Throughout the COVID-19 pandemic, societies throughout the world have been divided on the efficacy of face coverings to prevent influenza or influenza-like-illness (ILI), such as COVID. However, research conducted by the independent Cochrane, a charitable medical research organization based in London, England appears to have put to rest this longstanding dispute.
Published earlier this year, Cochrane’s analysis of 78 global studies involving over one million people provided evidence that masks reduced the risk of infection and death by a mere five percent, causing researchers to assert that the benefits of wearing masks and mask mandates did not outweigh the risks, such as impeding children’s academic and cognitive development in their early years.1
Considered the “gold standard” in demonstrating the accuracy of evidence-based medicine, most reviews by Cochrane follow a rigorous methodology, are generally less vulnerable to bias, and tend to only consider high-quality evidence in systematic reviews that investigate the effects of interventions for disease prevention, treatment and rehabilitation.2
Francois Balloux, director of the UCL Genetics Institute and professor of computational biology at University College in London said of the findings:
Irrespective of the limitations of the study, its results indicate that the true impact of medical/surgical masks and N95/P2 respirators on the transmission of respiratory viruses is at best small.3
Key Findings of Cochrane Analysis
- There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection.
- Community mask-wearing makes little to no difference in lab-confirmed infections, compared to not masking.
- Immunocompromised or vulnerable individuals may benefit from mask-wearing since interventions that are not effective at a population level may still provide personal benefit to at-risk individuals.1
Mask Mandates: How Did We Get Here?
With the onset of COVID in 2020, all major health authorities collectively decided that masks were effective and required for combating the flu-like virus. Almost immediately, mask mandates became ubiquitous, even on airplanes where safety announcements routinely thanked passengers for following the mandate “in accordance with federal law.”4
A federal judge later ruled the 14-month mandate was unlawful, citing that the U.S. Centers for Disease Control and Prevention (CDC) had “exceeded its authority, had not sought public comment, and did not adequately explain its decisions.” There have been transgressions within the legislative process and many parents opposed unprecedented masking and vaccine mandate bills.5
Early on, guidance from public health officials was indecisive at best. Initially, the former director of the National Institute of Allergy and Infectious Diseases (NIAID) Anthony Fauci, MD warned that masks were not as protective as people think. He said:
When you’re in the middle of an outbreak, wearing a mask might make people feel a little bit better and it might even block a droplet, but it’s not providing the perfect protection that people think that it is.
Shortly afterward, Dr. Fauci did an about-face and unequivocally supported mask usage, citing that the initial recommendation not to mask up was due to fears of PPE shortages for healthcare workers. Adding to growing distrust in public health officials, the recommendation was not for N95 masks, which at the time were in short supply, but for cloth face coverings, which the CDC admitted were least effective at virus prevention and spread.6 7
Research on Mask Efficacy Limited Before the COVID Pandemic
Despite health authorities forging full speed ahead with mask mandates at the outset of the crisis to minimize the impacts of the global pandemic, existing research on mask efficacy at the time was limited and, according to one analysis, too preliminary to support an informed policy. That didn’t stop public officials from enacting several years-long mask mandates, including one that required restaurant patrons to wear masks only until they were seated, where removal was permitted for drinking and eating.8
It was not only society that was divided on the effectiveness of mask-wearing. Scientists have been divided on the subject as well. The same analysis shared that scientists have different opinions on wearing masks, claiming that masks are ineffective in preventing the spread of COVID. Further, a perspective published in the New England Journal of Medicine concluded that cloth face masks offer little to no protection to the general population and health care workers. The author pointed out that masking is not a standalone panacea, and without meticulous hand hygiene, eye protection, gloves, and a gown, masks alone would not protect healthcare providers from contracting the virus.9
Masking Contributes to Developmental Delays in Children
The latest analysis proving the inefficacy of masks is hardly the first to pose the question of whether or not the risks outweigh the benefits. One scientific paper established that face coverings made it harder to hear and understand speech and identify facial expressions and emotions—all critical developmental functions for children in their first few years of life.10
Manfred Spitzer, a psychiatrist and a cognitive neuroscientist in Germany, shared concerns that masking interfered with nonverbal communication and emotional bonding. The latent effects of children being unable to see their friends or family smile or frown and pick up on emotional cues—all of which help children to develop empathy, an integral emotional response sociopaths are devoid of—are still unknown. While the CDC states that SARS-CoV-2 infections are generally mild or 11 12
One study, while not yet peer-reviewed, found a striking decline in cognitive performance since the onset of the COVID pandemic, with infants born since mid-2020 showing an average decrease of 27-37 points.13
Public Health Measures Based on Force: Relic of the 19th Century
Over the past several years, dissenters of mainstream opinion have been vilified and dehumanized—even losing their jobs—for not immediately complying with authoritarian public health policy mandates that have now proven to be ineffective at best, and overarchingly harmful at worst.14 15
President Biden has made multiple remarks disparaging unvaccinated individuals, blaming them for slowing down the U.S economy in 2021 by costing jobs and putting unnecessary strain on the healthcare system. In the winter of 2021, he warned that unvaccinated individuals face “a winter of severe illness and death.”16 17
One article published by bioethicists in the American Journal of Public Health in 2005 discussed the 1905 U.S. Supreme Court decision, Jacobson v. Massachusetts, in which a Lutheran pastor refused to comply with a smallpox vaccine mandate because he and his son had suffered a severe reaction to a previous smallpox vaccination. The authors emphasized the importance of balancing the constitutional authority of state government to protect the public’s health with the importance of upholding the constitutional right to personal liberty. Trust, they said, should not be underestimated:
“People are more likely to trust officials who protect their personal liberty. Without trust, public officials will not be able to persuade the public to take even the most reasonable precautions during an emergency, which will make a bad situation even worse. The public will support reasonable public health interventions if they trust public health officials to make sensible recommendations that are based on science and where the public is treated as part of the solution instead of the problem. Preserving the public’s health in the 21st century requires preserving respect for personal liberty.”18
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1 Jefferson T, Dooley L et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database of Systematic Reviews 2023; Issue 1. Art. No.: CD006207 (accessed Feb 13, 2023).\
2 Useem J, Brennan A, LaValley M, Vickery M, Ameli O, Reinen N, Gill CJ. Systematic Differences between Cochrane and Non-Cochrane Meta-Analyses on the Same Topic: A Matched Pair Analysis. PLoS One. Dec 15, 2015; 10(12): e0144980.
3 Francois Balloux, [@BallouxFrancois]. Cochrane reviews are the ‘gold standard’ in evidence-based medicine. They follow a rigorous methodology and only consider high quality evidence. As such, the review included a limited number of studies and has moderate power to detect small effects. Twitter Jan. 30, 2023.
4 Face masks now a federal requirement in airports, on planes under new CDC order. Delta News Hub Feb. 1, 2021.
5 Shepardson D. U.S. will no longer enforce mask mandate on airplanes, trains after court ruling. Reuters, Apr. 19, 2022.
6 Jankowicz M. Fauci said US government held off promoting face masks because it knew shortages were so bad that even doctors couldn’t get enough. Business Insider June 15, 2020.
7 U.S. Centers for Disease Control and Prevention. Types of Masks and Respirators. Sept. 28, 2022.f
8 Nie J, Kang L, Pian Y, Hu J. Need for more robust research on the effectiveness of masks in preventing COVID-19 transmission. Future Virol. March 2022: 10.2217/fvl-2021-0032.
9 Klompas M et al. Universal Masking in Hospitals in the Covid-19 Era. N Engl J Med May 21, 2020; 382: e63.
10 Fitousi D, Rotschild N, Pnini C, Azizi O. Understanding the Impact of Face Masks on the Processing of Facial Identity, Emotion, Age, and Gender. Front Psychol Nov. 3, 2021; 3(12): 743793.
11 Reilly P. Study finds children have harder time recognizing masked faces than adults. New York Post Feb. 7, 2022.
12 CDC. Information for Pediatric Healthcare Providers. Feb. 10, 2023.
13 Deoni SC, Beauchemin J, Volpe A, Dâ Sa V; RESONANCE Consortium. The COVID-19 Pandemic and Early Child Cognitive Development: A Comparison of Development in Children Born During the Pandemic and Historical References. medRxiv Aug. 16, 2022.
14 National Public Radio.Thousands of workers are opting to get fired, rather than take the vaccine. Oct. 24, 2021.
15 Sigalos M. You can’t sue Pfizer or Moderna if you have severe Covid vaccine side effects. The government likely won’t compensate you for damages either. CNBC Dec. 17, 2020.
16 Towey R. Biden says unvaccinated Americans are ‘costing all of us’ as he presses Covid vaccine mandates. CNBC Sept. 24, 2021.
17 Sink J. Biden Says Unvaccinated Face Winter of Severe Illness, Death. Bloomberg Dec. 16, 2021.
18 Mariner WK, Annas GJ, Glantz LH. Jacobson v Massachusetts: it’s not your great-great-grandfather’s public health law. Am J Public Health April 2005; 95(4): 581-90.