Last summer, as the Delta wave was upending hopes that widespread vaccination would end the pandemic, several Democratic-run cities and states in America reintroduced the mask mandates they had ditched earlier in the year. A few other blue states and cities, notably New York, as well as many Republican-led states and municipalities, opted not to require masking again at that point.
This policy divergence created an opportunity to examine the impact of mask mandates. Those areas that rescinded their mandates could function as control groups for evaluating the effect of the policy on cases and mortality. But neither public health experts nor any of the major media outlets took up this opportunity. The reason, most of them would likely have said if pressed on the subject, was there was nothing to learn: “the science” was settled.
For their part, critics of masking and other Non-Pharmaceutical Interventions (NPIs) typically relied on principled assertions of freedom. This gave them little reason to examine the evidentiary basis of these policies, since they would have rejected them on moral grounds even if they worked. Only a few sceptical observers drilled into the data that could be found on sites such as the New York Times — even if the paper’s own reporters made little of it. The most prolific of these was Ian Miller, who over the past two years has published copious data-driven commentary on the track record of various Covid public health interventions.
Miller arrives time and again at the same conclusion: that the ad hoc pandemic mitigation policies rolled out since 2020 have systematically failed to achieve goals. Miller has now compiled one subset of his graphs and commentaries into a book titled Unmasked: The Global Failure of Covid Mask Mandates which focuses solely on the most ubiquitous pandemic containment strategy deployed by governments worldwide: masks.
The endorsement of masking by medical bodies and public health authorities worldwide, Miller shows, entailed the abandonment of a longstanding view that masks were a useless and even harmful intervention. Over the previous decades, numerous randomised controlled trials had assessed the efficacy of masks in controlling the spread of respiratory viruses like influenza, and pandemic simulations had evaluated their potential.
A document published by the World Health Organisation in 2019 framed the results of these studies in no uncertain terms: “there was no evidence that face masks are effective in reducing transmission of laboratory-confirmed influenza”. It’s unsurprising, then, that when the CDC briefed reporters on the pandemic in February of 2020, masking was not even mentioned among the NPIs that might be deployed. The UK government, too, stated early in 2020 that there was no evidence to support masking.
After the CDC and other agencies revised their guidance in April 2020, Dr. Anthony Fauci, by then a staunch advocate of masks, claimed that he and other officials had discouraged the public from obtaining masks to ensure there were adequate supplies for health care workers. Ever since, promoters of masking have cited Fauci’s “noble lie” to account for the abrupt reversal of prior guidance. But as Miller notes, it was not just during the early months of the pandemic that officials said masks were ineffective. They had said so for years, and Fauci had advised against masks not just in public statements but in private emails in early 2020.
In light of the earlier consensus, Miller’s findings in Unmasked should not be surprising. As we might have predicted based on a plethora of trials and meta-analyses published prior to the pandemic, mask mandates have had little to no demonstrable impact on curbing the spread of the virus. Miller reaches this conclusion by comparing areas with mask mandates of longer and shorter duration with each other and with areas that never imposed mandates at all. The results, he shows, simply do not support the standard adage that “masks save lives”.
For example, Los Angeles County, the most populous county in the US, imposed one of the earliest mask mandates in the United States, just after the CDC released its new guidance in early April 2020. By May, the county was requiring masks outdoors as well as indoors and enjoying 96-97% compliance. (It also imposed an array of other strict mitigation measures.) But it had case and mortality rates well above the national average throughout 2020 and 2021. LA currently ranks 3rd among California counties in its Covid death rate, faring worse than numerous counties with mask mandates of shorter duration and lower levels of compliance.
It’s possible to quibble with Miller’s methodology. As he readily acknowledges, we don’t know precisely how LA and other heavily masked areas would have fared against Covid in the absence of mandates, and the fact that mask mandates have tended to be deployed alongside social distancing and other NPIs muddies the water. Miller’s comparisons of LA’s outcomes with those of neighbouring Orange County, which has had no mask mandate since last year but has had lower case and death rates, seem rather conclusive, but a sceptic might note confounding variables such as demographic differences, population density, and so on.
Such criticisms would be more damaging to Miller’s case if the officials and experts who have embraced mask mandates were more modest in their own assertions. Not only did they jettison years of prior research pointing to the minimal efficacy of masking, they also made empirically indefensible claims that masks alone could end the pandemic.
For instance, Miller compiles the astonishing claims made by Dr. Robert Redfield, who directed the CDC until just a year ago. In September 2020, Redfield described masks as “the most powerful public health tool we have”, claimed they offered “more Covid protection than vaccines would”, and stated: “If we [wore masks] for 6, 8, 10, 12 weeks, we’d bring this pandemic under control.” While they may not rule out some small effects of masking, Miller’s charts expose claims such as Redfield’s as delusional propaganda.
Likewise, those sceptical of what Miller’s comparative graphs can teach us should be even more suspicious of the shoddy studies published by the CDC over the past two years. For example, one study claimed to show a decline in Covid cases in certain Arizona counties as a result of mask mandates. But it failed to note that cases declined at a similar rate over the same period in Arizona counties without a mandate. In the months following the completion of the study, moreover, cases rose well above prior levels in counties with mandates still in place. Such studies produced a mirage of success by limiting the period of study, conflating correlation and causation, and avoiding comparisons with non-mandate counties.
The most disastrous failing of the experts has been their lack of curiosity about the actual results of the policies they have staked their reputations on. Mask mandates have been, in Miller’s phrase, “a population-wide experiment”, but few within the US scientific and medical establishment have seemed interested in parsing the resulting data, leaving that task to outsiders like Miller. Astonishingly, there have been just two randomised controlled trials on masking published since the pandemic began. One found no significant effect at all, while the other found a small effect of 11% for surgical masks and no significant effect for cloth ones. The first was largely ignored or dismissed, while the second was optimistically glossed as proving that masks work.
Moreover, even the most bullish case for the technical efficacy of at least some higher-quality masks does not constitute a case for mask mandates, a distinction that most commentary elides. The only way to measure the efficacy of mandates is to look at their actual track record. This is what Miller has done, and the result, he argues, is clear: “mask mandates have demonstrated very little impact, if any, on case curves throughout the United States and in many other international locations.”
Miller is justifiably derisive about the experts who have oversold dubious policies at every turn, but the ironic implication of his book is that much of the expert guidance from prior to 2020 has been vindicated. Before Covid appeared, scientists and officials advised time and again that masks would be ineffective at containing a pandemic respiratory virus, and the evidence Miller has compiled suggests they were correct.
Two years into the pandemic, the experts are now the last to acknowledge the accuracy of their earlier predictions. This raises the question of why they changed course and sacrificed their own credibility in the process. Miller confines himself to the data, and if there’s a limitation to his book, it’s that he does not offer any compelling explanation of why the expert class threw itself a policy it once regarded as worse than useless.
It is not difficult to see why mask mandates proved irresistible to politicians. Masks are the perfect form of hygiene theatre, conveying an intuitive sense of safety regardless of demonstrable efficacy at scale. They also offload responsibility for controlling the pandemic to ordinary people. The overcrowding of ICUs can be blamed on the bad behavior of “anti-maskers”, rather than on the allocation of resources by governments and hospital CEOs. When cases and deaths spike, it is the fault of the citizenry, not the leadership.
The scientific and medical establishment’s uncritical support of masks and other dubious policies is just the latest manifestation of its lack of independence from political imperatives. After several years of finding themselves at the receiving end of rhetorical assaults from rising Right-wing populists, the experts seized on the pandemic as an opportunity to reassert their own status and authority — and that of the liberal-technocratic politicians with whom they are largely aligned.
In the long run, however, the temporary political advantages they gained from this will be outweighed by the discrediting effect of their embrace of censorship, propaganda, and rule by decree. Making us all put masks on was the expert class’s mask-off moment — and what we can see now isn’t pretty.