No Mask, No Dice

Thursday, 21 May 2020

Josh Marshall, writing at Talking Points Memo, “Unpacking the Mask Debate”:

Here’s an article that is very current among mask skeptics. It’s a review by two bona-fide experts, Dr. Lisa M. Brosseau and Dr Margaret Sietsema, writing back on April 1st, a veritable lifetime ago in COVID19 terms. It was published by the Center for Infectious Disease Research and Policy at The University of Minnesota.

The gist is that there’s little to no scientific evidence that masks are effective for the population at large and that what protection there might be is minimal at best. Additionally, they argue that mask-wearing may create a false sense of security that leads people to relax more effect mitigation strategies like distancing and hand washing. So the net effect of mask-wearing may actually be more infections rather than fewer.

If you read the report closely however a few points emerge.

First, it’s not evidence that masks are not effective — few studies really show this or demonstrate it in any clear way — but a lack of evidence for their efficacy. Second, they focus heavily on health care workers, both for available studies about what works and doesn’t and for the standards we should apply for efficacy. Finally, they take a very binary approach to efficacy. They work or they don’t.

As a vocal face mask proponent, I’ve heard something like the above counterargument from a small number of mask skeptics. Basically, the pro-mask argument is that there seems to be a lot of upside to widespread mask-wearing, and effectively no downside whatsoever beyond the initial “this feels weird” social awkwardness and mild physical discomfort. (Pro tip: Keep a tin of Altoids next to your masks.)

We’re waiting for peer-reviewed studies. In the meantime, early studies and anecdotal evidence from countries with established mask-wearing social norms suggest quite strongly that mask wearing is effective. And so if there are no downsides, there really is no argument against universal face mask wearing in public, especially indoors.

One segment of anti-mask crusaders are those who insist that the whole pandemic has been so profoundly overblown that it’s effectively a hoax. This is lunacy — there’s no point arguing with them. No surprise, some of them are flat-earthers too. But there are more than lunatics who are opposed to face masks.

The in-touch-with-reality anti-mask skeptics seem to have latched onto the idea that maybe there are downsides, that wearing a mask might somehow make it more likely that you’ll get infected — the “false sense of security” argument proposed in the article Marshall cites. That’s a plausible hypothesis, and the world is full of counterintuitive truths. E.g. the fact that one typically stays drier walking, rather than running, to shelter in a rainstorm — even though running decreases your exposure time to the rain, it so greatly increases the number of droplets that hit you that you wind up wetter. Maybe wearing a face mask in a pandemic is like running in the rain, the thinking goes, counterintuitively making things worse.

The problem for masks skeptics is there’s no data that suggests this might be the case. A plausible hypothesis is only the start of the scientific method. There is longstanding evidence in Asian countries with mask-wearing norms that, at the very least, face-mask-wearing causes no harm. As Marshall notes, if anything, as evidence comes in, masking-wearing appears to be even more effective than even proponents thought.

I’m old enough to recall when wearing seat belts became mandatory. Roughly speaking, these laws spread quickly from state to state, starting with New York in 1984 and becoming the rule rather than the exception within a decade. (“Live free or die” New Hampshire is the only remaining state that doesn’t require adults to wear a seat belt.)

I recall a similar sort of opposition to these laws as we see now with mandatory face masks. Opposition to compulsory seat belt laws always seemed crazy to me, because the evidence was so overwhelming that seat belts save lives and greatly reduce injuries that it was clearly worth making an exception to the principle, widely held in America, that the government generally shouldn’t tell people what to do. But crazy or not, opposition there was. “Fuck you, I don’t want to wear one, it’s a free country.” Word for word, the same sentiment then about seat belts as now about face masks.

One of the arguments against compulsory seat-belt-wearing was that sometimes wearing a seat belt makes things worse. “What if I’m in an accident and my seat belt gets jammed, trapping me in a burning car?” “I read about a guy who wasn’t wearing a seatbelt and he walked away from a terrible accident because he was thrown out of the car before it was totaled.”

I don’t agree with it, but to some degree I get it: What right does a government that sells you lottery tickets have to tell you that your odds are better if you’re wearing a seat belt?

But there’s a fundamental difference between wearing a seat belt in a car and wearing a face mask in a store. A seat belt really only protects the wearer. There are tangential arguments that society as a whole benefits from fewer car crash deaths and injuries, but the primary reason we have laws requiring you to wear a seat belt is to protect you from harm. Face mask requirements aren’t like that. They’re more like laws banning smoking in restaurants and making drunk driving a serious crime — they protect us all from harm.

From earlier in my childhood, I recall ubiquitous signs at the entrances of stores and restaurants: “No shirt, no shoes, no service.” There were variants, but that exact phrasing was common. I always considered those signs so strange, as I couldn’t imagine why anyone would even want to go into a store or restaurant without a shirt or shoes, let alone need a sign telling them that doing so was not permitted, but I figured it must have been a problem with hippies or something. (There were a lot of old people complaining about hippies long after there were any hippies left to complain about.)

Basically, other than poolside or at a beach, anyone who wants to go into a public establishment barefoot or shirtless is an asshole. It seems pretty clear that the people today angrily objecting to mandatory face masks aren’t really concerned with the epidemiological efficacy of masks. They’re concerned with asserting their perceived entitlement to be an asshole. You don’t need to hang a “No assholes allowed” sign to enforce it as a rule.