Sunday, December 6, 2020

The TSAP's New Updated Position On Face Mask Mandates

NOTE:  The following shall fully supersede any positions taken or advice given prior to December 1, 2020, and shall remain in effect until further notice.

With the CDC doubling down on universal face mask use 11 months into the pandemic, and President-Elect Joe Biden wanting Americans to wear masks during his first 100 days in office (which will not even start until January 20, 2021, thus lasting until April 30, 2021), it is time for a fresh review of the TSAP's position on face masks and any mandates thereof.

From April/May until August 2020, the TSAP had enthusiastically supported broad but nuanced, relatively short-term mask mandates, primarily as a safe pathway out of lockdown.  Since then, in light of recent evidence, our position has gradually shifted.

A cursory review of the empirical evidence so far reveals that while masks may very well be marginally effective at the micro level, they apparently are practically insignificant at the macro level, at least in the long run.  To wit, as the charts here so clearly show, broad mask mandates do not appear to have had any noticeable impact on the course of a country, state, or locality's epidemic curve.  To name a few, Hawaii, Illinois, LA, Miami, Kansas, Wisconsin, Israel, Japan, Spain, Argentina, and most notoriously Peru all have seen no beneficial long-run impact on cases (which actually increased at some point after implementation, even in conjunction with strict lockdowns in some cases), and the same was ultimately true for deaths and hospitalizations as well, except for Hawaii and Japan whose death rates remain unusually low for reasons not yet fully understood.  As for Czechia, the crown jewel of early mask mandates, it appears to have only worked the first time in conjunction with their early suppression strategy in the spring, but not the second time around when the virus came roaring back in the fall.  Ditto for Slovenia, a fortiori in fact.  France and Italy's second waves were also a milder version of this phenomenon.  Meanwhile, mandate-free Sweden, Denmark, Norway, North and South Dakota, Georgia, and the parts of Florida without local mandates don't seem to have had worse trends overall compared to many places that have such mandates.  And until very recently, The Netherlands as well, having gone until December without a broad mask mandate.

And we certainly do NOT support any federal mask mandates in the USA at all, period.  They are not only constitutionally dubious at best, but as noted above there is simply not nearly enough evidence in their favor to justify such unprecedented federal government overreach even temporarily.  Fortunately, even Joe Biden himself has largely walked back his initially strong support for such federal mandates.

Furthermore, on November 18, 2020, the much awaited Danish mask RCT study was finally released and published three months late in the Annals of Internal Medicine.  And the results were, shall we say, rather underwhelming, and not statistically significant (i.e. not statistically different from null).  Not necessarily the final word, but hardly a ringing endorsement for the effectiveness of general mask use in the community at the macro level.

A recent Cochrane review of the literature is not exactly reassuring either, to put it mildly.

But what about source control, you say?  That is, protection of people around the wearer, which most studies were not designed to look at?  Again, a cursory look at the data in the weeks and months following the implementation of mask mandates doesn't really support that either, at least not at a general population level.  Thus any such community benefit is likely either very small, very transient, or both.

Thus, we can conclude that even if there is some overarching benefit to wearing masks in some situations, universal community masking (or lack thereof) is nowhere near the game-changer it was originally sold as.  If it were, the pandemic would have been effectively over in a given locality, state, or country (even as it raged elsewhere) within two or three weeks following the implementation of a broad mask mandate.  And that has not happened anywhere in the world, even in places with very high (90%+) compliance, and even when combined with a ban on indoor restaurant dining (a behavior which might vitiate the results).  And as of November, the TSAP believes going forward that mask wearing (outside of a healthcare setting) should be largely (if not entirely) voluntary, and that businesses of any kind should be free to decide whether or not to require employees and/or customers to wear them.  And they certainly should not be government-mandated in private residences, as that is a truly massive and unprecedented overreach, not to mention unenforceable.

What consenting adults do in their own private residences with each other or their guests is none of the government's business, period.  Alas, the progressive left seems to have regrettably forgotten that in the fog of pandemic.  Let people of reasonably sound mind choose to take the risks they feel comfortable with when in private, at the very least.  As for the supposed externalities when a guest or host of a private gathering or visit inadvertently and unknowingly infects someone who then infects someone who infects someone (and so on) who dies or becomes severely ill, there are enough degrees of separation that unless it was at the very beginning of the pandemic (nearly a year ago globally, and at least nine months ago in the USA), the virus would already be so widespread that in the grand scheme of things such unfortunate people would likely have caught it regardless.  Thus, it would still be well within the realm of what modern civilized and free societies tolerate as acceptable risks, for better or worse.

And while we shouldn't have to dignify this with a response, we will note that the idea that people should wear masks during sexual activity is just plain silly because if you're getting that close to someone for that long, presumably indoors (or in a vehicle), it's more like the mask is wearing YOU for protection, not the other way around.  Even if it's the vaunted N95 or KN95, in fact.  It's like wearing a helmet while skydiving, as the old Seinfeld joke goes.  Thus you might wanna just simply take a rain check on such activities for now if you are that concerned about the virus, at least with people outside your "bubble".

Riddle me this:  if masks work so well, why is six-foot distancing still needed?  If six-foot distancing works so well, why are masks still needed?  If both work so well, why are lockdowns and closures still supposedly needed?  And if lockdowns worked so well the first time, why do we need to do it again?  If they did not work the first time, why are we doing it again?  Why still nearly a whole year into the pandemic when the curve was clearly flattened many months ago? And of course no measure can logically be both "Swiss cheese" and the "most effective tool we have" at the same time, unless one were to tacitly admit that all such measures are largely ineffective in practice, meaning that even the "most effective tool" would be largely useless.  Give the zealots enough rope...

(Oh, and masks are not exactly eco-friendly in the long run either, by the way.  The very same folks who want to quickly phase out plastic bags, containers, straws, etc. seem to have a real blind spot here.)

Thus our current position is that mask mandates from any level of government should only be imposed on bona fide local red zones, with nuance, and even then only for two or three weeks at a time.  That's it, full stop.  Children under the age of 12 should be exempt in any case, both in school and otherwise.  And after January 1, 2021 at the latest, all existing mask mandates in green zones ought to be rescinded or allowed to expire, though voluntary recommendations can still remain in effect.

Our best advice?  "Use masks judiciously, NOT superstitiously", pretty much sums it up.

2021 UPDATE:  The much-ballyhooed CDC mask mandate study has now been utterly debunked as of March 4, 2021.  And just a few days later, another one bit the dust as well.  And this debunking is basically Strike Three after 1) the underwhelming Danish mask study even after it was clearly "nerfed" to get it past the censors, and 2) a cursory comparison of states, localities and countries that had vs. did not have mask mandates before and during this past fall and winter.  Spoiler alert:  the mandates were a big nothing in terms of effectiveness.  From the looks of it at face value, Fauci may have indeed been largely right the first time when he initially pooh-poohed masks and actually told us not to touch our faces, and we're certainly old enough to remember that.  And it's not like mask mandates have actually led to faster reopenings or averted lockdowns either.  So whatever merits there are to individual mask wearing in whatever circumstances, there is no valid reason for any government to force them on anyone (outside of a healthcare setting), period, and it should be left to individuals and businesses to decide for themselves. 

By the same token, it looks like the WHO was also right the first time in that regard as well.  Even as recently as July 2020, believe it or not.

Kinda like when they let it slip in June 2020 that truly asymptomatic spread, while possible, is a lot rarer than most people think, a mere 0.7% even in that very closest and riskiest setting of all, within households.  Only to be forced to walk it back the very next day, of course.  And outdoor spread?  A vanishingly low 0.1% of cases.  And fomites (surfaces)?  An even lower still < 0.01%, and probably even less than that if people wash their hands and don't touch their faces or keep fiddling with their masks!  All for a disease with an infection fatality rate within the ballpark of a nasty flu season for most people, and that we know now how to treat effectively.  This is what the actual science says.  And it utterly demolishes the need for lockdowns, closures, mask mandates, or any other New Abnormal restrictions at this juncture, period.

See also here as well for a good explanation of the crucial difference between large droplets (that masks do seem to work for) and much smaller aerosols (which basically go right through and/or around essentially ALL masks other than properly fit-tested N95s).  It is the latter that seem to be a bigger driver of transmission, unfortunately, and worse, since they tend to penetrate deeper into the lungs, they also tend to make you sicker too.  Thus, we should not be at all surprised by the null effects of universal community masking at the macro level.  In fact, even the "variolation" theory is basically turned on its head as well--larger droplets would probably provide better "variolation" than aerosols would, ironically.

As for children, see here for a good and thorough debunking of the notion that forcing them to wear masks in school and elsewhere is somehow necessary, effective, or benign.  Even the WHO says that children under 5 years of age should not wear masks at all, children ages 6-11 should only wear them in certain circumstances, and children of any age with various kinds of disabilities or health conditions should not be required to wear them at all.  The CDC, on the other hand, apparently prefers to steamroll over anything even remotely resembling nuance in that regard.

See also here as well for an excellent article about how continued universal masking may even be harmful in the long run for all ages.  All the more reason NOT to make this practice permanent in any sense, and to phase it out completely in nearly all circumstances. We ignore actual science at our peril.

1 comment:

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