Are Face Masks Effective? The Evidence.

Updated: August 2021.   Published: July 2020

An overview of the current evidence regarding the effectiveness of face masks.

A) Studies on the effectiveness of face masks

So far, most studies found little to no evidence for the effectiveness of face masks in the general population, neither as personal protective equipment nor as a source control.

  1. A May 2020 meta-study on pandemic influenza published by the US CDC found that face masks had no effect, neither as personal protective equipment nor as a source control. (https://wwwnc.cdc.gov/eid/article/26/5/19-0994_article)
  2. A Danish randomized controlled trial with 6000 participants, published in the Annals of Internal Medicine in November 2020, found no statistically significant effect of high-quality medical face masks against SARS-CoV-2 infection in a community setting. (https://www.acpjournals.org/doi/10.7326/M20-6817)
  3. A large randomized controlled trial with close to 8000 participants, published in October 2020 in PLOS One, found that face masks “did not seem to be effective against laboratory-confirmed viral respiratory infections nor against clinical respiratory infection.” (https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240287)
  4. A February 2021 review by the European CDC found no high-quality evidence supporting the effectiveness of non-medical and medical face masks in the community. Furthermore, the European CDC advised against the use of FFP2/N95 masks by the general public. (https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-face-masks-community-first-update.pdf)
  5. A July 2020 review by the Oxford Centre for Evidence-Based Medicine found that there is no evidence for the effectiveness of face masks against virus infection or transmission. (https://www.cebm.net/covid-19/masking-lack-of-evidence-with-politics/)
  6. A November 2020 Cochrane review found that face masks did not reduce influenza-like illness (ILI) cases, neither in the general population nor in health care workers. (https://www.cochrane.org/CD006207/ARI_do-physical-measures-such-hand-washing-or-wearing-masks-stop-or-slow-down-spread-respiratory-viruses)
  7. An April 2020 review by two US professors in respiratory and infectious disease from the University of Illinois concluded that face masks have no effect in everyday life, neither as self-protection nor to protect third parties (so-called source control). (https://www.cidrap.umn.edu/news-perspective/2020/04/commentary-masks-all-covid-19-not-based-sound-data)
  8. An article in the New England Journal of Medicine from May 2020 came to the conclusion that face masks offer little to no protection in everyday life. (https://www.nejm.org/doi/full/10.1056/NEJMp2006372)
  9. A 2015 study in the British Medical Journal BMJ Open found that cloth masks were penetrated by 97% of particles and may increase infection risk by retaining moisture or repeated use. (https://bmjopen.bmj.com/content/5/4/e006577)
  10. An August 2020 review by a German professor in virology, epidemiology and hygiene found that there is no evidence for the effectiveness of face masks and that the improper daily use of masks by the public may in fact lead to an increase in infections. (https://www.thieme-connect.com/products/ejournals/html/10.1055/a-1174-6591)


B) Development of cases after mask mandates

In many states, coronavirus infections strongly increased after mask mandates had been introduced. The following charts show the typical examples of Germany, Ireland, Italy, Spain, the UK, California. Furthermore, a direct comparison between US states with and without mask mandates indicates that mask mandates have made no difference. 

C) Additional aspects

  1. There is increasing evidence that the novel coronavirus is transmitted, at least in indoor settings, not only by droplets but also by smaller aerosols. However, due to their large pore size and poor fit, most masks cannot filter out aerosols (see video analysis below): over 90% of aerosols penetrate or bypass the mask and fill a medium-sized room within minutes.
  2. The WHO admitted to the BBC that its June 2020 mask policy update was due not to new evidence but “political lobbying”: “We had been told by various sources WHO committee reviewing the evidence had not backed masks but they recommended them due to political lobbying. This point was put to WHO who did not deny.” (D. Cohen, BBC Medical Corresponent).
  3. To date, the only randomized controlled trial (RCT) on face masks against SARS-CoV-2 infection in a community setting found no statistically significant benefit (see above). However, three major journals refused to publish this study, delaying its publication by several months.
  4. An analysis by the US CDC found that 85% of people infected with the new coronavirus reported wearing a mask “always” (70.6%) or “often” (14.4%). Compared to the control group of uninfected people, always wearing a mask did not reduce the risk of infection.
  5. Researchers from the University of Minnesota found that the infectious dose of SARS-CoV-2 is just 300 virions (virus particles), whereas a single minute of normal speaking may generate more than 750,000 virions, making face masks unlikely to prevent an infection.
  6. In the US state of Kansas, the 90 counties without mask mandates had lower coronavirus infection rates than the 15 counties with mask mandates. To hide this fact, the Kansas health department tried to manipulate the official statistics and data presentation.
  7. Contrary to common belief, studies in hospitals found that the wearing of a medical mask by surgeons during operations didn’t reduce post-operative bacterial wound infections in patients.
  8. During the notorious 1918 influenza pandemic, the use of face masks among the general population was widespread and in some places mandatory, but they made no difference.
  9. The initially low coronavirus infection rate in some Asian countries was not due to masks, but due to very rapid border controls. For instance, Japan, despite its widespread use of face masks, had experienced its most recent influenza epidemic just one year prior to the covid pandemic.
  10. Early in the pandemic, the advocacy group “masks4all” argued that Czechia had few infections thanks to the early use of masks. In reality, the coronavirus simply hadn’t engulfed Eastern Europe yet; a few months later, Czechia had one of the highest infection rates in the world.

D) Studies claiming face masks are effective

Some recent studies argued that face masks are indeed effective against the new coronavirus and could at least prevent the infection of other people. However, most of these studies suffer from poor methodology and sometimes show the opposite of what they claim to show.

E) Risks associated with face masks

Wearing masks for a prolonged period of time may not be harmless, as the following evidence shows:

  1. The WHO warns of various “side effects” such as difficulty breathing and skin rashes.
  2. Tests conducted by the University Hospital of Leipzig in Germany have shown that face masks significantly reduce the resilience and performance of healthy adults.
  3. A German psychological study with about 1000 participants found “severe psychosocial consequences” due to the introduction of mandatory face masks in Germany.
  4. The Hamburg Environmental Institute warned of the inhalation of chlorine compounds in polyester masks as well as problems in connection with face mask disposal.
  5. The European rapid alert system RAPEX has already recalled 70 mask models because they did not meet EU quality standards and could lead to “serious risks”.
  6. A study by the University of Muenster in Germany found that on N95 (FFP2) masks, Sars-CoV-2 may remain infectious for several days, thus increasing the risk of self-contamination.
  7. In China, several children who had to wear a mask during gym classes fainted and died; the autopsies found a sudden cardiac arrest as the probable cause of death. In the US, a car driver wearing an N95 (FFP2) mask fainted and crashed due to CO2 intoxication.

Conclusion:

Face masks in the general population might be effective, at least in some circumstances, but there is currently little to no evidence supporting this proposition. If the coronavirus is indeed transmitted via indoor aerosols, face masks are unlikely to be protective. Health authorities should therefore not assume or suggest that face masks will reduce the rate or risk of infection.

WHO Admits: No Direct Evidence Masks Prevent Viral Infection


  • According to the World Health Organization's June 5, 2020, guidance on face mask use, there's no direct evidence that universal masking of healthy people is an effective intervention against respiratory illnesses
  • While masks do not prevent the spread of viral infections, the WHO still makes a case for universal mask-wearing, citing benefits such as reduced stigmatization of people caring for COVID-19 patients in nonclinical settings, making people feel like they're doing something to help, serving as a reminder to be compliant with other measures, and economic benefits for people who can sew homemade masks
  • Despite the fact that cloth masks are far less effective for blocking potentially infectious respiratory droplets, the WHO recommends cloth masks should be worn by infected persons in community settings
  • A policy review paper published in the CDC's journal Emerging Infectious Diseases found that masks did not protect against influenza in non-healthcare settings
  • Harms and risks of mask-wearing include health effects associated with poor air quality and toxic ingredients in the mask, self-contamination caused by manipulation of the mask by contaminated hands, general discomfort, facial skin lesions, irritant dermatitis or worsening acne, and a false sense of security that may reduce adherence to other preventive measures such as hand hygiene


Sixth Tone: Voices from Today’s China:

https://www.sixthtone.com/news/1005609/after-multiple-deaths%2C-officials-call-for-no-masks-in-gym-class

Several education bureaus in China are rethinking COVID-19 control policies after three students died running in masks at school. The Beijing News

Bureaus in the eastern city of Xiamen, the southern province of Hainan, and the central city of Changsha have issued notices that either discourage schools from requiring students to wear masks during gym class or prohibit the facial accessories during exercise outright.


Two boys drop dead in China while wearing masks during gym class

The students, who were both 14, were each running laps for a physical examination test when they suddenly collapsed on the track, Australian outlet 7News reported. The death certificate listed the cause as sudden cardiac arrest.


AMA Journal: Masks Are Bad For Your Kids. Quit Forcing Them To Wear Them

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