For the eighth day of mask mess, we got these:

Wilson et al.

Factors Influencing Risk for COVID-19 Exposure Among Young Adults Aged 18–23 Years — Winnebago County, Wisconsin, March–July 2020. MMWR Morb Mortal Wkly Rep (2020); 69:1497–1502.

Posted October 9, 2020, this study relied on telephone interviews with 13 young adults, nine business owners, and eight community leaders in Winnebago County, Wisconsin, regarding COVID-19 infections among young adults (ages 18–23), since by July 18 they accounted for 32 percent of known infections there despite comprising only 12.5 percent of the population.

Wilson et al.’s interest was to “identify drivers of behavior that influence risk for exposure to COVID-19 among young adults.” Each survey participant was given “a gift card of $25” since Wilson et al. determined that amount would “balance motivating interviewees to participate without offering a coercive sum.” They tailored their questions to the different groups and stopped at 30 interviews because they had achieved “Thematic saturation” beyond which they determined they weren’t getting any new information.

The “drivers of behavior” they identified were “perceived low severity of disease outcome; perceived responsibility to others; peer pressure; and exposure to misinformation, conflicting messages, or opposing views regarding masks.” Wilson et al. start with the presumption that “Masks are an effective tool to prevent the spread of COVID-19,” so their focus is on “framing messaging to target those factors.”

Wilson et al. find that their report provides,

a framework for tailoring communication messages that are empathetic, that amplify personal responsibility and responsibility to protect others, and that focus on perceived pressure to not wear a mask, all of which might persuade young adults to adhere to public health guidelines (e.g., wearing masks) to prevent the spread of COVID-19.”

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


Regardless of whether the themes of 30 phone conversations in Winnebago County, Wisconsin, are forcibly applicable to the entire state of North Carolina, nothing in this study pertains to extreme emergency orders. It is about “tailoring communication messages” to persuade people (young adults) to adopt wearing masks voluntarily. Tailoring messages is not the business of extreme emergency orders.

Cooper still has — and has always had — the option to treat North Carolinians as free-thinking adults and use his office and state health department “to recommend, to persuade, even to urge people to adopt practices such as wearing face coverings that they believe is healthy,” but he has chosen instead to issue extreme emergency orders.

Leffler et al.

Association of country-wide coronavirus mortality with demographics, testing, lockdowns, and public wearing of masks. medRxiv (2020).

Posted August 5, 2020, this study looked at “per-capita mortality” in “countries where mask use was either an accepted cultural norm or favored by government policies on a national level” as compared with “countries which did not advocate masks.” They looked at the early outbreak in 200 countries around the world, from the beginning of the outbreak through April 16 for infections and May 9 for deaths.

Leffler et al. found several factors associated with higher national per-capita mortality from COVID-19: “older age of the population, urbanization, obesity, and longer duration of the outbreak.” Other than international travel restrictions, other containment measures were not associated with lower per-capita mortality, including notably “internal lockdown and viral testing policies and levels.” They found that “societal norms and government policies supporting mask-wearing by the public were independently associated with lower per-capita mortality from COVID-19.”

They write that “Available scholarship and surveys do corroborate reports in the news media that mask wear was common in public in many Asian countries,” as well as “parts of the Middle East, Africa, Latin America and the Caribbean.” But they say, “Conversely, in Western countries which had no tradition of mask-wearing, and which only recommended (rather than mandated) mask-wearing by the public, such as the United States, the practice has been steadily increasing, but change has not been immediate.”

Nevertheless, the authors scored the United States as a “mask-wearing” country prior to most statewide mask mandates. The U.S. was one of 41 countries for which Leffler et al. had surveys of mask-wearing. They write that,

To determine the influence that actual mask-wear, as opposed to mask policies, might have on the model, we scored countries as mask-wearing if at least 50% of the public wore a mask, and non-mask wearing if less than 50% of the population did so.

Based on surveys, Canada, Finland, France, Germany, and Malawi were not considered mask-wearing countries at any time during the exposure period (ending April 16). In contrast, Italy was scored as mask-wearing beginning March 19, Spain and India beginning March 21, Saudi Arabia beginning April 1, Russia beginning April 4, Singapore beginning April 10, and the United States, Brazil and Mexico beginning April 12. (End notes omitted.)

Surveys cited by Leffler et al. found that mask-wearing had already reached 66–68 percent in the U.S. by late May into early June.

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


This study is very far-ranging and looks at 200 countries with different “societal norms” and government policies regarding mask-wearing. It is nevertheless an impressively extensive exercise in suggesting correlation is causation. Leffler et al. do not offer strong enough evidence for government coercion as opposed to recommendations (and public messaging) for their study to be used to justify an extreme emergency order.

This study, like some others used by the Cooper administration, prefers Asian mask-wearing “tradition” over the culture in the West and the U.S. Changing the culture is still no business of an extreme emergency order.

The U.S. in general was scored by the authors to be “mask-wearing” as early as April 12. North Carolina was well past 60 days into the outbreak before Cooper’s mask order. So the findings of the study seem moot here. A moot finding does not back an extreme emergency order.

Meanwhile, the subsequent “second wave” of the virus as fall arrived has upended early mask research, most done as spring gave way to summer, and this one looked at infections through April 16, when North Carolina was in the grips of Cooper’s initial lockdown order.

Furthermore, as Leffler et al. point out, a serious limitation in their study is that “the ultimate source of mortality data is often from governments which may not have the resources to provide a full accounting of their public health crises, or an interest in doing so.” Leffler et al. seem to regard the only way governments would err in death reporting would be to undercount, but it is also possible for governments to err in the other direction — indeed, the Cooper administration conflates death data so that researchers cannot disaggregate who died owing to COVID-19 or from fatal complications arising from it and those who died while coincidentally also having been diagnosed with COVID-19 (the difference between those who died from and who died with the virus).

The Cooper administration has, however, shown a lack of interest in reporting deaths other than COVID-19 deaths, causing North Carolina to lag the rest of the nation by over two months in reporting deaths data to the Centers for Disease Control and Prevention. There is a growing alarm among health experts, economists, policymakers, and others worldwide about the negative health impacts from government restrictions and lockdowns in response to COVID-19. If this is true in North Carolina and being exacerbated by Cooper’s orders, we’d find out far too late.

As for that, Leffler et al. also find that lockdowns are not associated with reduced mortality from COVID-19. Despite his interest in the mask portion of this study, Cooper seems doggedly uninterested with this finding — q.v., Cooper reiterated his threats for further lockdowns when announced his “Modified Stay-At-Home” (i.e., modified lockdown) order. Such cherry-picking cannot support extreme emergency orders.

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