not providing the perfect protection that people think it is,” his statement reflected scientific consensus, and was consistent with the World Health Organization’s guidance.
Almost overnight, the recommendations flipped. The reason? The risk of asymptomatic transmission. Health officials said mask mandates were now not only reasonable but critical. This is a weak rationale, given that presymptomatic spread of respiratory viruses isn’t a novel phenomenon in public health. Asymptomatic cases of influenza occur in up to a third of patients, according to a 2016 report in Emerging Infectious Diseases, and even more patients had mild cases that are never diagnosed. Asymptomatic or mild cases appear to contribute more to Covid-19 transmission, but this happens in flu cases, too, though no one has called for mask mandates during flu season.
The public assumes that research performed since the beginning of the pandemic supports mask mandates. Policy makers and the media point to low-quality evidence, such as a study of Covid-19 positive hairstylists in Missouri or a Georgia summer camp with an outbreak. These anecdotes, while valuable, tell us nothing about the experience of other hairdressers or other summer camps that adopted similar or different masking practices. Also low-quality evidence: Videos of droplets spreading through air as people talk, a well-intended line of research that has stoked fears about regular human interactions.
Rather, the highest-quality evidence so far is studies like the one published in June in Health Affairs, which found that U.S. states instituting mask mandates had a 2% reduction in growth rates of Covid-19 compared with states without these mandates. Because respiratory virus spread is exponential, modest reductions can translate into large differences over time. But these shifts in trajectory are distinct from the notion that mandating masks will bring the pandemic to an end. Based on evidence around the world, it should be clear that mask mandates won’t extinguish the virus.
The most reasonable conclusion from the available scientific evidence is that community mask mandates have—at most—a small effect on the course of the pandemic. But you wouldn’t know that from watching cable news or sitting next to a mother being forced off an airplane because her small children aren’t able to keep a mask on.
While mask-wearing has often been invoked in explanations for rising or falling Covid-19 case counts, the reality is that these trends reflect a basic human need to interact with one another. Claims that low mask compliance is responsible for rising case counts are also not supported by Gallup data, which show that the percentage of Americans reporting wearing masks has been high and relatively stable since June. Health officials and political leaders have assigned mask mandates a gravity unsupported by empirical research.
On even shakier scientific ground is the promotion of mask use outdoors. One contact-tracing study identified only a single incident of outdoor transmission among 318 outbreaks. Even the Rose Garden nomination ceremony for Justice Amy Coney Barrett, which the media giddily labeled a “superspreader” event, likely wasn’t; transmission more likely occurred during indoor gatherings associated with the ceremony.
By paying outsize and scientifically unjustified attention to masking, mask mandates have the unintended consequence of delaying public acceptance of the unavoidable truth. In countries with active community transmission and no herd immunity, nothing short of inhumane lockdowns can stop the spread of Covid-19, so the most sensible and sustainable path forward is to learn to live with the virus.
Shifting focus away from mask mandates and toward the reality of respiratory viral spread will free up time and resources to protect the most vulnerable Americans. There is strong evidence that treating patients early in outpatient settings can be effective, as outlined in a recent American Journal of Medicine paper, but these treatments are underused. Identifying effective treatments for hospitalized patients with Covid-19 is essential, but preventing severe illness before hospitalization will save more lives.
Until the reality of viral spread in the U.S.—with or without mask mandates—is accepted, political leaders will continue to feel justified in keeping schools and businesses closed, robbing young people of the opportunity to invest in their futures, and restricting activities that make life worthwhile. Policy makers ought to move forward with more wisdom and sensibility to mitigate avoidable costs to human life and well-being.
In the perfect, Aristotelian theoretical world measures that provide fractional improvements should always be put in place whether they produce 2% improvements or 25% improvements because, well, those are improvements but in the the messy, complex practical world it is different and there are many more factors that must be taken into consideration. Does the downside risk of the moral hazard introduced by the measures outweigh the gains? An example of the moral hazard to which I refer would be, in the case of mask-wearing, when people engage in more risky behaviors when they’re wearing masks in the mistaken belief that they are more protective than they really are but it also includes the risks introduced by the erosion of the rule of law produced by unenforced mandates or even laws. Both qualitative and quantitative results need to be taken into account. My take, for example, on the outbreak of cases of COVID-19 among White House staff is that it was caused by mistaken over-reliance on testing as a strategy for avoiding the disease.
There is also cost-benefit to be taken into account. The only known way to avoid contracting the virus completely is total isolation. If only benefit were considered, we should all lock ourselves into our homes and not venture out until the virus had vanished. But the costs of that are simply too high—not only would the economy collapse but we would all die of starvation.
I don’t think all of this makes me a “naysayer”; I wear a mask when I’m in stores or in the common areas of the office and on many other occasions simply to set a good example. I invariably wear my masks properly and launder them after use. I also maintain a three meter social distance to the greatest degree possible and avoid social contacts other than with my wife with whom I share my residence to the greatest degree possible. But I recognize that many people are not as coldly rational or completely disciplined as I and act and propose courses of action accordingly.