On the third day of mask mess, we got these:

Gandhi et al.

Masks Do More Than Protect Others During COVID-19: Reducing the Inoculum of SARS- CoV-2 to Protect the Wearer. J Gen Intern Med (2020);1-4.

Received on June 22, 2020, this study tests a new theory for universal masking, that it “reduces the ‘inoculum’ or dose of the virus for the mask-wearer. Authors acknowledge it is “one of the first times” and “one of the first perspectives to discuss this evidence supporting this theory.” The study proceeds from the assumption of “the effectiveness of facial masks,” which in this study includes cloth masks, and moves to test this “unique angle on why universal public masking during the COVID-19 pandemic should be one of the most important pillars of disease control.”

Gandhi et al. find outcomes in Asian countries “accustomed to masking” and some early-mask countries to be “suggestive of this viral inoculum theory.” Those countries “have fared well in terms of rates of severe illness and death,” and even when cases have resurged in those areas after reopening, “case-fatality rate has remained low.”

Of note, Gandhi et al. state that “For this particular pillar of pandemic control to work in the USA, leading politicians will need to endorse and model mask-wearing.” The study does not specifically endorse universal mask orders with enforcement. It does, however, specifically warn against economic shutdowns and lockdowns:

The efforts to preserve life must be balanced against the catastrophic consequences of shutting down economies, which ultimately will lead to more suffering, poverty, and death than the virus itself, especially for the working poor.

Does this study support Cooper’s extreme exercise of power?


However compelling it may sound to a policymaker, a novel theory in the early stages of research cannot be the basis for extreme emergency orders. Changing the culture is no business of an extreme emergency order.

Furthermore, while Gandhi et al. propose that politicians “endorse and model” mask-wearing, they specifically warn against the even deadlier effects of another aspect of Cooper’s order: “shutting down economies.” Cooper has already done that once, and in recent weeks he and Cohen have been threatening to do it again.

This study put forward by the Cooper administration warns that shutting down the economy bodes “catastrophic consequences … which ultimately will lead to more suffering, poverty, and death than the virus itself, especially for the working poor.”

Howard et al.

Face Masks Against COVID-19: An Evidence Review. Proceedings National Academy Sciences (2020).

Compiled on April 4, 2020, this study finds that the evidence for “The positive impact of public mask wearing on this [COVID-19] is ‘scientifically plausible but uncertain.'” Nevertheless, Howard et al. “recommend that public officials and governments strongly encourage the use of widespread face masks in public, including the use of appropriate regulation.” The authors base that recommendation on the following:

  • that “a primary route of transmission” of COVID-19 is through droplets
  • that “homemade cloth masks” have some level of filtration capacity and “may be a pragmatic alternative to surgical masks for the public”
  • that “universal policy” would prevent “employer restrictions” against mask-wearing and the “stigma” attached to mask-wearing by “minorities” and “infected/sick people”
  • that it would “serve as a visible signal and reminder of the pandemic,” which would be buttressed by “the importance of ritual and solidarity in human societies”
  • that under the (enforced) ritual of the mask, “Mask-wearing and even mask-making or distribution can provide feelings of empowerment and self-efficacy, which would in turn also suggest masks could increase compliance in other health-behaviors as well by increasing self-efficacy”
  • that “Cloth masks could be an additional tool to enhance awareness of the importance of physical distancing in public places, serving as a visual reminder”

Setting aside the significance to Howard et al. of the importance of human ritual and inducing feelings of empowerment and the like, the filtration capacity for cloth masks discussed in the study ranges widely: “household materials had 3% to 60% filtration rate for particles in the relevant size range, finding them comparable to some surgical masks.” Their effectiveness is less for aerosols: “some evidence suggests they may have a partial effect in reducing viral aerosol shedding” (some, suggests, may have). Later they noted that homemade masks weren’t as well-fitted as surgical masks: “the median-fit factor of the homemade masks was one-half that of the surgical masks.”

The authors cite Hong Kong favorably for community mask use and support on more than one occasion, and they also note that “A number of countries have distributed surgical masks (South Korea, Taiwan) from early on while Japan and Singapore are now distributing close masks to their whole population.” They write that “cloth masks may be a pragmatic temporary alternative to surgical masks for the public.”

Making frequent use of the term “pragmatic,” Howard et al. unsurprisingly base their recommendation that “mask use requirements are implemented by governments, or when governments do not, by organizations that provide public-facing services” explicitly on the Precautionary Principle:

The loss of life and economic destruction that has been seen already from COVID-19 is a “morally unacceptable harm.” The positive impact of public mask wearing on this is “scientifically plausible but uncertain” … while researchers may reasonably disagree on the magnitude of transmissibility reduction and compliance, seemingly modest benefits can be massively beneficial in the aggregate due to the exponential character of the transmission process. Therefore, the action of ensuring widespread use of masks in the community should be taken, based on this principle.

Does this study support Cooper’s extreme exercise of power?


“Scientifically plausible but uncertain” is insufficient for extreme emergency orders. It should be self-evident that the Precautionary Principle is no basis for extreme emergency orders.

Probable effects (“some evidence,” “suggests,” “may have,” “may be,” etc.) are insufficient for extreme emergency orders.

Changing the culture is no business of extreme emergency orders — not even to induce a policymaker’s desired new human ritual, inspire feelings of empowerment and self-efficacy, remove feelings of social stigma, or enhance people’s awareness of other practices a policymaker wishes people to adopt.

Click for more of the Twelve Days of Mask Mess series.