Do Masks Work? What the Data Shows

The efficacy of COVID-19 mask mandates remains in question.

by Rachel del Guidice: Do masks really work? Can they help contain the spread of COVID-19?

Why does some data show that mask mandates in the U.S. and other countries did not prevent surges in COVID-19 cases?

Doug Badger, a visiting fellow in domestic policy studies at The Heritage Foundation, and Norbert Michel, director of Heritage’s Center for Data Analysis, join “The Daily Signal Podcast” to discuss these questions and more.

Rachel del Guidice: I’m joined today by Doug Badger, he’s a visiting fellow in domestic policy studies at The Heritage Foundation, and Norbert Michel, director of The Heritage Foundation Center for Data Analysis. Doug and Norbert, thanks so much for coming on “The Daily Signal Podcast.”

Norbert Michel: Thanks for having us.

Del Guidice: Well, it’s great to have you both with us. You both authored a Heritage Foundation report called “Mask Mandates: Do They Work? Are There Better Ways to Control COVID-19 Outbreaks?” So, Doug, can you just start off by telling us what the report is about?

Doug Badger: Sure. It was actually a collaboration between Norbert and me. Norbert was looking at counties that either had mask mandates themselves or there were state mask mandates that covered that county, or both.

So you looked at the U.S., I was looking at Italy, by comparison, a country that had a national mask mandate. And the question we asked was, did these mandates prevent the big run-up in cases that occurred in the fall and that we’re really still in here in early January of 2021?

I saw in Italy, we presented data to show that it really didn’t work. Norbert looked more specifically at US counties. And the question was, what happened in those counties, Norbert, that had mask mandates in place?

Michel: And what we saw was much like what we saw in Italy, which was that virtually all of those counties already had mask mandates in place. When you look at where are all the cases, you find that all of those counties had mask mandates, basically.

Out of the top 100, the counties with the 100 most, largest amount of cases, 97 of them had a mandate in place. When you look at the top 25, all 25 had a mandate in place. And most of those were in place before October. Only about 10 that weren’t in place before October.

So whether a mask works to help slow the transmission is one thing. But whether these mask mandates have worked is another thing. The mandates themselves clearly didn’t prevent the surge. The data just clearly supports that.

Del Guidice: Well, on that note, in the piece, you all point out that while mask-wearing can help reduce transmission of COVID-19, data shows that mask mandates in the U.S. and other countries did not prevent a surge of cases. So, Doug, can you talk more about why this is the case?

Badger: Sure. I think there are two reasons for that. First—and I want to be really clear about this, we are in the paper, but I want to make sure we’re not misunderstood—we are not saying that you shouldn’t wear a mask or that that mask-wearing does no good.

And there is a good deal of evidence out there that both the [Centers for Disease Control and Prevention], the World Health Organization, and other bodies have found that say that if you have COVID and you don’t know it, a mask makes it less likely that you will spread the disease to other people. So there’s certainly an argument to be made that these have some value in suppressing infection.

The problem is that what we know is that even with mask-wearing and social distancing and other precautions we take to prevent infections, that a lot of people get infected anyway.

It’s not that masks don’t work, it’s that they’re not perfect and they don’t suppress the infection. And where we fail in our public health policy has been in what we do once people get infected.

We need to do a better job of identifying people with the infection, separating them from people who aren’t yet infected, and also trying to identify people that they may have infected.

That’s where the policy has fallen down. It’s not that mask-wearing is a bad thing. It’s just that it’s really insufficient, as Norbert points out. The numbers are irrefutable in terms of the run-up in cases that occurred despite mask mandates and relatively widespread mask-wearing.

Del Guidice: Well, Doug, you had mentioned that you were looking specifically at Italy and their mandate. Can you tell us a little bit more about how that country fared, even though they had a national mask mandate?

Badger: Yeah. And unfortunately for them, and now we’re talking about a mask mandate in Italy, it’s a thousand-euro fine if you’re outside your house without a mask. It’s enforced by the military police and the local authorities. So they’re very deadly serious about the mask mandate.

And what happened is that as much as we read about the pandemic in the early days in Italy, going back to March and April, the run-up in cases that they had in October and November and into December was far in excess of what they had back in March and April, when, obviously, there were no mask mandates in place.

So again, it was an earnest effort by the government, along with other things, partial lockdowns and so forth, that they deployed throughout the fall and early winter. And unfortunately, it just simply did not curb the increase in infections there.

Del Guidice: Norbert, you also unpack how the Centers for Disease Control believe that masks have a source value. What is source control and how does this work?

Michel: When you look at the question of do masks themselves help stop the spread, or does a face covering help reduce the spread or the speed of the disease, which it spreads, you have to ask a few different questions. And one of those is source control.

So, does it control the disease at the source? And specifically, in other words, if we’re talking about does it have source control, we’re saying, does it block release of the respiratory particles that someone exhales? So the source of where those respiratory particles are coming from, that is source control.

So the CDC for a long time now has said that they think that there is at least some evidence to suggest that masks do have some source control. They do stop people, say, if you’re going to sneeze, or if you’re yelling and sort of—I hate to use the word spitting—spraying those particles out into the environment, the mask can help sort of stop that.

It can reduce the speed with which things get out and reduce, I would imagine, the total amount of those things that can get out. So in that sense, it can help protect people who are not yet infected from becoming infected. And that’s the source control part.

Badger: Yeah. Norbert did a very good job of describing the source control. That means if I have it and don’t know it, I’m protecting you against me because I’m carrying the disease.

The second is protection. And that is to say, if I don’t have it and I wear a mask, will the mask protect me from getting it from somebody else? So now I’m no longer the carrier, I’m the person who is not infected.

Now, CDC in November changed its guideline and said, “Yeah, masks do have a protection value.” Unfortunately, there’s only been one controlled experiment of that. It was conducted in Denmark with 6,000 participants.

And it concluded quite the opposite, that it’s not going to keep me from getting it if I’m not infected. It doesn’t have a protective value. But if I have it, it will reduce the chances that I will infect somebody else. That’s the source control value.

Del Guidice: We talked about how during the surge in the fall, 97 of the 100 counties with the most confirmed cases had either a county-level mask mandate, a state-level mask mandate, or both. And I just wanted to hear from you both, is it possible that without mask mandates in those 97 counties, there could have been even more COVID cases than there were?

Michel: Statistically, that’s something that we can’t prove. So, I mean, the honest answer is yes. But what we do know is that the largest surge in cases that we’ve seen now in that period around Thanksgiving through December, larger than even the previous surges, really, did take place in places where there were mask mandates.

So could it have been worse? Yes. But, I mean, it was really bad.

So all we can do is look at what the data definitely tells us. And the date data definitely tells us that those surges were worse than they were in some of the same places after the mandates were in place than they were before. And the total number was much worse than what we had seen in the past, even though we had the mandates.

Badger: And just to emphasize again, we’re very clear in the paper, we’re not saying don’t wear masks—

Michel: Right.

Badger: … they don’t do any good. We think they do. But the problem is that public health policy has almost become obsessed with masks. And what we do know about them is precisely what Norbert pointed out, that whatever value they have, they didn’t prevent the biggest run-up of cases that we’ve seen since the beginning of the pandemic.

And that’s not just true of the United States, that’s also true of throughout Europe, certainly. We cite Italy as an example, but Italy is only one example. Universally, mask-wearing for whatever value it had, and we encourage people to wear masks, our policy needs to go further than that in order to suppress the pandemic.

Michel: That was great. And if I could just tail off of one point that Doug mentioned there. In terms of the public policy part of this, it’s clear both with lockdowns and mask mandates, not just in the U.S., that relying on those two things, locking everything down and implementing a mandate, it’s clear that those two things have not prevented these surges.

You can get into the details over whether they do any good or not, but that’s almost irrelevant. I mean, you can look at L.A. County, Los Angeles area versus Florida.

Los Angeles has some of the most severe restrictions in the U.S., Florida does not. It’s worse in Los Angeles than it is in Florida. But even aside from that, if you just look at what works and what doesn’t work, we can pretty definitively say now that this strategy that relies just on lockdowns and mask mandates has not prevented these surges.

Del Guidice: On that note, Doug, what does your data mean for personal behavior? Should we wear a mask when it’s not mandated, like when we’re around friends or family indoors? And what about wearing a mask outdoors?

Badger: Yeah, I don’t want to go into issues [like] that. I think I would listen to your local public health officials. I would talk to your doctor if you have a question about that.

Mask-wearing, again, definitely has value. But where you should wear them and whether it’s appropriate to do so indoors and, frankly, in some cases, your doctor may say that if you have certain gatherings with people, you should avoid them entirely and not rely on masks to protect you.

What I’d really like to focus on is when we talk about the fact that we haven’t implemented policies that do work, I’d like to talk just for a couple of minutes, if it’s OK, about what those policies might look like.

Del Guidice: Yeah. Go for it. I would love to hear. That was one of my follow-up questions. But yeah, feel free to bring that up now.

Badger: Yeah. I mean, as I said, what we focused on is saying, “Let’s take steps like mask-wearing and distancing and so forth to prevent the spread of the infection.”

And what we know now, I think, or should know by now, is that we can slow the rate perhaps at which the infection spreads, but the infection continues to spread. And unfortunately, it is spread at an unacceptably high rate.

So what’s the other side of the coin? If you know that people are going to get infected anyway, you need a strategy to say, “Well, what do we do once people get infected? Since we can’t stop those infections, we can only slow them, what do we do when that happens?”

And again, the most important thing we can do is a better job of identifying people that have the infections. And that’s where we get into the issue of testing.

Right now, we’re testing somewhere between a million and a half and 2 million people a day. And when I say that, what I mean is we get test results back as to whether they’re positive or negative, and that’s how we understand how many daily new cases we have of confirmed COVID.

Now, those test results were performed on people who were tested two, three, four, sometimes more days before. So we’re not getting a lot of data. A million and a half and 2 million a day in a nation of 330 million people is really not much. And we’re not getting timely data on those folks.

And so one of the things that we’ve talked about, and Heritage did a symposium with Dr. Paul Romer, a Nobel-winning economist, Michael Mina, an epidemiologist from Harvard, and I also participated in that, in which we talk about rapid self-testing.

These are tests that cost about a dollar to produce. They’re very simple tests involving either a swab or a bit of saliva. You do it yourself, you do it at home. You get the results in 15 minutes. And unfortunately, the [Food and Drug Administration] has not approved these for public use.

We believe very strongly—and Norbert and I argued for this in the paper—that the FDA should allow these tests to be made available to people so that we can find out our COVID status, not in two or three or four days after it comes back from a laboratory, but we can find out within 15 to 30 minutes in our homes and take appropriate steps once we know what our infection status is.

Del Guidice: Well, Doug and Norbert, what is the best way as we go forward to protect the most vulnerable, such as those in nursing homes, the elderly, as well as those with preexisting conditions? Michel: Well, I think the rapid testing is part of that, has to be part of that strategy. I mean, at the core, what this means is that we’re empowering people and giving them the information that they need to protect themselves, as opposed to preventing them from having that.

If you look at nursing homes, what happens? Well, you have a congregate setting where a bunch of people are living and you have a staff that comes in and out. Well, obviously, even if you cordon off the residents, unless you keep the staff away from them, that’s a source of bringing the virus in.

So what do you do? Well, you rapidly test people. I mean, the staff coming in and out, right? But without having the approval of the tests and having enough of those tests produced, which isn’t going to come without the approval, you can’t do that. And you prevent some people from having the information that they need.

You have a staff member who could test themselves before they leave their home, and if they test positive, they could stay home. I mean, that’s a commonsense part of how we need to combat this stuff.

Del Guidice: Well, lastly, Doug, something that is suggested in your paper is establishing voluntary isolation facilities, saying that they should be strictly voluntary.

And I wanted to hear from you as how you think this should be gone about, making it strictly voluntary, especially in today’s day and age, where there’ve been so many mandates that have come down during this time.

Badger: Yeah. It’s very important, the voluntary nature of these things.

When you think about what happens, we all kind of walk around with our masks and distancing and so forth, hoping that we don’t get infected or infect somebody else. But then once we find out that somebody is infected, we tell them to go lock themselves in their house with their family members for 10 days or 14 days, whatever that is.

And so what happens is one of the principle ways COVID is transmitted is in the home. So you want to give people a safe alternative.

And I would at least say, with respect to people who have a vulnerable person in their home, an older relative, someone who might have a respiratory illness or something, if I get that, give me an alternative to locking myself in the house with that person and trying not to infect him or her.

So it should be voluntary. And it should be something where if you agree to stay until you’re cleared of the infection, I think the government ought to compensate you for doing that.

We’re mailing out checks to people indiscriminately. If we’re going to direct resources appropriately, we want to direct them at people who are infected.

Because here’s the thing, we go to great lengths through mask-wearing and so forth to prevent the infections from occurring. But then somebody gets it, that person, you want to make that infection a dead end. You want to make sure that person doesn’t infect others.

We know what happens when you send that person home. Typically, the other people in the household get infected. Let’s create some alternatives to allow that person to recover from the infection without putting other people at risk.

Del Guidice: Well, Doug and Norbert, thank you so much for joining us on “The Daily Signal Podcast.” It’s great having you with us.

Michel: Thanks, Rachel.

Badger: Thank you, Rachel.
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Rachel del Guidice is a congressional reporter for The Daily Signal.

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