Top journal retracts study claiming masks ineffective in preventing COVID-19 spread

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One of the world’s leading medical journals has retracted a widely circulated paper published in April that concluded that “both surgical and cotton masks seem to be ineffective in preventing the dissemination of SARS–CoV-2 from the coughs of patients with COVID-19 to the environment and external mask surface.”

The study, published by the Annals of Internal Medicine, has been cited by dozens of news stories, nearly 10,000 Twitter users — some of whom raised red flags about its methods — and by the World Health Organization.

But it turns out that the authors failed to consider the limits of the test they were using to detect the presence of coronavirus.

The paper only involved four participants. Apparently, the authors thought a correction — adding more patients — would be enough:

According to recommendations by the editors of Annals of Internal Medicine, we are retracting our article, “Effectiveness of Surgical and Cotton Masks in Blocking SARS-CoV-2. A Controlled Comparison in 4 Patients,” which was published on Annals.org on 6 April 2020 (1).

We had not fully recognized the concept of limit of detection (LOD) of the in-house reverse transcriptase polymerase chain reaction used in the study (2.63 log copies/mL), and we regret our failure to express the values below LOD as “<LOD (value).” The LOD is a statistical measure of the lowest quantity of the analyte that can be distinguished from the absence of that analyte. Therefore, values below the LOD are unreliable and our findings are uninterpretable. Reader comments raised this issue after publication. We proposed correcting the reported data with new experimental data from additional patients, but the editors requested retraction.

The article joins our ever-growing list of retracted COVID-19 studies. It is a reminder that for all of the alarm over publicity of preprints, because they are not peer-reviewed, “Peer-Reviewed Studies Also Require Caution.” 

Perhaps the real problem is speed, not peer-review status. If only someone had warned us.

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12 thoughts on “Top journal retracts study claiming masks ineffective in preventing COVID-19 spread”

  1. Didn’t the editors or the “peer reviewers” spot the small sample size and question that? Strange.

  2. The journal are acting like bulshit why not journals make their review process transparent and better to pay reviewers so they can pay attention to review correctly. Journals making money only

  3. This seems to be a failure of peer review. I would be irate if I was the authors. Their record is now tainted with a retraction.

    1. Peer review failed (though really the editors are to blame, as anything with “4 patients” in the title should be desk rejected), but I don’t see why the authors should be irate. They had to have known that this paper was half baked when they submitted it.

    2. The failure is really first with the authors themselves & ineptness at properly applying the Scientific Method to their research, something we all learned in high school. Secondly, the failure is with a shoddy review process. They should have caught the paucity of research upon which the study was based.

    3. The use of 4 patients is directly in the title. There is nothing wrong with publishing data on 4 patients as long as the conclusions are tempered appropriately.

      And the authors are not responsible for WHO and other public health officials over-interpreting their results.

      The authors are responsible for making some mistakes that seem to be predicated on overconfidence in their expertise. The study was really simple, have a few people cough into a petri dish and test for virus concentration. So to not understand how the virus concentration measurement works makes one wonder what sort of expertise they ever thought they’d be bringing to the study in the first place. And when they got seemingly surprising results that should have given them pause and sought expert advice.

      The reviewers also made a mistake, but they usually work for free and cannot be relied on for perfect quality control.

      The editors also probably made a mistake, as it appears likely they didnt send to virus test experts, despite the surprising result.

  4. You have physicians and physician-scientists competing to become famous and journals competing to publish the first great Covid papers. These are physician journals. Submit Covid studies to real scientific journals such as Journal of Virology or Journal of General Virology for real peer review.

  5. Alert to citizens, governors, mayors, presidents, prime ministers, and public health officials—

    You want science. You always state that. Well, here is your very own science.

    The reference is: “Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Personal Protective and Environmental Measures.” Published in: “Emerging Infectious Diseases, Vol.26, No. 5, May 2020.” (That journal is published by the CDC.)

    I quote from the abstract: “Here, we review the evidence base on the effectiveness of nonpharmaceutical personal protective measures and environmental hygiene measures in non-healthcare settings and discuss their potential inclusion in pandemic plans. Although mechanistic studies [*] support the potential effect of hand hygiene or face masks, evidence from 14 randomized controlled trials of these measures did not support a substantial effect on transmission of laboratory-confirmed influenza. We similarly found limited evidence on the effectiveness of improved hygiene and environmental cleaning.”

    Here are quotes from pages 970-972 of the review: “In our systematic review, we identified 10 RCTs [randomized controlled trials] that reported estimates of the effectiveness of face masks in reducing laboratory-confirmed influenza virus infections in the community from literature published during 1946–July 27, 2018. In pooled analysis, we found no significant reduction in influenza transmission with the use of face masks…”

    “Disposable medical masks (also known as surgical masks) are loose-fitting devices that were designed to be worn by medical personnel to protect accidental contamination of patient wounds, and to protect the wearer against splashes or sprays of bodily fluids… There is limited evidence for their effectiveness in preventing influenza virus transmission either when worn by the infected person for source control or when worn by uninfected persons to reduce exposure. Our systematic review found no significant effect of face masks on transmission of laboratory-confirmed influenza.”

    “In this review, we did not find evidence to support a protective effect of personal protective measures or environmental measures in reducing influenza transmission.”

    “We did not find evidence that surgical-type face masks are effective in reducing laboratory-confirmed influenza transmission, either when worn by infected persons (source control) or by persons in the general community to reduce their susceptibility…”

    [*] In case you want to quibble about the value of what the authors refer to as “mechanistic studies,” the authors are correctly setting those studies off to the side, in favor of the material they preferred to examine: randomized controlled trials—which are widely considered to be more valuable, relevant, and meaningful.

    So there you have it.

    Your science.

    Take off your masks. Governors and mayors and presidents and prime ministers, cancel the orders to wear masks. You’re non-scientific. In the extreme.

    SOURCE:

    https://wwwnc.cdc.gov/eid/article/26/5/19-0994_article

    https://wwwnc.cdc.gov/eid/article/26/5/pdfs/19-0994.pdf

    (Note the “wwwnc” — which is correct. It is not “www”.)

    1. It is possible that a difference that did not reach statistical \clinical significance with influenza would be reached with Covid mainly because Covid is much more contagious than influenza (e.g., greater viral load through droplets). From the CDC:

      While COVID-19 and flu viruses are thought to spread in similar ways, COVID-19 is more contagious among certain populations and age groups than flu. Also, COVID-19 has been observed to have more superspreading events than flu. This means the virus that causes COVID-19 can quickly and easily spread to a lot of people and result in continuous spreading among people as time progresses.

      https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm

      I’m not waiting for the experiments, but will, instead, rely on common sense and the guidance from the experts. Robert, I suggest you do the same.

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