A “world-first” Australian study into face masks has been ripped to shreds as “very, very low quality”, with questions over how it was even published.
A “world-first” Australian study which Victoria’s government has held up as proof its mandatory face mask policy worked is riddled with basic errors and should never have been published in a major journal, medical researchers and experts say.
Victoria first made face masks mandatory outside the home in Melbourne during its second coronavirus wave in July 2020, but the Department of Health and Human Services has been unable to provide any scientific research or studies upon which the decision was made.
Instead, DHHS directed news.com.au to a paper published in July this year by the Burnet Institute – an influential public health body which has come under fire in recent months for its alarmist predictions – as justification for the mandate which has resulted in thousands of dollars in fines for Victorians.
The study claimed the mandatory face mask rule had turned the pandemic “almost overnight”.
“There has been a lot of low-quality research that has come out in the pandemic, but for this to be used as a basis for a policy change is staggering,” said Dr Kyle Sheldrick, a medical researcher and PhD candidate at the University of NSW.
‘I agree, it’s crap’
Dr Sheldrick was one of a group of independent scientists who recently highlighted major issues in a number of studies held up by proponents of the drug ivermectin to treat Covid-19.
“To me it’s very clear this has not had a close peer review, partly because of the serious and substantive issues, but [also] it just clearly hasn’t been proofread,” he said.
“When I look at this particular piece of research, it is very, very low quality. I was staggered to see this was published by a major journal.”
Another researcher, an eminent Australian clinician and scientist who spoke on the condition of anonymity, was equally scathing.
“I agree, it’s crap,” he said.
“It’s extremely lightweight. I think it’s a totally feeble article. It doesn’t have a rigorous methodology and it is weak in its scientific inference. I’ve been around a long time – I teach how you do clear thinking, I teach how you do reproducible science. I’m a bit of a stickler for these things.”
Dr Sheldrick said despite its obvious flaws, very few scientists would be willing to publicly call out the study.
“Not just in relation to this paper but in general I think there has been a reluctance to criticise research and to criticise public health interventions [during the pandemic] and to be seen as a wrecker,” he said.
“Unfortunately there is a culture in science which sees criticising other researchers or research as something fundamentally bad – that we should be presenting a united front to laypeople.”
Burnet says study ‘world-leading’
The study, published in the journal Plos One, purported to show that mandating masks was the “single most important control measure” that “turned an exponential increase in community transmission into an exponential decrease, almost overnight”, the Burnet Institute said in a July press release.
“The key finding from this study is that masks work,” one co-author was quoted as saying.
“Whilst we are confident that masks are highly effective indoors, we don’t know how much more effective they are indoors compared to outdoors. Importantly given the growing evidence of outdoor transmission of the Delta variant, it makes sense that masks are worn both indoors and outdoors during a Covid-19 outbreak.”
The Burnet Institute advises state governments including Victoria and NSW on Covid-19 responses.
The paper’s competing interests statement notes that five of the 12 authors “provide guidance to the Victorian government’s Covid-19 response”.
News.com.au has sought clarification from the Burnet Institute as to whether any of the paper’s authors specifically advised the Victorian government on the introduction of the mandatory mask policy.
The Burnet Institute described the study as “world-leading” – and the finding would be highly significant, given the lack of published research supporting mask mandates, which have been one of the most controversial public health measures during the pandemic.
In the paper, the authors themselves noted that international bodies such as the World Health Organisation and the US Centers for Disease Control and Prevention have recommended face masks, but that “despite these recommendations there is limited data from community settings supporting mask use”.
Experts have previously said there is little evidence face masks prevent outdoor transmission.
One of the largest real-world studies, a randomised controlled trial of nearly 5000 Danish people, found virtually no difference in Covid-19 infection rates when people wore masks outside the home.
‘The data set is useless’
The Burnet Institute study relied on images from the photo library of The Age newspaper showing Melbourne community settings to conclude that mask usage rose from 43 per cent to 97 per cent after the July 22 mandate came into effect.
Dr Sheldrick said it was “hard to think of a worse methodology to answer this question than just looking at which photos are collected by a metropolitan newspaper”.
“Even ignoring the fact that the photos were taken for an editorial purpose, that this is not a random sample, when you look at the actual data in the Excel spreadsheet it is stunning to me,” he said.
The spreadsheet lists the date, time and location of 44 photos – 19 taken before the announcement, 18 after mask rule came into effect and seven in between. Nearly all of the photos in the before group were taken between 2pm and 4pm, while nearly all of the photos in the after group were taken between 8am and 12pm.
“Which just means the data set is useless,” Dr Sheldrick said.
“As a responsible researcher, I can’t draw any conclusions from that. You could just as easily draw the conclusion that mask wearing is different in the morning and afternoon. If a student came to me and said, I’m going to compare these two sets of photos and draw some conclusion about whether a policy worked, you would send them away to think about it.”
The second expert agreed.
“If a student presented the photographic data it would be ridiculed,” he said.
Dr Sheldrick said it “wasn’t a defensible methodology from the beginning, and certainly once they had the data it should have been abandoned”.
“Pushing ahead to draw any sort of causal inference is not appropriate,” he said.
“If I had been involved [in the study], and one of my collaborators came to me with that data and said we’re going to draw these conclusions, I would have asked for my name to be taken off.”
Commenters on Plos One have highlighted other errors, including the authors’ claim that there was “no reason to believe that mask usage changed in the healthcare setting during the study period”.
Safer Care Victoria’s chief medical officer Professor Andrew Wilson told the RACGP’s newsGP in October last year that the state’s guidance had been updated on August 1.
“In response to emerging evidence, the Victorian guidance was upgraded on August 1 to use Tier 3 PPE [including N95 respirators] in caring for patients with known or suspected Covid-19 infection who are cohorted in wards, intensive care units and emergency departments,” he said.
Paper admits ‘causality’ difficult
More broadly, Dr Sheldrick said it was odd that the paper singled out the mask mandate as the key reason for the fall in transmission out of all of Victoria’s sweeping lockdown measures, which included retail closures, movement restrictions and an 8pm curfew.
The paper’s authors even conceded that Covid-19 transmission fell at the same time in rural areas, where masks were not introduced.
“Care should be taken in ascribing causality,” they wrote.
“We cannot determine whether masks had a direct effect or whether near-universal adoption of masks reminded wearers to engage in other behaviours recommended to reduce SARS-CoV-2 transmission, including regular hand hygiene and physical distancing. Interestingly, introduction of masks in Melbourne coincided with a decrease in the growth rate in rural areas, where masks were not introduced, which is consistent with an indirect effect, a decrease in seeding of rural areas from the Melbourne, or both.”
Dr Sheldrick said it “certainly seems like” the authors were working backwards from a conclusion.
The second expert agreed it was “quite possible” that was the case.
“It doesn’t seem like [they] are looking for the most obvious interpretation of the data, because that would be to say this was not just a mask mandate,” Dr Sheldrick said.
“It seems like there is a selective latching onto one possible explanation. It really looks like an exercise in justifying mask mandates rather than a neutral research activity trying to find the truth.”
The Burnet Institute has been contacted for comment.
Virus risk ‘far less’ outdoors
Australians across the country have been hit with millions of dollars in fines for breaching Covid-19 public health orders since the start of the pandemic, the bulk of which relate to failing to wear a face mask in various settings.
In July this year, NSW Health admitted that there had not been a single confirmed case of outdoor transmission in the state during the entire pandemic.
News.com.au asked NSW Health to confirm whether there had been any known cases of outdoor transmission since July, but a spokeswoman would say only that they were “relatively uncommon”.
“The risk of Covid-19 transmission is far less in outdoor settings than in indoor settings, if people maintain physical distance,” she said.
“While confirmed cases of outdoor transmission are relatively uncommon, in many cases it can be difficult to pinpoint the exact point of transmission, especially if people have been in each other’s company for long periods of time.”
Victoria’s DHHS says there have been “dozens” of cases linked to outdoor events including at the MCC Members Reserve and AAMI Park.
“Face masks remain an important measure in our fight against this highly contagious and deadly virus,” a DHHS spokeswoman said.
“While the risk of outdoor transmission is substantially lower, superspreader events can still happen outside and we need to remain cautious as we gradually open up and move towards 80 per cent double dose.”
Journalists pushed mask rule
Former NSW Premier Gladys Berejiklian made face masks mandatory outdoors for the first time in August this year, having previously resisted the move.
At the time, she acknowledged part of the reason was that it “makes it easier for police” to identify rule-breakers.
“Our concern is that when people are walking past a group of people or accidentally bumping into people, that can cause that fleeting contact and transmission,” she said.
“It also makes it easier for police to make sure everybody is sticking to the rule. Unless you are exercising, masks outdoors applies to every single citizen across NSW, whether you live in Sydney or the bush, everybody has to respect that.”
News.com.au also asked NSW Health to provide any studies or research that had informed the decision, but did not receive a response.
Ms Berejiklian’s former strategist Ehssan Veiszadeh told The Sydney Morning Herald that it was persistent pressure from the media at daily press conferences about copying various Victorian measures – such as curfews and mandatory masks outdoors – that ultimately saw them adopted in NSW.
“If there are certain questions repeated every day with the same kind of ferocity, it does become an issue that bureaucracies and governments need to respond to, and internally they try to come up with answers,” Mr Veiszadeh said.
“There would be occasions when that media response becomes a policy response.”
The mandatory mask rule was scrapped last Monday as NSW emerged from more than 100 days of lockdown.
Masks are still mandatory outside the home in Victoria for everyone over the age of 12, and will remain so until the state reaches 80 per cent double-dose vaccination.
Premier Daniel Andrews was fined a total of $400 earlier this month after being caught out twice failing to wear a mask outdoors.