Conflicting claims on efficacy of masks

In social interactions, nuanced deviations from the truth or “pro-social lies” can occasionally tide over a thorny situation. Extending this to science can however bring about its nemesis. And if practised by hallowed scientific institutions, they can result in irreparable harm to their credibility and reputation.

Of late such deviations from evidence-based practice have become rather too frequent on the part of reputable institutions like the Centre for Disease Control (CDC), Atlanta, USA, the US Food and Drug Administration (FDA), and others. Misinformation from such esteemed institutions, which had been acknowledged as the final authority by scientists, researchers and the general public, can have devastatingly adverse impact on current and future pandemics. It can also lead to irreparable erosion of trust among the general public in science and scientific institutions, and also cause dismay and disillusionment, if not a little embarrassment, among practising researchers. These misguiding signals also have the potential to push research priorities down the wrong path.

In English literature, Shakespeare is said to have captured the whole gamut of the human experience including deceit, greed and pathos, using melodrama to appeal to the emotion of the masses. In Julius Caesar, one of his wellknown tragedies, Caesar’s last words were, “Et tu, Brute, Than fall Caesar”, which translates to “You too, Brutus, then fall Caesar”, as Caesar’s assassins included his best and trusted friend Brutus.

Indian mainstream art and culture too captures this vast canvas through current medium of mass entertainment, the movies. A song in a classic Hindi film captures the current state of affairs in medical science. In this song there are many allegories to this situation.

For instance, there is a stanza which goes, 'Majdhaar me naiyya dole, to majhi paar lagaye, majhi jo nao duboye, use kaun bachaye...' which translates to “In the midstream when the boat is wobbling, the boatman saves it from going down; but when the boatman himself sinks the boat, who will save it.”

The current pandemic is exposing the cracks in our public health and regulatory systems. US being the bellwether of global trends, some serious misinformation and misdemeanours on part of those entrusted to safeguard public health and ensure safety of interventions for controlling the pandemic is cause for great concern and a threat to humanity.

Some time back the CDC Director tweeted, that masks cut down transmission of the novel coronavirus by 80%. This statement, which flies in the face of evidence, coming from the CDC director does immense harm to the credibility of this august institution. CDC Atlanta used to be the last word in public health protocols and this highly inaccurate statement would undermine the trust of public health professionals in the CDC. Far lesser deviations from the truth by lesser mortals are routinely labelled as “fake news” by mainstream consensus and censored.

The scientific evidence of protection by masks is that cloth masks do not check transmission of the virus and surgical masks offer very modest protection to the tune of 11%. A Danish Randomized Controlled Mask Study did not find any benefit of using surgical masks while a very large Cluster Randomized Mask Study from Bangladesh found that cloth masks offered no protection while surgical masks reduced transmission by mere 11%.

Such misinformation can be hazardous. The misleading statement of 80% efficacy by masks could lull many into a false sense of security. Overestimating the protection offered, most may neglect other safe behaviour such as the three ‘Cs,’ i.e. avoid closed spaces, crowds and close contacts. This can be hazardous particularly for the old and the vulnerable.

Masks not used properly also have the potential of being extremely hazardous. In hot and humid weather, sweat and saliva can wet the masks within a couple of hours providing ideal soil for growth of other pathogens and fungi more virulent than the novel coronavirus.

A hypothesis can be proposed that the high incidence of mucormycosis or black fungi during the second wave in hot and humid summer of India might have been due to improperly used soiled masks besides use of steroids and underlying diabetes. This is a topic for research which is however not being explored.

This may be due to the belief that masks are holy and sacrosanct the way they are being advocated by people in high places such as the Director of CDC without any evidence, rather against all evidence.

Another clumsy and amateurish action recently by CDC is the propaganda that vaccine induced immunity is superior to immunity after recovery from natural infection based on a highly flawed study. This study was an observation based on a sample of just 89 unrepresentative patients in various hospitals and has been criticised severely by serious researchers.

On the other hand, real world studies on very large sample sizes in Israel and Cleveland Clinic, USA among others, have established beyond reasonable doubt that immunity after natural infection confers at least 13 times more robust immunity compared to vaccine induced immunity.

The FDA too is complicit in acts of omission if not commission. According to a recent investigative report in the prestigious British Medical Journal (BMJ), there were gross irregularities in one of the centres conducting the Pfizer vaccine trials.

The director of this centre reported sloppy quality control during the vaccine trials such as untrained vaccinators, poor follow up of adverse events, unblended participants and other lapses to the FDA. This regulatory body even on being informed about these lapses did not take any action. To add insult to injury, the whistle-blower was summarily sacked by her employers.

Such acts of omissions and commissions by august bodies like the CDC and regulatory authorities like the FDA echo the pathos of the Bard and that in the classic music song questioning who will save us from drowning if the boatman himself sinks the boat.

(The writer is Head, Department of Community Medicine, Dr DY Patil Medical College, Pune and a clinical epidemiologist with over 20 years experience in the Armed Forces)