The troubling normalisation of mask wearing

Even now, after England (originally I had written the UK) has removed all Covid restrictions and made mask wearing no longer a legal requirement, there are still huge numbers of people walking around, queueing up or sitting alone in train carriages wearing their masks. I am particularly fond of those that continue to wear a mask but do it very half-heartedly just over their mouth…this article is written to implore those still wearing masks to think a little more about the long term consequences of their actions and whether they think this actually contributes to a better and healthier society.

Happy, smiling faces…

This is even more critical now that omicron has been shown to be very mild. Even if you ever so slightly reduced the risk of transmitting something that, for many people just shows up as a positive test result (vs a nasty symptomatic disease), is that worth the real cost?

This has never been “just a mask” and a minor imposition…Let me explain.

Still no empirical evidence

The first problem is that the introduction (and repeated use of ) mask mandates represents the worst part of the pandemic. The moment when scientific debate was lost and when sensible counter arguments become ignored or censored. The point at which there was no thought about secondary consequences and just a Pavlovian response of being “seen” to be doing something. Even now the evidence that mass mask mandates prevent transmission doesn't exist. Yes, there are countless mathematical models and there are lab studies of airflow and particle expulsion on individuals when masks are worn perfectly. But that doesn’t represent the chaotic nature of the real world. The only formal randomised trials show there is no statistical impact. Empirical data everywhere reinforce what is obvious to anyone who observes a train carriage full of complicit mask wearers. En masse they simply don’t work, humans are not robots.

The largest Bangladesh trial showed a small reduction in positive rates for mask wearing villages (albeit with very high variability) but was structurally unsound as it was effectively a study showing the difference of a Covid-awareness campaign. Then there are the “studies” and meta-analysis to try and show the impact of masks but dig below the surface of an example: the BMJ article which prompted this recent Guardian headline “Mask-wearing linked to 53% cut in Covid incidence, global study finds” and you will find the underlying research behind such categorical statistics is incredibly flimsy.

Guardian headline in November 2021

One such example is the Xu 2020, which was one of the 6 included in the aforementioned “global study” and was based on online survey data of 8158 adults in China where only 57 tested positive for Covid in March 2020. You don’t need to be Einstein to see the myriad flaws in using that dataset to conclude there is a 53% reduction in Covid incidence from mask wearing…Yet that one study alone contributed 35% of that 53% reduction (it was given a weighting of 23% and purportedly showed a relative risk reduction of 66% (1–0.34) — see Fig below).

Indeed in the response section of that BMJ study there is a letter to the Editor highlighting the misrepresentation of public health benefit and risk along with the many issues behind this study. Even within the text of the original study the authors highlighted as follows:

“It was not possible to evaluate the impact of type of face mask (eg surgical, fabric, N95 respirators) and compliance and frequency of wearing masks owing to a lack of data. Similarly it was not feasible to assess the differences in effect that different recommendations for physical distances have as preventive strategies.”

The Omicron wave that swept across the US presents us with another interesting empirical dataset. Pretty much every US state has slightly different public health requirements and mask mandates ranging from nothing in Florida, Iowa, Texas to mandatory mask wearing for everyone over the age of 2 in California. We can track the positive rate (indexed at 100 on 01/11/21) for each state, it is important to track the positive rate instead of case rates as it normalises for the amount of testing.

Indexed positivity rates by US state. Mask states in Red, non-mask in blue. Source: CDC

If, as many mask proponents highlight, mass mask wearing reduces transmission considerably then we would logically expect to see very different curves for those states without mask mandates vs those with them. They should be significantly shallower for the states with mask mandates. Needless to say this isn't the case and all states follow almost exactly the same exponential increase. Indeed the same is true across Europe where there have also been varying degrees of strictness to recent mask mandates.

A true patriotic hero…(or a complete berk)

Despite this there pervades a narrative that masks obviously “work” which has been a globally coordinated and heavily politicised strategy. Just watch Formula 1, or Emmanuel Macron wearing a mask alone in a room on a zoom call or observe the recent ridiculous headline which made international news (again hat tip to the wonderful Guardian’s reporting) that masks make some men more attractive…(this Twitter thread rather brilliantly dug behind the ludicrously concocted study which enabled such tosh to be printed).

The erosion of sensible scientific debate

The problem with us allowing mask mandates to flourish despite any decent evidence or analysis of the downsides (more on that below) is that this lack of scientific rigour and debate has pervaded, and allowed for much more troubling actions to be taken by governments without true scientific justification. Let’s not wade too far into the vaccine debate but make one observation. In the UK there was never the intention to mass vaccinate the entire nation with a novel and trial-status new drug, indeed the data showed a sensible approach was to vaccinate those most likely to need hospitalisation ie the over-50s and those with co-morbidities.

FT Article from October 2020. Source:

However this view changed, and it is a truth that many lives have been wrecked by unnecessary vaccination. Many, many elderly lives have been prolonged of course, far more. But this doesn't change the fact that any child or healthy young adult that has died post vaccination or suffered a disability is an event that has happened as a result of a forced action, it wasn’t passive. In the US for instance 9,354 individuals under the age of 39 have either died, been hospitalised or permanently disabled in the 14 days post vaccination and reported as adverse events the US vaccine safety data system VAERS. Admittedly we don’t know the underlying health conditions of these individuals but that is not an inconsiderable tally.

List of Covid vaccine adverse events by age. Source: VAERS from CDC Wonder

Given the average age of death from Covid is 82 in the UK there is a big mismatch in life years lost. To date in the UK only 185 healthy individuals under the age of 39 have died while testing positive for Covid in hospitals…compared to total deaths of 105,140. Why has the vaccine debate been so aggressively skewed such that healthy under 50 year olds are described as anti-vaxxers if they don’t want to be injected by a still very nascent drug?

The opportunity cost of mask making and the environmental impact

Back to masks and a critical downside that only occasionally makes headlines is the environmental cost of these very disposable but environmentally permanent plastic blue masks. There was already a fundamental problem with plastic waste, especially in the oceans and the creation of billions and billions of masks will have hardly helped. The true consequences will only be evident many years down the line. A study by Swansea University highlighted the following:

“The findings reveal significant levels of pollutants in all the masks tested — with micro/nano particles and heavy metals released into the water during all tests. Researchers conclude this will have a substantial environmental impact and, in addition, raise the question of the potential damage to public health — warning that repeated exposure could be hazardous as the substances found have known links to cell death, genotoxicity and cancer formation.”

Yet of course the opening line of said study couldn’t begin to question the rationale for wearing a mask…

“All of us need to keep wearing masks as they are essential in ending the pandemic. But we also urgently need more research and regulation on mask production, so we can reduce any risks to the environment and human health”.

A less obvious and less discussed issue is the opportunity cost for all this mask manufacture. It requires real capital to manufacture so many masks, then there is the transporting, then the money spent marketing masks (Trusted PPE seem to have cornered the market on UK radio) and the consumer dollars spent purchasing them. Imagine if that money had been put into less environmentally harmful or more permanent forms of prevention. New playgrounds to encourage outdoor play, exercise parks, campaigns and incentives to promote better eating.

The long term health impact and lost opportunities.

This leads neatly into another critical downside. Perhaps the most distressing element of mask mandates is that they have been responsible for deflecting the conversation from what really needed to be talked about. Obesity and public health. That masks and vaccines have been seen as the panacea to protecting the population is a missed opportunity.

I wrote — slightly tongue in cheek — that exercise should have been made mandatory rather than mask wearing and to some degree I stand by that point. Below is a plot using data from the website World in Data showing this point. There are outlier countries and the use of the total deaths per million is very blunt due to different countries having different demographic profiles and different ways of categorising a death from, rather than with, Covid…

Nonetheless it makes for quite a striking observation. Was South East Asian countries success in avoiding deaths due to mask wearing or the underlying condition of the population…I know which I would put my money on.

Obesity rates vs Covid attributed deaths per million. Source:

Sadly the debate about hospitalisation and putting pressures on the system has shifted from one about underlying health to the binary vaccinated or unvaccinated debate. Granted there is some sense in trying to inform those at risk and otherwise in younger age groups (45 year overweight males for instance) that vaccination dramatically reduces their likely burden on the health system but this has become lost in the noise and very aggressive messaging. In the UK the Minister for Health repeatedly refers to 90% of ICU patients being unvaccinated despite this being categorically inaccurate (most recent figures are around 60%) but surely the more pertinent message is what the general underlying health is of ALL those still going into ICU (age aside).

Longer term the damage from persistent mask wearing will only begin to surface many years from now. There is the immediate potential physical impact on some people (CO2 levels etc) but to my mind it is the psychological damage I am most concerned about.

Humans have always been terrible about understanding relative risk levels (cf Daniel Kahneman’s work on behavioural psychology) but now perfectly healthy people seem to believe that the only safe way for them to conduct human interaction is behind a mask. Yet these same people probably gladly drive at 80mph on a motorway or cross a road when the red man is showing…

This has led to some very poor and diabolical decision making. Recently in the UK all school children above a certain age had to conduct all their school lessons and corridor interactions constantly in face masks. Shockingly this has been the case for all children over the age of 5 in some US states, even when they are outside. Can you imagine the impact this will be having not just on immediate learning but interactions with friends, perceptions of risk etc etc. The NHS digital survey of Mental Health of Children and Young People in England, 2021 was conducted across over 3000 children and presents an alarming and hardly surprising picture.

Bad guys wear masks…

There is a reason the bad guys in movies and films always wear masks. 100,000s of years of evolution have attenuated our vision to use the expressions from people’s faces. This is what helps us innately decide on trust, likeability etc. Breaking that evolutionary mechanism, rather like the hacking of the dopamine system by social media, will definitely have consequences and should not be seen as the new status quo.

A signal of true virtue…

In conclusion I think that, more than ever, those proudly wearing a mask are espousing a set of beliefs and a fundamental outlook to society and life that is both deeply hypocritical and very troubling. That social scorn can be heaped on “the world’s fittest man” for choosing to remain unvaccinated (yes, there is more to this debate around avoiding clear rules even if the rules were wrong) yet the wokeratti trip over themselves to appease every tiny minority to be accepted for who they are is pretty symptomatic of the mixed up world we currently inhabit.



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