Paul Grenelle
I have been delaying writing this article for a long time. Mostly I feel this discussion is a distraction from real the issues facing Christians and the church today. We have bigger fish to fry, so I thought. But now I’m forced to reverse to a definitive maybe not. Maybe this is the next front line for truth. You see recent discussions in the “Twitterverse” have lead me to discuss the morality of wearing a mask during this pandemic. I could barely write that sentence without a sigh and an eye roll but when I see pastors elevate this to a sin issue or equate it with being pro-life, then its time to speak truth into the issue. I do not intend to deal with the pro-life issue because I do not have room to address the legitimacy of co-opting the definitions of words. We will save that for a future post.
Now, before we get started, I would like to remind everyone that there is no mask mandate in the Bible. The Biblical evidence supports quarantining of the sick, Leviticus 13:5, and protecting the vulnerable, Psalm 82:3-4, but does not mention anything about mandatory face coverings. The Bible is our ultimate authority in defining sin and we clearly have no evidence of God decreeing masking for the asymptomatic during a pandemic. But maybe we could make an argument for the protecting of the vulnerable and loving our neighbors through wearing a mask. For that to be established, we must establish that masks make a definite difference in COVID transmission to the degree that not wearing them becomes reckless. This can’t be a gray area if we are going to make it a sin. If it is a sin, then being unrepentant in it could lead to church discipline so this must be definitive.
Now the argument over mask usage has to deal with the efficacy of the mask to prevent the spread of COVID-19. Firstly, COVID-19 is a real virus that has killed real people. The loss of those lives is a real tragedy in our world that should really cause us to mourn the loss of image bearers and the effects of depravity. This is truly sad. Yet another truly sad event is when we bind the conscience of Christians unnecessarily. When we do this we add to the law of God and that is a truly sad and dangerous place to be. Furthermore, to disfellowship someone from a local church unnecessarily would be another tragedy, especially in a time of social distancing where fellowship is difficult.
So masking during a pandemic with a respiratory virus seems like a no brainer. Except it is far from a no brainer. Let me explain. The current thinking behind masking is to prevent spread by reduction of droplets from the nasopharynx containing replicating competent virus. When we are speaking of masks then we are mostly speaking of the cloth face coverings or the disposable surgical masks the majority of people wear. The reason for universal masking is to prevent this transmission in asymptomatic patients. There is a lot to unpack here but let’s begin.
First a time machine. Let’s go back to January 2020, when Dr Fauci at the 44:00 minute mark stated that in the history of respiratory pandemics, asymptomatic cases haven’t driven the spread of the virus. So what changed? Well apparently we made history because they estimate that as much as 50% of cases are asymptomatic and now we are saying that the asymptomatic cases are driving the spread. The experts have had to switch and adjust constantly during this time. We went from two weeks to flatten the curve back in April to canceling Thanksgiving and Christmas. We went from masks don’t help to Dr. Fauci stating wearing masks and social distancing may be needed even after a vaccine. This isn’t necessarily their fault, because they have had to live out the process of addressing a pandemic in a very public way. Medicine can be messy, but it was historically messy behind the curtain. Well the curtain was pulled back and everyone got to see how the sausage is made and it’s not always pretty. So the communication has been messy and we haven’t had a consistent message from our experts.
And even if we are to listen to the experts then we have to pick which experts we listen to. The World Health Organization is at odds with the CDC. States are all over the place in their recommendations from their experts. For every medical expert that says to wear a mask you have an equally qualified expert stating that masks are not very effective. Again, there was a time that Fauci and the surgeon general both stated that masks were ineffective but have changed their tune. So when an expert changes their mind then we have a responsibility to ask for the evidence that warrants such a change.
Beyond that, truth is not found simply in the words of an expert. If we have learned anything it is that no one person has been able be a reliable source of good information. Again this is a novel virus being addressed by the world with a lot of moving parts to it. Truth is found or at least best approximated in facts. In medicine, this is established through the scientific method and found in medical studies. So we research and look to see what resources we can find. As it turns out there are many resources available. Now not all studies are the same. Random control trials are some of the best quality studies that we use to develop best practices. Correlation studies can have merit but correlation does not mean causation and thus we don’t rely on them as much. Anecdotal evidence from stories is not usually considered as they have a wide range of problems associated with them and are highly unreliable. So we go to dependable resources and look for facts. Here is what we find:
- https://wwwnc.cdc.gov/eid/article/26/5/19-0994_article This cdc study was a review of all random controlled studies on mask efficacy with viruses since 1946 and it concluded that masks had “no significant reduction in influenza transmission with the use of face masks”. Influenza or flu is actually a larger virus in size than coronavirus and thus any mask that would allow for transmission of flu would definitely allow for transmission of coronavirus.
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420971/ This study published by the British journal of medicine and linked on the National Institute for health website states “This study is the first RCT of cloth masks, and the results caution against the use of cloth masks. This is an important finding to inform occupational health and safety.”
- https://aapsonline.org/mask-facts/ This a rather large review of literature and studies put out by the Association of American Physicians and Surgeons. They again conclude that masks have not been found to reduce transmission of COVID infection effectively.
- https://www.acpjournals.org/doi/10.7326/M20-6817 Recently a large Dutch study did a randomized control trial comparing the infection rates of 400 participants divided by those who wore a mask to those who did not. They found that the difference in contracting COVID-19 between the groups was statistically insignificant. So again there appears to be no significant advantage in wearing a mask.
- https://rationalground.com/mask-charts/ A review of this website which tracks cases in relation to mask mandates also show that overall masks do not seem to affect transmission rates. I will stress that this is correlative and in itself would not define proof but in conjunction with the above studies does add to the evidence.
The preponderance of evidence here does not support wearing a mask. Are their other studies that show masking works. I’m sure there are. Are they as strong as what is presented here as a whole. No they are not. Most studies supporting masking are correlation studies that would present weaker evidence. Using the above studies we see very strong evidence that masking does not seem to affect transmission to any significant level. Certainly not to the level where you could assert that a person not wearing a mask is acting in a sinfully reckless or unloving way as to endanger their neighbor.
But wait, there’s more! Mandating universal masking fails to take into consideration those who have already contracted and recovered from COVID-19. Many studies have shown that a person with a moderate to severe case of COVID-19 would make antibodies for at least 3 months. Thus why there was a great push for those who have recovered to give plasma for antibody transfusion therapy for those currently sick. Added to that is this study which has not been peer reviewed yet and thus is not conclusive, but shows that b memory cells and T cell modulated immunity might last long after the antibodies have declined. The best statistics show that in the 35 million reported cases worldwide we have only had 5 reported reinfections . So a person that has been infected and recovered is almost guaranteed not to be reinfected and thus would be safe to walk around the general public without a mask. They would have a ridiculously low chance of catching the virus again. So in these cases, again, if a person has recovered from COVID-19 and has finished their quarantine time then it seems very foolish to accuse that person of being unloving to their neighbor for not wearing a mask.
A couple of studies have been presented in rebuttal to low mortality rates to help justify their assertion of the imperative of wearing a mask. These were found mainly in response to a post on Twitter supporting not wearing masks. These article are here and here. The problem with both of these studies is a reporting of case fatality rate or CFR versus infection fatality rate or IFR. Case fatality rate is the rate at which actual known cases died. This rate is always skewed higher because the people usually got tested once they felt ill enough to go to a healthcare facility. This is a known phenomenon seen in every flu season and every epidemic we have tracked. Furthermore, one of the studies was done in Italy. Italy is known for having the oldest population in the world and where medical facilities were over run to the point of reportedly sharing ventilators and doctors deciding to let some die to save resources for others. That was not what happened in the United States. Everyone needing a ventilator got a ventilator. Our healthcare system has responded in a much better way. Instead, to get a more true picture of a fatality rate you have to go by the infection fatality rate or IFR as this rate seeks to include the estimated asymptomatic cases into the number and gives a more accurate picture. If you go by CFR then you are conceding to only mask the symptomatic because the CFR is inclusive usually of only those who are symptomatic. If you are going to talk about asymptomatic spread then you must talk about the IFR for consistency. According to the CDC, your rate of survival by the IFR rates in America are as follows:
Age 0-19: 99.997%
Age 20-49: 99.98%
Age 50-69: 99.5%
Age 70+: 94.6%
These are far from the CFR reported in Italy and represents a more accurate picture of the reality of COVID in the United States. This again makes a tough case to call someone reckless if they don’t wear a mask. Assuming that masks were more effective than shown above, if someone infects another person, knowing that they have a greater than 90% chance of living through it hardly makes for reckless or unloving sinful behavior.
So, we have a real disease with real deaths and a real tragedy for all those lost lives. We have a real disease with a relatively low chance of dying if infected. We have a real disease that doesn’t appear to reinfect the overwhelming majority of people who were previously infected and thus they walk around with confidence that they aren’t an asymptomatic spreader. And we have a real disease in which it really looks like masks do not offer any type of sufficient protection. So, in light of these findings, I cannot see a way in which we could elevate not wearing masks to the level of a sin. At best it is a wisdom issue in which patience and grace should be given for each person’s individual choice for the sake of unity. As I said before, we have to find ways to unite through these situations because we have bigger things facing the church right now. So this post is a call for unity but a call for unity in truth and not in narrative.
Now am I advocating that we all refuse to wear masks? Definitely not. I wear a mask if a place of business asks me to. It is their business I freely choose to patronize so if they set up their terms of doing business then I will respect them as I would want people to respect the rules of my business. You know, “do unto others as you would have them do unto you”. I wear a mask at work and I do it happily because I also realize two things. First, this is the request of my place of work. This issue is not a case for civil disobedience according to Scripture so I will happily comply. Second, as a part of my job, I want to help people and ease suffering and realize that many are not comfortable with people who don’t wear masks. So my desire to help people is greater than my desire to ditch a mask. But my decision to wear a mask is a decision from wisdom and to elevate it to the level of sin is unwarranted and divisive.