Flummoxed: Will the Debate About COVID Masks Ever End?

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COVID misinformation rules once again.  This time it is about the value of masks preventing illness.


Like so much else in life, it’s complicated. It is also nuanced and subject to oversimplification.


Years ago, I was involved in a public uproar when the Affordable Care Act was debated in Congress. There was the possibility, based on a newly-issued government guideline, that screening mammograms would not be covered until age 50 as opposed to age 40, which had been the recommendation of several prominent organizations. There was a huge outcry, and the legislation was amended. I learned firsthand about how influential the public can be when they have strong personal views on a specific health guideline, especially if they believe the government might restrict access to a medical service. In this case, the Secretary of Health and Human Services lost no time assuring the public their voices had been heard.


The current renewed debate about masks began when Dr. Anthony Fauci–an infectious disease expert who was front and center during the pandemic and is now vilified regularly by certain groups because of his leadership during that time—was interviewed on CNN.


Dr. Fauci was asked about a scientific review and an expert’s comments that reportedly showed masks don’t prevent COVID. He explained the review may not have helped reduce infection at the population level but also made the argument that many studies showed masks help individuals. He tried to explain nuanced science within the time limits of a network interview.


A storm of negative publicity followed in certain media promoting the idea that masks don’t prevent COVID and that Dr. Fauci was somehow caught off guard. Some of the reports appeared almost gleeful at the takedown.


I am not certain it was such a significant takedown. In mass media, simplicity is the order of the day, and these issues are not simple. Even highly qualified experts can examine the same data and come to different conclusions. The world of science in medicine is not always as clear as we would like.


When you read the “source” document for the review, you find it really didn’t answer whether masks reduce the risk of COVID infection. The report was based on pooled scientific data from many research studies, almost all done before COVID.  The design of some of the research was not ideal, and the authors concluded that they did not have confidence that their efforts answered the question of whether masks reduce the risk of respiratory viruses in general. What the study did not do was rigorously demonstrate whether or not wearing high-quality masks made a difference in COVID infection rates.


As the authors wrote in their summary:

“The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions…There is uncertainty about the effects of face masks. The low to moderate certainty of evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect.”


What we end up with is a discussion in the public square influenced by opinion and anecdote and not by facts. Echo chambers rule once again where individuals can be influenced by the opinions of experts who themselves may not understand the limitations of the available information. Talking points and sound bites rule; data and evidence be damned.


I have been concerned with the manipulation of history regarding COVID and its impact when people—especially political leaders—whitewash the reality of what occurred in early 2020 and repurpose today’s narrative to suit their needs.


Trashing COVID prevention has become a bit of a sport. We should never forget that hospitals were overwhelmed, folks died, and impairment remains real for many. In early 2020, we were facing an unknown disease. We had calculations that over 2 million people could die in this country. Over 1 million people have died—but that inconvenient truth is forgotten, in no small part, because dead people don’t talk.


We live in an age of instant information, where everyone acts as their own judge of what is fact and what is not, what is true and what is false. Millions of people are making those judgments every day. And we do that in the context of a news cycle that lasts a day or two at best, trying to help folks understand complex concepts that can elude anyone’s capability to explain in a short moment on a television interview.


The reality is that when we have these discussions, we are dealing with the public’s health and people’s lives. We are providing information and making pronouncements that can profoundly impact society. If we don’t figure out how to do that in a way that is understood by and has the support of the public, the next pandemic may be worse than the current one.


We can and must do better…for all our sakes.



Len Lichtenfeld, MD, MACP

Dr. Lichtenfeld (or Dr. Len, as he is commonly known) is a board-certified medical oncologist with long standing interests in cancer care, public health, and health policy. He has served in executive and advisory roles for companies engaged in cancer research, drug and technology development and cancer patient/caregiver support. He recently completed 19 years of service to the American Cancer Society as Deputy Chief Medical Officer and interim Chief Medical and Scientific Officer. For many years he managed the Society’s Cancer Control Science Department which was best known for the Society’s well-respected guidelines on the prevention and early detection of cancer. Dr. Lichtenfeld has been widely quoted in the print and electronic media and is recognized for his expertise in medical policy, cancer care and the early detection of cancer.


A board-certified medical oncologist and internist who was a practicing physician for over 19 years, Dr. Lichtenfeld remains active in several state and national medical organizations and continues his longstanding commitment to address legislative, regulatory, and clinical practice issues related to health care including physician payment, medical care delivery systems, and health information technology among others. He is on the board of CancerCare, an organization providing emotional and financial support for cancer patients and their families.


Dr. Lichtenfeld is a graduate of the University of Pennsylvania and Hahnemann Medical College (now Drexel University College of Medicine) in Philadelphia.  His postgraduate training was at Temple University Hospital in Philadelphia, Johns Hopkins University School of Medicine and the National Cancer Institute in Baltimore. He is a member of Alpha Omega Alpha, the national honor medical society.  Dr. Lichtenfeld has received several awards in recognition of his leadership and efforts on behalf of his colleagues and his professional activities.  He has been designated a Master of the American College of Physicians in acknowledgement of his contributions to internal medicine.


He is married and currently resides with his wife in Atlanta, Georgia.

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