It seems every time I write about this topic, I have to start by pointing out that you shouldn't jump to a conclusion over what I'm saying; for example, I generally don't approve of alcohol or drug abuse, prostitution or promiscuity, gambling, or 101 other things that offend my moral or religious sensibilities. I am practically but not a principled teetotaler. I will have an occasional social drink or two at an occasional company Christmas party or share a nightly glass of wine when I visit my mother. In part, I just don't really care for the taste of alcoholic beverages, they are an expensive indulgence, and I generally don't like the idea of being potentially out of control of my actions. The same thing holds true for prescriptions; I remember I had been prescribed some pain medication (not my idea) after an outpatient procedure several years back, and I remember it was a hassle getting it filled. I think I maybe took 2 or 3 pills over the next few days and basically threw out the rest. I really, really don't like the idea of developing a dependency on medication. I even didn't like the idea of taking a daily aspirin until my doctor insisted. I'm not suggested I'm better than others, including my readers; I'm making decisions based on my values. So if I'm more tolerant of anti-maskers, it doesn't mean I myself don't practice masking. In fact, I do.
So why don't I want others to do the same "good things"? Well, familiar readers know I have affection for St. Thomas Aquinas and his discussions of free will and cautions on the application of human law, e.g.,
The purpose of human law is to lead men to virtue, not suddenly, but gradually. Wherefore it does not lay upon the multitude of imperfect men the burdens of those who are already virtuous, viz., that they should abstain from all evil. Otherwise these imperfect ones, being unable to bear such precepts, would break out into yet greater evils…
ST I-II, q. 96, a.2, ad 2
…those who are in authority, rightly tolerate certain evils, lest certain goods be lost, or certain greater evils be incurred: thus Augustine says (De Ordine ii.4): “If you do away with harlots, the world will be convulsed with lust.”
ST II-II, q. 10, a. 11
Now human law is framed for a number of human beings, the majority of whom are not perfect in virtue. Wherefore human laws do not forbid all vices, from which the virtuous abstain, but only the more grievous vices, from which it is possible for the majority to abstain; and chiefly those that are to the hurt of others, without the prohibition of which human society could not be maintained: thus human law prohibits murder, theft and such like.
In fact, many libertarians reference Aquinas' focus on the rights of conscience.
On the topic of the day, a purported mandate on face masks, I should note that relatively early on, I was an early adopter, looking for my own before Gov. Hogan (R-MD)'s mandate (which I was a critic of). I had been searching for some time, and I wasn't the only one: I had been searching online (because they weren't available locally), and they were all but impossible to find in stock and with short-term delivery. (This has since changed; several weeks back, I noticed disposable ones on sale at Walmart and Sam's Club, in its recently announced mandate, announced it would furnish a complimentary one for shoppers, plus others for sales; it seems I can't watch cable TV without an ad for mail-order masks or visit a webpage without a relevant ad.) As regular readers know, I have an RN sister (14 months younger), and her three daughters showed up on Facebook one day wearing the cloth masks she made (one of my nieces, my goddaughter, is also an RN). I basically contacted her; she mentioned she was doing it as a hobby; I don't sew at all and asked her if she could make me one or 2, promising to cover any out-of-pocket costs. I've been regularly wearing masks venturing outside my home ever since.
Now there are theories in terms of COVID-19 infections, in particular, the nature and extent of exposure to the virus. Let's call it the magical number X of microbes. We really don't know what X is; it may vary differ based on one's individual differences, including one's immune system, acquired related immunities, etc. But the general concept is that it's not likely that you would be infected by the cumulative effect of a few random microbes, but being in the vicinity of someone who is shedding viruses, the nature and extent of his exhalations (increasing load from breathing to talking to shouting, singing, sneezing, coughing or more), the duration of exposure and the circulation of relatively unfiltered air, etc. could overwhelm the body's defenses.
It's very conceivable that masks in general could be particularly helpful in mitigating the effects of larger respiratory droplets laden with virus. However, note that airborne microbes are less constrained by cloth face masks: if you can breathe through the fabric, chances are you can also breathe in microbes. The type of mask matters: there is a reason N95 respiratory masks are in demand, especially by health workers. Note, though, the improvement is not 100% microbe-free. But clearly some type of filter, even cloth, is an improvement over direct inhalation of shed viruses. Obviously social distancing helps in that heavier virus-laden droplets tend to drop in the immediate area surrounding an infected person. Obviously it is best to know who has the virus, with a significant percentage of people shedding who are not, at least initially, symptomatic. Long-term, close encounters with infected individuals pose a danger of reaching that X magical number threshold for infection. That's why I screamed at this pro-mask nurse in a recent Twitter war that testing is your critical containment policy; masks are a secondary consideration. Maybe if you have a strategy, say, of limiting your in-person exchanges with others to 5 minutes or less.
Now in terms of public policy, I don't rule out certain compulsory actions I see consistent with my libertarian beliefs, in particular, the non-aggression principle, e.g., vaccines. Part of the problem here is that almost all of the people being targeted with face mask mandates are non-COVID infected. The issue here is in part limited testing and a large percentage of infected people are asymptomatic, at least for a period of time while they are shedding virus. It's one thing to require symptomatic individuals to cover themselves. Where do you justify enforcing a regulation where over 90% of individuals don't have the virus? It could take days even to get test results. A second consideration is it's difficult to enforce. I see people all the time wearing them minimally (e.g., to get past checkpoints), rolling them up to breathe more comfortably (which defeats the purpose of wearing them). So even if they have the virus, they are shedding at times not in compliance: and those microbes may remain airborne for hours. A third complication is the variability of materials used in masks or coverings, ill-fittings, etc. We've already alluded to (more effective) N95 respirator masks vs. surgical masks vs. cloth masks. Obviously more layers are more protective. Do we really want police to use subjective judgments over mask quality and fittings or not knowing health reasons (respiratory-related) for not using masks and/or judging whether social distancing mitigates the need for a mask? A fourth consideration is mask wearing affects air flow, and people with respiratory conditions may find wearing masks compromises their ability to breathe.
Then there's question of the nature of enforcement. To give an example, recently the governor of Alabama issued a broad face mask mandate while the Georgia governor recommended compliance but rejected municipalities from passing more restrictive policies. I've already opined that I don't believe a federal mandate (beyond federal property) is constitutional (tenth amendment). So for example, Justin Amash was critical of Kemp's (GA) restrictions, and I disagreed by tweet. Why? Isn't Amash's position more consistent with the Principle of Subsidiarity, which I subscribe to? It's complicated. As a libertarian, I'm wary of government overreach, regardless of level of government, at the expense of liberty.
Brion McClanahan (think locally, act locally) is a non-libertarian historian I love to embed in my daily blog; he's fairly open to local government discretion, provided it doesn't violate the state constitution. And I am somewhat sympathetic to the idea that large cities, like Atlanta, GA, dealing with densely populated areas and facilities, should have the discretion to implement health protocols to deal with the reality of a pandemic vs. state or federal bureaucrats. I understand universal application is viewed as fairer and easier to implement; there are 2 principal issues I have: I don't think face mask mandates are very effective, particularly since many people will simply work around compliance; you simply can't monitor a large number of people in public all the time short of a curfew. For example, my local Walmart has checks at the store entrance, but I've seen people in the store without masks or with their masks rolled up. And technically they were in compliance with social distancing guidelines. (That may not help with filtering airborne microbes, to whatever effectiveness their masks may provide in either direction.) The second thing is this is a very inefficient way of dealing with the problem; over 90% of the population is uninfected; of those infected, a fraction are asymptomatic, which is what is causing the real concern. What we need is expanded testing, particularly of more socially active people. For example, I work remotely and rarely leave my home except for grocery runs, checking mail or throwing out trash. (I've done a couple of doctor visits and had a haircut and that's about it.) People need protection from me? Give me a break. We have to look at costs and benefits of public policy. Police hassling an uninfected person over wearing a mask: how does it make us any safer? Is this an effective deployment of scarce public resources? It's more like a politically correct kabuki dance. Most people are wearing masks that don't go a good job filtering for microbes either direction.
Just a side note: I saw a critical note on N95 respiratory masks the other day (I think involving those with a release valve option). N95 masks are sort of the gold standard of protective gear for surgeons and other medical personnel dealing with COVID-19/other virus-infected patients, and demand vastly outstripped supply in the early days of the crisis; health professionals were obsessed with the notion the general public was procuring the masks at their expense, leaving them with no protective gear to work with patients, effectively putting their own health/lives at risk. (A recent Hogan WashPo column noted that Baker (R-MA) procured some N95 masks, and the feds confiscated the supply.) So the critical note about the release option said that it did not clean the personnel's own exhalation for virus. (I can't tell you about testing schedules for medical personnel.) Now if you have an infected doctor working with non-infected patients, you have serious problems; yes, unfiltered exhalations can add to possibly long-lasting local area aerosols. But in context you're dealing with infected patients and other personnel hopefully with their own N95 masks and I would expect specialized air filtration systems in operating theaters, etc. I'm just puzzled by the concern of infected doctors using N95 masks with optional releases.
I did see a related obsession in an unexpected Twitter war I had last weekend with a purported ICU nurse with 30 years of experience. I think it was sparked by a (generally supportive) tweet I wrote over the Southern grocery chain Winn-Dixie, which announced that it wouldn't enforce mask compliance at its stores (I'm not sure about things like Alabama's recently announced mask mandate). I certainly don't have an issue with any store issuing a policy intended to protect its employees and customers. And personally I would likely choose a store with those policies in play. But I think that Winn-Dixie didn't want to confront or alienate loyal customers over an unpopular, dubiously effective policy. (For example, maybe unmasked individuals are maintaining social distancing.)
Whereas I'll reference in greater detail below, here's a good relevant synopsis to discussion:
But [homemade] masks are not expected to be as protective as surgical masks, [Chu] said. That's why public health officials are warning people to remain at least 6 feet apart from one another, even if they are wearing masks. In other words, homemade masks are likely to be just a small piece of the puzzle for controlling the COVID-19 pandemic.
"There's been enough research done to be able to confidently say that masks wouldn't be able to stop the spread of infection, that they would only have a small effect on transmission," Cowling said. "We shouldn't be relying on masks to help us go back to normal."
Let's furthermore discuss a typology of face masks:
The N95 mask effectively prevents viral spread. These masks, when properly fitted, seal closely to the face and filter out 95% of particles 0.3 microns or larger. But N95 masks are in serious shortage even for medical professionals, who are exposed to the highest levels of SARS-CoV-2 and are most in need of the strongest protection against the virus. They're also difficult to fit correctly.
In a surgical mask, about 70% of the outside air moves through the mask and about 30% travels around the sides, Chu told Live Science. For that reason, they don't offer as much protection as N95s.
That leaves fabric masks, which currently are recommended for general use by the CDC. Fabric masks also allow air in around the sides, but lack non-woven, moisture-repelling layers. They impede only about 2% of airflow in, Chu said.
I'm not going to reproduce the exchanges with the nurse here (they'll probably be included in this weekend's digest post), but the nurse basically made the point that you wear masks primarily to protect other people from your (unknown?) virus. I do admit, a lot of popular sources focus on protecting others from an asymptomatic infected person, especially capturing some or all of moisture, e.g., from coughs, sneezes, speaking, yelling, etc. But what about the other side of the mask?
I actually had to look a while, because a lot of discussion is written in an obscure way. For example,
consider these points from Mayo Clinic on fabric/homemade masks:
- Wash or sanitize your hands before and after putting on and taking off your mask.
- If you accidentally touch your mask, wash or sanitize your hands.
- Remove the mask by untying it or lifting off the ear loops without touching the front of the mask or your face.
You have to read between the lines here. Obviously if you already have the virus, these steps don't help you (maybe they protect from other viruses). But in discussing say the front of the mask, they seem to suggest the mask may protect from droplets exhaled from other people.
These guidelines from John Hopkins:
- If the person who is ill is unable to wear a mask, their caregiver should wear one.
- If you are healthy, a mask may protect you from larger droplets from people around you.
So, let's summarize a bit here: except for N95 respirators, other masks have relatively leaky/unfiltered air flows, to and from an individual (including infected ones). These air flows allow exhalation and inhalation of aerosols/airborne particles/microbes, which can lead to infection of oneself and/or others. These masks may help control larger droplets (e.g., coughs, sneezes, spittle from singing, etc.) which are virus-laden. Certainly some level of protection is better than no level of protection, but if you look at the estimate that the vast majority of mandated homemade masks may only filter 2% of microbes in either direction, the public policy fixation on masks seems, at best, exaggerated in terms of pandemic control. We need faster, accurate, more convenient, scalable methods of COVID-19 diagnosis. Mask mandates are a type of desperation politics I've repeatedly linked to Obama: "We can't afford to do nothing." No, the wrong "solution" can exacerbate the problem, like digging yourself deeper into quicksand. There's also the problem of unrealistic expectations of how effective masks are; what do you say to people who catch the disease despite following all the mask and social distancing rules established by politicians in consultation with public health experts?
One thing I did want to point out is some stupid thing journalist Soledad O'Brien tweeted the other day, intending to dismiss the COVID-19 thoughts of "just a meteorologist". (Side note: I'm the proud uncle of a National Weather Service meteorologist based in Texas.) Just to provide a context: we know of seasonality aspects, e.g., with the flu, which happens to thrive in lower humidity and/or temperatures. I've also speculated whether air conditioning in the south US is possibly linked to the observed surge of cases
I'm going to end this essay by citing a number of relevant articles, some of which may be redundant and/or skeptical of current policy, but which may interest the reader (note that I do not claim this list is comprehensive):
- Hitchens here points out that the WHO flip on face masks (to favorable) had more to do with politics than science
- Mercola here, an early proponent of mask usage, points out rigorous scientific studies have found no statistically significant advantage to face masks on infection, has found public statistics, e.g., mortality, materially misleading, and found public policy has exacerbated the crisis (he doesn't mention Nursing Home Killer Cuomo, but I will)
- The CDC here points out 2 case studies that support the use of face masks, including the case I've cited in the past of a salon where the stylists contracted COVID-19, but none of their masked customers. Note that case studies are on the lower end of the food chain for scientific studies. Customers would not be at a salon for an extended period of time like full-time workers.
- Here is a CDC list of recent face mask studies.
- This study notes superiority of N95 masks over surgical masks and suggest the production of more N95 respirators is feasible.
- This paper deals with the above-discussed link between viral seasonality and meteorological factors.
- Here is a discussion of the above-described link between exposure and infection.
- A similar discussion of exposure times duration to infection; this post also discusses viral loads of behaviors and notes low risk associated with breathing.
- This news report shows reopening Denmark schools did not exacerbate COVID-19 spread.
- This post focuses on airborne transmission and how air conditioning can exacerbate the social distancing heuristic.
- Here is a study showing microbe penetration of 97% for cloth and 44% for (surgical?) masks.
