Ivermectin Sparks Yet Another Covid Culture War

“You are not a horse. You are not a cow. Seriously, y’all. Stop it,” read a recent viral tweet warning readers away from using a certain medication to treat Covid-19. The tone of affectedly folksy condescension would be expected from any of thousands of Twitter-addicted progressive journalists, but less so from the official account of the United States Food and Drug Administration. Perhaps even more surprising, the tweet linked to a warning advising readers not to take a drug, ivermectin, that has been used in humans for decades and is a standard Covid-19 treatment in much of the world.

The FDA’s framing has been echoed by a rash of media articles warning that ivermectin is ineffective and fit mostly for animals, typically citing the FDA’s public statements as the main evidence of inefficacy. A recent story in the Washington Post, for instance, noted in the headline that an Arkansas prison doctor had given inmates the “livestock drug ivermectin,” even “despite FDA warnings.” NPR noted that the popular podcast host Joe Rogan had attempted to treat his own case of Covid-19 with “a deworming veterinary drug that is formulated for use in cows and horses” that “the FDA urges people not to use.” (Both articles eventually noted, less prominently, that the drug had human uses, though NPR mentioned its use only as a topical treatment for head lice.) NBC’s story on Rogan called ivermectin “typically used on livestock” in the first paragraph, “not an anti-viral drug” in the third, and “widely discredited” in the headline—adducing as evidence only that “the U.S. Food and Drug Administration last month urged people to stop believing misinformation claiming the livestock treatment would help cure Covid.” A New York Times story dismissed evidence for the drug with the statement “Ivermectin Won’t Treat Covid 19 But Demand For Drug Surges,” and its discussion of scientific evidence on the drug focused only on negative studies, but the story authors at least acknowledged that the drug was commonly used in humans.

To be fair, a few Americans who couldn’t obtain human ivermectin have, in fact, tried to self-medicate with veterinary formulations—provoking a slew of reports about overwhelmed poison-control systems and ER departments that spread wildly across liberal Twitter, often with mocking commentary on the stupidity that must be required to take animal medicine. Many of these stories have also proved to be huge exaggerations. One widely circulated Associated Press report alleging that livestock ivermectin caused 70 percent of calls to Mississippi poison control—the real figure is 2 percent—seems to have stemmed from a misreading of a poorly worded bulletin from the state Department of Health. In any case, the story noted in its seventh paragraph, “most callers have had mild symptoms.” According to national data, while poison-control calls for ivermectin did increase in late August, they remained quite low in absolute numbers, peaking at a few dozen per day. One story reprinted in Rolling Stone alleging that ivermectin poisoning had overwhelmed hospitals in Oklahoma seems a near-complete fabrication, or, at best, wild extrapolation from the article’s one source.

Another story from NBC reported that a study had found that ivermectin “causes sterilization in 85 percent of men.” Such an enormous undiscovered side effect of a common drug was implausible enough even without consulting the underlying study, published in 2011 by four Nigerian researchers in an obscure journal whose publisher’s homepage includes a bizarre essay on buying CBD oil. Those researchers attributed the 85 percent figure to a different study that supposedly appeared in another, now defunct Nigerian journal in 2002—a year before the journal began publication, according to an online index that lists no articles with a relevant title in any of its seven volumes. Links to the story, including several posted by high-profile liberal Twitter users, racked up tens of thousands of posts and retweets, many with gleeful comments about the salutary effect that ivermectin would have on the gene pool.

The media’s recent reporting on ivermectin is a fitting sequel to their reporting on hydroxychloroquine near the beginning of the pandemic—but not, as received opinion would have it, because both are tales of red-state yokels duped into taking poisonous phony remedies. As in the earlier case, media coverage of ivermectin exemplifies how the liberal political class’s bias, and its confusion of respect for science with blind trust in a scientific establishment, impairs their skepticism and their capacity to appraise complex scientific questions.

Ivermectin is one of several derivatives of a family of compounds first isolated in the 1970s from soil bacteria in Japan. The compounds are highly toxic to invertebrates but have few effects on mammals, making them excellent treatments for many diseases caused by parasitic worms. Though ivermectin is more commonly used in livestock in First World nations where human parasites are rare, it is widely given to humans for internal use elsewhere. Distribution of ivermectin in tropical Africa has virtually eliminated diseases such as river blindness, a success that won the drug’s discoverers a share of the Nobel Prize in Medicine in 2015.

Ivermectin, then, has long been used in humans—and it is entirely reasonable to think that it could be effective against Covid-19. It may be surprising that an antiparasitic medication might work against viruses, but such surprises are common in medicine: as another example, the psychotropic drug fluvoxamine, used to treat OCD and depression, has shown positive results against Covid-19 in multiple trials, including one large international collaboration. Ivermectin was shown to have antiviral effects in laboratory settings in 2012, when one study found that it protected cell cultures from infection by flaviviruses, which include the viruses that cause yellow fever and dengue. Interest in ivermectin as a Covid-19 treatment was sparked by a study at Monash University in Australia, which found that the drug could virtually eliminate SARS-CoV-2 from cell cultures within two days, albeit at very high concentrations.

Though ivermectin has some side effects—dubious Nigerian studies aside, some legitimate research in rats suggests that several weeks of regular exposure may impair male fertility—it is relatively safe. One recent study examining data from VigiBase, a large international system for monitoring drug side effects run by the World Health Organization, found only 667 serious possible reactions to ivermectin, many of the worst of which were reactions that occur as the body rids itself of dead parasites, such as Mazzotti reactions and certain encephalopathies. (Adverse reactions to veterinary ivermectin in humans, as the FDA’s own statement acknowledges, are likely the result of inactive ingredients or dosage miscalculations.)

Studies in cell cultures, though, can establish only that a drug might work; to decide that it does work requires human studies. The evidence base in this regard is ultimately inconclusive but suggests that ivermectin could provide a meaningful benefit.

Media attention to ivermectin is largely thanks to a group of doctors who call themselves the Frontline Covid-19 Critical Care Alliance. Pierre Kory, one of FLCCC’s founders, has advocated ivermectin treatment in several high-profile public appearances, including testimony before the Senate Homeland Security Committee last December and a more recent interview in June on the popular podcast DarkHorse, hosted by Bret Weinstein and Heather Heying. FLCCC puts out continually revised protocols that include ivermectin as a main component, as well as other drugs with varying degrees of empirical support.

FLCCC’s exact protocols have never been tested in randomized trials, but there are some weaker forms of evidence in their favor; many other doctors who use FLCCC or similar protocols have claimed vast improvement over typical rates of death and hospitalization. Overseas, influential doctors such as the chairman of the Tokyo Metropolitan Medical Association have called for widespread ivermectin use, and the drug is a standard treatment in much of Latin America, among other areas.

A few epidemiological observations show potential effectiveness of ivermectin, though deducing causality from such observations is fraught. For instance, Covid-19 has largely spared Central Africa, where the drug is widely administered for parasitic diseases, even as recent waves have struck other tropical areas that had earlier seemed immune. In India, the horrendous Covid wave from April and May has dwindled to insignificance in all states but Kerala, which now contains about two-thirds of India’s total new Covid cases and only 3 percent of the nation’s population. This difference may have other contributors such as Kerala’s mass testing regime, but Kerala is also one of only a few places in India where ivermectin is not a standard treatment: the state health department recommended it only for high-risk patients in treatment guidelines in April and removed it altogether in August.

The evidence from more formal studies, though, is conflicted. Several studies have shown substantial positive results, but reason exists for skepticism. Most studies are small, often with only a few dozen subjects, and have large error bars. The largest recent trial, a multinational collaboration called the TOGETHER Trial, tested several promising repurposed drugs on outpatients and found only statistically insignificant benefits for ivermectin: a 9 percent reduction in hospitalization and 18 percent reduction in death, both with error bars that extended well across zero. (Ivermectin advocates have claimed that TOGETHER used too low a dose, but a smaller study also widely cited by advocates claimed good results with even smaller doses, on hospitalized patients with more severe disease.)

Ivermectin research, finally, may involve a surprising amount of outright fraud. A few researchers and journalists have found clear evidence that at least three studies frequently cited in support of the drug—one since formally retracted by the journal that published it—are likely based on fabricated data.

Still, given the drug’s relatively low risk profile, it may be reasonable to try ivermectin against Covid-19 despite the ambiguous evidence of benefits. And in any case, the sneering descriptions of the drug as an assuredly useless livestock de-wormer and the wild exaggerations of its dangers—both close parallels with the news coverage of hydroxychloroquine in spring 2020—cannot be justified.

Liberals have no monopoly on gullibility or lazy journalism, but the biased coverage of ivermectin springs from one of the worst pathologies of liberal discourse in particular: conflation of respect for science with fealty to established scientific institutions. A “pro-science” disposition has long been integral to American liberals’ self-conception (a ubiquitous yard sign reads, in part, “In this house, we believe science is real”); it grew especially strong during the George W. Bush years as a reaction to the administration’s stance on global warming and alliance with the religious Right.

But most Americans are scientists neither by training nor by temperament, and “pro-science” politics usually calcifies into blind trust in a few politically congenial authorities—such as universities and government health agencies, which have enjoyed high levels of liberal confidence throughout the pandemic despite such actions as reversing longstanding advice on face masks based on a dubious judgment call.

Conflating science with the scientific establishment not only corrodes the capacity for skepticism but also helps questionable or corrupt actions by authorities escape scrutiny. The hullabaloo over ivermectin poisoning, for example, far exceeds the attention given to another questionable treatment pushed not by right-wing hucksters but by the FDA itself: remdesivir, an antiviral produced by the pharmaceutical giant Gilead Sciences that is still the only Covid-19 treatment with full FDA approval.

The FDA’s approval of remdesivir in October 2020 was based on only three trials, one neutral and two showing only moderate shortenings of hospital stays. A week before the approval, a far larger trial sponsored by the WHO had found that remdesivir did not reduce mortality, leading the WHO to advise against the drug in November. (The New York Times report on the WHO trial, incidentally, gave ample space to a fair presentation of criticism of the trial from defenders of remdesivir, a marked difference from the tone of most recent ivermectin coverage.) Furthermore, remdesivir seems to cause significant harms to the kidneys in many cases: a “disproportionality analysis” of VigiBase, for instance, found that reports for remdesivir were 20 times as likely to mention kidney failure as reports for other Covid-19 drugs. The FDA’s full approval of remdesivir contrasted with its summary dismissal of ivermectin suggests, at the least, a double standard.

The oddity of the FDA’s remdesivir approval received some mainstream coverage, but it came nowhere near the level of media saturation reached by the reports of Mississippians taking horse de-wormer. It’s not hard to understand why: the horse de-wormer stories gave some readers a delicious opportunity to feel smugly superior to their political enemies—a temptation that few of us find easy to resist. But the tale of remdesivir presents a more threatening specter, which journalists and politics junkies would do well to confront: the possibility that a scientific authority might be wrong.

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Biden’s Competitiveness Executive Order Fixes the Wrong Freight Problems

President Biden recently issued an executive order targeting corporate consolidation and anticompetitive behavior in several industries, including freight-rail and ocean shipping. The order may contain some salutary provisions, but on these issues it is more notable for what it doesn’t do. American freight-rail and ocean shipping are held back less by oligopoly than by specific government regulations—some of which Biden supports—that raise costs and subsidize trucking, an inefficient and environmentally dirtier competitor.

A press release summarizing the order focuses on the industries’ consolidation. It noted that “in 1980, there were 33 ‘Class I’ freight railroads, compared to just seven today, and four major rail companies now dominate their respective geographic regions.” The executive order “encourages the Surface Transportation Board . . . to strengthen [freight railroads’] obligations to treat other freight companies fairly” by not overcharging other railroads that use their tracks through trackage rights. The press release also noted a massive consolidation of ocean shipping, citing a 2019 article in a trade publication noting that the ten largest shipping companies controlled 82 percent of the global shipping business, up from 51 percent in 2000, and observed that “carriers’ behavior is shifting towards strategies that can make use of the newly established oligopolistic structure.” Finally, it complained that consolidation lets shipping companies charge their customers excessive fees for “detention and demurrage”—essentially, penalties for leaving cargo to be shipped in port terminals for too long—and claimed that the executive order “encourages the Federal Maritime Commission to ensure vigorous enforcement against shippers charging American exporters exorbitant charges.”

But the unfair competition that freight railroads face with each other pales in comparison to the competition they face with the trucking industry, which has also seen substantial consolidation in recent years yet escaped attention in Biden’s executive order. The American system of road funding constitutes a massive subsidy for trucking. Interstate highways are maintained with a mixture of general tax revenues and gasoline taxes collected from all drivers (and local roads are typically funded by general revenues), but trucks cause almost all road damage. A rule of thumb in transportation planning is that the damage a vehicle causes to roads is proportional to the fourth power of the weight on each axle: for instance, a four-axle, 30-ton truck, possessing ten times the weight per axle as a two-axle, 1.5-ton compact passenger car, causes about 10,000 times more damage to the road. It’s no surprise that areas such as Pennsylvania’s Lehigh Valley—whose proximity to New York and Philadelphia has made it a growing hub for distribution centers for Amazon and other companies—have had to invest hundreds of millions in freeway improvements.

Biden’s executive order ignores other disadvantages that freight rail faces. Railroads not only have to maintain their own rails as well as their trains but also generally must pay property taxes on the improved value of their own facilities. That policy helps make many infrastructure upgrades, such as electrification that could allow faster, higher-powered trains to compete with trucking on time-sensitive deliveries, uneconomical. (In Europe, even rural railroads with little passenger traffic tend to be electrified.) And under Biden, the Federal Railroad Administration has proposed to reinstate a burdensome rule that would require a two-person crew for freight rail operations, which railroad workers’ unions insist is necessary for worker safety but is rare in nations with far better rail-safety records than the United States. (In northern Sweden, for example, solo train operators drive half-mile trains of iron ore hauled by some of the world’s strongest locomotives.)

As for shipping, the White House frames Biden’s measures as protecting American manufacturers against foreign depredations. It complains that shipping-industry consolidation is “leaving domestic manufacturers who need to export goods at these large foreign [shipping] companies’ mercy.”

As for domestic manufacturers that want to ship goods domestically, though, they’re out of luck. Biden has repeatedly supported one of the most egregious anti-competitive policies not just in freight transport but in all federal policy: the Jones Act, a 1920 law that prohibits ships from carrying cargo between American ports unless they are built in the United States and have American crews.

The Jones Act ostensibly exists to maintain U.S. shipbuilding capacities that could prove necessary for national defense, but, as a 2018 analysis from the Cato Institute showed, it has clearly failed. The U.S. shipbuilding industry has a mere fraction of the capacity of those of world leaders such as China, Korea, and Japan; U.S.–built ships are dilapidated, inefficient, and inexpensive, thanks, largely, to the Jones Act’s shielding American shipyards from having to keep up with global state of the art. Meanwhile, the nations that lead the world in shipbuilding, with the exception of China, are longstanding U.S. allies, making a national security argument still more tenuous.

Though Biden views the Jones Act as a vital part of revitalizing American manufacturing, the law conflicts with his stated priorities. It raises the cost of living in island areas such as Hawaii and Puerto Rico; there are no Jones Act–compliant ships that can transport certain commodities, such as liquified natural gas. Even in the American mainland, liberalized sea shipping could replace truck transport in areas such as the U.S. East Coast, going a long way toward the administration’s claimed environmental goals. As Scott Shackford notes at Reason, Biden’s Jones Act support sits uneasily alongside his administration’s solicitude for racial minorities, given that Hawaii and Puerto Rico, the two areas of the United States that suffer the most from the Jones Act, are also among the least white. Moreover, it is poor urban neighborhoods that suffer the most from truck pollution.

Actions to de-consolidate the freight rail and shipping industries may prove salutary, but they address only a small, politically convenient part of the problem with freight transport in America. Far worse inefficiencies—not only harming manufacturers and consumers but also wasting large sums of tax money and adding to air pollution—are the fault of bad regulations and sops to narrow special interests. The Biden administration plans to leave these unaddressed, and in some cases to exacerbate them.

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A Nation of Rentiers | City Journal

A recent Wall Street Journal report that institutional investors were buying single-family homes as rental properties spurred outrage from populists across the political spectrum, from conservative author and Ohio Senate candidate J. D. Vance to socialist magazine editor Nathan J. Robinson. One common phrase appeared in many of these condemnations: that institutional investors were depriving the working and middle classes of a chance to “build wealth” through homeownership.

This conventional wisdom that homeownership ought to be a chance to build wealth deserves scrutiny, along with related notions, such as that renting a dwelling means throwing money away. The prevalence of such ideas itself illustrates a disordered investment marketplace. In a free market, asset prices adjust so that no asset remains a clearly better investment than another for long. If buying a house consistently offers better returns than, say, renting a dwelling instead and putting the money saved into the stock market, this can be due only to market distortions.

Owning a home has long been a worthy investment in the sense that house prices were generally stable and less volatile than stocks. And the idea that homeownership makes for better citizens—the justification for homeownership subsidies, such as federal subsidized mortgages—has some empirical support. Several studies have found that homeowners are more likely than renters to vote, join civic organizations, or be good citizens in other ways (though nations such as Switzerland and Germany that don’t lack for civic order and bourgeois virtue have far lower homeownership rates than the United States). Economist William Fischel’s work on what he calls the “homevoter hypothesis” explains many facets of American local governance, such as how state funding of schools tends to produce worse education than local funding. Homeowners must take an interest in local governance, Fischel argues, to protect their property values.

But making one’s town more desirable is just one way to protect property values. The easier way is to pass negative-sum policies that inflate housing prices by restricting housing supply, letting homeowners “build wealth” by taking it from poorer renters and future generations of homebuyers rather than by creating anything of value. Such policies, which account for the vast majority of the wealth accumulated by homeowners, are of recent vintage. As Jake Anbinder, a historian of American housing policy, points out, housing became a lucrative instead of merely stable investment only in the 1970s and 1980s, after the baby boomers had bought into the housing market. This turning point coincided with a massive surge in policies such as historic-district designations and ostensibly environmentalist “slow growth” land-use planning.

Anti-growth housing policies worked out well for the baby boomers who got in on the ground floor but have forced subsequent generations to confront massively inflated housing prices. One ironic result: homeowners today must take out massive mortgages to afford price-inflated houses, placing themselves in a precarious position that makes them even more risk-averse to downturns in their housing value.

Institutional investors are a useful scapegoat for housing unaffordability, but they bear only a small portion of the blame. Single-family rental companies own less than 1 percent of the country’s total supply of single-family houses; the states where they own the largest part of the total, such as Georgia, Florida, and Arizona, are not notable for high housing prices. Investor purchases of housing sales, meantime, have actually declined as a percentage of the whole market since the last decade.

If homeownership represents many Americans’ best attempt to build wealth, that is largely because laws bar most Americans from other, safer high-yield investments—ostensibly for their own good. For example, the Securities and Exchange Commission’s accredited investor rules essentially bar all but the wealthiest individuals from investing in unregistered securities, including early-stage startups that can provide massive returns on investment. In theory, these rules protect individuals from risky speculations. But even the riskiest securities can be diversified or bought in small enough increments that a complete collapse in their price would not ruin investors’ livelihoods. Houses are far more dangerous investments: they’re unavoidably massive, illiquid, and typically highly leveraged. And unlike investments in housing, investments in startups contribute to making the nation more prosperous.

The real blame for housing unaffordability lies not with institutional investors but rather with heavy government interventions in the housing market—above all, supply restrictions whose most numerous beneficiaries and supporters are regular homeowners. Any justifications for such policies pale compared with their massive economic costs. The best way to get institutional investors out of the housing market is to support expansions in housing supply and make homeownership a way to store, not build, wealth—as it was for most of American history.

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A Crisis in Transit Maintenance

Many are aware of the United States’ world-leading incompetence at building transit infrastructure, thanks to such efforts as the Transit Costs Project at New York University’s Marron Institute. Less studied but equally important is a crisis in transit maintenance: the United States, especially New York, spends too much simply keeping its subways and railways in good order. As Congress debates an infrastructure plan that may send massive sums of money to wasteful repair projects, these costs deserve more attention.

One example familiar to many New York commuters is Metro-North’s New Haven Line. The majority of this line lies in Connecticut and is owned and maintained not by the Metropolitan Transportation Authority but by the Connecticut Department of Transportation. To save money, CTDOT maintains the tracks to a low standard that imposes a speed limit of only 75 mph, though trains run at up to 90 mph in New York, and much of the track could support still-higher speeds.

But even this shoddy maintenance is done at great expense and inconvenience to passengers. A State of Good Repair program has kept the New Haven Line under constant intrusive maintenance for decades while producing no noticeable improvements to service. Though the line has four tracks, large chunks of it function as a three-track line because of track closures for maintenance. Maintenance also requires trains to slow down to jogging speed for worker safety as they pass work sites. The result is that run times from New York to New Haven have actually slowed down over the past several years. As noted by Alon Levy, a researcher for the Transit Costs Project, Connecticut’s annual spending on State of Good Repair is comparable to a German track-renewal project meant to last 30 years. A report from CTDOT consultants estimates that reducing New York–New Haven trip times by only 25 minutes would cost $8 billion, though travel times could be cut by much more even without straightening tracks.

The New York City subway is another example of the crisis in maintenance productivity. The system’s operational expenditures are quite high compared with those of most other subways in the United States. The bulk of the premium, according to data kept by federal regulators, is maintenance costs: per track mile, New York’s maintenance spending on tracks and other immobile facilities is four times that of any other subway system in the nation, except for New Jersey’s PATH.

Excessive technological conservatism is likely a main contributor to high maintenance costs: many transit authorities opt for labor-intensive methods over new technologies that have long been standard internationally. For instance, track replacement in Europe today is commonly carried out using track-renewal machines: large contraptions that continuously move along a track, prying up and replacing rails and ties in one pass. According to Network Rail, the state-owned enterprise that owns the U.K.’s rail infrastructure, one team with a track-renewal machine can replace the ballast on a mile of track and replace the rails and ties themselves on three-quarters of a mile, within one overnight maintenance window; the resulting track is stable enough for full-speed operation the next morning. (Some American freight railroads also use track-renewal machines.)

Routine checking for track defects can also be automated heavily. For decades, the Japanese Shinkansen high-speed-rail network has been maintained with the help of specialized trains nicknamed “Doctor Yellow,” which carry equipment to examine the tracks and overhead wires for defects while running at a full line speed of close to 200 mph. Lower-speed subway systems in other countries also use automated maintenance, which have only limited deployment in the U.S.

Organized-labor interests bear some responsibility for inefficient maintenance. In 2018, the head of TWU Local 100, which represents New York City subway workers, and an ally on the MTA board objected that an MTA proposal to increase the use of automated track inspections would compromise safety. Never mind that rail-safety records in other nations are superior to those in the United States: the Shinkansen rail network has never had a fatal accident at speed.

But a still more disconcerting possibility is that agency heads don’t know that better maintenance technologies exist. Officials at Metro-North and CTDOT have demonstrated a lack of knowledge not only of routine European rail operations but also of relevant changes to American federal regulations that had been announced years in advance. According to Roger Senserrich, a political activist in New Haven, CTDOT entirely lacks an in-house design staff for rail projects and outsources such work to consultants. These consultants likely work principally on American projects, and they have little incentive to produce lower cost estimates.

Maintenance issues may not be as visible as construction-cost overruns, but they’re an important source of waste. Congressional Democrats’ initial infrastructure proposal, for instance, would have spent $39 billion on bringing the northeast corridor to a “state of good repair,” a cost per mile far exceeding that of a brand-new high-speed rail line in most of Europe. Modernizing maintenance practices, which in most cases means adopting technologies already routine in other countries, is an indispensable step in making American infrastructure more functional.

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California’s Progressive Anti-Housing Warriors | City Journal

California’s state legislature is currently considering AB 1401, a state bill that would prevent municipal zoning codes from imposing parking minimums near public transit. The bill would mitigate one of the worst elements in California’s morass of anti-growth housing regulations. Parking minimums constrain development in urban areas, as underground parking garages can cost tens of thousands of dollars per spot.

Many California environmentalist groups and affordable-housing activists, however, have opposed AB 1401. And AB 1401 is far from an isolated case: left-wing interest groups are often the fiercest supporters of housing regulations that impoverish California’s working class while enriching landowners. The reason: complicated, capricious development laws give politically connected groups more opportunities to extort concessions from developers.

In the case of AB 1401, for instance, a coalition of progressive opponents insisted that the law should be passed only “with amendments to ensure that parking reductions remain coupled with the density bonus framework for mixed-income housing projects.” This means, essentially, that developers should still be forced to provide more parking unless they rent out much of their properties at below-market rates at their own expense. “Density bonuses” are a feature of many zoning codes in California and elsewhere, letting developers build more densely than the requirements of the zoning code if some of their units are rented at below market price. Density bonuses create a perverse incentive for advocates of subsidized housing to make the base zoning code stricter, so that any new development project has to use density bonuses to be economically viable. Such policies may produce a few extra subsidized housing units, but they also worsen market-rate housing shortages for everyone not lucky enough to snag a subsidized housing unit.

Other provisions of California development laws allow for more blatant extortion. The California Environmental Quality Act (CEQA) allows members of the public to complain about the environmental impacts of development projects and has very broad rules of standing. “CEQA is intentionally designed for broad public enforcement,” notes one environmentalist group’s summary, “and in general, anyone who has an environmental concern with a project has the standing to bring a lawsuit if the legal violation they are alleging was raised during the administrative process.” CEQA also defines environmental impact broadly: at least in some circumstances, it is possible to object to a development because it will make parking more difficult. A CEQA lawsuit can force developers to incur years of delay and hundreds of thousands of dollars on additional environmental reviews to a project—enough of an incentive to get developers to do whatever it takes to avoid one.

It’s no surprise, then, that CEQA lawsuits are widely abused. One analysis by Bay Area attorney Jennifer Hernandez estimates that 80 percent of CEQA lawsuits are filed against infill projects in already developed areas, belying the law’s ostensible justification of protecting California’s wild areas. One of the biggest abusers: California construction unions, which routinely threaten meritless CEQA lawsuits against projects that don’t use union labor. An article from 2017 published by the San Francisco-based progressive, pro-housing think tank SPUR noted matter-of-factly that construction unions bore much of the responsibility for scuttling one CEQA reform attempt because “they rely on CEQA lawsuits to get developers to use union contractors.” The website Phony Union Tree Huggers provides a large compilation of CEQA complaints filed by union front groups. To take one recent example of many, in 2019, East Bay Residents, which described itself as an “unincorporated association of individuals and labor organizations,” complained to Oakland’s city government under CEQA about noise and emissions from construction equipment on a planned 37-story residential tower in the city center, 200 yards from a subway stop. Unions have even used CEQA lawsuits to file complaints against solar energy projects.

San Francisco has a similar local ordinance under which any citizen can protest a new development anywhere in the city. This was used most infamously by the nonprofit Calle 24, which claims to advocate for the interests of the Latino community in the city’s Mission District. Calle 24 delayed a local laundromat owner’s plan to sell his property to a housing developer with a series of nuisance complaints—arguing, for instance, that the laundromat deserved historic preservation because neighborhood Chicano groups had used it as a meeting site decades earlier. Calle 24 all but admitted that the complaints were largely pretextual: notwithstanding its own complaints about the historic significance of the laundromat, the group even tried to force the owner to sell to a nonprofit organization that would redevelop the property into below-market housing with government subsidies.

Perhaps the most charitable explanation for many California progressive organizations’ opposition to reform is that they have grown so accustomed to housing scarcity that they can no longer imagine how substantial reforms might work. Tiny concessions extracted by whatever means necessary are the best that they can do. Fortunately, however, such voices represent only one political faction. Many other progressive activists in the Golden State support AB 1401 and similar laws because they recognize that reforming zoning laws to make them less restrictive could improve affordability. The future of California housing may depend on how quickly the broad progressive movement recognizes that free markets are the way forward.

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The Case for Proportional Representation

While the mayoral race is absorbing New Yorkers’ attention, dozens of equally important races are flying under the radar: the contests for New York’s 53 city council districts. The city’s housing crisis makes these races especially urgent. Like many cities, New York has a tradition of “member deference” that gives council members unofficial veto power over all development in their district.

Council members rarely face competitive elections. As Daniel J. Hopkins notes in a Manhattan Institute policy brief on local election turnout, New York is overwhelmingly Democratic and conducts elections in two phases: a partisan primary, and a general contest between one candidate from each party. The winner of a Democratic primary in most races is certain to win the general election.

New York’s undemocratic politics help explain why anti-development policies persist in a city where considerable majorities support more housing construction. As Hopkins notes, New York’s primary process disempowers non-Democrats unwilling to register with a party they dislike. Furthermore, primaries are often held on obscure dates and feature races between low-profile neighborhood politicians. Hence, turnout often falls below 10 percent in New York primaries.

Low-turnout elections, in turn, encourage politicians to take narrow views of politics, cobbling together a plurality by catering to organized interest groups that can get their members to the polls. These concessions often take the form of anti-growth politics, as candidates pander to anti-development groups with self-serving motivations such as preserving their property views and inflated house values, or groups such as organized labor that want to keep out non-union jobs.

Consider councilman Carlos Menchaca, who represents a district in Brooklyn that would have been home to the canceled Industry City development. The project would have created tens of thousands of jobs, but thanks to member deference, Menchaca could decide its fate. He insisted on so many onerous conditions—including the elimination of a planned hotel that might have posed competition to the city’s powerful hotel workers’ union, which has spent years fighting for a de facto ban on new hotels—that the developers decided the project could not be profitable and gave up. It bears noting that Menchaca’s district has about 157,000 residents, but only 8,615 votes were cast in his last remotely competitive election: the 2017 Democratic primary, which he won as an incumbent with 48.5 percent of the vote.

Hopkins proposes reasonable reforms for boosting turnout, such as shifting municipal elections by a year to coincide with more prominent national elections. But it is worth considering a more radical (though not unprecedented) scheme: abolishing city council districts altogether and electing city councils by proportional representation.

In New York, such a scheme might work as follows. Organizations that gather enough signatures from city residents (an appropriate threshold may be in the tens of thousands) could register as New York City–specific political parties, and state affiliates of the two major parties and larger third parties could get automatic registration as well. Regional political parties, such as the Minnesota Farmer–Labor party that dominated Minnesota politics in the 1930s, are not unprecedented in the United States, and still have substantial power in other nations such as Canada, where federal and provincial political parties are separate and autonomous organizations. New York City–specific political parties might therefore include not just Democrats, Republicans, and smaller parties such as Libertarians and Greens, but could also allow new organizations or ideologies that don’t fit neatly into the extant party system to get a voice in city politics.

Before the election, party leaders would write a platform and choose a ranked slate of candidates for city council. In general elections, voters would choose a political party rather than a specific candidate. Then, each party would send some number of their top-ranked candidates to the council in proportion to the share of the vote that they received—for instance, if the council had 60 members, then a party that received 20 percent of the vote would win seats for its top twelve candidates.

Such a plan would have many advantages over district elections. First, proportional representation would allow voters more significant choices. Currently, most city voters have to register as Democrats to vote in a meaningful election, and in primaries, candidates are often distinguished more by interest groups than by ideology. Even districts with some partisan competition offer a choice only between a Democrat and a Republican, chosen in primaries that do not hinge on ideological differences. Under proportional representation, voters could choose between several parties and have better odds of finding one that represents their own political views. Their choice would have a real chance of affecting the balance of power.

Second, voters could better comprehend the stakes of a competition between parties with clear platforms and citywide name recognition than those of a competition between obscure neighborhood politicians running low-budget campaigns. A substantial body of political science literature finds that proportional representation systems produce higher voter turnout than district elections.

Severing the link between city council members and individual districts would also eliminate member deference and remove members’ incentives to pander to narrow neighborhood interests. Instead, politicians and their parties would have to appeal to broader citywide constituencies. Local interests could still form a political party and nominate their own candidates and might even be able to win a seat if they genuinely have broad support in their neighborhood. But without member deference, they would not have the outsize influence that city councilmen often have today. With wider competition, finally, local Democratic parties would face the threat of losing control of city councils to a coalition of other parties and would have to work harder to solve voters’ problems in order to retain support.

One final concern: racial representation. The scheme of “majority-minority” districts set up by the Voting Rights Act (VRA) presupposes single-member districts, and lawsuits under the VRA have invalidated several “at-large” voting schemes in which all members of a legislative body are chosen by all voters in the city. But these schemes, frequently adopted after Jim Crow by white-majority southern cities, were typically designed to give all seats to the city’s majority. Proportional representation, however, guarantees representation of minority political interests, and ethnic groups with coherent political demands could start parties and nominate slates of their own. A 1978 law review article by political scientist Joseph Zimmerman concludes that at least one variant of proportional representation would be acceptable under the VRA.

Zimmerman also notes that proportional representation has advantages over district-based elections for promoting ethnic diversity. It would not require racial minorities to live in the same neighborhoods to retain political strength, a feature of district elections that perversely encourages racial-minority politicians to preserve racial segregation. And it would empower ethnic groups besides those officially regarded as racial minorities and remove conflicts between them provoked by the VRA’s racial gerrymandering. For instance, the 1977 Supreme Court case United Jewish Organizations of Williamsburgh, Inc. v. Carey concerned a VRA–mandated redrawing of New York state legislative districts that split a district in Brooklyn with a Hasidic Jewish majority in order to fortify black political power. (Irish-, Italian-, and Polish-American interest groups also objected to the redistricting on similar grounds.) The Supreme Court rejected a complaint that the redistricting harmed Hasidic political power on the grounds that Jews were merely an ethnic group, not a race, and ethnic groups were not protected under the VRA. Under proportional representation, though, Hasidic Jews could start a political party devoted to their own interests and have a chance to win seats without worrying about the vagaries of redistricting plans.

To abandon such a universal feature of American politics as single-member districts may seem radical, but city politics are the perfect laboratory for such changes—especially in cities like New York that need radical changes. Proportional representation would reintroduce a healthy form of partisan competition, one that makes elections meaningful and gives ruling parties a greater incentive for good governance while also getting rid of the parochialism that underlies many citywide problems.

In the tightly interconnected economies of modern cities, important issues are seldom local matters. It’s time to redesign our cities’ electoral systems accordingly.

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In Cambridge, Massachusetts, Local Control Means Restrictive Zoning

Moderna’s Covid-19 vaccine has been lauded as a triumph of American industry, but it’s a triumph of one corner of American industry in particular. Moderna is one of a cluster of biotechnology startups in Kendall Square, a neighborhood of Cambridge, Massachusetts, just east of MIT and a few minutes by subway from Harvard and downtown Boston. Spillovers from research at the city’s hospitals and universities, combined with generous state- and university-supported startup incubators, have fostered what some reporters call the “most innovative square mile in America.” And Kendall Square is but one part of a much broader Boston biotechnology ecosystem.

Kendall Square’s location in Cambridge, though, is in many ways a misfortune. The biotech industry depends on geographical concentrations of highly skilled researchers and specialized facilities, as well as collaboration with immobile institutions such as universities, leaving it captive to the expensive Boston-area housing market. Cambridge, in particular, is extremely pricy, with an average home value of $900,000—nearly twice what it was ten years ago—according to data from the real estate information company Zillow.

The reason for the massive cost escalation is simple: a well-financed biotech industry has collided with an inflexible housing market. Almost half of Cambridge’s housing stock was built before 1940; a time-traveler from the postwar period would find most of the city’s appearance virtually unchanged. And the lack of new housing has put a severe cramp on the city’s expansion: despite some population growth over the past decade—accommodated largely by rampant housing overcrowding, even among highly educated workers—Cambridge is still slightly below its population in 1950, when it was a working-class city with a below-average median income. Housing prices aren’t the only drag on the area’s biotech sector: laboratory space for biotech startups, which can be built only in the city’s comparatively small portion of nonresidential land, have also seen massive price increases.

As in many other high-cost blue cities, the housing shortage in Cambridge was engineered by an entrenched cohort of wealthy, politically influential long-time homeowners who see no contradiction between progressive political ideals and reflexive opposition to letting anything in their neighborhood change. In Harvard Square, for instance—a neighborhood with excellent transit access, in which skyrocketing commercial rents have repeatedly forced popular businesses to close—the Cambridge Historical Commission and the Harvard Square Neighborhood Association caused substantial delays to a plan to renovate a closed movie theater for more commercial space. Among the reasons: the head of the Harvard Square Neighborhood Association, a longtime Harvard art and architecture professor, complained that renovations would add 14 feet to the building’s height; the Cambridge Historical Commission objected that an LED display on the building might be “on the spectrum of Times Square.”

In 2019, similarly, the Cambridge chapter of Our Revolution, an activist organization spun out of the Bernie Sanders 2016 campaign, supported a slate of candidates for city council opposing a zoning change that would have allowed more housing construction—even though all new housing allowed by the zoning change would have to be “100% affordable,” rented entirely at below-market rates. Another zoning change currently under consideration—designating an unremarkable swath of East Cambridge adjacent to Kendall Square as a historic district—seems specifically targeted at stopping the biotech industry from expanding.

Cambridge biotech firms have to pay employees far more than they would earn elsewhere just so they can afford housing, or to compensate for enduring the area’s overcrowding. This business tax, in effect, inflates the home values of long-time residents, who thereby leech off of a productive industry. Small startups pursuing innovative, uncertain ideas are the firms most affected by Cambridge’s inflated real-estate prices—and the high cost of living in Cambridge has doubtless killed off many medical innovations by convincing prospective founders that a longshot research idea was unlikely to pay off, or by making it too expensive for startups to expand.

Cambridge’s example shows the limits of defending zoning as simply an outgrowth of principles of federalism or local control. Zoning policies are far from merely local concerns; they can have broader influence. Imagining how many patients could have been treated by medical innovations that Cambridge’s zoning policy effectively stopped is a sobering exercise. Defending local control in this instance means accepting these losses as a fair price for protecting a few thousand wealthy homeowners from the indignity of living near tall buildings.

Alas, Cambridge is not unique. America is filled with world-leading high-productivity industries—software development in San Francisco and Seattle, for instance, or entertainment in New York and Los Angeles—stuck in areas where zoning policies are a drag on their growth and output. Policies to reduce housing costs over homeowner cartels’ objections—including state preemptions of local zoning policy, which several states have recently passed—could turbocharge American innovation.

Photo by Dina Rudick/The Boston Globe via Getty Images

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Biden’s Infrastructure Bill Makes No Effort to Control Costs

At long last, President Biden has unveiled an infrastructure bill: a proposal containing $2 trillion in infrastructure spending, including $85 billion on mass transit and another $80 billion on Amtrak and freight rail. Despite popular perception, however, U.S. transportation spending—though on the low side of the range for developed nations—is hardly anomalously low. The poor state of American infrastructure owes mainly to failed cost control—a problem Biden’s proposal won’t solve.

American infrastructure is expensive. Systematic investigations have found that recent rail projects in cities such as New York, San Francisco, and Boston cost several times the typical price tag of projects elsewhere in the world on a per-mile basis. Many urban regions have squandered billions of dollars on expensive mass-transit lines through sparsely populated exurbs. Transit authorities in Dallas–Fort Worth, for instance, have built or are building suburban rail lines costing several hundred thousand dollars per weekday rider. The region is scarcely alone in this regard.

The cost excesses are ultimately the responsibility of state and local leaders, especially managers. In Connecticut, to take just one example, a fierce debate in 2019 over whether to reimpose tolls on some freeways to fund road and rail improvements largely neglected the improvements’ extravagant costs. The state Department of Transportation estimated that a two-mile freeway viaduct replacement would cost $4 billion—a sum far exceeding the price of other, more complex freeway projects in the U.S. and elsewhere (in Europe, it would buy 100 or so miles of high-speed railway). When I pointed this out in an op-ed, Connecticut’s state DOT commissioner issued a virtually contentless response—the only substantive point being a quibble about inflation adjustments that explained only a sliver of the cost excesses—assuring the public that “the employees of the DOT are experienced professionals that work to stretch every dollar as far as possible.” Another example: two highly paid managers in charge of Connecticut rail investments demonstrated at a public meeting in 2019 that they had no knowledge of best industry practices.

The federal government enables this cost bloat by heavily subsidizing new mass infrastructure. It may be in local politicians’ interests to build worthless transit projects if it means providing local jobs with what, as far as they are concerned, is free money. Meantime, the existence of external funding frees transportation managers from having to worry about efficient construction. This problem is hardly exclusive to mass transit: the federal government’s subsidy of about 40 percent of state and local freeway spending has also made for plenty of boondoggles.

To be fair, Biden’s plan does have a paragraph discussing cost issues that suggests at least a vague understanding of American cost difficulties, but it speaks mostly in platitudes, and what details it provides are not promising. The paragraph begins by noting that “America lags its peers—including Canada, the U.K., and Australia—in the on-time and on-budget delivery of infrastructure.” This is a misdiagnosis on two scores: the problem with American infrastructure budgeting is less overrunning budgets than the excess of the budgets in the first place, and the selection of three English-speaking nations as comparisons is misjudged—after the United States, the rest of the Anglosphere has the world’s highest construction costs, in part because its countries copy bad American ideas. The page also assures us, “When President Biden managed the implementation of the Recovery Act, he insisted on the strongest possible accountability and transparency measures to ensure public dollars were invested efficiently and effectively.” That is far from encouraging, given that the American Recovery and Reinvestment Act filled America’s low-density cities with low-ridership light rail systems.

The more concrete details that have emerged about Biden’s plan, meanwhile, show a lack of interest in cost control. For instance, the infrastructure plan promises that all materials used in federal infrastructure projects will have to come from American manufacturers, a provision that has massively inflated costs on previous projects (with most of the surplus going to consultants and corporate managers, not workers). And much of the money seems likely to go to the nation’s leader in cost bloat: New York, where Senator Chuck Schumer has said that a new rail tunnel under the Hudson River and an extension of the city’s Second Avenue Subway, both among the most overpriced projects in the world, are likely to get funding.

The best way for the federal government to control costs? Turn off the spigots. Most transportation infrastructure—including virtually all mass transit—serves local rather than national interests; there is little justification for federal support. Greater local responsibility for transit may force local managers finally to take a serious look at reducing costs. Cut off from a hose of free money, officials might adopt innovative approaches to reducing the risk that new infrastructure poses to public finances, such as public-private partnerships for building new roads that can be financed entirely out of vehicle tolls.

Whatever the solution to improving American infrastructure, rewarding rampant wastefulness with more no-strings-attached federal money is certainly not it.

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Do We Need Mask Mandates?

Joe Biden has counted on face masks to control the Covid-19 pandemic. On his first day in office, the president issued an executive order requiring masks on federal property and called for their widespread use for 100 days. More recently, the Centers for Disease Control has mandated masks on airplanes and mass transit, though most airlines and transit systems already require them.

These recommendations mark the latest step in a thorough reversal of the pre-pandemic public-health consensus that masks are useless or counterproductive. Yet the evidence underlying this reversal turns out to be quite weak. Widespread use of masks throughout the United States and Europe has failed to stop massive pandemic waves in the fall and winter. Preliminary signs also suggest that mask mandates may be causing considerable harm. Several state governments have recently rescinded their mask mandates, and a look at the science suggests that more should consider following.

Researchers have investigated masks for disease protection since the discovery, in the late nineteenth century, that many respiratory pathogens spread in droplets of exhaled moisture that follow ballistic paths extending a few yards. It seemed logical that a device to block relatively large droplets could also block smaller pathogens, both protecting wearers and serving as “source control,” stopping them from infecting others.

Later research has shown, however, that respiratory droplets obey a more complicated set of physical laws. In particular, once exhaled, they shrink rapidly through evaporation. One widely cited model estimates that droplets with diameters smaller than about 100 microns (a micron is a thousandth of a millimeter) evaporate before reaching the ground, leaving their contents as long-lasting aerosols; particles smaller than about five microns can stay aloft indefinitely and travel beyond droplet range. Individual coronaviruses are about 0.1 microns across, smaller than the pores of surgical masks (0.3 microns to 10 microns) and minuscule compared to those of cloth masks (80 microns to 500 microns).

In practice, other factors can inhibit complete droplet evaporation. But evaporation still reduces relatively large droplets to sizes small enough to stay airborne. And numerous case studies, such as a choir practice in which one singer infected dozens of members beyond droplet range, show that airborne Covid-19 transmission takes place—as does rare outdoor transmission, as outdoor air currents rapidly clear away aerosols but have little effect on droplets. So while masks may stop short-range, face-to-face spread from large droplets, they are likely less effective—and perhaps completely ineffective—at stopping airborne spread from aerosols.

It’s instructive to compare the first two epidemics involving wide usage of masks. To combat the Manchurian Plague, a bacterial epidemic in northern China in the winter of 1910-11, the doctor Wu Lien-Teh devised a cloth mask that tightly covered the nose and mouth. A report found that “the careful use of the mask appeared to confer absolute protection.” But masks proved far less useful in the subsequent 1918 Spanish flu, a viral disease spread by pathogens smaller than bacteria. California’s Department of Health, for instance, reported that the cities of Stockton, which required masks, and Boston, which did not, had scarcely different death rates, and so advised against mask mandates except for a few high-risk professions such as barbers. The Surgeon General of the United States Navy warned that masks were “designed only to afford protection against a direct spray from the mouth” and could even spread disease if used improperly. The epidemiologist Warren Vaughan used even blunter terms: “Certainly the face mask as extensively used during the 1918 epidemic was of little benefit and in many cases was, without doubt, a decided detriment.”

Nevertheless, doctors have continued to study the use of masks to protect against viral diseases. The studies vary widely, starting with the populations they consider—many studies use hospital workers as subjects, and their results may not generalize perfectly to nonhospital environments with different balances of aerosol and droplet transmission. Studies also differ in the type of masks they consider: some consider surgical masks, others makeshift cloth masks, still others N95 masks, which seal tightly around the mouth and nose. The latter protect the wearer well if worn correctly, but they are more expensive and limited in supply, are uncomfortable and difficult to wear correctly, and generally do not filter exhalations, thus providing no source-control benefit. Most discussions about mask mandates for the public have thus focused on cloth or surgical masks. Cloth masks, for their part, have proved far inferior to surgical masks in tests of filtration efficacy. One large randomized trial found that hospital workers who wore cloth masks were 6.6 times as likely to contract flu-like illnesses as those who wore surgical masks—a difference that the study authors speculated may be because cloth masks confer greater infection risk than no mask at all.

Some studies directly test whether masks filter air particles, either on volunteers connected to breath analyzers or on mannequin heads with breathing simulators. These studies show widely varying effectiveness. Other limitations on their real-world applicability exist, too: the fit of a mask in a supervised study or on a mannequin is likely better than in real-world use; experiments often last only a few minutes; and simulated breath likely degrades mask performance more slowly than real, humid breath. (One influential 2006 paper on influenza control claims that masks quickly become ineffective as “the pores in the mask become blocked by moisture from breathing.”)

Furthermore, few studies look specifically at the particles with diameters five microns or smaller that are responsible for airborne transmission. The studies that do examine those particles give equivocal results. One small study found that surgical masks filter exhaled particles smaller than five microns for volunteers sick with mild coronaviruses (based on a sample of only 17 patients), but not flu viruses or rhinoviruses. Another 2009 study tested filtration rates for five FDA-approved surgical masks fitted to mannequin heads with exhalation simulators. They provided widely varying and generally highly imperfect filtration, with the worst mask letting through more than 90 percent of particles in the 0.1–0.4-micron range in one test, even though masks were sealed to the mannequin’s face with silicone, providing far better filtration than real-world use. The authors concluded that “surgical masks should not be used for respiratory protection.”

Real-world studies, mostly focusing on protection rather than source control, are also equivocal. Some observational studies seem positive: for instance, one study of SARS in Beijing found that 94 SARS survivors were far less likely to have worn masks outside the home than 281 residents in their areas who had not contracted SARS. A study of Covid-19 among 124 families in Beijing found that wearing masks before the first household member showed symptoms was associated with a 79 percent lower transmission rate.

Observational studies such as these, however, have severe limitations. Mask-wearers are more likely to be conscientious and take other precautions whose effects can be confounded with those of masks. (One finding of the Beijing Covid-19 study suggests that something like this occurred: frequent surface disinfection supposedly reduced household transmission by 77 percent—almost as much as masks—though surface transmission of Covid-19 is now known to be insubstantial.) Observational studies also suffer from “recall bias”: inconsistent mask-wearers may report themselves as not wearing masks if they fell sick, or as wearing masks if they did not.

Randomized controlled trials (RCTs) on mask use, generally more reliable than observational studies, though not infallible, typically show that cloth and surgical masks offer little protection. A few RCTs suggest that perfect adherence to an exacting mask protocol may guard against influenza, but meta-analyses find little on the whole to suggest that masks offer meaningful protection. WHO guidelines from 2019 on influenza say that despite “mechanistic plausibility for the potential effectiveness” of masks, studies showed a benefit too small to be established with any certainty. Another literature review by researchers from the University of Hong Kong agrees. Its best estimate for the protective effect of surgical masks against influenza, based on ten RCTs published through 2018, was just 22 percent, and it could not rule out zero effect.

More recent studies back up these results. A November 2020 report by Cochrane, a nonprofit organization that produces authoritative reviews of medical research, notes: “There is low certainty evidence from nine trials (3507 participants) that wearing a mask may make little or no difference to the outcome of influenza-like illness . . . compared to not wearing a mask . . . . There is moderate certainty evidence that wearing a mask probably makes little or no difference to the outcome of laboratory-confirmed influenza compared to not wearing a mask.” The only complete RCT for Covid-19 was also disappointing: a spring 2020 trial in Denmark showed a protective effect statistically indistinguishable from zero.

Public-health authorities justified mask mandates not for personal protection, however, but as a means of stopping wearers from spreading Covid-19—a pressing matter once case studies showed that spreaders may not show symptoms. Since exhaled droplets are larger than inhaled droplets shrunk by evaporation, masks might be better at source control than at personal protection. Indeed, some trials support a source-control effect at least for brief direct exposures: one study shows that surgical masks cut bacterial spread from coughing cystic fibrosis patients by 94 percent.

Other studies have been less promising. First, many studies (summarized by a researcher for the National Institutes of Health) find that exhaled droplets can be small enough to become airborne and slip through mask pores: “most particles in exhaled breath are smaller than 4 [microns], with a median between 0.7 and 1.0 [microns].” These small particles are indeed infectious: one study on influenza viruses in exhaled droplets found that “the fine particles [smaller than 5 microns] contained 8.8 times more viral copies than did the coarse ones.” Another study found that most infectious particles were smaller than one micron.

Studies in hospitals, likewise, have repeatedly shown that surgical masks worn by surgeons do not reduce bacterial wound infections, even though masks might be expected to work best against short-distance transmission of bacteria rather than smaller viruses. One study even found that when surgeons in one British hospital got rid of face masks, the rate of wound infections fell by half. Surgical masks, another study showed, did not reduce bacterial contamination of surfaces in an operating theater. There are several case studies, furthermore, of Covid-19 outbreaks in confined spaces despite good mask adherence, such as one outbreak in a Marine Corps barracks whose residents wore cloth masks almost constantly.

The most powerful evidence, though, comes from comparing Covid-19 in different regions: do areas with mask mandates or widespread mask use see fewer cases? Last spring, the answer seemed to be yes. Many Asian nations, prominently Taiwan, South Korea, Hong Kong, and Japan, had adopted public mask use during SARS in 2003 and readopted it for Covid-19. They saw outbreaks in February that quickly subsided. Japan’s success seemed particularly hard to attribute to anything but masks: the nation saw only weak government interventions, principally a brief, likely ineffective school closure. Some Western nations followed suit, with apparent success. The Czech Republic was the first, thanks to Petr Ludwig, an influential science popularizer, who posted a YouTube video on March 14 urging Czechs to use improvised cloth masks. Poland quickly followed; a social media campaign in late March exhorted Poles to kryj ryj, or “cover your snout.” Both nations escaped the spring wave nearly unscathed.

The subsequent record, though, is less encouraging. Ian Miller, a writer for the lockdown-skeptical website Rational Ground, has compiled dozens of examples of massive outbreaks in U.S. states and other nations with strict mask mandates. His most convincing examples are natural experiments: comparisons of similar jurisdictions, only one of which mandated masks. For instance, North Dakota and South Dakota both largely escaped Covid-19 in spring 2020 but saw large waves of infections in the fall. North Dakota introduced a mask mandate and business closures on November 17, but South Dakota never did. Nevertheless, both states saw nearly identical epidemic curves, with a peak in new cases in mid-November and quick falls thereafter. North and South Dakota now have low rates of new cases and nearly identical total cases and deaths: 133 cases and 1.96 deaths per 1,000 residents in North Dakota, versus 130 and 2.17 in South Dakota, according to data collated by the New York Times as of March 18. Similarly, in the summer and fall, Alabama, which imposed a mask mandate on July 16, had an epidemic curve nearly indistinguishable from its neighbors Georgia and Mississippi, which never did.

The fall coronavirus wave hit several of the mask success stories especially hard. Poland and the Czech Republic had uncontrolled outbreaks (the Czech wave was Europe’s worst for a time); Japan and South Korea, meanwhile, saw more muted surges.

So what accounts for some nations’ initial good fortune? The best explanation may just be luck. Much early Covid-19 spread was caused by a few superspreader events; nations without a superspreader event may simply have managed to avoid an outbreak until better weather reduced transmission. Denmark and Norway, for instance, had tiny first waves, despite loose lockdowns and little mask use.

Another possibility: SARS-CoV-2 is related to several widespread mild coronaviruses, and immune responses to one virus frequently confer some resistance to others. In some studies, more than half of people in Western nations show preexisting immune responses to SARS-CoV-2. Viruses that confer cross-immunity may circulate more strongly in Asia than elsewhere, explaining why not just East Asia but also Indochina—including some nations, such as Cambodia, with weak initial responses—had tiny outbreaks. Similar patterns, with lower death rates near the origin than elsewhere, have occurred in flu pandemics from Asia as well as the misnamed Spanish flu, which started in the United States but had higher mortality in Europe.

The remaining evidence that masks work for source control amounts largely to case studies that could simply be coincidence (Covid-19 patients vary greatly in their infectiousness) and questionable regional comparisons with poor controls for one important fact: the farther an epidemic has progressed, the slower it grows in percent per day, as each newly infected person encounters fewer susceptible others. One widely cited study finds that states that enacted mask mandates in the spring saw lower growth rates in the following weeks—but those states were mostly early hotspots already closer to herd immunity, where one would naturally expect to see decelerating transmission. The same problem affects an influential CDC study finding that, during the summer, Kansas counties with mask mandates had slower growth of Covid-19 cases than those without: mask-mandate counties had seen a large spike in cases just before the mandate went into effect and had consistently higher absolute infection rates.

But even if masks probably don’t help, one might reasonably ask, what’s the harm in requiring them if they might help a bit?

These harms, it turns out, are severely understudied. The Cochrane review of mask RCTs notes, “Harms were rarely measured and poorly reported”—but some are uncontroversial. The Washington Post reported in May, for instance, that masks could cause persistent face rashes. They can also cause headaches: a small Japanese study testing whether surgical masks could stop the spread of colds among health care workers found that mask wearers were almost four times as likely as controls to report headaches. In a self-selected survey of German schoolchildren, more than half of the participants reported headaches.

Unhygienically used masks can also trap moisture and thus promote bacterial and yeast growth. It’s natural to suspect that this promotes other infections: an article in the New York Post, for example, reported that many dentists had observed an increase in problems such as cavities and gingivitis that they attributed to mask wearing. Finally, there is the unknown health effect of fiber inhalation (not to mention environmental plastic pollution). One paper noted that most surgical masks have loose fibers.

Potential harms to children deserve special mention. Two Italian professors of plastic surgery, for instance, have hypothesized that the pressure of elastic ear straps may give children permanently protruding ears. Some child development researchers also worry that widespread mask-wearing may hamper children’s linguistic and emotional development.

There may even be ways by which masks might worsen Covid-19 itself. The basic reason is simple: germs caught by a mask do not simply disappear. The evidence for these is spotty or speculative but concerning enough to merit attention. In any case, the evidence justifying mask mandates is often equally speculative.

First, as Kevin McKernan, a microbiologist who worked on the Human Genome Project, has pointed out, forcing liquid through a porous membrane is a standard “nebulization” technique for producing emulsions of small droplets. McKernan hypothesizes that masks may likewise split large respiratory droplets into more dangerous airborne particles rather than trapping them. This hypothesis has some weak empirical support: multiple studies have found that some low-quality cloth masks increase emission of micron-scale particles, through nebulization or through detaching of particles from cloth threads. These studies, furthermore, last only for minutes, and the risk of pathogen dispersal from masks likely increases with prolonged use. One study of masks in surgery found that exhaled bacteria accumulate on the exterior of masks worn longer than about two hours.

Second, when droplets trapped in a mask dry out—according to speculation by the German doctor Zacharias Fögen—viruses might be re-inhaled as individual particles, penetrating deep into the lungs as well as infecting the olfactory nerve and, thence, possibly the brain, worsening existing Covid-19 cases. Fögen has analyzed Kansas epidemiological data to conclude that counties with mask mandates have a Covid-19 case fatality rate, or ratio of deaths to confirmed infections, 85 percent higher than those without. Fögen’s study is far from dispositive. My own attempt to apply his method to two other states has yielded different conclusions, and other evidence suggests a countervailing hypothesis that even imperfect masks may reduce Covid-19 severity by reducing the number of initially inhaled viruses. But Fögen’s argument is at least plausible enough to justify more attention and attempts at replication.

It would be an overstatement to say that cloth and surgical masks are unambiguously ineffective or harmful. But neither is there a firm case that they provide any meaningful benefit. Limited mask mandates may be justified in circumstances with unavoidable face-to-face contact within the range of droplet spread, such as public transport, and private businesses should be free to require masks if they like. Citizens at high risk should be free to wear effective N95 masks for their own protection, and federal regulators should clear away barriers to domestic production.

But mandates of cloth and surgical masks impose major inconveniences and potentially serious health risks on citizens, for no clear benefit either to themselves or to others. Leaders who pride themselves on following the science should consider ending them and letting citizens protect their health as they see fit.

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