Rand Paul’s Criticism of Cloth Masks Was Stronger Than the Evidence Justifies
YouTube this week suspended Sen. Rand Paul’s account because of a video in which the Kentucky Republican claimed that “most of the masks that you can get over the counter don’t work” as a safeguard against COVID-19. “The virus particles are too small and go right through them,” Paul says in that video, which shows him speaking with a Newsmax interviewer. “They don’t work. There’s no value.”
YouTube said Paul violated its “COVID-19 medical misinformation policy,” which among other things forbids “claims that masks do not play a role in preventing the contraction or transmission of COVID-19.” While conceding that “private companies have the right to ban me if they want to,” Paul said he was troubled by the fact that the major social media platforms seem to be insisting that users toe the official line on COVID-19, which makes it harder to criticize ill-founded positions and policies. YouTube, he said, is acting like “an arm of the government.”
Paul has a point. But in this case, his flat, categorical statements about cloth masks are stronger than the scientific literature supports, relying on a couple of cherry-picked studies with known limitations while ignoring countervailing evidence.
In a video responding to his YouTube suspension, Paul reiterates that “most of the masks that you get over the counter don’t work” and “don’t prevent infection.” He argues that “saying cloth masks work when they don’t actually risks lives,” describing it as “potentially deadly misinformation.” While N95 respirators are effective at preventing virus transmission, he says, “the other masks don’t work.”
Paul would have been on firm ground if he had said cloth masks offer less protection than N95 masks. But the claim that cloth masks “don’t work,” meaning they offer no protection at all, is inconsistent with multiple studies suggesting that they reduce the risk of infection, especially when worn by carriers but possibly also when worn by other people in their vicinity.
Paul cites two studies to back up his belief that cloth masks are ineffective: a 2015 study of health care workers in Vietnam and a 2021 Danish study that compared people who were advised to wear masks with people who weren’t. Neither study proves that cloth masks “don’t work.”
The 2015 study, which was reported in BMJ Open, involved about 1,600 hospital employees who were randomly assigned to groups that used “medical masks” (meaning “disposable medical/surgical masks”), used “cloth masks,” or followed “usual practice,” which notably “included mask wearing.” The researchers measured each group’s rate of “clinical respiratory illness (CRI), influenza-like illness (ILI) and laboratory-confirmed respiratory virus infection.” Here are the results they reported:
The rates of all infection outcomes were highest in the cloth mask arm, with the rate of ILI statistically significantly higher in the cloth mask arm (relative risk (RR)=13.00, 95% CI 1.69 to 100.07) compared with the medical mask arm. Cloth masks also had significantly higher rates of ILI compared with the control arm. An analysis by mask use showed ILI (RR=6.64, 95% CI 1.45 to 28.65) and laboratory-confirmed virus (RR=1.72, 95% CI 1.01 to 2.94) were significantly higher in the cloth masks group compared with the medical masks group. Penetration of cloth masks by particles was almost 97% and medical masks 44%.
Those results contradic
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