The Science and Politics of Masks

How "The Science™" made breathing out a subversive act

There are few COVID-related hornet’s nests that I haven’t kicked yet. So why stop now?

Before COVID, being afraid to exhale around others was an issue only for smokers. But breathing out without a mask is now seen as a dangerous and subversive act.

Here in Nova Scotia, it is currently still not “safe” to be in an indoor public space without a mask. Because you will kill grandma. Even though she is vaccinated. Three times. And has her mask on. And is six feet away.

Magically though, as of 12 midnight on March 20th, it will be perfectly safe to take our masks off. At 11:59:59 on the 20th, you will be putting others in grave danger if you don’t wear it. At 00:00:01 on the 21st, you can be morally upright and unmasked at the same time, for the first time since the summer of 2020. Because, y’know, Science™ and all that stuff...

Talking about this could quite possibly get me in hot water (more than I’m already in). So why bother speaking out when the end of masking has already been announced? Why not just shut up and let masks fade away into memory like hula hoops, pet rocks, or chia pets (OK, chia pets are still cool...)

I’m pushing back now because I strongly believe mask mandates should never, ever happen again. I see them as a symptom of how when COVID came into the building, common sense and real science fled out the back door.

Rather than be angry that our personal freedoms were taken away for what appears to be a near-zero benefit, it seems we will we simply be thankful to the Great Overlord for allowing us to once again breathe out and enjoy our God-given freedom to see each others’ faces. Mask mandates may be re-instituted in a heartbeat. Thus, these articles are still necessary.

The masking issue is complex and controversial, and therefore I’m going to write this in several parts: a 7-course meal rather than a stew. (One of my favourite self-deprecatory jokes: What is a Cape Breton 7-course meal? - A 6-pack and a pizza. We are not known for high culture)

First, I should say that by writing this, I am potentially violating the spirit of a notice we Nova Scotia physicians got from our regulatory college in March of 2021. This is the relevant part:

Physicians continue to meet their professional obligations of complying with public health COVID-19 guidance. As well, physicians on the frontlines are providing important education to their patients regarding public health safety and vaccination information. The vast majority of the profession is modeling compliance and as such there has been little problem with anti-maskers or anti-vaxxers. The College wishes to recognize the leadership that physicians are playing in supporting this unanimity so key to our success in combating COVID.

(As an aside, “unanimity” is antithetical to scientific debate - more on this soon from Julie.)

Note that the college does not define what an “anti-masker” or an “anti-vaxxer” is. Miriam-Webster updated their definition of “anti-vaxx” to include anyone who is against vaccine mandates. So the College could conceivably use just as expansive a definition of “anti-masker”.

Given that I’m about to write extensively arguing against mask mandates, anti-maskerdom, here I come!

I have spoken to physicians supportive of the ‘unanimous’ approach to COVID “suggested” by the college. Such physicians seem to believe that average citizens are neither interested enough to listen to a complex message, nor bright enough to understand it. So we have to dumb it down for them. A message like “Masks don’t really make a difference, unless you are actively sick or around someone who is in an enclosed and poorly ventilated space for a period of time” gets shortened to “Thou shalt always wear masks”. Nice and simple. Even those drooling troglodytes who don’t want their 5 year-olds vaccinated, they opine, can understand something that clear.

Masking Science - before the flip-flop

We started the pandemic with public health telling us that masks cleary did not work. Luminaries such as Theresa Tam (chief public health officer of Canada and she of “wear masks if having sex” fame), Anthony Fauci, Bonnie Henry (chief medical officer of health for British Columbia) all told us not to wear masks. There is a great mash-up of this message being repeated by Bonnie Henry, ending with her flip-flop on the issue. In fact, we were told by St. Fauci and others, masks were probably WORSE than nothing because they made you touch your face more.

Fauci later recanted and said he had lied to the public in order to save masks for healthcare workers - it was for our own good, don’t y’know. Other public health luminaries simply started contradicting the advice they had given a week, or even a day, earlier. They did not feel an explanation was required (see the Bonnie Henry video link above). Public Health COVID rules started to feel like a game of Simon Says, rather than science-based recommendations.

Be suspicious when The Science™ turns on a dime. Real science doesn’t. When we use real science, a body of evidence develops over years or decades. This evidence has momentum. One study can’t - shouldn’t - suddenly overpower years of accumulated scientific data. Smoking will not suddenly cease to be dangerous next week if one new study suggests so. It can’t be unsafe to send kids back to school on a Friday, then suddenly safe on Monday. It can’t be unsafe to be bare-faced on Sunday and safe on Monday. Politics can change that quickly, but not science. Political winds are fickle and change direction suddenly after new opinion polls or backroom discussions. As I’ve said before, mix science with politics and you get politics.

Pre-pandemic mask science was quite clear

We did have very large body of research, or “scientific momentum” on masking. Numerous studies over many decades (mainly looking at influenza) showed that universal masking was not helpful. Should you wear a mask when you are sick and coughing, and have to be around other people? Sure, probably. But should every well person walk around masked all day during flu season? There is no evidence for that – even in hospitals. And that’s why respiratory pandemic guidelines from the WHO, CDC, and other organizations were clear on that issue. Until COVID, and what I will call the Great Mask Imperative suddenly struck.

on February 25, public-health authorities in the United Kingdom had published guidance that masks were unnecessary even for those providing community or residential care: “During normal day-to-day activities facemasks do not provide protection from respiratory viruses, such as COVID-19 and do not need to be worn by staff.” About a month later, on March 30, World Health Organization (WHO) Health Emergencies Program executive director Mike Ryan said that “there is no specific evidence to suggest that the wearing of masks by the mass population has any particular benefit.”

(from a City Journal article well worth reading)

Early Pandemic

Here in NS, we made frantic preparations for what we thought was going to be the bubonic plague, or something close to it. Apocalyptic scenarios on the news from Bergamo Italy and then NYC had us scared witless (or something that rhymes with ‘witless’). Quite quickly we in hospitals decided that we should mask, gown, and glove when seeing any patient with COVID-like symptoms. (As an aside – the glove/gown/scrubbing down surfaces thing turned out to be unnecessary, since this is not a fomite-driven disease – ie: it passes through the air and not significantly by touch or surfaces. Regular handwashing is fine).

Wearing protection around sick people, back when we thought this disease was an incredibly deadly killer of people of all ages and health statuses, was logical to me. We had already been in the habit of doing that with potential dangerous respiratory pathogens such as TB, and during some tense months during SARS version 1.0 back in 2003, when I worked just outside Toronto. I had numerous nervous ER shifts in the early COVID pandemic making sure my “PPE”, including my mask, was on properly whenever I went near anyone in the least bit sick. I was even grumpy and demanding with coughing patients who didn’t have their mask on properly.

But something felt strange. Donning PPE had never felt like a religious ritual during SARS-1, but it started to feel that way. We had been careful back then, but not terrified. But with COVID, doctors that I know and respect became hyper-paranoid, worrying their clothes were contaminated and arguing for “clean rooms” akin to level 3 biohazard facilities for changing in and out of their work clothes before and after shifts. And this was after the evidence had already come out regarding the average age of death from COVID.

Evidence-based policy, or Simon Says

Suddenly, and with no supporting evidence provided, we were told to wear our masks at all times in the hospital. I asked for the evidence, and was told “because the committee decided”, which is not a great scientific explanation, nor does it make one feel like a valued member of the team. We were expected to be masked even when seeing a patient with a broken ankle who was otherwise well, sitting in the break room together, or even sitting at a desk alone writing on a chart. Things got worse and more uncomfortable when contrary to any logic (let alone evidence), plastic face shields were added to the mandatory “wear at all times while in patient care areas” gear.

I found myself in a surreal situation when I attended an in-person meeting with a group of physicians in late 2020. At that time we had a grand total of zero COVID cases in NS outside of Halifax – not one community case in all of Cape Breton where I work, let alone anyone hospitalized. Despite the fact that we were a small group of well people in a huge, well-ventilated room, all sitting 8-10 feet apart – docs sat for almost 2 hours with their masks on. The paranoia had wormed its way into our minds. The scientific/rational part of our brains had been eaten by fear.

Interesting when the masks you are wearing to prevent viral transmission specifically say that they don’t prevent viral transmission. At least the lawyer who developed this wording was being scientifically accurate.

Normally I shout at the TV and radio news. (That’s normal right?) Well, since COVID I started shouting at my podcasts too. A medical science podcast that I greatly respect did a review of masking science. The data they provided suggested that masks had little or no effect in preventing spread of respiratory viruses. These podcasters are normally relentlessly data-driven. But by the end of the podcast they were editorializing and making backhanded comments about Trump, en route to plugging universal masking. Even a JAMA (Journal of the American Medical Association) podcast that I follow started making pronouncements such as “We now now that masks work amazingly!” without any supporting evidence.

Masks leak out of hospitals

In summer of 2020, Nova Scotia announced a universal mask mandate for all indoor public places. This mandate was imposed at a time when we had almost no cases in the province. If we were starting at a time with near zero cases, I had a hard time understanding how we would decide when it was safe to end masking. Where was the “out door”? I predicted that masking would be with us for a long, long time. It felt like real science had died, and like The Invasion of the Body Snatchers, had been replaced by The Science™. By that time we had been under a state of emergency for months, were effectively ruled by one man (unelected and answerable to no one), and our governing principle was “you can never be too careful”.

The first imperative is to look as if you’re doing something

A mask mandate is win-win for governments. They look like they are doing something rather than nothing. When cases stay low or decrease, the mask mandate did it. When cases go up, it would have been worse if it wasn’t for masks. A government that doesn’t force mask wearing will ‘wear it’ if cases rise.

Early in my ER training I was taught an important adage: “Don’t just do something, stand there”. Although there is a strong temptation to act immediately and impulsively in times of crisis, we have to remember that we can easily make things worse. I don’t think public health training includes this lesson.

At a time where there was hardly an active case in all of Nova Scotia, suddenly we were taught - mandated - to treat everyone as if they were a threat, and to think of ourselves as a threat to everyone else. Breathing out was now considered dangerous and irresponsible. Institutionalized hypochondria had arrived. It was mandatory to live in fear of one’s neighbour.

NEXT UP ON MASKS – Absolute versus Relative Risk, or how to sell people things they don’t actually need