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The Twelve Days of Mask Mess: The first day

It apparently took two prior literature reviews, one devastating blast from an EPA science advisor, and … well … zero questions from hand-picked media over half a year to get the actual “science and data” that Gov. Roy Cooper supposedly uses to justify his open-ended extreme emergency order forcing face masks on everyone.

Nevertheless, we have it, and the research series “Does Cooper’s own research justify his extreme orders?” is going through all 22 of them one by one, holding them to this standard:

Does this research offer a slam-dunk case justifying Cooper’s extreme emergency orders? 

Why that standard? Because Cooper chose not to follow research recommendations to model, recommend, persuade, or even urge people to adopt face mask–wearing voluntarily.

Instead, Cooper issued orders against the normal scope of the Emergency Management Act, and Cooper has forced face masks on North Carolinians, even in their own homes at times, at the threat of misdemeanor charges, civil fines, business closures, people being turned away at business doors, people being threatened with trespassing, people being urged by the governor to call the cops on their fellow citizens, and perhaps worse.

This series on the Locker Room will feature a different sampling from Cooper’s research each day until all have been discussed. It’ll examine and discuss each study, asking whether it supports Cooper’s extreme exercise of power, because that is the relevant standard.

Let’s get started. On the first day of mask mess, we got these:

Chu et al.

Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet (2020).

Published June 1, 2020, this study is a systematic review and meta-analysis of observational studies, not randomized controlled trials (RCTs), of COVID-19 transmission. Chu et al. were interested in studies of social distancing of 1 meter or more (3.28 feet), face mask use (not cloth masks, but surgical masks, surgical-like masks of 12-16 layers, and N95 respirators), and eye protection.

From 38 studies of physical distance, Chu et al. found “moderate certainty” of that “physical distance of more than 1 m probably results” in reduced virus infection. Chu et al. had “low certainty” in finding that “Medical or surgical masks might result” in reduced virus infection. They likewise had “low certainty” that “Eye protection might result” in reduced virus infection.

In their discussion Chu et al. reference the Precautionary Principle but also recognize “strong, perhaps opposing, sentiments about policy making during outbreaks” as well as the “scientific uncertainty”:

A counter viewpoint [to the Precautionary Principle approach to policymaking during COVID-19] is that the scientific uncertainty and contextual considerations require a more nuanced approach. Although challenging, policy makers must carefully consider these two viewpoints along with our findings.

Does this study support Cooper’s extreme exercise of power?

No.

Chu et al. had “low certainty” in their findings regarding masks. Low certainty is obviously not enough for extreme emergency orders.

Observational studies as opposed to randomized controlled trials (RCTs) are also unlikely to provide evidence compelling enough for extreme emergency orders. RCTs are considered the gold standard, avoiding recall biases and other confounders in observational studies. Young’s review of RCTs concerning face masks and influenza yielding him this finding: “The evidence from RCTs suggested that the use of face masks either by infected persons or by uninfected persons does not have a substantial effect on influenza transmission.” The statistician explained that the findings meant “the results are consistent with chance.”

Also, Chu et al. did not study “face coverings” as Cooper’s orders define them — specifically excluding N95 respirators and surgical masks, but requiring coverings that could be almost anything: “synthetic and natural fabrics, including cotton silk, or linen. Ideally , a Face Covering has two (2) or more layers. A Face Covering may be factory-made, sewn by hand, or can be improvised from household items such as scarfs, bandanas t-shirts, sweatshirts, or towels.” (See discussion here.) Chu et al.’s low-certainty findings regarded the more protective surgical masks, surgical-like masks, and N95 respirators.

Finally, Chu et al. specifically advised policymakers to recognize scientific uncertainty, opposing viewpoints, and contextual considerations for a “more nuanced approach.” Extreme emergency orders are the opposite of a nuanced approach.

MacIntyre et al.

A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients. International Journal of Nursing Studies (2020).

Received March 24, 2020, this study reviewed 19 RCTs of the efficacy of face mask use, including eight in community settings. The study found that “Medical masks were not effective, and cloth masks even less effective.” It even “suggests cloth masks may increase the risk of infection” but says that finding “may not be generalizable to all homemade masks.”

The Cooper administration’s interest in this study appears to be its conclusion in the face of its findings. MacIntyre et al. wrote, “The study suggests that community mask use by well people could be beneficial, particularly for COVID-19, where transmission may be pre-symptomatic.” Note that the words suggests, could be, and may be are all included in that one sentence.

Interestingly, it also sheds doubt on the “six feet” social distancing rule (or 1–2 meters): “the rule of 1–2 m of spatial separation is not based on good evidence, with most research showing that droplets can travel further than 2 m., and that infections cannot be neatly separated into droplet and airborne.”

Does this study support Cooper’s extreme exercise of power?

No.

If anything, it specifically cautions against the kind of masks in Cooper’s order since “cloth masks may increase the risk of infection.”

Click for more of the Twelve Days of Mask Mess series. 

Jon Sanders / Research Editor and Senior Fellow, Regulatory Studies

Jon Sanders studies regulatory policy, a veritable kudzu of invasive government and unintended consequences. As director of regulatory studies at the John Locke Foundation, Jo...