In my September 10 article “Who Should We Listen to About Coronavirus?”, I addressed a September 2 New York Times article that asserted that only epidemiologists and infectious disease experts are qualified to offer policy advice on how the government should respond to the epidemic of SARS-CoV-2, the virus that causes COVID-19. I explained why that argument was not only fallacious but dangerously irrational.
The target of that Times article was Dr. Scott Atlas, whom the Times also criticized for his views on universal mask-wearing policies. According to the Times, we should instead trust the judgment of Dr. Anthony Fauci, the director of the National Institute for Allergy and Infectious Diseases, who has urged state governments to be “as forceful in possible” with executive mask-wearing orders. We should instead trust Dr. Deborah Birx, an immunologist and vaccine developer in the State Department who likewise “has been advocating rigorous rules on wearing masks”.
Under a headline declaring that Atlas has “Unorthodox Ideas” and an article description calling him “a coronavirus contrarian”, the Times criticized him for having “argued that the science on mask wearing is uncertain”. His view on mask use is “both ideologically freighted and scientifically disputed”, and it’s an idea that Fauci, Birx, and Surgeon General Jerome Adams consider “misguided” and “dangerous”.
As a newly appointed member of the White House coronavirus task force, Atlas has “argued over the science of mask wearing.” In one of his first meetings, “As Drs. Fauci and Birx maintained that drops in caseloads reflected public health measures such as social distancing and mask-wearing, Dr. Atlas insisted that peaks and declines could have merely been the virus running its course, senior administration officials said.”
The Times criticized Atlas for telling Tucker Carlson on Fox News that “The reality is that there’s certain data that’s very controversial about masks,” and for “railing against the ‘massive amount of fear bordering on hysteria.’”
The New York Times didn’t cite any studies to support its implicit claim that the science on universal mask use among members of the public is firmly settled, only the contrary opinion of Fauci, Birx, and Adams.
While the Times didn’t clarify, Dr. Atlas does advocate the use of masks to reduce transmission of SARS-CoV-2. The fundamental difference between his view and that espoused by the Times is that his view accounts for individual variance in risk and the right of individuals to make their own choices depending on their own unique circumstances.
The Times quoted Atlas saying that there is scientific controversy about masks but didn’t explain what controversy Atlas was referring to. He was talking about state policies of recommending or mandating universal mask use by members of the public.
“In certain settings,” he proceeded to explain in the interview with Tucker Carlson, “it’s reasonable to wear a mask when you cannot social distance, and particularly if you’re trying to protect—[if you’re] at proximity to a high risk individual or you are a high risk individual.” Such a recommendation is “a rational policy”.
However, both he and Carlson commented, you often see people wearing a mask while driving alone in their car or while alone outdoors running. Atlas further commented on such irrational behavior by saying, “It’s stemming from a massive amount of fear bordering on hysteria now. And this is a real problem because public policy is supposed to be taking into consideration not just stopping COVID-19 at all costs but understanding the impact on people of what you do and what you say.”
“The reality is there are reasons to wear a mask,” Atlas went on to say, but if driving alone or in other circumstances mentioned by Carlson, it is “not really rational to wear a mask.”
Elaborating on his point about universal mask-wearing policies being controversial, he said, “There’s no real good science on [the] general population, widespread, at all circumstances wearing [of] masks.”
Referring to the World Health Organization, he pointed out that “WHO itself says there is no sound science for general population wearing masks. However, in certain settings, I think we can say it’s reasonable to wear a mask.”
More recently, on September 18, Dr. Atlas told CNN that “there’s no sound science that shows that you should have all populations wear a mask in all circumstances.”
Indeed, the WHO observes in its mask guidance document that “the widespread use of masks by healthy people in the community setting is not yet supported by high quality or direct evidence and there are potential benefits and harms to consider”, including the potential for wearers to increase their own or others’ risk of infection through improper use of the mask.
The WHO made that observation after a study it funded was published in The Lancet, which was a systematic review and meta-analysis that summarized “the best available evidence” on the use of masks to prevent transmission of novel coronaviruses (SARS, MERS, or SARS-CoV-2).
The review turned up no randomized controlled trials, only observational studies, which aren’t as well able to control for innumerable variables that might affect outcomes and are thus prone to selection bias, or non-randomization that can result in invalidation of findings.
Most of the studies on masks were relevant to the health care and not the community setting. None of the few studies relevant for non-health-care settings examined the use of masks to prevent transmission of SARS-CoV-2. All of the studies examined the effectiveness of masks considered personal protective equipment (PPE); none considered the effectiveness of the kinds of cloth masks that policymakers have been telling members of the public to wear and that are not considered PPE. All were relevant to the use of masks to protect the wearer, not as source control in the community setting to prevent the wearer from transmitting the virus to others.
The WHO mask guidance document comments on the meta-analysis by noting that there are “intrinsic biases” in observational data and that, even if “considered indirect evidence for the use of masks (medical or other) by healthy individuals in the wider community”, the available studies “suggest that such individuals would need to be in close proximity to an infected person in a household or at a mass gathering where physical distancing cannot be achieved, to become infected with the virus.” (Emphasis added.)
As a logical corollary, the use of a mask in circumstances where one does not have prolonged close contact with others is pointless.
Again, the New York Times cites no studies supporting its claim that universal mask-wearing orders are evidence-based policies, but instead relies on the fallacy of appealing to its preferred authorities, who’ve argued “that drops in caseloads reflected public health measures such as social distancing and mask-wearing”. The Times scorns Dr. Atlas for insisting “that peaks and declines could have merely been the virus running its course”. But the Times makes no effort to demonstrate why we should reject Dr. Atlas’s alternative explanation.
To be sure, what the Times is implying is that correlation equals causation, which is a distinctly unscientific argument. Just because numbers of reported cases declined after an executive mask-wearing order is implemented does not mean that it was the policy that caused the decrease in case numbers.
For example, by the time a mask-wearing order was issued in New York on April 17, the epidemic in New York City, the hardest-hit location in the US, had clearly already peaked, with case numbers already declining. Indeed, the decline was more precipitous before the mask order than after, so if we are to accept the Times’ implicit argument that correlation equals causation, we must conclude that the mask order hindered the slowing of transmission. Here is what the data looks like graphed:
In sum, the view expressed by Dr. Atlas is precisely the same as the mask guidance from no less authoritative a source than the World Health Organization, which likewise recommends the use of masks in certain circumstances when prolonged close contact with others is unavoidable while also observing that policies recommending or mandating the universal use of masks by the public are unsupported by scientific evidence.
Consequently, the New York Times’ characterization of the science as having been settled in favor of executive mask-wearing orders is unequivocally false.
[Correction appended, September 23, 2020: As originally published, this article stated that the executive mask-wearing order was implemented on March 17. It was April 17, as shown on the graph.]