Masks found wanting in comparative study of 35 countries

YET ANOTHER study has been published pulling down the claims of effectiveness of mask wearing and consequently mask mandates as a worthwhile medical intervention to prevent the spread of Covid-19. Published in the medical journal Cureus, the peer-reviewed ‘Correlation Between Mask Compliance and COVID-19 Outcomes in Europe’ is naturally causing a stir.

Authored by Beny Spira, an associate professor at Universidade de San Paulo, Brazil, the study considered data on morbidity, mortality, and mask usage from 35 European countries during a six-month period. Noting that mask uptake was more common in East Europe than West European jurisdictions, its analysis found that differing correlations between those two groups indicated countries with high levels of mask compliance did not perform better than those with low mask usage.

The report is worth reading in full (here) as this review can only provide a summary and reaction from a non-professional perspective. As we know from the lived-experience we all shared, mask wearing became a ubiquitous intervention across Europe, either through guidance, rules enforced with fixed penalties or laws subject to criminal convictions if broken – and yet studies for or against their efficacy have proven controversial. The reason is obvious; before and even after the appearance of Covid-19 the use of masks was not accepted by the public health authorities as beneficial. Indeed on many occasions the medical establishment was quite specific that they were not required – but then dramatically it changed its mind without any scientific basis for doing so. 

The policy U-turn that masks were needed after all only fed the concerns that it was part of Government psych-ops to obtain public compliance with other arbitrary socially restrictive rules such as numbers of people in any one place. 

Subsequent studies on mask efficacy have produced mixed and conflicting results, the difference with this study is that it considers the results of countries where masks were accepted and compliance was greater and others where it was not, giving an opportunity to analyse if this resulted in different outcomes.

The study included all European countries with populations of more than one million inhabitants (resulting in a total of 602 million people) over the period of October 2020 to March 2021. By selecting this particular six months’ time period all 35 countries also endured a peak of Covid-19 infections. A concern of Beny Spira is that many past studies conducted during the pandemic have covered periods where the peak of Covid had passed and it could therefore look as if the fall in Covid-19 cases was assisted by mask wearing when it had already started. As an example of this difficulty Spira explains, 

“For instance, the peak of cases in Germany’s first wave occurred in the first week of April 2020, while masks became mandatory in all of Germany’s federal states between the 20th and 29th of April, at a time when the propagation of Covid-19 was already declining. Furthermore, the mask mandate was still in place in the subsequent autumn-winter wave of 2020-2021, but it did not help preventing the outburst of cases and deaths in Germany that was several-fold more severe than in the first wave.”

Spira believes his findings “suggest that countries with high levels of mask compliance did not perform better than those with low mask usage in the six-month period that encompassed the second European wave of Covid-19.” He gives consideration to possible confounding factors that could have influenced the results but has answers that dismiss them.

“It could be argued that some confounding factors could have influenced these results. One of these factors could have been different vaccination rates among the studied countries. However, this is unlikely given the fact that at the end of the period analysed in this study (31st March 2021), vaccination rollout was still at its beginning, with only three countries displaying vaccination rates higher than 20%: the UK (48%), Serbia (35%), and Hungary (30%), with all doses counted individually. It could also be claimed that the rise in infection levels prompted mask usage resulting in higher levels of masking in countries with already higher transmission rates. While this assertion is certainly true for some countries, several others with high infection rates, such as France, Germany, Italy, Portugal, and Spain had strict mask mandates in place since the first semester of 2020. In addition, during the six-month period covered by this study, all countries underwent a peak in COVID-19 infections, thus all of them endured similar pressures that might have potentially influenced the level of mask usage.”

Spira’s conclusion then is unsurprisingly firm, 

“While no cause-effect conclusions could be inferred from this observational analysis, the lack of negative correlations between mask usage and Covid-19 cases and deaths suggest that the widespread use of masks at a time when an effective intervention was most needed, i.e., during the strong 2020-2021 autumn-winter peak, was not able to reduce Covid-19 transmission. Moreover, the moderate positive correlation between mask usage and deaths in Western Europe also suggests that the universal use of masks may have had harmful unintended consequences.”

From what I’ve seen of the mask debate there are some firmly entrenched views and no amount of studies seeking to establish the truth will, I expect, convert what has for many become almost a religious rite among some mask adherents or a martyrdom among mask opponents. I don’t accept masks work but I did accept obeying the law (as opposed to guidance) and treating my neighbours with respect if they wished me to wear a mask around them (very few did).  For me it was often simply a case of common courtesy. I don’t think I was particularly unusual in trying to get through the pandemic without falling out with everyone over mask wearing, even though my own views never wavered.

Nevertheless, however I got through it, trying to resolve the question of mask use is important for we can be sure that if there is an inkling of any new Covid variant or another respiratory disease, those who wish to introduce lockdowns will start to create alarm by first calling for mask mandates. We need to win the argument they are about manipulation of fear across communities rather than an effective preventative intervention. For that reason alone the Spira study is an important one.