The "noble lie" on masks probably wasn't a lie

Why Western public health went all-in on a campaign against masks.

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Last week’s post looked at the Western institutional anti-mask campaign which escalated over the first few months of 2020.

This week we look at whyWestern public health went all-in on their campaign against masks before the abrupt change of course.

The standard explanation is it was all a cunning plan to preserve mask supplies for healthcare workers. Anthony Fauci has suggested this on a few occasions as summarised by Noah Smith:

“…according to Fauci, public health experts knew that even cloth masks helped prevent the spread of COVID-19, but they were worried that if they admitted that cloth masks work, people would conclude that N95 masks work even better (which is true), and hoard N95s, thus depriving medical workers who needed the supplies more.”

I don’t think this is true. We can’t see what the US experts were saying to each other at the time, but the UK government has published the internal minutes of deliberations by expert science teams who would have had very similar information to their American counterparts. Those documents don’t reveal a coherent plot to pretend they thought masks wouldn’t work, unless months of fraudulent minutes and other kayfabe were also part of the conspiracy- it just seems more likely that most of them just really believed masks were ineffective, or at least weren’t confident enough about what they thought to fight about it.

One of the reasons there was a shortage of masks in the first place was the consensus that they were ineffective for regular people. The UK pandemic flu plan:

Facemasks must be worn correctly, changed frequently, removed properly, disposed of safely and used in combination with good respiratory, hand, and home hygiene behaviour in order for them to achieve the intended benefit. Research also shows that compliance with these recommended behaviours when wearing facemasks for prolonged periods reduces over time.

Accordingly,

"In line with the scientific evidence, the Government will not stockpile facemasks for general use in the community."

Based on the expert view that regular people just wouldn’t make good use of them, the UK standing stockpile was reduced to keeping masks for healthcare workers only. The CDC had similar longstanding guidelines in place prior to the pandemic, so it’s not plausible to believe that the anti-mask stance came about because of shortages- rather the shortages were (in part) caused by the belief.

At the end of January 2020, as the pandemic began to bite in China and masks were made mandatory there, the UK NERVTAG (New and Emerging Respiratory Virus Threats Advisory Group) committee was asked whether the standing view, that masks wouldn’t help regular people, should change. Again, they said there was no evidence in support of members of the public using masks, and advised their colleagues to keep the recommendation against wearing them, with an extra focus on washing hands:

The Committee reported that there is no evidence to support that the wearing of face masks by the general public reduces transmission. It was also noted that this may add to fear and anxiety.

If this was all a fake campaign to keep back masks for healthcare workers, then it’s very odd again that in mid February, as cases were beginning to be imported into the UK, healthcare workers in the nursing homes where the UK would see most of its first-wave covid deaths were told:

During normal day-to-day activities facemasks do not provide protection from respiratory viruses such as COVID-19 and do not need to be worn by staff in any of these settings

In March 2020, NERVTAG, who had previously said that there was no evidence masks could be effective, began to debate the issue again with Dr Lisa Ritchie, the Head of Infection Prevention and Control for NHS England, though it was framed around messaging, rather than science:

Members raised concerns around explaining why facemasks were acceptable for healthcare staff but not the general public

Ritchie told the panel:

“healthcare staff are trained to use the masks and know when to change the masks when they become soggy or contaminated however with the general public, there is no control over how they would use the surgical facemasks so they may use the same one for a week which is inappropriate.”

This could have all been for show and “preserving supplies”, but in the same meeting there is considerable concern expressed for the vast number of masks being used up in testing and training for healthcare workers. Much of the highest grade FFP3 standard masks’ stockpile was disappearing in fit-testing, and there were “concerns that there may not be enough FFP3 stock for use later on when it may be needed.”

Again, if they didn’t believe that ordinary people would get no benefit from masks because they wouldn’t know how to use them, why carry on using up dwindling supplies in a farce of testing and training healthcare staff in their safe use? Why recommend that care home workers not wear them at all?

This internal view on masks and their (in)effectiveness when used by an untrained member of the public was matched by external pronouncements from infectious disease academics. Here Dr Shunmay Yeung from the LSHTM recorded an anti-mask video for the BBC, confidently endorsing the consensus view at the time that covid spread through touch and that masks would therefore not be helpful:

For more on how the overconfident consensus on covid came to be so wrong, this thread was pretty helpful and explanatory. The TL,DR is that infectious disease experts have strong priors against accepting that diseases spread through the air, and applied these beliefs very strongly to covid.

So it seems there was a mixture of views informing the anti-mask position: experts were reluctant to think of diseases spreading through the air for complicated status reasons; masks wouldn’t work for regular people because they wouldn’t use them properly, they wouldn’t be needed in care homes because normal activities wouldn’t create conditions conducive to covid spreading in a way that masks could limit, and masks were so difficult to use that using supplies to train healthcare staff how to wear them was worthwhile.

Given that what we can read in minutes and contemporary statements from public health officials shows a muddle of disagreement, why are so many people invested in the idea that this was an organised conspiracy and not just a panicked fudge during a difficult time to be an expert?

I think this might be a dual handed coping strategy for dealing with stress of the pandemic and the pressures of decision-making in public health. If everyone believes that an omniscient public health bureaucracy “knew really” what the right thing was, but lied out of a sense of duty to the public, then you can probably sleep more soundly: the total chaos of those first few months is much more frightening to imagine (and reflects worse on people occupying those roles) than a chain of command possessed of all the facts making a morally difficult call.

The most important lesson though is not just that this was likely a muddle being retconned as strategy (and we should be wary of such post-hoc reasoning in the future) but it also illustrates a key weakness of groupthink among expert views- once something becomes the “institutional opinion” it automatically gets endorsement from every other major institution similar to the way an AAA rating was rebroadcast through the financial system in 2008. You think you’re getting a diversity of viewpoints which are coalescing around the truth, but in reality many institutions are just repeater stations who accept the incoming opinion unquestioningly and then derive all their other positions from there.

In March 2020 you could read explainer articles pathologising the superstitions of mask wearers, and in April 2021 you can read studies investigating the psychological drivers behind the worrying trend of mask refusal, but in all cases the assumption is that anyone disagreeing with the official line must have something slightly wrong with them, even if the official line changes (who will speak up for the “premature pro-maskers”?).

Will Time magazine ever call a psychologist to comment on whether the US Surgeon General was suffering from “psychological reactancewhen recommending against masks, or “superstition” when in favour? The battle of ideas isn’t symmetrical, and for next time we should remember how difficult and yet how necessary challenging a consensus like this can be.

Lessons From The Crisis will soon be going subscriber-only. If you like what we do, subscribe and we’ll be in your inbox next week and every Wednesday after that