Thursday, March 9, 2023

Those Masks Again

Environmental & Science Education, STEM, Health, Medicine, Nature of Science

Ed Hessler

A column with the audacious title, "The Mask Mandates Did Nothing. Will Any Lessons Be Learned?" (New York Times, February 28, 2023" is attractive enough - clicky baity - that it could do without the typical bold, large font size column headings.

I was going to write about it but others have and well so here is a short reading/viewing list.

The author is New York Times columnist Bret Stephens. It was published as a commentary in the StarTribune with a different but clever title, "Truth Unmasked, at Last" that I thought hyperbolic. (subscription required to view).
This short list is by no means comprehensive:

--The original published scientific study, Physical Interventions to Interrupt the Spread of Respiratory Viruses. It is from The Cochrane Library, an organization that describes itself as having an international reputation "as the benchmark for high-quality information about the effectiveness of health care." The article may be read in full at the link and it has some reader aids.
--The StarTribune editorial page column regarding the Stephens's column. It is completely accessible; no walls. 
--The StarTribune editorial (linked above) referred readers to a podcast with UMN epidemiologist Michael Osterholm who is interviewed by Chris Dall. You may listen and/or read it. The section on the Cochrane study is well done and has a thorough discussion of flaws in the study (and of Cochrane Library as an impartial research organization). This section begins at 38 m 52 s and ends following the discussion at 45 m 59 s (times also noted in the transcript).

--An interview with journalist Maryanne Demasi and the lead author of the Cochrane study, from which Stephens quotes. Demasi is an investigative medical journalist with the credentials for an informed interview. 
--"Masks Revisited" from Science-Based Medicine. Includes comments on the CochraneLibrary study.

My short list emphasizes a point I was going to make as emphatically as I could about the Stephen's column that this is a population or community study. It too easily leads to the conclusion that individual masking-does-not work. Well, as many studies have shown, masking works and is effective in protecting the wearer and others IF worn properly (not under one's chin or held at by the ear strings) and is of high quality. The IF is really important and the mask needs to fit, gap free around the nose and the lower face and jaw.

The other point is that about half of the column is on what Stephens calls "the mindless adherence" by policy makers and institutions especially the CDC who supported the mask mandates" and their reliance on the "chance that mask mandates in the United States would get anywhere close enough to the compliance level necessary to reduce transmission in a way that could be measured" (this is not a direct quote but comes from Stephens essay). He rails against the idea of "doing something" early on and making it public policy. This, he reminds us, is not science. 

The interview with Maryanne Demasi also provides you glimpses on how science works. You may also be reminded that as the late science educator Mary Budd Rowe observed (paraphrase): Science is a social enterprise but not always sociable.
Finally, I return to the original Cochrane review. The sentence beginning the conclusions reads.  "The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions." (my bold)
And yet the lead author is very forceful when interviewed  about what the study showed. Stephens didn't include it in his reporting. It seems important to me. Furthermore, the lead author finds no ambiguity at all. Truth?  Science at any level study - a single one in the laboratory or field or at the much more complicated level of the community level - draws conclusions that are tentative and based on the evidence. Some hint of tentativeness in the conclusion would have been welcome.

We have seen and will see more studies claiming that decisions made during the peak of the Covid pandemic were wrong. It reminds me that policy making under conditions of lack of knowledge and uncertainty are difficult. There are too many unknowns at the time decisions must be made. And not enough time to do the research to provide helpful leads to decision makers.

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