Is the Mask-Wearing Policy Promoted by the CDC Actually Supported by Science?
Editor’s note: This article argues that the CDC mask-wearing policy is not supported by science. It is written by an experienced attorney, published legal author, and knowledgeable researcher, Allison Lucas, Esq., who worked for ten years in hospital laboratories and operating rooms in some of the largest level I trauma hospitals in the country. Many of our readers have been asking for an update of this article, which we published in May. Here you go!
What Happens When the CDC Uses Crude Science to Support Public Policy?
By Allison Lucas, Esq.
When coronavirus first became a concern, the Centers for Disease Control & Prevention (CDC) told the American people not to wear face masks. But in April 2020, the CDC did an about-face on its previous mask-wearing policy. Government officials started aggressively promoting mask-wearing in public as a means to limit the spread of COVID-19. The current recommendation by the CDC is for all people to wear cloth masks in public spaces.
But the CDC’s mask-wearing policy lacks viable scientific support. It’s not supported by science. Let me explain why.
The benefits of mask-wearing by the general population are solely theoretical
The CDC asserts that cloth face coverings “are most likely to reduce the spread of COVID-19 when they are widely used by people in public settings.”
This policy is balderdash. Here’s why:
The use of masks, especially cloth masks, is not supported by science
The University of Minnesota Center for Infectious Disease Research & Policy calls out CDC for using bogus sources to support its revised cloth mask-wearing policy because the sources “employ very crude, non-standardized methods” and “are not relevant to cloth face coverings because they evaluate respirators or surgical masks.”
The National Academy of Sciences is a private, nonprofit organization of the country’s leading researchers and provides objective, science-based advice on critical issues.
In April of 2020, the National Academy published the following statement:
There are no studies of individuals wearing homemade fabric masks in the course of their typical activities. Therefore, we have only limited, indirect evidence regarding the effectiveness of such masks for protecting others, when made and worn by the general public on a regular basis. That evidence comes primarily from laboratory studies testing the effectiveness of different materials at capturing particles of different sizes.
The evidence from these laboratory filtration studies suggests that such fabric masks may reduce the transmission of larger respiratory droplets. There is little evidence regarding the transmission of small aerosolized particulates of the size potentially exhaled by asymptomatic or pre-symptomatic individuals with COVID-19. The extent of any protection will depend on how the masks are made and used. It will also depend on how mask use affects users’ other precautionary behaviors, including their use of better masks, when those become widely available. Those behavioral effects may undermine or enhance homemade fabric masks’ overall effect on public health. The current level of benefit, if any, is not possible to assess.”
Other recent peer-reviewed science concurs: “There is no good evidence that [any] facemask protect[s] the public against infection with respiratory viruses, including COVID‐19.”
Zero efficacy trials have been conducted regarding the use of cloth masks by the general public as a means to limit or prevent the spread of COVID-19.
Thus, as suggested by the National Academy of Science, the current public policy that a cloth mask prevents the spread of COVID-19 is scientifically invalid.
Mask-wearing policy of limited benefit to healthcare workers
While the use of cloth masks in the general public have not been scientifically studied for effectiveness, in 2009 a study found no benefit to healthcare workers wearing medical masks to prevent the common cold.
Six years later, in 2015, researchers studied the efficacy of cloth masks in hospital setting and concluded that healthcare workers “should not use cloth masks as protection against respiratory infection. Cloth masks resulted in significantly higher rates of infection than medical masks.” (My emphasis.)
A more recent study from June 2020 reiterated that a cloth mask should only be considered as “a last resort” and will only offer “limited success.”
In fact, after a recent review of the available research, CIDRAP determined that “[c]loth masks are ineffective as source control” and that “very poor filter and fit performance of cloth masks and very low effectiveness for cloth masks in healthcare settings lead us conclude that cloth masks offer no protection for healthcare workers inhaling infectious particles near an infected or confirmed patient.” (My emphasis.)
Based upon available data, the World Health Organization does not recommend use of facemasks in the general public as a means to prevent transmission of COVID-19, stating that the
lower filtration and breathability standardized requirements, and overall expected performance, indicate that the use of non-medical masks, made of woven fabrics such as cloth, and/or non-woven fabrics, should only be considered for source control (used by infected persons) in community settings and not for prevention.” 
WHO’s guidance is further supported by a June 2020 study concluding that the questionable benefits of masks did not justify the use of them for healthcare workers and a recent article appearing in the New England Journal of Medicine opined that:
a mask alone will not prevent health care workers with early Covid-19 from contaminating their hands and spreading the virus to patients and colleagues. Focusing on universal masking alone may, paradoxically, lead to more transmission of Covid-19 if it diverts attention from implementing more fundamental infection-control measures.”
Finally, the CDC does not know COVID-19 is spread predominantly by droplets or aerosols.
Any type of facemask is ineffectual if COVID-19 transmits via aerosols.
Theoretical benefits of mask-wearing policy undermined by improper use
The small and theoretical benefit of any mask, cloth or otherwise, is nullified once other factors are considered.
- Facemasks do not protect the wearer from getting the virus into the eyes,
- People may not fit the masks properly or take them on and off hygienically, and
- People wearing the mask may have a false sense of reassurance and neglect to engage in behaviors vital to reducing transmission, such as hand washing.
For example, a recent article provides proper practices for donning and doffing a mask for preventing the spread of COVID-19. But the general public is not aware of these directives and people are certainly not heeding them consistently.
[I]t is important to wash your hands with soap and water for at least 20 seconds prior to putting on the face mask. An alcohol-based sanitizer that contains at least 60% alcohol can also be used if soap and water are unavailable.
After cleaning your hands, place the face mask over your nose and mouth. Make sure there are no gaps between the face mask and your face, and ensure a tight seal. Try to avoid touching the face mask when wearing it. If you do touch the face mask, wash your hands or use hand sanitizer again. When you are done using the face mask, remove it without touching the front of the face mask, and discard it into a closed bin. Wash your hands again after discarding the face mask.”
In order to provide some benefit, cloth masks must be laundered after each use.
But how many Americans are actually washing their masks each day?
Moreover, cleaning methods and rates will inevitably vary by household, creating yet another variable affecting the tenuous efficacy of the cloth mask.
Mask-wearing carries risk of tangible harm
Some argue that even if in the absence of scientific evidence, the precautionary principle requires the use of a mask—even a cloth mask. For example, see this finding that “the evidence base on the efficacy and acceptability of the different types of face mask in preventing respiratory infections during epidemics is sparse and contested” but arguing anyway that masks should be worn because “we have little to lose and potentially something to gain.”
However, this narrow-sighted, fantasy ignores the real and potential harms of mask-wearing: cloth masks increase the likelihood of infection and transmission, hinder communication, limit oxygen exchange, and cause headaches.
Let’s take a closer look at these problems.
Cloth masks increase the likelihood of infection
Cloth masks increase the risk of infection to the wearer because people do not comprehend the importance of removing the mask correctly. “[P]oor doffing techniques can lead to the transfer of infectious material to the user’s hands.”  Moreover, a 2015 study compared the efficacy of cloth masks to medical masks in hospital healthcare workers. Healthcare workers who elected to wear cloth masks were directed to wash and dry the mask after daily use. Even so, the authors advised against the use of cloth masks because “moisture retention, reuse of cloth masks, and poor filtration may result in an increased risk of infection.”
The authors elaborate that the:
…virus may survive on the surface of the facemasks, and modelling studies have quantified the contamination levels of masks.” Self-contamination through repeated use and improper doffing is possible. For example, a contaminated cloth mask may transfer pathogen from the mask to the bare hands of the wearer. We also showed that filtration was extremely poor (almost 0%) for the cloth masks. 
Cloth masks increase the likelihood of transmission
Cloth masks, such as cotton masks, do not trap the virus, and particles can be detected on the outer surface of the masks for up to 7 days.
“A pre‐symptomatic or mildly infected person wearing a facemask for hours without changing it and without washing hands every time they touched the mask could paradoxically increase the risk of infecting others.”
Reused and reusable masks have the potential to harbor bacteria
To my knowledge, no study has been conducted to refute this finding. The general public is not professionally trained in the practices of medical hygiene and universal precautions. On the contrary, all the above-cited studies were performed on healthcare workers in a medical setting. Healthcare workers’ health, livelihood, and patient well-being depend on constant use of universal precautions and other forms of personal protective equipment such as gloves. Yet, even in the ideal conditions provided in the studies, masks provided either no benefit or increased the risk of virus transmission.
Masks hinder facial expression and nonverbal communication
Covering the face is detrimental for adequate social connection because “[f]acial expressions are one of the more important aspects of human communication. The face is responsible for communicating not only thoughts or ideas, but also emotions.” A 2013 study found that facemasks “had a significant and negative effect on patients’ perceptions of the doctors’ empathy.” Also, consider that:
[E]very time you interact with another person  the two of you subconsciously and subtly reflect each other’s facial expressions. By mirroring the other person’s expressions, you not only signal you are engaged and participating, but it’s also a kind of feedback loop that helps you empathize. If you hinder your ability to do that even slightly, you’re changing the social dynamic between you and the other person” and “we might be grossly underestimating just how powerful our facial expressions are,”  We have to recognize how informationally rich facial feedback is and when we block it, we are cutting off a major channel about our own emotions and information about social emotions.”
Mask-wearing eliminates an important form of communication and social interaction and will have a substantial negative impact on everyone; however, the people who already struggle with communication and social interaction will disproportionately carry the weight.
Masks limit oxygen exchange
Masks lower blood oxygen levels and raise carbon dioxide blood levels. For further consideration, see:
“Two Chinese boys drop dead during PE lessons while wearing face masks amid concerns over students’ fitness following three months of school closure”
“Student deaths stir controversy over face mask rule in PE classes”
and “Jogger’s lung collapses after he ran for 2.5 miles while wearing a face mask”
We also know that mask-wearing can alter breathing physiology by increasing nasal congestion.
Masks cause headaches or exacerbate headache disorders
A hand-washing policy, not a mask-wearing policy is an appropriate and scientifically sound mitigating measure
Respiratory viruses are transmitted more commonly via contact than droplet, and the control measure to reduce the spread of respiratory viruses should, therefore, focus on contact precaution.
In fact, “[t]he single most important protective measure is hand washing, rather than mask wearing.”
The CDC used crude science to support its mask-wearing policy
Wishful thinking is the basis for mask-wearing by the general public, not science. This public policy was born of fear and anxiety, as noted in “Universal Masking in Hospitals in the Covid-19 Era”:
masks serve symbolic roles. Masks are not only tools, they are also talismans that may help increase health care workers’ perceived sense of safety, well-being, and trust in their hospitals. Although such reactions may not be strictly logical, we are all subject to fear and anxiety, especially during times of crisis. One might argue that fear and anxiety are better countered with data and education than with a marginally beneficial mask, particularly in light of the worldwide mask shortage, but it is difficult to get clinicians to hear this message in the heat of the current crisis. Expanded masking protocols’ greatest contribution may be to reduce the transmission of anxiety, over and above whatever role they may play in reducing transmission of COVID-19.
Even if a mask serves as a security blanket to some during unsettling times, we deserve sound public policy measures that account for actual benefits and tangible harms.
The leading medical agency in the county does not get to use a talisman and call it science or sound public policy.
So, what happens when the CDC uses crude science to support public policy?
You take notice.
You realize government agencies are fallible.
You become discerning.
You question if other CDC policies are based on junk science.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7323223/ See also, https://www.medrxiv.org/content/10.1101/2020.04.01.20049528v1 (stating that “evidence is not sufficiently strong to support widespread use of facemasks as a protective measure against COVID-19.”)
See also, https://www.bmj.com/content/369/bmj.m1422 (finding that “[v]ery little good quality research exists on the use of cloth masks, especially in non-medical settings”; https://www.bmj.com/content/369/bmj.m1422 (recently finding that “[t]here have been a number of laboratory studies looking at the effectiveness of different types of cloth materials, single versus multiple layers and about the role that filters can play. However, none have been tested in a clinical trial for efficacy.”)
https://www.cidrap.umn.edu/news-perspective/2020/04/commentary-masks-all-covid-19-not-based-sound-data See also, https://jamanetwork.com/journals/jama/fullarticle/2762694 (“face masks should not be worn by healthy individuals to protect themselves from acquiring respiratory infection because there is no evidence to suggest that face masks worn by healthy individuals are effective in preventing people from becoming ill.”
 https:// jamanetwork.com/journals/jama/fullarticle/2768396
 Id. See also, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293495/ (“the effectiveness of the use of masks for the control of [COVID-19]-laden aerosol transmission from an infected person to a susceptible host is uncertain and not fully conceivable; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7108646/ (“we would not recommend the use of homemade face masks as a method of reducing transmission of infection from aerosols”).
 https://www.bmj.com/content/369/bmj.m1422. See also, https://pubmed.ncbi.nlm.nih.gov/32329337/ (“[o]ur studies also imply that gaps (as caused by an improper fit of the mask) can result in over a 60% decrease in the filtration efficiency, implying the need for future cloth mask design studies to take into account issues of “fit” and leakage, while allowing the exhaled air to vent efficiently).
“Wash cloth mask at least once per day.” (https://www.who.int/images/default-source/health-topics/coronavirus/clothing-masks-infographic–web—part-1.png?sfvrsn=679fb6f1_26); “Cloth face coverings should be washed after each use” (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-to-wash-cloth-face-coverings.html).
 “Cloth masks are generally retained long term and reused multiple times, with a variety of cleaning methods and widely different intervals of cleaning.” https://bmjopen.bmj.com/content/5/4/e006577.
 Validation and Application of Models to Predict Facemask Influenza Contamination in Healthcare Settings found at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4485436/
 International Encyclopedia of the Social & Behavioral Sciences, found at https://www.sciencedirect.com/science/article/pii/B0080430767017137
 Effect of facemasks on empathy and relational continuity: a randomised controlled trial in primary care, found at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3879648/
 Can Botox and Cosmetic Surgery Chill Our Relationships With Others? found at https://www.nytimes.com/2019/04/18/well/mind/can-botox-and-cosmetic-surgery-chill-our-relationships-with-others.html
 Effects of long-duration wearing of N95 respirator and surgical facemask: a pilot study, found at http://medcraveonline.com/JLPRR/JLPRR-01-00021.pdf
About the Author: Allison Lucas, Esq. is an experienced attorney, published legal author, and knowledgeable researcher. Before attending law school, Allison Lucas worked for a decade in hospital laboratories and operating rooms in some of the largest level I trauma hospitals in the country. She has also worked at the National Institutes of Health, the nation’s leading medical research agency. Allison is the mother of four children.