WHO Mask Study Seriously Flawed

Published: Sept. 9, 2020
Updated: Sept. 18, 2020
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The WHO-commissioned meta-study on the effectiveness of facemasks, published in the medical journal The Lancet in June 2020, has been instrumental in shifting global facemask policies during the covid pandemic. However, the meta-study, which claimed a risk reduction of 80% with facemasks, is seriously flawed on several levels and should be retracted.

A. General flaws

1. Of the 29 studies analyzed by the Lancet meta-study, seven studies are unpublished and non-peer-reviewed observational studies that should not be used to guide clinical practice according to the medRxiv disclaimer (references 3, 4, 31, 36, 37, 40 and 70; see table above).
2. Of the 29 studies considered by the meta-study, only four are about the SARS-CoV-2 virus; the other 25 studies are about the SARS-1 virus or the MERS virus, both of which have very different transmission characteristics: they were transmitted almost exclusively by severely ill hospitalized patients and not by community transmission.
3. Of the four studies relating to the SARS-CoV-2 virus, two were misinterpreted by the Lancet meta-study authors (refs. 44 and 70), one is inconclusive (ref. 37), and one is about N95 (FFP2) respirators and not about medical masks or cloth masks (see detailed analysis below).
4. The Lancet meta-study is used to guide global facemask policy for the general population. However, of the 29 studies considered by the meta-study, only three are classified as relating to a non-health-care (i.e. community) setting. Of these three studies, one is misclassified (ref. 50, relating to masks in a hospital environment), one showed no benefit of facemasks (ref. 69), and one is a poorly designed retrospective study about SARS-1 in Beijing based on telephone interviews (ref. 74). None of these studies refer to SARS-CoV-2.
5. The authors of the Lancet meta-study acknowledge that the certainty of the evidence regarding facemasks is “low” as all of the studies are observational and none is a randomized controlled trial (RCT). The WHO itself admitted that its updated facemask policy guidelines were based not on new evidence but on “political lobbying”.

In view of these shortcomings, University of Toronto epidemiology professor Peter Jueni called the WHO study “methodologically flawed” and “essentially useless”.

B. Study misinterpretations

As mentioned above, several studies have been misinterpreted by the authors of the meta-study. All of the misinterpretations resulted in falsely claiming or exaggerating a benefit of facemasks. In the following, only the four studies relating to SARS-CoV-2 are reviewed. (HCW: health care worker)

1. Heinzerling et al. (ref. 44): The meta-study claims that 0 of 31 HCW wearing a facemask and 3 of 6 HCW not wearing a facemask got infected. This is not correct: the study showed that 0 of 3 HCW wearing a facemask and 3 of 34 HCW not wearing a facemask got infected. This result was not statistically significant (p=0.73). Moreover, of the 3 HCW who got infected, one reported wearing a facemask “most of the time”, but the meta-study classified this HCW as “not wearing a facemask”.
2. Wang et al. (ref. 41): This study, which did show a benefit of facemasks, was about N95 (FFP2) respirators in a health-care setting, not about medical masks or cloth masks.
3. Wang et al. (ref. 70): The meta-study claims that 1 of 1286 HCW wearing a facemask and 119 of 4036 wearing “no facemask” got infected. This is not correct: according to the study, 78.3% (94/120) of infected HCW were in fact wearing a surgical mask, and only 20.8% (25/120) did not wear any mask when exposed to the source of infection. The “1 of 1286 HCW” mentioned in the meta-study refers to HCW wearing an N95 (FFP2) respirator, not a medical or cloth mask.
4. Burke et al. (ref. 37): This study had no results relating to the use of facemasks.

Non-covid studies were also misinterpreted or misrepresented by the the Lancet meta-study authors. For instance, in the case of the non-covid study with the allegedly biggest impact of masks (Kim et al. (ref. 49) about N95 respirators in a hospital with MERS patients), the meta-study authors incorrectly mixed serological and PCR results, again exaggerating the benefit of (N95) masks. The actual results of the Kim et al. study were not statistically significant (p=0.159).

Update: A US researcher reviewed all 29 studies and found numerous additional mistakes.

C. Studies relating to “social distancing”

In an additional section, the WHO meta-study evaluated studies on the benefit of “social distancing” measures. However, several independent experts have shown that this section is seriously flawed, too, as the authors again misinterpreted several studies and made several statistical errors. As with the studies on facemasks, all of these mistakes resulted in falsely claiming or exaggerating a benefit of “social distancing” measures.

For more information on this section, see PubPeer (and links therein) and the CEBM review.

Conclusion

As shown in this analysis, the WHO-commissioned meta-study on the effectiveness of facemasks and social distancing, published in The Lancet, is seriously flawed and should be retracted. Health authorities may want to reconsider their covid policy guidelines.

See also: Are face masks effective? The evidence.

∗∗∗

Original study: 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, The Lancet, June 2020, Volume 395, Issue 10242, P1973-1987.

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Coronavirus Covid-19 Research History – Index

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Specific Issues Index

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Danish Mask Study: No Benefit

Published: November 18, 2020
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The Danish randomized controlled trial on the real-world efficacy of face masks against coronavirus infection – the first of its kind – has now been published in the Annals of Internal Medicine. As expected, the trial found no statistically significant benefit of wearing a face mask. The study used “high-quality surgical masks with a filtration rate of 98%”.

For political reasons, three major journals had previously refused to publish the Danish study.

Meanwhile, US researcher Yinon Weiss has updated his charts on mask mandates and coronavirus infections in various countries and US states. The charts indicate that mask mandates have made no difference, or may even have been counterproductive.

People who want to avoid a coronavirus infection must avoid situations in which they can get infected. If they cannot avoid such situations, and if they belong to a high-risk group, they should discuss prophylactic and early treatment options with their doctor, which according to international studies may reduce the risk of severe disease and hospitalization by up to 90%.

The Danish study: Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers. A Randomized Controlled Trial. AIM 2020.

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The Face Mask Folly in Retrospect

Published: August 2021 (upd.)
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It has been known for decades that face masks don’t work against respiratory virus epidemics. Why has much of the world nonetheless fallen for the face mask folly? Twelve reasons.

1) The droplet model

Many health authorities have relied on the obsolete ‘droplet model’ of virus transmission. If this model were correct, face masks would indeed work. But in reality, respiratory droplets – which by definition cannot be inhaled – play almost no role in virus transmission. Instead, respiratory viruses are transmitted via much smaller aerosols, as well as, possibly, some object surfaces. Face masks don’t work against either of these transmission routes.

2) The Asian paradox

During the first year of the pandemic, several East Asian countries had a very low coronavirus infection rate, and many health experts falsely assumed that this was due to face masks. In reality, it was due to very rapid border controls in some countries neighboring China as well as a combination of metabolic and immunologic factors reducing transmission rates. Nevertheless, many East Asian countries eventually got overwhelmed by the coronavirus, too (see charts below).

3) The Czech mirage

In the spring of 2020, the Czech Republic was one of the first European countries that introduced face masks. Because the Czech infection rate initially stayed low, many health experts falsely concluded that this was due to the masks. In reality, most of Eastern Europe simply missed the first wave of the epidemic. A few months later, the Czech Republic had the highest infection rate in the world, but by then, much of the world had already introduced face mask mandates.

4) Fake science

For decades, studies have shown that face masks don’t work against respiratory virus epidemics. But with the onset of the coronavirus pandemic and increasing political pressure (see below), suddenly studies appeared claiming the opposite. In reality, these studies were a mixture of confounded observational data, unrealistic modelling and lab results, and outright fraud. The most influential fraudulent study certainly was the WHO-commissioned meta-study published in The Lancet.

5) Asymptomatic transmission

Another factor contributing to the implementation of mask mandates was the notion of ‘asymptomatic transmission’. The idea was that everybody should be wearing a mask because even people without symptoms might spread the virus. The importance of asymptomatic and pre-symptomatic transmission is still a matter of debate – up to half of all transmission might occur prior to symptom onset –, but either way, face masks simply don’t work against aerosol transmission.

6) Political pressure

Several political factors contributed to the implementation of mask mandates. First, some politicians simply wanted to “do something” against the pandemic; second, some politicians thought face masks might have a “psychological effect” and might “remind” citizens to stay cautious (if anything, it had the opposite effect: creating a ‘false sense of security’); third, some politicians used mask mandates to enforce compliance and pressure the population into accepting mass vaccination.

In addition, there was a vicious circle involving science and politics: politicians claimed to “follow the science”, but scientists followed politics. For instance, the WHO admitted that their updated mask guidelines were in response to “political lobbying”, not new evidence. The most influential lobby group was “Masks For All”, founded by a “Young Leader” of the World Economic Forum (WEF).

7) The media

Perhaps unsurprisingly, most of the ‘mass media’ amplified the fraudulent science and the political pressure driving mask mandates. Only some independent media outlets and some truly independent experts questioned the validity of the underlying evidence. However, their voices got suppressed as dubious “fact checking” organizations eagerly enforced official guidelines and throttled or censored many articles and videos critical of face masks.

8) “Surgeons wear masks”

Surgeons wear masks, so they must be effective, right? This was another notion contributing to the face mask misunderstanding. In reality, surgeons wear masks not against viruses, but against much larger bacteria, but more importantly, studies have long shown that even surgeons’ masks make no difference in terms of bacterial wound infections.

9) “Masks suppressed the flu”

“Masks suppressed the flu, so they obviously work.” This was another very common claim in favor of masks. While it is true that the flu (i.e. influenza viruses) disappeared in the spring of 2020 and remained absent throughout the coronavirus pandemic, masks had nothing to do with it.

This is evident as the flu disappeared even in states without masks, lockdowns and school closures – such as Sweden, Florida and Belarus – while the flu hadn’t disappeared during earlier flu epidemics and pandemics, despite widespread mask use (e.g. during the 2019 flu epidemic in Japan).

Instead, influenza viruses disappeared globally because they were temporarily displaced by the more infectious novel coronavirus (so-called viral interference, known from previous pandemics); for the same reason, new coronavirus variants repeatedly displaced existing variants, often within weeks. Indeed, in countries that had reached very high levels of population immunity against the coronavirus, the flu returned by summer 2021 (e.g. in India at 80% population immunity).

10) Misleading memes

To convince low-IQ social media users of the effectiveness of face masks, several unscientific memes were created. The most notorious one probably was the “peeing into your pants” meme, shared by many ‘health experts’ (really). Many of these memes exploited the fact that most people simply don’t realize how small and ubiquitous viral aerosols really are.

11) Doubling down

After mask mandates had been implemented globally and billions of dollars had been spent on masks, it soon became obvious – once more – that masks simply don’t work against respiratory virus epidemics (see charts below). But at that point, neither politicians, nor ‘health experts’, nor duped citizens who had to wear them for months wanted to admit this anymore.

Instead, some ‘health authorities’ doubled down and enforced outdoor masking (even on beaches), double-masking, or N95/FFP2 masking, to no avail. The one novel scientific insight produced during the coronavirus pandemic was that even N95/FFP2 mask mandates have made no difference at all.

12) Sweden: The exception that proved the rule

Only very few countries in the world have resisted the face mask folly. The most famous example is probably Sweden (see charts below), which has also resisted the lockdown experiment. Naturally, Swedish coronavirus mortality has remained below the European average. But the many vicious attacks against Sweden by much of the international media showed just how difficult it has been to escape the global madness and follow the real science during this bizarre pandemic.

The facemask aerosol issue

In the following short demonstration video, Dr. Theodore Noel explains the facemask aerosol issue.

How face masks and lockdowns failed

The following charts show that infections have been driven primarily by seasonal and endemic factors, whereas mask mandates and lockdowns have had no discernible impact (charts: IanMSC).

“The more masks fail, the more we need them.” (IanMSC)

You have been reading: The Face Mask Folly in Retrospect.
An analysis by Swiss Policy Research.

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Coronavirus Covid-19 Research History – Index

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Specific Issues Index

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