COVID-19, Masks, Politics, and Authoritarianism.

Statists on either side of the coin take issue with libertarians when it comes to liberty. We unapologetically defend everyone’s freedom from state intrusion. Where that confuses people is that we’ll even defend freedom when the exercise of that freedom is hateful, self-harmful, or stupid. That doesn’t mean we’ll agree with the use of those freedoms, just that we’ll support the right.

The exercise of liberty does not mean the right to intrude on someone else’s freedom. Nor does it make someone free from consequences. If you’re a jerk, people may not want to be around you. They may not want to do business with you. It may cost you your job. These are all private consequences for exercising your freedom, and we’re ok with that as well.

So how does liberty fit in with individual and government reactions to COVID-19? Most certainly the severity of the virus and the issue of masks has been politicized. The government has also given citizens plenty of reasons to distrust it. Does the politicization of COVID-19 square with the dangers and efficacy of face masks?

Masks and Politics

The issue of wearing a mask has been controversial since the beginning. First, the CDC flip-flopping on whether people should wear a mask. Fauci explained the rationale was that they didn’t want a run on masks that should go to government personnel. That seems to be flawed reasoning because if masks could cut down on transmission, then medical staff wouldn’t be so overwhelmed. Then the government mandates and shutdowns, which have increased anti-government animus. Throw in a large amount of misinformation and ridiculous anecdotal claims, and it’s a recipe for overreaction. Everything around COVID has turned into a political issue where people are taking a hard line.

Businesses certainly have a right to deny entry to anyone not wearing a mask, just as they have a right to refuse you service for not wearing a shirt. I don’t know how exercising an individual right suddenly became a right to trespass on private property for not following that owner’s rules for entry.

No Middle Ground

This entire mask debate reminds me of climate change (NOTE: I’m not taking a stance on climate change, I’m just making a point). On one side is the left, who presents scientific studies and apocalyptic scenarios to support their position that humans are causing climate change. Their goal is to increase government power to combat the problem.
On the other side, the right denies that climate change exists. The right claims that the science is flawed, or have opposing studies showing it’s not a concern.

As a result, there’s no middle ground to be had. If the right admits that it’s a thing, then the government will be expected to do something about it. Both positions are at odds. There’s no place for middle ground.

It’s the same thing with masks. You have the left, which has likened COVID-19 to the apocalypse and exercised exceptional emergency powers limiting liberty. The right makes claims that COVID-19 is no worse than the flu and doing nothing about it. No middle ground.

I’m not oblivious to the concerns of people about government overreach. Most assuredly, I disapprove of the governor of my state unilaterally shutting down vast swaths of the economy. I certainly don’t agree with her lack of transparency either. There’s plenty of reason to distrust the government at all levels when it comes to handling this pandemic, as it seems that everyone has their own agenda.

Rationality in the Age of Extremes

What happens if we take a step back and look at it rationally without looking at it through a political lens? Is there a way to filter through the data and come to a rational conclusion? The age of hyper-partisanship has undoubtedly made it difficult as both sides have compromised the raw data in their ways. How do you know what data to trust?

We know the government has fudged the data from both sides of the aisle. You have one side pumping up the numbers and the other side downplaying or not releasing the numbers. Early on, the COVID-19 data was corrupted. Anyone that died of flu-related symptoms was presumed to have died from COVID-19. Additionally, people that died of unrelated causes while having COVID-19 were initially listed in the COVID-19 death toll (since corrected). If the data is faulty, how can we trust it? We can’t. But we can come up with some reasonable estimates.

If you’re a skeptic like me, you aren’t going to blindly accept the government’s numbers as fact. You’d want peer-reviewed scientific studies. That sounds easy, but it’s also more complicated because it depends on where these studies were published. Why? Because some of these sites are questionable as sources because they have clear political leanings.

The challenge here is to assess the real threat of COVID-19, then the efficacy of the masks. In terms of evaluating the danger, the best way is coming up with a reasonable estimate. In terms of assessing the effectiveness of face masks, it would be preferable to find scientific studies published before COVID-19.

COVID-19 – Danger?

First, it’s useful to look at the mortality rates for the typical flu as we know those numbers were added to the COVID-19 death toll. According to the CDC between 12 and 61 thousand people die annually from the flu. The mortality rate for typical influenza is 0.13% or around 37.5k annually.

As of August 22nd, 2020, 5.8 million people have contracted COVID-19. It should be noted that those numbers are probably low as not everyone that has been symptomatic has been tested. COVID-19 has claimed 180k lives so far. Based on those numbers, the mortality rate is around 3.1% of those that contract the virus (in the US).

Assuming that the numbers of people that contracted COVID-19 is higher than reported, and the death toll is lower, then it follows that he mortality rate is lower than reported. For the sake of argument, I’ll remove the typical flu deaths from the total. That still leaves a mortality rate of 2.2%. If you double the number of people that have contracted the virus (and I think that’s a high estimate), you’re still left with a mortality rate of 1.1%. Keep in mind the typical flu has a mortality rate of 0.13%. As a best case scenario it still means COVID-19 is nearly 10 times as deadly as the typical flu.

The more troublesome aspect of COVID-19 is the asymptomatic transmission. Hard to stay away from people or people to stay away from you if they don’t know you’re sick. That increases the infectiousness of the virus.

Efficacy of Masks

By nature, I’m a skeptic. I don’t trust every study that’s been released unless it’s been peer-reviewed (and I also look at the sources of the peer-review). Additionally, I’m only looking at the efficacy of masks that are effective for the wearer.

In order to eliminate confirmation bias in newer studies, I sought out older studies. I fully expected to find studies that verified the efficacy of masks. Surprisingly, the studies were all a bit mixed with no outright confirmation on the general use of masks. I should have expected what I found: studies which confirmed the efficacy of N95 masks and respirators (which non-medical professionals cannot easily obtain). There are many studies out there, but this study from 2017 conducted by Infectious Diseases Society of America was particularly interesting. It concludes:

We found evidence to support universal medical mask use in hospital settings as part of infection control measures to reduce the risk of CRI and ILI among HCWs. Overall, N95 respirators may convey greater protection, but universal use throughout a work shift is likely to be less acceptable due to
greater discomfort.

and

Our analysis confirms the effectiveness of medical masks and
respirators against SARS. Disposable, cotton, or paper masks
are not recommended.

Basically, it’s not just wearing a mask…it’s the type of mask you wear which is important. Cotton-based masks are entirely dependent on the thread count.

What about others?

The argument made by government and mask mandate proponents is “wearing masks is not protecting you, it’s about protecting others.” If you don’t comply, you’re obviously selfish. Gee, that’s a great way to sell wearing a mask to a public that has good reason to be skeptical of government given their inconsistent and authoritarian response.

The big question: is that statement true?

The answer? It depends on the mask and the fit. The key is that we’re searching for the effectiveness of masks in vivo, where the wearer is infected. Surprisingly, there was a lack of research in this area as noted by many of the studies I read.

A study from 2011 concluded:

It was observed that fully sealed facemasks provide the highest protection, while the least protective was the normal wearing. It was also observed that the reduction of exposure decreases with increasing emission velocity and emission duration, and with decreasing separation distance between source and susceptible manikins. The current results have important implications for public health as wearing facemasks has become a common protection measure, particularly in some Asian countries.

Effectiveness of facemasks to reduce exposure hazards for airborne infections among general populations

A study from 2005 concluded:

The N95 filtering face piece respirators may not provide the expected protection level against small virions. Some surgical masks may let a significant fraction of airborne viruses penetrate through their filters, providing very low protection against aerosolized infectious agents in the size range of 10 to 80 nm. It should be noted that the surgical masks are primarily designed to protect the environment from the wearer, whereas the respirators are supposed to protect the wearer from the environment.

Do N95 respirators provide 95% protection level against airborne viruses, and how adequate are surgical masks?

And finally, a study from 2015 concluded:

To our knowledge, this is the first human study to assess the comparative efficacy of surgical versus N95 masks in patients with laboratory-confirmed acute influenza and suggests that, within our study design, both masks are equally effective when used for short periods to prevent the spread of infection. Our findings support current guidelines recommending surgical or procedural masks be worn by patients with suspected influenza to limit viral dissemination to others.

A Quantitative Assessment of the Efficacy of Surgical and N95 Masks to Filter Influenza Virus in Patients with Acute Influenza Infection

To summarize, bandanas and most other cloth coverings have limited effectiveness in vivo. N95 masks do the best to protect the wearer, and surgical masks work if everyone is wearing them. Unsurprisingly, the #1 thing that prevents the spread of the virus? Social distancing. If you limit contact with people, the less likely you’ll get the virus.

Conclusion

There’s nothing clean about the reaction to COVID-19. At the beginning with the CDC/FDA dropping the ball on testing out of the gate, to the conflicting guidance on wearing face masks given by Fauci, to the denial that it is more severe than the seasonal flu. Like anything else politicized, the messy truth lies somewhere in the middle. COVID-19 is not the end of the world, but it’s certainly worse than the seasonal flu. Masks have efficacy, but it’s dependent upon the type and the fit. Social distancing works, but that’s difficult as human beings are social animals.

What I find most disturbing about the government mask mandates (outside the authoritarianism) is that they give the public a false sense-of-security. It’s not just wearing a face covering. The type and fit are the determining factors in efficacy. Homemade cloth masks have limited effectiveness unless there are enough layers to increase the thread count.

Ultimately, humans operate in their own self-interest. It’s up to each individual to assess the risk for themselves and mitigate that risk as they see fit.

As for me? I’ll continue to wear a N95 mask when I’m out. That’s how I will mitigate my risk. You can do what you want…but please, do it from a distance.