The worship at the church of the mask
Another in-depth analysis of masks as a defense against Covid-19 is out, and it comes with conclusions much the same as those in the Cochrane analysis in January.
The newest analysis, a “systemic review” published in the peer-reviewed Annals of Internal Medicine, gives masks a little more support than the Cochrane review, saying that “updated evidence suggests that masks may be associated with a small reduction in risk for SARS-CoV-2 infection in community settings.”
The operative words there are “may” and “small.” As the study points out, there have been few controlled studies of masks but a lot of flawed observational studies prone to the biases of the researchers.
The main conclusion of the Annals authors was that better studies are badly needed before anyone can say anything definitive about masks.
“Studies should use appropriate methods for diagnosing SARS-CoV-2 infection, describe key mask characteristics, evaluate adherence, and assess harms as well as benefits,” they wrote.
What is most interesting about all of this is not the new studies, but the reactions to the new studies.
Cochrane studies have long been considered a research gold standard, but the blowback on the Cochrane mask study was such that Cochrane felt forced to issue a post-study statement saying “that the results were inconclusive. Given the limitations in the primary evidence, the review is not able to address the question of whether mask-wearing itself reduces people’s risk of contracting or spreading respiratory viruses.”
All the Cochrane study could and did conclude was that there is no good evidence that masks do much of anything to change the infection rate. The latest study added to that with the conclusion that if there is any change in the rate, it’s small.
The reactions to this study as to the Cochrane study have been dishearteningly predictable with masking’s true believers claiming the studies are wrong, non-believers embracing them as support for their stance against mandatory masking from the beginning, and those in the middle, who think there might be some situations where masks help at least as personal protection, pigeon-holed as heretics by both sides.
It’s like the Catholics, the non-believers, and the Protestants of Europe in the 16th and 17th centuries. Science be damned, Galilelo, the sun does revolve around the earth.
Anyone skeptical that we’ve once again, as a species, strayed this far into NeverNeverLand, should go read the comments on the latest study posted at Medpage Today, where comments are limited to supposedly science-trained members of the medical establishment.
“This study should never have been published,” writes DrSHB. “Ultimately, it is only looking at a bunch of other studies which examined whether masking policies work, not masking itself. In almost no cases do they have data to show the numbers of maskers vs non-maskers, did people mask all the time, etc. Are we going to start telling surgeons and surgical staff to stop wearing masks? What about in the transplant unit or the NICU?”
“Most of those folks who say ‘Masks don’t work’, have not worn masks and have had Covid at least once,” wrote Dru. “I listen patiently to them talk to me explaining why they don’t wear a mask, and then in the next breath tell me how many of their family members have suffered with Covid.”
“I am a healthcare provider and transplant patient so I always mask and avoid crowds,” wrote Mary_Kay_Grosskopf. “Sadly our health system has made masking optional so I am one of the few but I don’t care. Masks make a huge difference in both contracting and spreading COVID. Fortunately I have not contracted it yet as my immunosuppressants make the vaccines I have received less effective and I am at high risk for severe infection. I feel the immune compromised or frankly any thought of others has sadly been left out of the discussion for many.”
And when Michael John pushed back with the response “just don’t force me. I don’t disparage you for wearing one don’t disparage me for not. the evidence provided over the last few years is inconclusive,” there came this from Dr_Kenneth_Merena:
“I know this is stretching the analogy a bit, but I hope you get the point. May we force you to NOT go 100 MPH down a crowded street? If so, then why can’t we force you to take an action that could expose your fellow human beings to a potentially deadly virus?”
Ah yes, why can’t we force everyone to drive 3 mph on all city streets which would pretty much eliminate any of the potentially deadly collisions that now leave thousands of vulnerable road users seriously injured every year in the U.S. and kill 23 of them per day, according to the National Highway Traffic Safety Administration.
Or force everyone to give up their guns, so no one is ever shot in America again; and their knives, so no one is ever stabbed to death again; and their baseball bats, so no one is ever beaten to death again?
Why can’t we force everyone to subsist on 2,000 calories a day to end the epidemic of obesity costing the country an estimated $1.72 trillion per year, and force them all to run, or at least walk, a minimum of 20 miles per week to reduce the plague of heart disease that costs the country another $240 billion per year and kills an American every 33 seconds, which makes the Covid-19-causing SAR-CoV virus look like a slacker?
One can have a lot of fun with the “why can’t we” argument for imposing restrictions on the masses in the interest of saving lives. But the why-can’t-we argument coming from supposedly scientifically trained people when the scientific evidence indicates the restrictions don’t do much, if anything, is craziness.
Wearing a mask has nothing to do with driving 100 mph down a crowded street. It doesn’t even get over the bar of driving the speed limit through an urban area though collisions involving people driving the speed limit still result in deaths.
And this from the people who were screaming “listen to the scientists” during the height of the pandemic.
These are people who’ve since ceased to think like scientists and are people thinking like religious fundamentalists: “We believe, and therefore it is.”
Value in belief
Not that belief should be scoffed at. There is value in belief.
The study in the Annals of Internal Medicine did suggest that masking might produce a 10 to `18 percent “risk reduction,” which is not hard to believe. Such a reduction would be in line with placebo effect norms, and the placebo effect cannot be underestimated in observational studies both in terms of reporting and results.
If you believe the mask is protecting you, the odds are much better it will protect even if that protection only amounts to your ignoring minor symptoms associated with an infectious disease that the vast majority of people survive.
I actually had someone tell me during the height of the pandemic that they’d gotten sick but “knew,” it wasn’t Covid-19 because they’d been wearing a mask everywhere. And we now have some medical professionals, see those Medpage comments again, arguing that “yes, masks weren’t as good as we hoped. They DID prevent a bunch of influenza, saving some lives there.”
Never mind that flu case numbers are hugely variable from year to year – from 9 million to 41 million per year, a factor of almost five, according to the CDC – or that social distancing and people actually staying home from work for a change if sick, or working remotely so they didn’t have to be around others to begin with, could be expected to do far more to reduce influenza infections than any sorts of face coverings.
No, let’s not let science confound or mask worship.
The sad consequences of such worship is writ best in the lack of good studies of masks during the pandemic because of fears of going against the politics of the moment as Danish researchers discovered. As a result, we now don’t really know any more about masks than we did after the investigation into the Covid-19 outbreak on the USS Roosevelt aircraft carrier way back in March 2020.
Researchers investigating the infection that tore through the ship did find indications of limited protective values for both masks and social distancing, the latter despite the fact social distancing is difficult aboard ship.
“Face coverings (53.8 percent vs 67.5 percent) and social distancing (54.7 percent vs 70 percent) decreased the infection rate but did not halt spread in the closely confined spaces with a crew engaged in the high-paced operations of an aircraft carrier at sea,” researchers wrote in a commentary on the JAMA Network in October.
This amounts to a 13.7 percent reduction in risk of infection for those wearing masks, but the study is somewhat flawed by the participation of only 382 members of the crew and confounded by the fact that of the 4,800 sailors aboard the ship, only 1,326 or about 28 percent were found to have been infected despite the close quarters.
And 590 of those 1,326 or 44 percent didn’t know they had been infected because they were asymptomatic, meaning they didn’t get sick.
The data to support the idea masks would stop the spread of the disease, an idea subsequently and heavily promoted with the pitch that “my wearing a mask protects you,” didn’t exist then and hasn’t materialized since according to both of the latest studies.
The best that can be said is that in a community setting masking might have helped.
At this time, the best real-world data that exists for comparing differences between the masked and unmasked comes from Sweden, which became something of a global pariah for refusing to order masking, and from Norway, which took much the same stance with little notice.
At this time the Swedish death rate since the beginning of the pandemic stands at 2,377 deaths per million; the rate in the U.S. – where mandatory masking was ordered – is more than 46 percent higher at 3,478 per million, according to the Worldometer tracker.
The Swedish death rate is higher than that of its Scandinavian neighbors, but lower than that of every other European country but Germany, which has a death rate of 2,074 per million. Norway, where there was also little masking, has the fourth-lowest death rate in Europe. Only Belarus, Iceland and the Fareo Islands are lower.
The Norwegian Institute of Public Health (NIPH) “emphasized physical distancing, and proper hand and cough hygiene. The authorities have neither recommended, nor advised against, the use of facemasks as a general precaution,” according to the World Health Organization (WHO). “A returning message has been that it is more important for people to continue to uphold physical distancing and hand hygiene.”
Oslo, the capital city, did recommend the use of facemasks on public transport in August 2020 and mandated them in September of that year, the WHO added, but “in accordance with NIPH’s recommendations, facemasks have neither been recommended nor mandated for children under 12 years of age during the pandemic.”
The country did, however, shut down most public life, banned large gatherings, sharply restricted movements within the country, largely closed its borders to foreigners to prevent the spread of the virus, and initiated an aggressive testing and contact-tracing program.
Given these differences, it’s hard to compare Norway to the U.S., and any comparison of the U.S. to Sweden is confounded by the fact the average resident of that country is fitter than the average U.S. resident.
This has a huge effect on the death rate in what has been a pandemic of the old and unfit. Fitnesses has mattered. Ignore any mainstream media reporting you read suggesting Covid-19 was or is an equal-opportunity killer.
It isn’t and never was.
As of this writing, according to the latest CDC data, there have been 13,248 Americans under the age of 40 – including 408 under the age of 18 – who have died of Covid-19 since the pandemic began three years ago. They represent 1.2 percent of total Covid-19 deaths.
For those under the age of 18, unintentional injuries, such as being run down by motor vehicles; homicides, primarily shootings involving teenagers; and suicides, remain far greater threats than Covid-19.
According to CDC data, injury deaths for under-18s account for about 5,900 deaths per year, more than 43 times the annualized number of Covid-19 deaths at 136 per year. Homicides deaths claim about 2,500 per year, more than 18 times the annual Covid-19 number. And, sadly, about 2,200 under 18s – 16 times the number dead from Covid-19 – take their own lives each year.
Meanwhile, of those over age 40 dead of Covid-19, many if not most of the deaths can be traced to comorbidities (or what were once called chronic diseases), many linked to lifestyle choices, and immunosenescence, the natural decay of the immune system as humans age.
The latter has become the focus of an increasing amount of research because of the importance of natural T-cell responses in battling the SARS-CoV-2 virus and the link between those cells and exercise in people of middle age.
A group of scientists from the University of Arizona in January reported finding a key link between T-cells and exercise. Their work was published in the peer-reviewed journal Brain, Behavior & Immunity – Health under the title “Exercise mobilizes diverse antigen specific T-cells and elevates neutralizing antibodies in humans with natural immunity to SARS CoV-2.”
They noted the major role that physical activity has played during the pandemic “as those who are physically active have less acute morbidity, decreased mortality, fewer hospitalizations, and less severe symptoms. Indeed, the CDC now lists physical inactivity as an underlying condition for increased risk of severe illness from COVID-19. However, the mechanisms by which exercise is capable of reducing disease severity and potentially ameliorating symptoms of COVID-19 have yet to be determined.”
They went on to say they’d found the mechanism in the T-cell boost provided by exercise.
“We show here, in a larger cohort of naturally infected participants, that exercise reliably mobilizes cross-reactive SARS-CoV-2 virus-specific T-cells (VSTs) in an exercise-intensity dependent manner,” they said.
The elephant in the room
With the U.S. response to the pandemic focused on selling masks and vaccines, what has gone largely undiscussed are changes in behavior that could significantly boost natural defenses against the new but now-here-to-stay coronavirus and do much to protect Americans against not only it but other infectious diseases – both old or new – plus cardiovascular disease, which remains the nation’s number one killer.
Behavior has gone almost unmentioned despite the growing body of evidence that getting Americans up and moving – instead of sitting on their asses staring at computers or TV screens – would be a giant step down the road to better public health in general.
The latest research in this regard comes in the form of a study published in April in the peer-reviewed British Journal of Sports Medicine finding that exercise is not only highly protective against Covid-19 but also against influenza and pneumonia, infectious diseases that were regularly killing Americans before Covid-19 arrived on the scene.
Although the study was published in a British journal, what it looked at was physical activity and death from influenza and pneumonia among a sample of 577,909 U.S. adults.
All were participants in the National Health Interview Survey from 1998 to 2018, according to researchers from the CDC in Atlanta and the Brooke Army Medical Center in Houston.
During the years they participated in the study, “1,516 influenza and pneumonia deaths were recorded,” according to the researchers.
Those deaths tracked directly with exercise in a dose-related manner. People who engaged in as little as 10 to 149 minutes of aerobic activity per week had a 21 percent greater chance of survival than those who didn’t exercise, the researchers reported, and the value of exercise as a live-saver kept going up until it topped out at 600 minutes (or 10 hours) per week.
Risk reduction at the now recommended 150 to 300 minutes of exercise per week nearly doubled from 21 percent for minimal exercise to 41 percent and then climbed to 50 percent at 301 to 600 minutes (5 to 10 hours) per week before dropping back to 41 percent for those apparently overdoing it at more 600 minutes per week.
Related to this, the researchers also found that people engaged in muscle-strengthing activities at least twice a week had a 47 percent lower risk of death from the flu or pneumonia relative to those doing nothing.
They did, however, caution that it was easier to overdo the muscle-strengthening exercise than the aerobic exercise with the former displaying “a J-shaped relationship” wherein mortality went up beyond two days.
Those who went to the gym to pump iron seven times a week or more actually had a 41 percent higher risk of death from the flu or pneumonia.
Sadly, the researchers said that among the people involved in the study – 69.2 percent of whom were non-Hispanic whites and 52.2 percent of whom were women – “roughly half (50.5 percent) did not meet either the aerobic or muscle-strengthening guidelines.”
None of these findings – other than the positive effect of even limited exercise – is really new the researchers admitted.
“…Paffenbarger and colleagues dichotomized 3686 San Francisco longshoremen in 1951 as ‘low energy workers’ (4,750 – 8,250 kcal/week of occupational physical activity) or ‘high energy workers’ (8,500 – 10,750 kcal/week). In the following 22 years, the latter group experienced a 74 percent lower adjusted risk of pneumonia mortality.
“Among 24,656 adults who died of natural causes in Hong Kong during the 1998 influenza epidemic, respiratory and cardiovascular mortality was lower among those who had reported moderate levels of exercise during a baseline health assessment in 1988, compared with those who had reported no exercise.
“A longitudinal study of 83,165 US women found a 25 percent lower age-adjusted incidence of community-acquired pneumonia among those in the highest quintile of walking, compared with those in the lowest quintile, and walking appeared protective against pneumonia mortality in a longitudinal study of 110,792 Japanese adults. Zhao and colleagues reported a 54 percent lower adjusted hazard of influenza and pneumonia mortality among US adults who met both aerobic and muscle-strengthening guidelines, compared with neither.”
What also appears to remain unchanged – despite the high mortality in the wake of the Covid-19 pandemic and the number of still masked-up Americans living in fear of catching that disease – is the number of Americans unwilling to get off their asses and exercise to protect their own health.
In this, Americans followed a global, pandemic trend, according to researchers who published in the peer-reviewed Journal of Global Health in April of last year. They reported exercise declined almost everywhere even as lockdowns provided people more time to exercise.
“The overall physical activity levels dropped significantly worldwide during Covid-19, including decreases in light, moderate and/or vigorous, and total physical activity,” they reported with the exception of one study showing increases among confined university students.
“Other studies,” they wrote, “suggested a significant decrease in the proportion or the number of participants who met the recommended physical activity level during the pandemic, confirming the significant impact of COVID-19 on public health.
“Further, COVID-19 has resulted in significant decreases in daily step counts, outdoor physical activity and outdoor play, and exercise/sports.”
There was, however, one glaring exception.
“Of the 10 studies reporting significant changes in walking and biking during the Covid-19 pandemic, ” they wrote, “one study that focused on runners and cyclists demonstrated that daily pedestrian (ie, running, walking, and hiking) and cycling recreational activity increased by 291 percent in Oslo, Norway during the Covid-19 lockdown. The other nine studies indicated significant decreases in walking during confinement.”
It almost forces one to wonder if the low Covid-19 death rate in Norway could have something to do with Norwegians being smarter (or at least less lazy) than most everyone else.