Should I Wear a Mask in Class This Fall?
I’ve been wearing a mask in the classroom since September 2021, and I haven’t gotten Covid or even a cold. So should I mask again this fall?
HOBOKEN, AUGUST 15, 2024. I’m a fan of Sensible Medicine, a site where physicians examine medical practices with a critical eye. One contributor is Vinay Prasad, an oncologist whose critiques of cancer medicine I’ve cited in my reporting.
A debate recently broke out on Sensible over masking. The topic is timely. Covid cases are surging across the U.S., according to the CDC; lots of folks I know have gotten Covid over the last month or two. My fall semester begins September 3, and I’m wondering if I should keep wearing a mask when I teach.
The debate in Sensible focuses on a study of masking carried out in Norway and published in the medical journal BMJ. Researchers assigned 4,647 adults to two groups: one wore surgical masks in public spaces (stores, public transport, etc.) for 14 days; the control group didn’t.
Of the unmasked group, 12.2 percent reported symptoms “consistent with respiratory infection,” compared to 8.9 percent of the masked group. Based on that 3.3 percent difference between the groups, the researchers conclude that surgical masks “reduce the incidence of self-reported respiratory symptoms consistent with respiratory infections in real world settings.” In short, masks work.
The Norwegian researchers summarize the results of their masking study in this “visual abstract.”
Or do they? Prasad, who has often second-guessed U.S. policies on social distancing, masking and vaccines, says the Norwegian study “does not prove masks work.” He faults the study’s reliance on self-reporting, arguing that the placebo effect might account for the masked subjects’ lower reported rate of symptoms.
“If you wear a mask, you feel like you do better,” Prasad explains. “A better endpoint for future mask studies would be some objective measure of viral spread” such as tests of antibody levels in nasal mucus.
Prasad’s Sensible colleague Adam Cifu then critiques Prasad’s critique. Cifu says: “The endpoint is a good clinical one that we care about: ‘Do you feel sick?’ Sure, it is not hospitalization or death but that would require a giant study.”
Cifu adds: “Does this change anything I would personally do or recommend to my patients? Probably not. The cost of wearing a mask for two weeks, for me personally, is higher than the benefit of a 3% reduction in the risk of getting a cold.”
After Prasad rebuts Cifu’s rebuttal, a Sensible Medicine subscriber, computer scientist Ben Recht, challenges the analyses of both Prasad and Cifu. The Norwegian study, Recht points out, relies on subjects to say whether they felt sick and whether they wore masks. “The study staff never had in-person contact with any participants. We have zero evidence that anyone ever wore a mask! We just have emails.” [Bold in original.]
Recht adds, “Only 80% of the treatment group completed the survey, while 87% of the control group did. That’s a 7% difference,” which is larger than the 3.3 percent difference in self-reported symptoms between the two groups.
That difference in responses to the survey could have skewed the study’s results, Recht argues. In other words, Recht is even more critical of the Norwegian trial than Prasad!
The BMJ paper and analyses on Sensible Medicine provide a terrific case study of the limits of medical research, which I might assign to my science-writing seminar. Prasad, Cifu and Rech basically concur that the Norwegian study does not provide compelling evidence of masks’ benefits.
That Sensible conclusion is corroborated by another medical source I trust, Cochran. Last year Cochrane published a meta-analysis of masking studies and reported no evidence of a “clear reduction in respiratory viral infection with the use of medical/surgical masks.”
The conclusions of Sensible and Cochrane put me in an awkward spot. I often knock those who defend a medical intervention, whether psychiatric drugs or colonoscopies, based on anecdotes and personal experience. The only way to judge an intervention, I insist, is to look at clinical trials.
I nonetheless believe based on my personal experience that masks work. Let me explain.
Before the Covid epidemic began, I got a cold at least once a year. Over the past 4.5 years, I haven’t gotten a cold, let alone flu or Covid. Not once. That’s unprecedented for me.
One reason, I assume, is that I’ve gotten the CDC-recommended Covid vaccines and boosters. I’ve also gotten the flu vaccine every fall for more than a decade. But many vaccinated people still get Covid and flu.
For the first 1.5 years of the Covid pandemic, I practiced social distancing, and I masked when I bought groceries, rode the elevator, took the subway and so on. I always wear an N-95 mask, not a flimsy surgical mask.
I’ve also worn an N-95 mask in the classroom since in-person classes resumed at my school, Stevens Institute of Technology, in the fall of 2021. (I taught by zoom from March 2020 through the 2021 spring semester.)
It gets nasty inside my mask by the end of a 2.5-hour seminar, and I must speak loudly to make sure my students can understand me. But the hassle is worth it, because the mask protects me from my students--who, I’m guessing, have been my major risk factor for respiratory infections since I started teaching in 2005.
I typically teach three courses each semester, with 15-24 students each. In any given class, pre- and post-Covid, at least one or two young people sitting in the room with me are sniffling, coughing, sneezing.
So will I wear a mask in class this fall? I’m not sure. I’m not immune to peer pressure. Hardly any professors or students at Stevens still mask. I’ve gone maskless at a couple of Stevens events over the last year. Part of me is resigned to getting Covid one of these days; almost everyone I know has gotten it, and no one has ended up dead or debilitated.
So depending on trends in Covid cases, maybe I’ll teach without a mask in September. But that won’t mean I don’t think masks work. I know that, in my case, they do.
Further Reading:
I’m a Rational Anti-Medicine Nut
The Cancer Industry: Hype Versus Reality
Mammography Screening Is a Failed Experiment
Do Colonoscopies Really Save Lives?