In spite of mixed messaging at the beginning at the pandemic, most public health officials have recommended throughout the pandemic that people wear face masks to help slow the rate of transmission of COVID-19. What should have been a simple scientific question of efficacy became marred with politics. The pre-pandemic understanding of face mask usage was that healthy individuals masking up did nothing to stop spread (Desai and Mehrotra, 2020). It became apparent early on in the pandemic, at least for me, that N95 and surgical masks were more effective than cloth masks. But maybe COVID was different from past respiratory infections. At the beginning of the pandemic, it made more sense to take on the precautionary principle until we knew what we were dealing with, both in terms of the disease burden of COVID and the effectiveness of masks.
Some facets have changed and others have stayed the same since the beginning of the pandemic. One notable aspect of the face mask debate that has not changed is that the evidence base for cloth face masks is still low (see my analysis on the existing face mask research here, here, here, here, and here). As I pointed out in December, face masks have been shown to somewhat slow down droplet transmission, but lacks correlative evidence in terms of affecting infection outcome. While I was supportive of a temporary face mask mandate at the beginning, my agnosticism on face masks went from in favor of the mandates to being against them by the time that the Delta variant reared its ugly head. Given the low evidence base, I cannot state that they do not work, unlike with ineffective and harmful lockdowns. At the same time, I cannot say that they do work either. At best, the cloth face masks had minimal impact on COVID transmission. A University of Minnesota review of face masks concluded that "it should be well-known by now that wearing cloth face coverings or surgical masks, universal or otherwise, has a very minor role to play in preventing person-to-person transmission. It is time to stop overselling their efficacy and unrealistic expectations about their ability to end the pandemic." At worst, wearing the face masks was performative and an attempt to force compliance with government fiat to keep people in line.
Whichever scenario it may be, I can say that two major features have changed since the beginning of the pandemic. One is our ability to respond to COVID is better for two reasons: improved treatments and vaccines. Vaccines are especially important because they are the single-most important public health measure that has helped reduce severe COVID cases, COVID hospitalizations, and COVID-related deaths.
The other facet of this pandemic that has changed since the beginning has been the variants have been more transmissible. Delta was more contagious than the Alpha variant. I personally did not think that it would be probable, but there was a strain that is even more transmissible: Omicron.
Thankfully, the preliminary data show that the omicron variant is less likely to hospitalize than Delta. Its increased infectivity show that it still remains a threat to healthcare systems in the short-run. But if the United Kingdom and nations in southern Africa, the places furthest along in the omicron wave, are an indication of anything, the omicron wave very well could drop as quickly as it rose. Omicron's high transmissibility can also mean that enough people will incur natural immunity that it can, combined with vaccine immunity, put us at a place of herd immunity, as the Lancet points out (Murray, 2022).
But what about until we reach the point where the pandemic becomes endemic? Are the masks doing anything to help slow the spread of omicron or have we reached the point where cloth face masks are a form of public health theater or virtue-signaling? Arguments against cloth face masks only seem to have gotten stronger with the latest variant, and experts are starting to understand that cloth masks have minimal to no positive impact. CNN medical analyst Dr. Leana Wen, who has been strict with COVID-related public health measures, said last December that cloth face masks are nothing more than facial decorations and are not appropriate to fight COVID. The Kaiser Foundation admits that cloth face masks are not going to cut it with Omicron. The Mayo Clinic has begun requiring patients and visitors wear more effective masks in lieu of cloth masks. Although the CDC does not bother to quantify the effects, its latest mask guidance finally admits that cloth face masks are less effective than other mask alternatives.
The projections at the University of Washington's Institute for Health Metrics and Evaluation (IHME) show a minimal impact. IHME has the COVID death count at 5,955,911 as of January 5, 2022. With its current projections, it predicts the global death toll will increase to 6,326,655 people. IHME projects that even with 80 percent face mask usage, it will reduce global deaths by 18,183. This means that at best, masks could reduce COVID deaths over the next four months by 4.9 percent. This would imply that face mask usage will have minimal impact, certainly relative to what face mask proponents would wish for.
What does this all mean? Have we finally met a virus so transmissible that face masks make little to no difference? Can we accept that COVID is here to stay? England has at least realized the futility of face mask mandates and has lifted their mask mandate. Sweden never had a face mask mandate; it dropped its face mask recommendation last summer. The United States seems to be going in the opposite direction. Although the U.S. government had been hoarding 750 million N95 masks, it is looking to finally ship them out. That is subpar timing considering that the New York Times declared a couple of days ago that Omicron is in retreat. Yet one of Biden's campaign promises was to "shut down the virus." If I had to guess, the Biden administration is doubling down to seem tough on that campaign promise, although the upcoming midterm election cycle might change the administration's tune in the upcoming weeks.
I cannot predict which direction the Biden administration is going to take. If I were to be cynical enough, I would surmise that Biden will declare victory over COVID shortly before the November elections to give the Democrats running for re-election the best chance. On the other hand, intransigence, lack of political will, and fear might keep this country on the stringent end of public health measures.
I pointed out back in October that this pandemic will not formally end until we as a society can start to accept risk again. If the Biden administration's continued response to this pandemic and face masks is an indication of anything, it means that we as a society most likely have the majority of 2022 to deal with the fear-mongering, the inaccurate insistence that we can eradicate COVID, and the continued moving of goalposts to some unattainable utopia. The continued emphasis on face masks, in spite of highly questionable efficacy, signals that the U.S. government will be in pandemic mode after the metrics improve. I wonder how many more months or variants it will take for the COVID fear-mongers to realize the folly of their take on the pandemic. Time will tell, but given the Biden administration's handling of the pandemic, I am not optimistic.
No comments:
Post a Comment