by Tracy Beth Høeg, MD, PhD, The Pulse:
This week, the New England Journal of Medicine published an observational study claiming that lifting mask mandates in schools in Massachusetts was associated with increased COVID-19 rates.
First, even if these results were true, they have no applicability in the present. Seroprevalence has rocketed past 90%. Most kids have already had COVID. Ergo, they no longer need protection from COVID (which they will get again, eventually). Whether mask mandates avert RSV or other viruses is speculation, and contradicted by a mountain of pre-pandemic data.
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Second, these results aren’t true— they are unreliable, as detailed in this post by Tracy Beth Hoeg. She is going to walk you through the technical issues, including the crux of the matter: difference in difference analysis cannot handle time-varying confounders, and time-varying confounders are guaranteed when mask mandates fall.
Third, observational data will never settle mask debates. In recent years, a number of groups have asked what happens if the same dataset is approached with different analytic plans. What happens if you give the same data to multiple research teams, or if you simulate many analytic plans. These studies show observational studies can give a range of results, in many cases, they can conclude an intervention is harmful or helpful depending on the plan.
Masking kids is a divisive issue. Our friends across the pond do not do it. They do not like doing it to kids under 12. And they will never do it to kids under five. Our country is full of pro-mask zealots. They love masking kids. In this case, some of the authors of the NEJM paper have repeatedly advocated for the policy of masking kids in school.
What am I to think? When you give someone a question that has tons of analytic flexibility, and they have already said they vehemently support the policy. Their analysis delivers what they promised.
Is this science?
Fourth, the discussion of the NEJM paper says, “structural racism is embedded in public policies and that policy decisions have the potential to rectify or reproduce health inequities”. They authors frame masks as a tool to lower structural racism.
Whether masking kids slows respiratory viruses is a scientific question, and it is a dangerous to turn this into a proxy for political debates. I believe it is a mistake to weaponize structural racism to support masking kids.
If masks slow COVID19 and improve long term outcomes, then they might help minority kids more than the majority kids. But if masks don’t actually improve long term outcomes– because all kids get COVID anyway, or because masks don’t slow spread— then masking kids disproportionately hurts poor minority kids. This study actually shows American society was happy to mask minority kids longer.
During the pandemic, poor people had to mask more than rich people. I mask on the public bus, but not when I drive my car. Workers mask when they serve you at a restaurant, while you enjoy life unmasked.
Let’s not convert a scientific question about whether masks slow viral spread into a referendum about who cares more about structural racism or socioeconomic disparities. Evoking this rhetoric is inappropriate for the New England Journal of Medicine. It is a shame editors allowed it.
I suspect there is a reason why masking proponents want to tie their policy to structural racism. It allows them to claim their opponents aren’t just scientists who questions their methods, they are bad people. We cannot turn masking kids, and COVID-19 into a proxy war for political issues. We can’t make a scientific question a moral one just to shut down debate.
