A study revives debate on masks: Twitter explodes, public is 'befuddled;' prevention may depend on how they're worn

To be effective, masks need to be worn correctly. (Jacek Poblocki, Unsplash)

Haven't the questions about masking been asked and answered? "Or at least that we had all agreed to disagree, but no such luck," writes Felice J. Freyer of The Boston Globe. "The debate over whether masks limit Covid-19 transmission recently reignited after a new review of the research came out, drawing out skeptics and defenders, and — as so often happens — leaving the ordinary citizen befuddled."

How did this get started — again? "A British outfit known as the Cochrane Library put out a new report on masking. When the Cochrane Review, which is highly respected in medical circles, tackled the mask question, it found that "wearing a mask may make little to no difference in how many people caught a flu‐like illness/Covid‐like illness," Freyer writes. "But the review encompassed primarily studies conducted before the pandemic, which examined the spread of influenza. The flu is far less contagious than Covid-19, which could lead to underestimating the effects of masks. The review also mixed studies of health-care workers with those involving the general public, and included studies that couldn’t answer the question of whether people actually wore their masks correctly."

Who's causing the fuss? "Twitter erupted with criticisms. Then one of the Cochrane Review authors was quoted in a Substack newsletter article saying of masks, "There is just no evidence that they make any difference. Full stop." . . . The Substack interview prompted New York Times columnist Bret Stephens to scold all those who favored mask mandates, saying they owed the world an apology. That unleashed another round of social media outrage. . . . But as others have pointed out, there’s no evidence that masks don’t make a difference. The big problem is that there isn’t enough evidence, period."

Wait a minute; what do masks prevent? “We have good evidence from laboratory studies [that] if you’re wearing a mask correctly and you’re in the presence of the virus, the mask will protect you,” Jennifer Nuzzo, professor of epidemiology at Brown University School of Public Health, told Freyer. Commenting on the Cochrane Review, Freyer added, “The appropriate conclusion is, we don’t have great evidence showing that masks change infection rates in populations. But we don’t know why that is. It’s probably not to do with masks themselves, but how they’re worn.”

What did Dr. Anthony Fauci, former director of the National Institute of Allergy and Infectious Diseases, say about the Cochrane study? “It’s a meta-analysis of a very large number of studies, many of which had nothing to do with Covid, and many of which did studies with masks that were not regularly worn every day and properly,” Fauci told Freyer. “There were only two studies in that entire meta-analysis that were exclusively looking at masks with Covid.”

Could I get a straight answer? "The basic advice hasn’t changed. Wear a mask in situations where you think you’re at risk of infection, such as a crowded indoor setting, especially during a time when Covid transmission is high," Freyer reports. "The level of that risk is determined by the level of transmission in your community, your own vulnerability to severe illness, the vulnerability of people you expect to come in contact with, and your personal tolerance for risk."

Final thoughts? Fauci told Freyer, “Everyone is different. Everyone’s risk for a complication is different. So there’s no set rule.”

How older Americans can navigate the continuing pandemic will be the topic of a webinar at noon Tuesday, Oct. 11

Kaiser Health News and The John A. Hartford Foundation will host a webinar centered on older people and the state of the pandemic, which can be confusing, the Kaiser Family Foundation announced Wednesday. The presentation will be begin at noon ET Tuesday, Oct. 11. Learn more and register here.

The webinar will tackle questions like: "Is it over? Are ongoing precautions warranted? Should older adults get boosters? Should they continue to wear masks, and under what circumstances? What kinds of social interactions are safe and which may not be? How can older adults and their family caregivers best protect themselves in the months ahead, including over the holidays?"

Kaiser Health News columnist Judith Graham will moderate the event, which will have a panel of experts and a question-and-answer session. The panelists are:

• Dr. Sharon Brangman, distinguished service professor of geriatrics medicine at SUNY Upstate University Hospital
• Kathryn Haslanger, who runs JASA, one of New York City’s largest social service agencies, serving more than 40,000 older adults
• Jessica Kelley, a sociologist at Case Western Reserve University, with a focus on health disparities
• Dr. Eran Metzger, head of geriatric psychiatry at Hebrew SeniorLife
• Dr. Céline Gounder, an epidemiologist and infectious-disease specialist
• Richard Gard, a lecturer in music at Yale University before he was hospitalized in intensive care after contracting Covid-19 at the start of the pandemic.

'I don't know if the virus will kill me or it's going to be my rage" at anti-maskers, asthmatic clerk in rural store says

Lori Wagoner at her workstation (Photo by Eamon Queeney, The Washington Post)

Lori Wagoner, 63, never expected that her job as a retail clerk in a small North Carolina town would become so dangerous. But as she told The Washington Post for a July 18 package of 12 oral histories from the pandemic, covid-19 has drastically changed her job responsibilities.

Wagoner told reporter Eli Saslow that she has asthma, and if she got the novel coronavirus, she’d have an increased chance of developing a severe version of its disease. Thus, North Carolina’s mask mandate is crucial to her health, and she says about 95 percent of her customers have followed signs outside the store and worn a mask, but many of those who don’t have not been kind to her. Many are coastal visitors from cities: "They come here to have a good time and maybe they’re drinking. Some of them would see our signs, open the front door, and just yell: “F--- masks. F--- you.” Or they would walk in, refuse to wear a mask and then dump their merchandise all over the counter."

She relayed one encounter that spiraled downhill: “He rolled his eyes and ignored me, so I knew where it was going. . . . He said he just wanted to buy a drink. I said, ‘Okay, that means I will get your drink while you wait outside and I will bring it to the door.’ But he’s still moving into the store, and I’m trying to stay in front of his path and keep him from going down the aisle. He said, “Come on, lady. I just want water. I said: I’m tired of this. Just leave the store now.’ He kept moving toward me, yelling, ‘ADA exemption, ADA exemption’,” referring to the Americans with Disabilities Act that protects people with disabilities -- but not mask mandates.

“And now my body was starting to shake. It was fear and so much anger. My co-worker was yelling for him to get out, and another customer started yelling, and finally he stomped around for a while and then turned back outside. We locked the front door and my co-worker and I went back into the storage room. We sat there and sobbed.”

Now, at this small store on the coast of North Carolina, in a town Wagoner apparently didn't want to name, a customer has to ring a doorbell to enter. And next to her, behind her register, is pepper spray. With the local sheriff’s office refusing to help enforce the mandate, she said, she is now acting as enforcer of the mask mandate and ultimate defender of her own life; a retail clerk intimately trained in an array of behaviors from the public in response to a scientific and public-health effort.

“I don’t know if the virus will kill me or if it’s going to be my rage,” she said. “Sometimes I want to cut America into different pieces, and all these anti-maskers can live together, and we’ll see how it works.”