What with the ongoing arguments (I won’t even call them “debates”) about masking, I thought it would be interesting to try and give the arguments for masking a fair presentation, along with my reasons for remaining unconvinced.  Note: this isn’t about whether governments should mandate masking, its about whether/how much masking actually helps.

One caveat:  the only way this was going to get finalized and submitted was if I wrote it from memory, based on what I have seen and read over the past months.  It is sadly lacking in links, simply due to lack of time (and my inherent laziness).  I am confident the Glibertariat can remedy this shortcoming.

New Cases Stopped Rising and Started Falling

I see this one a lot now that new cases have rolled over pretty much everywhere in the US.  The argument typically refers to a handful of states where the correlation between a masking order and the rollover are actually pretty good, including Arizona.  I confess I haven’t done the legwork to see how masking orders line up with new case rollover in other states.  And, of course, there is a big caveat: masking orders are not the same as actual masking.

There also seems to be a correlation between mass protests and a rising trend in new cases.  This correlation could support masking and other lockdown orders – behavior inconsistent with those orders followed by an increase in new cases is not exactly an argument that the orders have no effect.  I wonder, though, the extent to which an activity by a very limited demographic group can be the basis for a broader trend.

Correlation is not causation, of course, but it can be pretty suggestive.  We are fortunate that we have a kind of control group for masking orders – states (and countries) that never had masking orders.  And we see bell curves in all those places that look a lot like the bell curves in places with masking orders, the same kind of bell curve that is typical of all epidemics/pandemics.  If anything, the bell curve in areas without masking orders is a little flatter – the rise to the peak is not as steep, and the peak rolls over more slowly.  This raises the very distinct possibility that the apparent correlation between masking (orders) and new case rollover is spurious, an epiphenomenon.

Also of interest, very few in the US thought masking was effective against respiratory epidemics until a few months ago.  The only new information that could support this about-face were the studies showing:

Masking Reduces the Spread of Droplets/Virii

For correlation to graduate to causation, you generally need a proven mechanism that connects the observed result with what is claimed to generate the observed result.  We’ve all seen the flashy graphics in the reporting on studies showing masking reduces spread of droplets/virii appear to provide that mechanism.

Do these studies support the conclusion that masking caused the observed rollover in new cases?  Well, leaving the spurious correlation problem aside, there are issues with making this leap.  First, there is still no scientific study that actually shows that masking reduces actual transmission.  Not one.  There are a number of reasons why, even if you grant that masking reduces droplet spread, it doesn’t reduce disease transmission, or at least not much.

One of those reasons is that it takes a lot of discipline to actually protect yourself against a virus like SARS-2.   To get the benefit of a mask, whatever that may be, you need to wear a good mask the right way.

The SARS-2 virus can also be spread by contact, typically getting it on your hands and touching your face or getting it in your eyes.  I constantly find myself unconsciously resting my hands on counters or surfaces in public that have been touched by god knows how many people.  If anything, wearing a mask causes people to touch their faces even more, because masks are uncomfortable.

The level of discipline it takes to protect yourself against an infectious disease is far beyond what people are demonstrating in the wild.  In hospitals, the training and auditing on PPE use and handwashing is relentless.  The dirty secret of  N95s is that they have to be properly fitted, which is not easy, and for some people proves nearly impossible.  A properly fitted and worn N95 is quite uncomfortable.  Out in the wild, there is no training and very little discipline, so even the optimal level of reduced spread that might be observed in a laboratory setting is going to be reduced.

Masks Postpone Some People Getting Sick

There are three potential benefits from postponing illness, and one problem.

First, was the hope that the SARS-2 virus would not be heat tolerant, and would go away in the summer.  This has turned out not to be the case.  Along these same lines, there is the hope that the SARS-2 virus will do what other coronaviruses have done, and mutate into a less virulent form (there are apparently evolutionary advantages to that).  This hasn’t happened yet, but it’s still a possibility.

Second, that our ability to treat COVID will improve over time, so its better to get sick later than sooner.  This has proven out, at least for the very sick who get hospitalized.  Length of stay and mortality rate for hospitalized COVID patients is down, although some this is likely attributable to more recent patients being younger and more resilient than the early cohorts.

Third, that we will develop a vaccine.  There is much chatter about the current vaccine trials, and who knows?  We may actually develop the first-ever effective coronavirus vaccine.

The ultimate goal in any pandemic, though, is herd immunity.  Postponing people getting sick is postponing herd immunity and prolonging the pandemic.  To the extent masks delay herd immunity, they are actually counterproductive, especially if “artificial” herd immunity via vaccination is delayed or never happens (such as with SARS-1).

It Doesn’t Do Any Harm, and Might Help 

Well, its not entirely clear that masking doesn’t do any harm.

It increases the concentration of CO2 for the wearer, which is admitted in a backhanded way by the exception from the masking mandates by people with COPD and other breathing problems (who also happen to be a high risk group; one would expect these mandates to be applied first to high-risk groups, not last).  It also increases the re-inhalation of bacteria and virii that they breathe out.

Masks also make communication more difficult.  People with hearing problems (and I suspect many people who don’t)  rely to some degree on lip-reading.  Masking also muffles your voice.   Arizona bizarrely has an exception from its masking mandates for people with hearing problems.  Not wearing a mask doesn’t improve your hearing; the problem is everyone else wearing masks.

And, of course, there’s the nonverbal communication that masks reduce.  Put on a mask, and people can’t see your face and what it expresses while you are talking (or even not talking).

Which leads me to my biggest objection to masking:

Masks are Dehumanizing

While I believe that the current tension and incivility in our country is  based mainly on fear and anxiety about COVID, to some extent it is also a result of so many people being masked.  In and of itself, dealing with masked people causes some level of anxiety, but its more than that.

Masks make people faceless.  Someone wearing a mask isn’t fully a person to other people; they are to some degree anonymized, depersonalized, a fungible person-unit, an “other”.  And nobody treats “others” as well as they do “real people”.  I think its no coincidence that the fundamentalist Muslim societies who force women to wear the full niqab treat women terribly.  The snapping and snarling that has become a prominent feature of the current unpleasantness can be chalked up in part to the fact that so many people are masked.

Masks also make people (feel) unaccountable.  Masks not only let you hide from others, they also let you hide from yourself.  The KKK wore hoods, not because they were particularly concerned with being identified and prosecuted, but because it made them more terrifying to their victims, and allowed them to do things that they might not have done bare-faced.  Outlaws, criminals, and even many police units also go masked.  In part, this is to avoid identification (although the extent to which SWAT teams and the like are under threat off the job is questionable), but I think it is also done because it is easier for masked people to do violence to others.  Nobody wears a mask to be kind and good and charitable.  A mask is a new face, a new persona, one that you can use, and then take off.  Masks don’t just dehumanize you to others, they also dehumanize you to yourself.  As I said, the snapping and snarling that has become a feature of the current unpleasantness can be chalked up in part to the fact that so many people are masked.

Masks have also become a vehicle for enforced conformity, which is also dehumanizing.

The dehumanizing effect of masks is, of course, unquantifiable, but I think its real, and a real problem.  And a good reason to require a strong case that masking has real benefits.  A case that I don’t think has been made.