The following article is a guest post by Dr. Allon Friedman, who has 27 years’ experience as a physician and a clinical researcher.


What is the evidence for face masks as a protection against COVID?

Studies done in the laboratory setting are not the ideal way to determine if masks protect against COVID in real life. To best answer this question we need to look to randomized controlled trials (RCTs), which are considered the gold standard evidence. Fifteen such RCTs have been conducted in this field, all within the past thirteen years. Their conclusion? All twelve studies found no indication that mask use in community settings protects the wearer or nearby individuals from respiratory viruses, including COVID. This held true despite differences in study populations, type of mask, geographic location, or setting. An analysis lumping ten of these studies together to increase the chance of finding a benefit did not change the results. It is therefore unsurprising that a subsequent study using data from all fifty states found that mask mandates had no effect on the spread of COVID.

Why is the Centers for Disease Control continuing to recommend masks?

Despite unanimous gold-standard evidence (i.e. RCTs) that masks do not provide benefit against respiratory viruses the CDC, the nation’s premier public health agency, continues to argue that masks protect the wearer and others from COVID. The CDC’s webpage also states that data “regarding the “real-world” effectiveness of community masking are limited to observational and epidemiological studies.” This statement is false and contradicted by the existence of the RCTs, ten of which the CDC previously published in its own journal. The CDC’s justification for masks therefore smacks of “cherrypicking” lower quality evidence to support predetermined health policies rather than letting the best scientific evidence shape policy. Local health departments or schools that justify their mask policies by citing the CDC’s flawed recommendations should be held to account and not excused simply because they were “just following guidelines.”

Do unmasked students increase the risk of transmitting COVID?

Sweden, which never required their schoolchildren to use masks, provides a valuable natural experiment. One study reported that in nearly 2 million Swedish schoolchildren aged 1 to 16 attending school from March to June 2020, only fifteen were admitted with COVID to the intensive care unit (four of these patients had underlying illnesses), and none died. Few than thirty teachers were admitted to the intensive care unit. Moreover, it is impossible to tell if the handful of sick individuals contracted COVID in school or elsewhere. Also of importance, teachers who cared for unmasked schoolchildren did not have a higher risk of contracting COVID than any other occupation. Thus, schools that do not require masks offer a safe environment to both students and teachers.

What are some risks of mask wearing in schoolchildren?

Masking can lead to exhaustion, fatigue, drowsiness, dizziness, headaches, and decreased empathy. Preliminary evidence in children has also found links to mental health issues, impaired cognitive development, irritability, headaches, difficulty concentrating, reluctance to go to school, fatigue and drowsiness. Some of these could be explained by higher levels of inhaled carbon dioxide seen with masking. Future ear deformities, increased exposure to other infectious organisms, and possible inhalation of micro-fibrils have also been described. Other hypothesized or as yet unknown risks may also arise. Masking schoolchildren is therefore akin to a grand society-wide experiment in one of our most vulnerable populations in which the normal informed consent process has been waived.


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