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Mask Mandates: Bret Stephens Gets It Wrong

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The New York Times ran a misleading opinion piece by Bret Stephens this week on the benefits of mask mandates, citing a Cochrane meta-analysis that came to inconclusive findings on whether wearing masks stops or slows down the spread of all respiratory viruses. Still, Stephens used the review paper to announce that “mask mandates did nothing.” 

Public health experts quickly responded to clarify the issue. 

JULIA RAIFMAN; JRaifman@bu.edu
    Raifman is an assistant professor of health law, policy and management at Boston University’s School of Public Health. She conducts research on how health and social policies shape population health and health disparities.

LINSEY MARR; lmarr@vt.edu 
    Marr is a professor of civil and environmental engineering at Virginia Tech.

Marr told the Institute for Public Accuracy: “I fear that some members of the public will interpret the Cochrane review and the discourse surrounding it as the final conclusion that masks don’t work. The problem is that people want to see this as a binary issue.” Last year, Marr stated: “Masks work vs. masks don’t work. Both sides are right and both are wrong because masks are neither 100% nor 0% effective.”

    “None of the studies reviewed [in the Cochrane paper] actually looked at the effect of a mask mandate. Many of them looked at studies involving healthcare workers who were instructed to wear a mask when interacting with patients, but we can presume that the healthcare workers did not wear masks at other times, such as when socializing, eating or shopping outside of work. It is quite possible that the subjects were infected at other times when they were not wearing masks and that the effect of mask-wearing would be diluted as a result. It’s like wearing a condom some of the time but not all of the time.”

Marr noted that there are other studies that have come closer to looking at community-wide masking measures, which found a “lower incidence of infections when masks were used.” A counter opinion may also be in works, which would clarify “that there is strong evidence that an individual can achieve a high level of protection through consistent wearing of a good-quality, well-fitting mask, while the effect at a population level will be lower due to lower adherence to proper, consistent mask use.”

Raifman spoke about the policy level. She told the Institute for Public Accuracy: “We have to look at the full body of evidence––and think about logic… Engineering evidence supports [the idea that masks] reduce spread. Masking is especially important for the person who has Covid,” including those who unknowingly have it. At this point in the pandemic, we have many “rigorous studies on this [that have been conducted] at very different periods in the pandemic.” We find that “mask policies do make a big difference in reducing spread.” Masking “together,” Raifman noted, “is much more effective than masking alone. Masking alone is a last resort.” Raifman added that the public needs a “good grasp of the facts” to then determine “when it is worth implementing the policies.” That includes Covid policies but also policies for other airborne diseases. (Scientists are currently concerned that the transmission of avian flu, for instance, which spreads from birds to humans, could at some point shift to an airborne disease capable of spreading directly between humans.)