The question of whether masks “work” or not has been a controversial issue mainly because few are willing to engage in the finer details of mask usage and hygiene.
On top of that limited discourse, those in the government and the media have lied about mask needs from the beginning, with Fauci himself admitting that he said to not wear masks at first.
See: Fauci says he doesn't regret telling Americans not to wear masks at the beginning of the pandemic
https://www.businessinsider.com/fauci-doesnt-regret-advising-against-masks-early-in-pandemic-2020-7
QUOTING: "I don't regret anything I said then because in the context of the time in which I said it, it was correct. We were told in our task force meetings that we have a serious problem with the lack of PPEs," he said.
Bear in mind that Fauci is lying here by his own standards because his view was not that people did not need PPE, but that he wanted to preserve what PPE existed for healthcare workers.
He said something UNTRUE by his own standards to get people to lay off of buying masks for a bit.
Quite manipulative, huh?
But were masks really going to be effective in the first place?
That’s the pressing question that still has many confused because the criteria for judgment of efficacy is not widely known.
For a solid backdrop to what one should think about when it comes to mask efficacy, Dr. Lisa Brosseau, a former professor at the University of Illinois at Chicago (UIC) School of Public Health from 2015 to 2019, and Dr. Margaret Sietsema, Assistant Professor of Environmental and Occupational Health Sciences at the University of Illinois Chicago, came up with some criteria for mask analysis.
In their joint paper published at the University of Minnesota’s Center for Infectious Disease Research and Policy Center titled, “COMMENTARY: Masks-for-all for COVID-19 not based on sound data,” they laid out 4 key elements for consideration:
The filter performance of a cloth material does not directly translate or represent its performance on an individual, because it neglects the understanding of fit.
Cloth masks or coverings come in a variety of shapes, sizes, and materials and are not made according to any standards.
Transmission is not simply a function of short random interactions between individuals, but rather a function of particle concentration in the air and the time exposed to that concentration.
A cloth mask or face covering does very little to prevent the emission or inhalation of small particles. As discussed in an earlier CIDRAP commentary and more recently by Morawska and Milton (2020) in an open letter to WHO signed by 239 scientists, inhalation of small infectious particles is not only biologically plausible, but the epidemiology supports it as an important mode of transmission for SARS-CoV-2, the virus that causes COVID-19.
As you can see, there is a wide difference between the idealization of a mask and the reality of what individuals choose in terms of material and hygiene.
And looking to materials, one of the best ways to wrap one’s mind around the issues is to look at studies of mask material efficacy before the extreme politicization of masks in later 2020.
Take for example the study,
“Aerosol Filtration Efficiency of Common Fabrics Used in Respiratory Cloth Masks.”
Available here: https://pubs.acs.org/doi/10.1021/acsnano.0c03252
In it, the authors note that aerosol particle filtration under lab conditions varied widely by material.
This chart below gives you a sense of how these masks and material combinations performed under limited, controlled conditions:
The efficacy for simple cotton masks with low thread counts per inch (80) barely stopped anything.
And, on top of that, the authors noted that,
“Our studies also imply that gaps (as caused by an improper fit of the mask) can result in over a 60% decrease in the filtration efficiency, implying the need for future cloth mask design studies to take into account issues of “fit” and leakage...”
So bear in mind that this study of masks was not done in a real-world environment. It was performed using a PVC tube with an end cap holding the material.
Obviously, this in no way reflects how regular people use their masks over an extended period of hours working and moving about their day.
Which is why the most important study of all to be done is an unbiased observational study.
An unbiased observational study would involve:
Monitoring real-world, high-contact use such as workers in a grocery store, or fast food service employees over a shift.
Self-selection by workers of their own mask materials as they normally would do.
Not informing the workers that they are being watched so that they do not change their hygiene because they know they are being watched.
Studying the masks and surfaces at the end of the shift to see what kinds of bacteria and viruses are present and transmitted.
Does this kind of study exist?
Of course not.
Not a single major institution is performing this most critical form of observation to see how typical masking practice operates in reality.
Likely though, it’s not done because the results would be damning.
If one looks at the CDC’s own mask wearing guidelines here:
See: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html
Few, if anyone, could actually keep up with these rules.
A good example of how easy it is to lose sense of one's hygiene is the video,
How To See Germs Spread Experiment (Coronavirus)
In that video, former NASA engineer Mark Rober shows just how easy it is to spread germs, even when one is trying to use proper hygiene and not touch their face.
In one of his experiments, he attempts to not touch his face at all (without a mask) for just a few hours while on his laptop working.
He failed miserably and noted at the end of the segment that people touch their face on average 16 times per hour.
Now imagine how much more this takes place when one has a sweaty, itchy mask sitting on their nose bridge and chin all day.
This lack of ability to prevent viral spread in real-world application is corroborated by other studies which have looked at mask usage in other contexts, from those wearing surgical masks in hospitals:
A cluster randomised trial of cloth masks compared with medical masks in healthcare workers
To using mannequins to simulate human use:
Effectiveness of facemasks to reduce exposure hazards for airborne infections among general populations
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3306645/
And they all come to the typical conclusion that mask wearing may not be as truly effective as one may think when one factors real-world aspects of gaps and hygiene.
With all this information in mind, it should be clear by now that "masking" is not a monolithic concept.
There are many factors that go into the calculation, from material, to hygiene, to environment.
Given what steps are needed to enact good control, it's unlikely that most anyone could uphold the necessary practices to meaningfully reduce viral spread, especially when most people are not using higher-end masks and continuous hygienic practice.
For further reading of other related studies and analysis that corroborate the above-noted concerns, please check out the following links:
This one study is quite fascinating because it's a study of surgical masks from 2010 performed as a Ph.D. dissertation for a current OSHA director, Erin Sanchez. In it, he notes the failure of surgical masks and the risk of usage as PPE. This study has been largely kept out of media attention.
Filtration Efficiency of Surgical Masks
https://digitalcommons.usf.edu/etd/1760/
His profile and work history: http://www.abih.org/content/erin-sanchez-cih
Do N95 respirators provide 95% protection level against airborne viruses, and how adequate are
surgical masks?
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.488.4644&rep=rep1&type=pdf
Masks Don’t Work: A Review of Science Relevant to COVID-19 Social Policy
https://www.rcreader.com/commentary/masks-dont-work-covid-a-review-of-science-relevant-to-covide-19-social-policy
Facemasks in the COVID-19 era: A health hypothesis
This article has been retracted, but in reviewing it, the citations used are seemingly credible and the questions asked do not seem inappropriately framed. I believe it was retracted out of censorship, not out of false information, as it is just a meta-analysis of other's published work that one can look into themselvs.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680614/
Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers
https://www.acpjournals.org/doi/10.7326/m20-6817