Walz administration threatened voters for not masking up; critics tear apart new mask study

Presumptive Democratic presidential nominee Kamala Harris picked a running mate, Tim Walz, known for severe COVID-19 restrictions as Minnesota's governor, including a hotline on which residents could report each other for violating his stay-at-home executive order.

Walz's administration threatened the medical license of his 2022 Republican challenger, Scott Jensen, who won Minnesota's Family Physician of the Year award in 2016, for COVID wrongthink. Two of its five investigations were opened after Jensen entered the race.

But it's Walz's crusade for masking, which he called  "one of the last" COVID mandates he would lift in fall 2020 and was upheld as constitutional a year ago, that could make swing voters more wary of a Democratic ticket that, unlike the GOP ticket, might bring mandates back.

When Minnesota Republicans sued to block Walz's mask mandate at polling places ahead of the 2020 primary, Secretary of State Steve Simon told the Star Tribune that he would direct officials to record the names of voters who refused to accept masks "and let them know they will be reported to authorities" if they vote inside without a "health reason."

Germany is still using a similar tack to protect masking from scrutiny. 

It prosecuted playwright and novelist CJ Hopkins, an American expat known for using Orwellian themes in his work, for putting a faint swastika on a mask on the cover of his book The Rise of the New Normal Reich. He told Just the News he expects his acquittal to be overturned this month and ongoing legal proceedings to find him guilty or bankrupt him through attorney's fees.

Public health pundits are laying the scientific groundwork for the possible resumption of mask mandates, hyping the rise of so-called FLiRT variants of COVID and touting a new randomized controlled trial that purportedly finds masking in public reduces respiratory infections.

But the RCT, promoted by scientists including widely followed Scripps Research Translational Institute founder Eric Topol, is also drawing scrutiny for its design and what it actually shows.

The British Medical Journal published the Norwegian study and an accompanying opinion by the researchers lamenting the "contrasting and strongly held positions" on masking "that dominate the discourse in some other countries," which in their own "would qualify as fringe."

They concluded that "wearing surgical face masks in public spaces reduces the incidence of self-reported respiratory symptoms consistent with respiratory infections in real world settings," but only "around 3,300 fewer infections per 100,000 people" – what they called a "moderate" absolute risk reduction of 3.2%.

"Mask non-believers will describe the effect size as too small to be of interest," Atle Fretheim and Runar Barstad Solberg of the Norwegian Institute of Public Health Centre and Lars Hemkens of the Research Centre for Clinical Neuroimmunology and Neuroscience Basel wrote in the opinion, predicting the polarized response.

They assume critics "will intensively highlight any source of potential bias that might have inflated the results in the wrong direction," while "the mask believers will do the same but in the opposite direction."

Solberg answered comments on the study in an X thread two days after it was published, saying the "key criticism is the potential bias due to unblinded self-reporting of a subjective outcome."

The researchers agree they need to consider whether "participants' expectations about face masks may have influenced the results," but Solberg said that collecting PCR results to objectively confirm infection "would have added hurdles to joining the trial."

1/5 Thanks to all who have commented on our face mask trial.

The key criticism is the potential bias due to unblinded self-reporting of a subjective outcome. We acknowledge this risk, which is difficult to quantify.

— Atle Fretheim (@AtleFretheim) July 26, 2024

"We are open to constructive criticism and welcome further discussion on the methods and outcomes of our research, which we are happy to engage in," Solberg told Just the News Wednesday.

The study says it took place "during the normal influenza season in the Nordic countries" in winter 2023, and Norwegian authorities were not enforcing "public health or social measures … on the general population during the trial."

It had a novel design. The intervention arm was given a "unique verification email" to obtain a free pack of "50 three-ply, disposable, surgical face masks … from their nearest pharmacy," and told to wear them "when close to people in public spaces" over two weeks.

"Participants assigned to the control arm were to remain mask-free when close to people in public spaces," the study says. Each arm ended up with roughly 2,300 participants.

The researchers emphasized mask-wearers were not told to wear them at home or work. An early study of COVID infections in China traced the vast majority to "home outbreaks," while an American meta-analysis found asymptomatic transmission rare in the home.

The medical newsletter Sensible Medicine hosted an ad hoc debate on the study, starting with University of California San Francisco epidemiologist Vinay Prasad, who said he interviewed Fretheim during the pandemic and praised his call for RCTs of school closure.

The problem for Prasad is the study's reliance on "self-reported illness" and its lack of "placebo control or sham control," which makes it "entirely possible the result is driven by the placebo effect alone. If you wear a mask, you feel like you do better."

The followup period is also too short to say much, Prasad said. It's like giving someone an energy drink when they start a marathon and testing their performance after the first mile.

"The endpoint is a good clinical one that we care about: 'Do you feel sick?'" University of Chicago internist Adam Cifu responded to Prasad, his co-author in the book Ending Medical Reversal, criticizing his "proverbial moving of the goalpost."

Cifu emphasized that neither arm was "committed mask wearers" in the two weeks before they were randomized, judging by their survey responses. To get the placebo effect Prasad suggested, "every participant who usually wore a mask would need to imagine they got sick during these two weeks," Cifu said.

University of California Berkeley machine-learning professor Ben Recht, profiled this year by Politico, said Prasad and Cifu were both wrong.

"We should use this study as a case of how not to design medical trials," Recht wrote, echoing his criticism of a previous mask RCT whose three-percentage-point differential between household visit consent rates in each arm could "wash away the difference" in infections.

"The treatment in this study is not mask wearing" and the "outcome was not illness" but "clicking the right boxes in an online survey," he said, assailing the "absurd" design. "The study staff never had in-person contact with any participants. We have zero evidence that anyone ever wore a mask!" Recht wrote.

Both sides are ignoring "the numerous qualifications that litter the report," including a seven-percentage-point difference between the treatment (80%) and control groups (87%) on who completed the survey, according to Recht. 

"We must conclude that emailing people instructing them to mask has a much greater effect on responding to follow-up surveys than on admitting cold symptoms," he wrote. "Just throw this study in the bin."

The study authors did not respond to a query for their response to the Prasad and Recht criticisms. The paper has received nine "rapid responses" since its publication.