Are Florida and Texas good natural experiments in the effectiveness of masks?

Given what I have seen of mask usage in practice, I do not think they will be helpful in the U.S. except maybe to delay infections by a few weeks. I agree with the Swedes and the WHO that this is likely to be a multi-year experience with the coronavirus. And there will likely be another similar virus right behind this one. So I think we would slow down viral spread more effectively by restructuring our physical environment so that it isn’t relevant whether people are using a bandana improperly (or wearing a mask with an exhaust valve, which I see regularly among the righteous of Cambridge), etc. More stuff could happen outdoors under shade structures, for example. Hey! Linus dropped his security blanket. Maybe ...

I wonder if the mask is like Linus’s security blanket in Peanuts. People like to believe that they can control their fate. We hear that someone died of cancer and ask “Did he smoke?” The person is dead so it shouldn’t matter, but we want to know because we want to be assured that we won’t be killed by a random cancer and that we can extend our lives by clean living. The “science” as of March (and through early June at the WHO!) was that masks wouldn’t protect 8 billion humans from spreading coronavirus. But we didn’t like that answer so “science” gave us a new answer. It is highly comforting because we are controlling our fate, not living or dying depending on the whims of the virus and the accidents of geography (Maine versus Massachusetts, for example, a 14:1 difference in death rate).

Like most people, I hope that the universal mask laws can have some beneficial effect. But I fear that we are setting ourselves up for yet another disappointment and we will whip ourselves for not doing a good enough job. Yes, we wore masks, but too many of us did so without covering our noses. Yes, we wore masks, but that led too many of us to abandon the 6′ social distance. We wouldn’t have had a death rate comparable to Sweden’s if only we had…

This is kind of like the difference between Greek/Roman religion and Christianity. If the barbarians attack and burn your Greek/Roman city, you say “That was a terrible experience, but the gods are capricious sociopaths so we will just have to rebuild as best we can.” If the same thing happens to a Christian, he/she/ze/they must say “God is benevolent and omnipotent, so it must have been our wickedness that led to this bad outcome.”

I wonder if there is a mask experiment happening for us right now. Massachusetts and New York had a big surge in infections and then deaths back before any mask laws went into effect (May 6 here in what is now “Maskachusetts”). Florida and Texas have come out of shutdown. They are pretty well masked. We would expect the arc of the epidemics there to be less dramatic than in NY and MA due to (a) a bunch of restrictions still in place, e.g., no mass gatherings, (b) nursing homes much better protected than in MA or NY. But is the arc yet more attenuated in a way that we can perhaps attribute to Floridians and Texans being under mask orders?


  • “Flu Masks Failed In 1918, But We Need Them Now” (HealthAffairs): In 1919, Wilfred Kellogg’s study for the California State Board of Health concluded that mask ordinances “applied forcibly to entire communities” did not decrease cases and deaths, as confirmed by comparisons of cities with widely divergent policies on masking. … Second, the review of practices in 1918 demonstrates masks must be worn correctly and consistently, fully covering the nose and mouth, with sufficient layers to prevent the spread of droplets. Advocates for masks in 2020 can use this historical lesson to argue that masks must be worn properly, or they will not achieve their objectives. [Summary: this time it is different and Americans will be as good at using masks as surgical nurses]

33 thoughts on “Are Florida and Texas good natural experiments in the effectiveness of masks?

  1. You should know by now that the New York Times and the Washington Post have coopted your “Get Outdoors!” theory, and Rice University is setting up huge tents for the Fall.

    Michigan: This guy didn’t want to wear a mask so badly he decided to die: first he stabbed a convenience store employee who told him to mask up, then he lunged at a cop with a knife, and blammo! she shot him dead at 43 years old. All things considered it would have been easier just to wear the mask:

    • But what if you work at MIT and help build databases of hip hop language?

      >The key problem is that the dataset includes, for example, pictures of Black people and monkeys labeled with the N-word; women in bikinis, or holding their children, labeled whores; parts of the anatomy labeled with crude terms; and so on – needlessly linking everyday imagery to slurs and offensive language, and baking prejudice and bias into future AI models.

      From the New York Times in 2007, a year before the 80 Million Tiny Images database started:

      “This bluesy Houston hip-hop star must be one of America’s most underrated rappers. Since the late 1990s, Z-Ro has been releasing brilliant albums and mixtapes at an impossible pace, often more than one a year. In November he released one of the best yet, “I’m Still Livin,” a surprisingly coherent collection of melancholy protest songs and gospel-inspired rants. He couldn’t do much to promote it, though: he was in prison, where he is to remain until July, serving a sentence for possession of a controlled substance.”

      So why is it unacceptable in an MIT image database culled from Google? The language is unquestionably a part of the culture. The terms are used everywhere in hip hop. Why is MIT deleting it?

  2. Sporting events should probably be held during the day outdoors…

    Serious answer: "work" in this context means "reduce the probability of transmission". Masks reduce the probability of transmission. Distancing by 6 feet (or preferably more) reduces the probability of transmission. Doing both reduces the probability of transmission EVEN MORE.— Carl T. Bergstrom (@CT_Bergstrom) May 24, 2020

    ‘“Behavioral Herd Immunity”If everyone wears masks and does hand hygiene etc. Japan is showing it can have massive impact.Our culture may be killing us.Very biblical stuff@endCOVID19— Christian DiPaola (@cdipaola62) March 24, 2020

    A very, very common source of frustration: confusing the necessary for the sufficient.— Luca Dellanna (@DellAnnaLuca) May 8, 2020

    • js290: These people sound intelligent. But my news feed is crammed with hysterical headlines about an apocalyptic plague in Florida and Texas. Both states have mask laws. If masks work, why are these states having plagues dramatic enough to generate media hysteria?

    • Phil: Florida does not have a mask mandate (some municipalities may).
      Texas does, but I suspect there is little or no enforcement.

      We have lots of speed limit laws, which are routinely disobeyed. We have mask “laws” here, but I have seen people not obey.

      I’m almost certain masks can help – they are no panacea! – (based on studies, Asian use, etc) but here’s an interesting question.. how would you use the Scientific Method to show they don’t?

    • Paul B: The fact that different states have required masks at different times provides a natural experiment. Here’s one study. Community Use Of Face Masks And COVID-19: Evidence From A Natural Experiment Of State Mandates In The US.

      State policies mandating public or community use of face masks or covers in mitigating novel coronavirus disease (COVID-19) spread are hotly contested. This study provides evidence from a natural experiment on effects of state government mandates in the US for face mask use in public issued by 15 states plus DC between April 8 and May 15. The research design is an event study examining changes in the daily county-level COVID-19 growth rates between March 31, 2020 and May 22, 2020. Mandating face mask use in public is associated with a decline in the daily COVID-19 growth rate by 0.9, 1.1, 1.4, 1.7, and 2.0 percentage-points in 1–5, 6–10, 11–15, 16–20, and 21+ days after signing, respectively. Estimates suggest as many as 230,000–450,000 COVID-19 cases possibly averted by May 22, 2020 by these mandates. The findings suggest that requiring face mask use in public might help in mitigating COVID-19 spread. [Editor’s Note: This Fast Track Ahead Of Print article is the accepted version of the peer-reviewed manuscript. The final edited version will appear in an upcoming issue of Health Affairs.]

      I see Trump finally wore a mask in public a couple days ago, which is great – if he does this consistently, his supporters should be more likely to wear masks.

    • That’s a great paper, Russil, and I hadn’t seen it. Thanks!

      (Separately, are you sure that Trump wore a mask “in public”? From scanning the headlines on Apple News I thought I saw that he was wearing a mask while in a hospital. A person wearing a mask in a hospital is a dog-bites-man story in my opinion, and doesn’t mean that the person would wear a mask when not in a hospital!)

    • Phil. In Texas until recently wearing masks was only a suggestion and in fact localities were prohibited from requiring them. Many people didn’t wear them. The plague got dramatic enough that the very republican governor decided to partially close back down and now require masks

    • Wally: The recency and suddenness of the Texas mask law makes it better for a natural experiment, doesn’t it? If masks work, we should see a dramatic inflection point in the curve, no? I guess it is confounded by some recent closures of bars? (but Tinder dates are still, um, open?)

    • Russil – thanks, I enjoyed that paper. Finally something besides spec sheets and back of the envelope calculations.
      Phil – Good point about Trump. To me the key thing is they (him and his minions?) allowed him to be photographed with it on. Heck, he never seems to allow photographs of him on the links.

    • I didn’t think Wehby and Lyu could top their minimum wage study, but I was wrong. rofl

    • philg,

      Thanks for the reply. As Carl Bergstrom points out, “work” in this context means reducing the probability of transmission, i.e. getting R_0 under 1.0. Masks are cheap and necessary, but may not be sufficient to eradicate the virus on its own. Lockdowns and contact tracing are also necessary, also much more expensive, but may be insufficient without masks. We kind of skipped the cheap and necessary option right to the expensive and insufficient option, i.e. cargo cult.

      This is the strongest statistical association I've seen w/ respect to the virus. Wear a mask, mandate others to wear masks, & remember that @WHO is criminally incompetent. To repeat:@WHO is criminally incompetent.PS-Don't get into elevators, buses, etc. unless your mask in N95— Nassim Nicholas Taleb (@nntaleb) March 31, 2020

    • How does Bergstrom know that masks would reduce the probability of transmission? The MD/PhDs who run Sweden’s police will tell you that people will likely inhale MORE virus if everyone has a mask on. People will feel protected (despite the fact that masks available to consumers offer minimal protection) and fail to maintain a “social distance”. That’s why the Swedes encourage masks on their metro, for example (the Stockholm metro is substantially busier in ordinary times than Boston’s MBTA), where it is pretty much impossible to set one’s own boundaries.

    • How do the Swedes (whose authorities are operating under the assumption of Gaussian distribution of the pandemic) demonstrate one inhales more viral particles while wearing a mask? Do air filters “work” at filtering HVAC air? Also, not sure how the American response is significantly different from the Swedish response (who are under performing their Nordic neighbors in terms of cases & deaths per capita).

      Pandemics are not normally distributed…
      “In the normal distribution of a bell curve asymptomatics sit at the margin, whereas most of the curve is occupied by symptomatics, the ones that we really need to stop.”

      Every mediocre strategist and state civil servant is now at the mercy of the fat tails. Like I said before, welcome to Extremistan mediocristans, all your bell curve assumptions have fat tail mismatches. All your fat tails are belong to us.— Ase Deliri (@AhsanDeliri) March 14, 2020

      FAU College of Engineering and Computer Science researchers use flow visualization to qualitatively test social distancing and the efficacy of facemasks in obstructing respiratory droplets.#go2zero #endcoronavirus— (@endCOVID19) July 9, 2020

      A Cambridge University study showed that lots of household materials are nearly as good as surgical masks, and you can use 2 layers of material to make them even better.It doesn't need to be perfect – it just needs to reduce viral load so your immune system can kick in!— Jeremy Howard (@jeremyphoward) March 25, 2020

  3. I don’t know about Florida, but here in Texas the government just lies about it. At the end of May the started reporting “probable” cases instead of actual ones–no actual testing required.

    Also, from what I’ve seen while I’m out and around in Austin most people ignore the mask nonsense. Some wear them, but even then the majority of mask-wearers are the people in shops desperately clinging to the few jobs the government hasn’t destroyed. Of course, this isn’t necessarily representative of the entire population of Austin–presumably the people who actually believe masks do something are all home hiding under their beds.

    • They lie in Florida, too. Like the labs “reporting” tests with 99% positivity rate.

  4. Good observation. People like to think, contrary to daily experience, that there is justice in the world, that good people are rewarded and bad people punished. So you get cancer/heart disease/ dementia because you did something wrong. So the media loves stories about someone who refused to wear a mask and then died of the virus, the wicked Swedes who get their just deserts, the evil Trump supporters who get what is coming to them — imagine the media’s feverish joy if Jared Kushner or Ivanka were to contract the disease, suffer awfully and die — and best of all on their deathbeds renounce their father/father in law and affirm their belief in science.

    • We would have no budget deficit if the government could charge for Dr. Fauci to come and administer last rites to the wicked unmasked-and-coronaplagued. “His last words were #BelieveScience”

  5. I’m baffled by your persistent battle with masks and your admiration of Sweden, which by most accounts is regarded as a failure (please, no more graphs or links). Florida and Texas are great examples of congregating in large groups and not wearing a mask…or wearing a mask improperly. They may or may not have laws requiring them, but they’re meaningless, just like texting while driving laws.

    I’m more disgusted by an American population who can’t do the simple things that doctors and scientists are recommending. Wearing masks, social distancing, washing hands. These things aren’t working because a portion of the population aren’t, or won’t, comply.

    • Jim: I’m not in a “battle with masks”. I live in Maskachusetts where there is no choice regarding masks and hasn’t been since May 6 (I actually discovered an N95 mask in the garage and wore it to Costco even in March!).

      You’re “disgusted” with your fellow citizens, immigrants, and the 22 million-ish undocumented and are praying for them to develop a range of new skills in the short term (an odd hope, I think, because the raison d’etre of the United States is sheltering “low skill” migrants; we actually prefer those who are as helpless as possible). I, on the other hand, accept my fellow residents of the U.S. as they are. Having seen them wearing their bandanas underneath their noses, I’m hoping for rebuilding our physical infrastructure so that it doesn’t matter if Americans ever learn to use masks correctedly (see ).

      [Sweden is a failure “by most accounts”? You mean “by most accounts authored by Americans worshiping at the Church of Shutdown”? How can they be a failure? Masks are free and 2 percent of Swedes are wearing masks! ]

  6. >(Maine versus Massachusetts, for example, a 20:1 difference in death rate)

    You mean 1:14.2?
    Technically correct – best kind of correct!

  7. Simple solution?

    Instead of taking one side or the other, why not let the data speak. Pitch this to a high Co-Vid infected State or community: We are attempting to determine the effectiveness of face-masks on the spread of the virus. For 3 (?) weeks, we are asking (?) for complete compliance and proper use of masks for all.

    The results will be fully transparent and available with no spin.

  8. Two states other than MA I am personally familiar with.

    In FL (Palm Beach County), stores like Costco, all grocery stores, HD, pharmacies started to require masks in early April. HD/Costco/Walmart limited number of people on premises at about the same time. I was surprised that the relative number of masked people in stores was subjectively higher than in MA at about the same time — I expected the reverse. Almost no one wore masks outdoors. Public places like restaurants, bars, etc were closed. Masks and other measures enforcement was left up to individual counties.

    In CA(Orange County), I observed a similar picture in May, but much more people wore masks outdoors. All measures were mandated from Sacramento. A company I am associated with in CA opened in early June and closed yesterday again after the number of infections spiked.

    Both states experienced rapid growth in the number of infected people after places of close public social contacts reopened which was to be expected– the virus did not go anywhere. My understanding is that masks and other measures enforcement was much stricter in CA, and yet the state now follows a similar infection trajectory to that of FL. The majority of new cases are concentrated in CA in LA and in FL in Miami. So, without any reliable data on people behavior, it *appears* that the main cause of rapid infection growths now at both places is caused by patterns of social interaction (e.g. the Italy vs. Sweden type of socializing) since mask wearing regime has not changed at all. As I mentioned earlier, there is some hope that the infection rate growth won’t translate in the respective death rate growth in 3-4 weeks due to much lower median aged of the infected (so far). That remains to be seen.

    • @Ivan: Two days ago, a woman (Lisa Sparks) representing the O.C. Board of Education was absolutely savaged on NPR by the interviewer who went up one side and down the other with a spiked pipe for defending the OC decision to reopen schools in the fall.

      Brutal. Nastiest interview I’ve ever heard on NPR. McCammon (NPR) basically called her a liar on the air and cut the interview short at 4 minutes.
      Take a listen:

    • Somewhere around 3:30 I expected McCammon to just lose it completely and say:

      “You f*******g brain-dead Republican bitch! You’re going to kill your children! You’re going to kill their teachers! You’re going to kill yourselves, you flat-earth Moonie! But you don’t care about that, do you, you idiot? You’re a murderous, moronic f*****g troglodyte!”

      If they had been sitting next to each other in the studio, McCammon would have swung the microphone and whacked her in the face.

    • Sorry, Ivan, but people in Orange County (Calif.) have been anti-mask from the beginning. I live in LA County and this is on the local news virtually every night. So your conclusion about that is wrong. Masks are just as much as an argument in LA as they are everywhere else.

      There is simply no way to accurately measure their effectiveness unless everyone wears them…clean and correctly. And, therein lies the problem.

    • Jim,

      People in the OC(populated by Republican losers) may have been anti-mask in theory, but in every store I visited in Irvine in May, masking was about 100% (I did not see a single person without a mask in any store I’ve been in). Granted, runners and bikers on the trail I ran on did not wear masks (some bikers did though, and gave me and other unmasked fellow runners nasty looks but no fingers). Now, the LA county may be different, I do not know. In any case the level of maskiness I observed in various places in the OC as well as distancing was much higher, subjectively, than in MA.

    • Ivan,

      They won’t let you into a store without a mask in OC or LA county. There’s just a lot more opposition to masks in the OC, as well as any restaurant, bar or beach closures.

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