UPDATE 28. May 2021: CDC SHAKE-UP - the rats are leaving the sinking ship

UPDATE 28. August 2020: Germany Imposes Fine For All Non-Mask Wearers In New National Crackdown

UPDATE 12. July 2020: The Truth behind the mask (must watch)

UPDATE 09. July 2020: Healthy People Should Not Wear Face Masks & What Is Causing the Spike in COVID-19 Cases?

UPDATE 05. July 2020: MUST WATCH - Mask test proves toxic for children (levels of carbon dioxide inside a mask, face shield, and cloth)

UPDATE 30. June 2020: Seeing is Believing: Effectiveness of Facemasks

UPDATE 25. June 2020: Masks Don't Work: A review of science relevant to COVID-19 social policy

UPDATE 21. June 2020: Can You Be Forced To Wear A Mask? Dr. Kaufman Weighs In.

UPDATE 20. June 2020: Computer Simulation of contagion spread

UPDATE 19. May 2020: COVID-19 Lockdowns Are Not Based on Science

The Miserable Pseudo-Science Behind Face Masks, Social Distancing And Contact Tracing

Masks, Social Distancing And Contact Tracing

By Patrick Wood - 19. June 2020

Once upon a time, there was something called science. It included the discovery of truth about nature, the elements, the universe, etc. It was practiced by honest and accountable practitioners called scientists and engineers. They often invented cool new things as a result of their studies, but generally they had no primal urge to use their knowledge to dominate other people, groups or even entire societies.

Then certain other scientists and engineers rose up and made a discovery of their own. If true science was ever-so-slightly skewed and engineering disciplines were applied to society at large, then they could indeed use their “knowledge” to dominate and control other people, groups, entire societies or even, heaven forbid, the entire planet. 

The first group pursued science. The second group pursued pseudo-science.

Merriam-Webster defines pseudo-science as “a system of theories, assumptions, and methods erroneously regarded as scientific.”  The Oxford dictionary clarifies by stating, “a collection of beliefs or practices mistakenly regarded as being based on scientific method.

Pseudo-science quickly emerged as the principal domain of Technocrats, but they soon found that scientific debate with those promoting real science was most inconvenient to their social engineering goals. The solution was simple: claim that their own pseudo-science was indeed the real science, and then refuse debate by excluding all other voices to the contrary.

In the context of pseudo-science, this report will examine the three primary tools of fighting COVID-19: face masks, social distancing and contact tracing.

Face masks

The Occupational Safety and Health Administration (OSHA) website plainly states that cloth face masks “Will not protect the wearer against airborne transmissible infectious agents due to loose fit and lack of seal or inadequate filtration.” 

But, what about surgical masks? OHSA is clear here also that they “will not protect the wearer against airborne transmissible infectious agents due to loose fit and lack of seal or inadequate filtration.”

But then right under these statements, OSHA furiously backpedaled by adding an FAQ section on COVID-19 directly underneath and stated

OSHA generally recommends that employers encourage workers to wear face coverings at work. Face coverings are intended to prevent wearers who have Coronavirus Disease 2019 (COVID-19) without knowing it (i.e., those who are asymptomatic or pre-symptomatic) from spreading potentially infectious respiratory droplets to others. This is known as source control.

Consistent with the Centers for Disease Control and Prevention (CDC) recommendation for all people to wear cloth face coverings when in public and around other people, wearing cloth face coverings, if appropriate for the work environment and job tasks, conserves other types of personal protective equipment (PPE), such as surgical masks, for healthcare settings where such equipment is needed most.

So, wearing a face mask cannot protect you from getting COVID, but it is supposedly able to keep someone else from getting it from you? OSHA is speaking out of both sides of its mouth. What it calls “source control” likely puts the real motive out in the open: since you are the source, it’s about controlling YOU. There is no true scientific rationale for anyone but the sick and medical workers to wear masks. 

The truly healthy have no business wearing a mask, period. 

But, what about asymptomatic carriers?

On June 8, 2020, Maria Van Herkhove, PhD., head of the World Health Organization’s emerging diseases and zoonosis unit released a compilation of a number of contact tracing programs from various nations and plainly stated “From the data we have, it still seems to be very rare that an asymptomatic person actually transmits onward to a secondary individual.” 

This writer hates to think what happened to Dr. Herkhove overnight at the hands of her WHO handlers, because the next day she also furiously backpedaled and stated “I used the phrase ‘very rare,’ and I think that that’s misunderstanding to state that asymptomatic transmission globally is very rare. I was referring to a small subset of studies.”

It is clear that Dr. Herkhove’s first statement that naively repeated the clear facts of the matter did not follow the WHO’s justification for non-infectious people to wear masks. In fact, the entire mask wearing narrative hangs on the single pseudo-scientific idea that asymptomatic people can spread the virus. 

In a recent Technocracy News article authored by highly-respected neurosurgeon Dr. Russell Blaylock, MD titled Face Masks Pose Serious Risks To The Healthy, he concluded, “there is insufficient evidence that wearing a mask of any kind can have a significant impact in preventing the spread of this virus.” (Blaylock represents real science.)

Nevertheless, in the face of clear evidence of the worthlessness of face masks for preventing disease, 

  • States and municipalities are mandating that face masks be worn by all citizens when outside their home
  • Large and small companies are forcing their employees to wear masks
  • People at large are scared to death to not wear a face mask for fear of getting sick or being mask-shamed by others if they take it off. 

Breath Is Vital To Life 

Many people believe that face masks lower the percentage of oxygen available for inhaling because you rebreathe much of your exhausted breath. However,  a face mask itself does not retain a significant amount of your exhaled breath since most of it is exhaled through the mask into the open atmosphere. Furthermore, when you inhale, most of the air delivered to your lungs comes from outside the mask.

The real science is much more complicated than the amount of residual air contained within a face mask. 

The real problem with breathing through a mask is that the lungs and chest muscles must exert a lot of extra energy to inhale and exhale. In other words, you must work harder to breathe the same amount of fresh air that you would normally breathe without a mask. 

For this reason, those who already have impaired lung functions, minor as they may be, should never wear a mask unless it is for a specific purpose for a very short period of time. The older you are, especially those over 70, lung capacity and muscle strength decline rapidly. 

This writer has already encountered several retail store employees, forced by their employers to wear a face mask during work hours, who exhibit symptoms like headache, shortness of breath or dizziness. When asked if they relate their symptoms to wearing the mask, every single one has emphatically said “Yes!”.

Workers with the most physically demanding jobs are the most likely to exhibit these kind of symptoms. Other considerations are age, any preexisting conditions of the lungs (like pleurisy, COPD, chronic bronchitis, pneumonia, etc.) or chest muscles and factors like poor physical condition and obesity. Actually, any debilitating health condition should be a red flag. In other words, those who are prone to get winded without a face mask will immediately be at a disadvantage when wearing a mask. The net effect is that the lungs receive less fresh air with vital oxygen even as the body is under more physical stress. 

Every employer and government entity that mandates the wearing of face masks should be required to do two things: first, they should carefully consider each employee as an individual to determine their suitability for wearing a mask.  All factors mentioned above should be included, and in any case, no one should be required to wear a mask if it puts too much stress on their lungs.

Many state-level politicians are now mandating the wearing of face masks for all citizens in public places. They have fallen prey to pseudo-science and are now putting entire populations at risk for physical harm that has nothing to do with the COVID-19 virus.

In sum, lung strength, physical condition, age, pre-existing conditions, physical demands of the job, etc., should all be carefully considered by all. A blanket statement that all employees or all citizens should wear face masks it wholly inappropriate.

Social Distancing

Adding to the fear of contagion, people across the nation are driven to practice social distancing, or staying 6 feet apart at all times. This is practiced to excess in almost every commercial establishment with markers taped or painted on the floor and shopping isles converted into one-way travel only. 

Yet, two real scientists at the University of Oxford in Britain, Professors Carl Heneghan and Tom Jefferson, wrote in The Telegraph (UK) recently that “the two-metre rule has no basis in science.” Their article was titled There is no scientific evidence to support the disastrous two-metre rule.

According to these scientists, 

The influential Lancet review provided evidence from 172 studies in support of physical distancing of one metre or more. This might sound impressive, but all the studies were retrospective and suffer from biases that undermine the reliability of their findings. Recall bias arises in research when participants do not remember previous events accurately, and it is problematic when studies look back in time at how people behaved, including how closely they stood from others.

More concerning was that only five of the 172 studies reported specifically on Covid exposure and proximity with infection. These studies included a total of merely 477 patients, with just 26 actual cases of infection. In only one study was a specific distance measure reported: “came within six feet of the index patient”. The result showed no effect of distance on contracting Covid.

Heneghan and Jefferson further noted, 

On further independent inspection of 15 studies included in the review, we found multiple inconsistencies in the data, numerical mistakes and unsound methods in 13 of them. When assumptions over distance were made, we could not replicate any of them.

This is the hallmark of modern pseudo-science: inconsistencies in the data, numerical mistakes, unsound methods and inability to replicate results. 

What is the real purpose of social distancing? It certainly is not to curtail contagion. The only other possibility is to curtail economic activity and prevent social cohesion. Humans are social beings, after all, and lack of close proximity leads to depression, anxiety and even serious health consequences. 

Contact Tracing

Contact tracing is an established practice in modern medicine. It is useful for the early stages of serious infectious diseases like Ebola, tuberculosis and sexually transmitted diseases like chlamydia.

Every credible expert on contact tracing says that it is effective only up to the point of mass distribution. In other words, during the early stages of a contagion or a slow moving or very serious disease.

In the case of COVID-19, the horse has already left the barn. Except to harass people, there is nothing useful that contact tracing can accomplish.

Yet, almost every state in America is implementing a wide-ranging contact tracing program that may ultimately employ some 300,000 tracers.   

The Center for Disease Control website states that “Contact tracing will be conducted for close contacts (any individual within 6 feet of an infected person for at least 15 minutes) of laboratory-confirmed or probable COVID-19 patients.”

Furthermore, CDC complete definition of “close contact” is,

Someone who was within 6 feet of an infected person for at least 15 minutes starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to specimen collection) until the time the patient is isolated.

If you are “exposed” to such a person, your personal information will be collected and you will be contacted by the “tracer” to be instructed to quarantine for up to two weeks. The infected person could have been mistaken about having contact with you. They could be someone who just wants to get you in trouble. If you live in Washington state, where all restaurants are now required to record the contact information of every patron, you might not have a clue who was infected, but you will be quarantined anyway. 

Now, the CDC’s declaration of “6 feet” above takes us back to social distancing, where we just learned above that there is “no effect of distance on contracting COVID” in the first place.

Thus, find that contact tracing misses the mark on two main points: first, the virus is too widespread throughout the population to make tracing effective and second, the criteria of six feet for defining a “contact” is bogus. 

So, why are governors, mayors and health departments ramping up for a nationwide exercise in obtrusive contact tracing? Again, pursuing a path of pseudo-science, the intended outcome is control over people. 

Conclusion

The American public is being spoon-fed a steady diet of pseudo-science in order to justify the wearing of face masks, social distancing and contact tracing. Yet, the actual science points in the polar opposite direction.

Furthermore, those who try to present the real science are shamed, ridiculed and bullied for having such narrow-minded views.  

This is a clear sign of Technocrats-at-work. Instead, these are the ones who should be exposed, shamed and ridiculed. 

In sum, these dangerous and destructive policies are designed to curtail economic activity, break down social cohesion and control people. Moreover, they fit the original mission statement of Technocracy as far back as 1938:

Technocracy is the science of social engineering, the scientific operation of the entire social mechanism to produce and distribute goods and services to the entire population…

It is highly doubtful that most state and local leaders understand the lack of real and verified science behind their actions and mandates. Nevertheless, they are implementing policies that are destructive to our economic system, harmful to our personal health and ruinous to personal liberty.

Author:

Patrick Wood is editor of Technocracy News & Trends, and a leading and critical expert on Sustainable Development, Green Economy, Agenda 21, 2030 Agenda and historic Technocracy. He is the author of Technocracy: The Hard Road to World Order (2018), Technocracy Rising: The Trojan Horse of Global Transformation (2015) and co-author of Trilaterals Over Washington, Volumes I and II (1978-1980) with the late Professor Antony C. Sutton. Wood remains a leading, critical expert on the elitist Trilateral Commission, their policies and achievements in creating their self-proclaimed “New International Economic Order” which is the essence of Sustainable Development and Technocracy on a global scale.

Permission is granted to repost or reprint this article with original credit and direct link back to Technocracy.news. An updated PDF version suitable for printing may be downloaded here

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This writer suggests that you print multiple copies of this report and deliver it to every political leader, every commercial establishment, all family and friends, etc.

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UPDATES:

CDC SHAKE-UP - the rats are leaving the sinking ship

First published on BITCHUTE May 28th, 2021.

channel image

The Highwire with Del Bigtree

The Highwire with Del Bigtree

CDC SHAKE-UP

Two top officials at the CDC have, without warning, rapidly exited the agency. Both Anne Schuchat and Nancy Messonnier have announced their departure from the troubled agency taking heat from a new Senate investigation, a teacher’s union scandal and continued botched, unscientific public health guidance throughout their Covid response.

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MUST WATCH: Watch the first 4 min. of this BANNED video

Germany Imposes Fine For All Non-Mask Wearers In New National Crackdown

It should surprise nobody that this happens first within the EU. While much of the world takes to mask-wearing more out of a social and health consciousness "most people are on board" type attitude, the government of Germany has announced fines as punishment for people not wearing them.

Chancellor Angela Merkel announced during a virtual meeting Thursday with state governors that almost the entire country will be under a 50 euros minimum ($59) fine for breaching the national mask mandate.  

Prior anti-lockdown protest in Germany - via Reuters 

After the meeting it was announced that all federal states except the east's Saxony-Anhalt agreed on setting a minimum fine.

In her comments Merkel also urged Germans to stay home “wherever it is possible” and avoid traveling to "hot spots" like the United States.

Berlin also agreed to impose a strict limiting on gatherings. Not only have many major public events been canceled outright, but police are enforcing a ban on private parties of more than 25 persons

Large public events will not return until 2021. The new stringent measures including the mask fines go into effect by the end of the day Thursday.

This also as most German schools are now back in session, though there's been a handful of closures due to new coronavirus cases.

It's part of a broader initiative proposed by German health officials to crackdown on people flouting social distancing measures amid the pandemic, even though in recent weeks authorities say coronavirus clusters are due mainly to incoming vacationers.

Germany's confirmed COVID-19 numbers have been on the whole relatively low compared to other Western nations, at about 240,000 out of a population of 83 million.

Author:

Tyler Durden 

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The Truth Behind The Mask

Jul 12, 2020

WATCH THIS BANNED VIDEO HERE

Greg Reese

Greg Reese

Wearing the mask is part of an initiation ritual for the New World Order  -  Download

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What Is Causing the Spike in COVID-19 Cases?

•Premiered Jul 9, 2020

PragerU

Dr. Jeffrey Barke: Cases are rising, but the fatality rate is dropping. The average age of new cases is 31—fatality is so low for that age group that it's hard to even calculate.

MIRRORED ON https://www.bitchute.com/video/7Na620ndjNsY/

MASK TEST PROVES TOXIC FOR CHILDREN

As mask mandates on children sweep the nation, HighWire host Del Bigtree’s 11-year-old son, Ever, joins him on stage to test his levels of carbon dioxide inside a mask, face shield, and cloth bandana. The results from the OSHA approved testing device should shock any parent.

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MUST WATCH

Mask test proves toxic for children (levels of carbon dioxide inside a mask, face shield, and cloth)

First published at 09:33 UTC on July 5th, 2020.

channel image

JimMub

As mask mandates on children sweep the nation, HighWire host Del Bigtree’s 11-year-old son, Ever, joins him on stage to test his levels of carbon dioxide inside a mask, face shield, and cloth bandana.

The results from the OSHA approved testing device should shock any parent.

The only reason they force masks on people is to scare them into getting a vaccine. No scientific evidence it prevents covid infection.


Oh also to discourage rallies and gathering except for rioting.

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Healthy People Should Not Wear Face Masks

By Jim Meehan MD - 09. July 2020

During the COVID-19 pandemic, public health experts began telling us to follow a number of disease mitigation strategies that sounded reasonably scientific, but actually had little or no support in the scientific literature. Community wearing of masks was one of the more dangerous recommendations from our confused public health experts.

The Pandemic of Bad Science and Public Health Misinformation on Community Wearing of Masks

Renowned neurosurgeon, Russell Blaylock, MD had this to say about the science of masks:

As for the scientific support for the use of face masks, a recent careful examination of the literature, in which 17 of the best studies were analyzed, concluded that, "None of the studies established a conclusive relationship between mask/respirator use and protection against influenza infection."[R] Keep in mind, no studies have been done to demonstrate that either a cloth mask or the N95 mask has any effect on transmission of the COVID-19 virus. Any recommendations, therefore, have to be based on studies of influenza virus transmission. The fact is, there is no conclusive evidence of their efficiency in controlling flu virus transmission. - Russell Blaylock, MD

You can read Dr. Blaylock's brilliant discussion of this matter at the end of this paper or at this link:

Blaylock: Face Masks Pose Serious Risks to the Healthy

Quarantining Healthy People - A Failed Experiment

We were told that everyone, even the healthy, should quarantine at home. All were told to "shelter-in-place," isolate ourselves, hide alone, indoors, until the danger of the virus passed, despite the large body of scientific evidence that shows our immune systems thrive on diversity of exposures, sunlight, time in nature, and in loving company of others.

Furthermore, it seemed that the public health experts were ignoring the very real harms that result from shutting down the economy, putting tens of millions of workers out of work, and the shadow pandemic of suicides, drug abuse, overdoses, and other harms that follow massive economic downturns.[R][R]

Historically and by definition, quarantines had always been about sequestering the sick. Never before had anyone beat a virus by quarantining the healthy. We were not told that quarantining healthy people was a first-of-its kind experiment. And the experiment failed. More on this topic later.

Community Wearing of Masks is a Bad Recommendation

We were frequently confused by the mixed messages coming from public health agencies. Early in the pandemic Dr. Fauci, the U.S. Surgeon General, and the WHO all told the public, in no uncertain terms, not to wear masks. Then, over the course of the next several weeks and months, the CDC twice changed their recommendations, as did the WHO, and the recommendations always contradicted each other!

The CDC made the mistake of telling us cloth masks worked, and they even provided directions on their website for making homemade cloth masks.

To clear up the confusion, I will show that the scientific evidence not only does not support the community wearing of face masks, but the evidence shows that healthy people wearing face masks pose serious health risks to wearers.

Hiding our faces behind masks and isolating in our homes is not the solution, at least not for most people with healthy immune systems. Supporting the health of your immune system, confidently confronting all pathogens, and allowing herd immunity (the better term is community immunity) to develop and protect the vulnerable populations should be the goal.

What's happening in the world today, including the misinformation surrounding community mask wearing, is about political agendas, symbolism, fear, and dividing and isolating the people. It has nothing to do with science.

Medical Masks are Bad for Health

As a physician and former medical journal editor, I've carefully read the scientific literature regarding the use of face masks to mitigate viral transmission. I believe the public health experts have community wearing of masks all wrong. What follows are the key issues that should inform the public against wearing medical face masks during the CoVID-19 pandemic, as well as all future respiratory disease pandemics.

Face masks decrease oxygen, increase carbon dioxide, and alter breathing in ways that increase susceptibility and severity of CoVID-19

Mask wearers frequently report symptoms of difficulty breathing, shortness of breath, headache, lightheadedness, dizziness, anxiety, brain fog, difficulty concentrating, and other subjective symptoms while wearing medical masks. As a surgeon, I have worn masks for prolonged periods of time in thousands of surgeries and can assure you these symptoms do occur when surgical masks are worn for extended periods of time. The longer a surgical mask is worn, the more saturated with moisture it becomes, and the more significantly it inhibits the inflow of oxygen and outflow of carbon dioxide.

In fact, clinical research shows that medical masks lower blood oxygen levels[R] and raise carbon dioxide blood levels.[R] The deviations in oxygen and carbon dioxide may not reach the clinical criteria for hypoxia (low blood oxygen), hypoxemia (low tissue oxygen), or hypercapnia (elevated blood carbon dioxide), but they can deviate enough to cause even healthy individuals to become symptomatic, as occurred with the surgeons studied and published in this report:

Preliminary Report on Surgical Mask Induced Deoxygenation During Major Surgery

At the same time masks inhibit oxygen intake, they trap the carbon dioxide rich breath in the mouth/mask inter-space. Thus, a fraction of carbon dioxide previously exhaled is inhaled at each respiratory cycle.

Masks force you to re-breathe a portion of your own breath, including all the stuff (infectious viral particles) the lungs were trying to remove from the body (more on this later).

As medical masks lower oxygen and raise carbon dioxide in the blood, the brain senses the changes and the risk they pose to the maintenance of normal physiology. Thus, the brain goes to work to bring things back in order. To obtain more oxygen and remove more carbon dioxide, the brain tells the lungs to increase the rate (frequency) and depth of breaths.[R] Unfortunately, struggle as they may, your brain and lungs can not fully compensate for the negative effects of the mask. Some may even suffer the symptoms of carbon dioxide toxicity.

For people with diseases of the lungs, especially chronic obstructive pulmonary disease (COPD), face masks are intolerable to wear as they worsen breathlessness.[R]

In the case of respiratory pathogens, the negative effects of masks and the respiratory changes they induce could increase susceptibility and transmission of CoVID-19, as well as other respiratory pathogens.

Viral particles move through face masks with relative ease. Studies show that about 44% of viral particles pass through surgical masks, 97% pass through cloth masks, and about 5% through N95 masks. Increasing tidal volume (depth of breaths) results in literally sucking more air, more forcefully through and around the mask. Any SARS CoV-2 particles on, in, or around the mask are more forcefully suctioned into the mouth and lungs as a result of the compensatory increases in tidal volume.

The changes in respiratory rate and depth may also increase the severity of CoVID-19 as the increased tidal volume delivers the viral particles deeper into the lungs.

These changes may worsen the community transmission of CoVID-19 when infected people wearing masks exhale air more heavily contaminated with viral particles from the lungs.

These effects are amplified if face masks are contaminated with the viruses, bacteria, or fungi that find their way or opportunistically grow in the warm, moist environment that medical masks quickly become.

Despite the scientific evidence to the contrary, public health experts claim that medical masks do not cause clinically significant hypoxia (low oxygen) and hypercapnia (high CO2). I would like to ask those experts to explain the growing number of cases in which medical masks worn during exercise have resulted in lung injuries and heart attacks:

Two Chinese boys drop dead during PE lessons while wearing face masks amid concerns over students' fitness following three months of school closure[R][R]

Jogger's lung collapses after he ran for 2.5 miles while wearing a face mask[R]

If medical masks were perfectly safe and effective, then why would healthy boys suffer heart attacks or a 26 year old man collapse his lung while wearing masks and running?! In my opinion, these are tragic examples of the risks of wearing medical masks. And we are only getting started.

SARS CoV-2 becomes more dangerous when blood oxygen levels decline

Low blood levels of oxygen is a critical issue in the pathogenicity of CoVID-19. The virus' ability to infect cells is markedly enhanced by oxygen desaturation, which we know occurs when wearing a surgical mask.[R]

One of the features that make SARS CoV-2 uniquely infectious is the "furin cleavage" sequence in the virus that activates increased ACE2 receptor attack and cellular invasion in low oxygen environments.[R]

The furin cleavage site of SARS CoV-2 increases cellular invasion, especially during hypoxia (low blood oxygen levels)[R]

The furin cleavage site found in SARS CoV-2 is the likely result of the bio-engineering "gain of function" (increasing the virulence of a pathogen) research conducted at the Wuhan Institute of Virology. This unethical, dangerous, and illegal-in-most-countries research is alleged to have been funded by Dr. Anthony Fauci (with $7.4 million taxpayer dollars) and Bill Gates.

Furin cleavage sites are found in some of the most pathogenic forms of influenza. The furin cleavage domain in SARS CoV-2 is cleaved by furin on the target cell.

Furin is an ubiquitous protease in humans. It is found in a wide variety of tissues in the human body: heart, brain, kidney, etc. It is expressed in significant concentrations in human lung cells, the common target of SARS CoV-2. When the virus encounters a lung cell expressing (both an ACE2 receptor and furin), the furin cleaves the furin cleavage site on SARS CoV-2, activates the virus' surface S (spike) protein, and enables the virus to more effectively bind the ACE2 receptors and more efficiently invade the cell.[R]

Remember how medical face masks decrease blood oxygen levels? Well, now you need to know that SARS CoV-2's ability to invade and infect our cells is greatly enhanced under conditions of low oxygen.[R]

Therefore, wearing a medical mask may increase the severity of CoVID-19. If that does not motivate you to ditch your mask, there are more reasons to come.

Some of the most pathogenic forms of influenza and HIV are armed with similar furin cleavage sites. However, furin cleavage sites are not present in other beta coronaviruses. The furin cleavage site is NOT present in SARS CoV-1, MERS, or the other "bat coronaviruses" postulated to be the progenitors of SARS CoV-2.

It is worth repeating: SARS-CoV, which is closely related to the newest SARS-CoV-2 strain, does not bear the furin cleavage site. So how did SARS CoV-2 gain the furin cleavage function?

Dr. Fauci built his career on HIV research, HIV vaccine failures, and unethical "gain of function" research. He undoubtedly knows a lot about furin cleavage sites and the suspicious origins of SARS CoV-2. Perhaps Congress should ask him…under oath…preferably with an indictment.

The question we should all be asking is how did the genetic sequence that codes for this serious gain of function that increases the potential for the virus to successfully infiltrate the host find its way into SARS-CoV-2? That's the trillion dollar question; it demands a real answer.

Medical masks trap exhaled viral particles in the mouth/mask interspace, increase viral load, and increase the severity of disease.

Face masks trap exhaled viral particles in the mouth/mask inter-space.[R] The trapped viral particles are prevented from removal from the airways. The mask wearer is thus forced to re-breathe the viral particles, increasing infectious viral particles in the airways and lungs. In this way, medical masks cause self-inoculation, increase viral load, and increase the severity of disease.

Asymptomatic or mild cases of CoVID-19 become more severe when an infected individual is masked, oxygen lowers, viral load increases from particle re-breathing, and the disease overwhelms the innate immune system.

1. The main purpose of the innate immune response is to immediately prevent the spread and movement of foreign pathogens throughout the body.[R]
2. The innate immune system plays a crucial role in destroying the virus, preventing infection, or decreasing the viral load to decrease the severity of infection.
3. The innate immunity's effectiveness is highly dependent on the viral load. If face masks increase viral particle re-breathing at the same time they create a humid habitat where SARS-CoV-2 remains actively infectious, the mask increases the viral load and can overwhelm the innate immune system.

This trapping, re-breathing, and increasing pathogen load delivered to the lungs becomes dramatically more dangerous when the medical mask becomes contaminated with the opportunistic viruses, bacteria, and fungi that can grow in the warm, moist environment of the mask.

"By wearing a mask, the exhaled viruses will not be able to escape and will concentrate in the nasal passages, enter the olfactory nerves and travel into the brain." - Russell Blaylock, MD

Masks are unnecessary when asymptomatic spreading of SARS CoV-2 is "very rare"

Much of the recommendation for community wearing of masks was based on the belief that asymptomatic carriers of SARS CoV-2 were responsible for the transmission and spread of CoVID-19. There was no real scientific evidence for this belief. However, antibody testing began demonstrating larger numbers of people with antibodies to the virus than anyone imagined. Therefore, the belief was that these people must represent asymptomatic carriers that were spreading the disease.

Contact tracing has determined that asymptomatic cases are not causing secondary transmission:

Asymptomatic spread of coronavirus is "very rare," WHO says

"We have a number of reports from countries who are doing very detailed contact tracing," she [Dr. Maria Van Kerkhove, head of WHO's emerging diseases and zoonosis unit], said. "They're following asymptomatic cases. They're following contacts. And they're not finding secondary transmission onward. It's very rare."

More from the article:

Coronavirus patients without symptoms aren't driving the spread of the virus, World Health Organization officials said Monday, casting doubt on concerns by some researchers that the disease could be difficult to contain due to asymptomatic infections.

Some people, particularly young and otherwise healthy individuals, who are infected by the coronavirus never develop symptoms or only develop mild symptoms. Others might not develop symptoms until days after they were actually infected.

Preliminary evidence from the earliest outbreaks indicated that the virus could spread from person-to-person contact, even if the carrier didn't have symptoms. But WHO officials now say that while asymptomatic spread can occur, it is not the main way it's being transmitted.

"From the data we have, it still seems to be rare that an asymptomatic person actually transmits onward to a secondary individual," Dr. Maria Van Kerkhove, head of WHO's emerging diseases and zoonosis unit, said at a news briefing from the United Nations agency's Geneva headquarters. "It's very rare."

The fact that asymptomatic carriers are not a major driver of the disease tells us that masks are unnecessary.

The Evidence for Aerosol Transmission is Weak

The likelihood of airborne transmission--especially compared with other routes, such as droplets or surfaces--remains unclear. Most researchers still think the new coronavirus is primarily spread via droplets and touching infected people or surfaces. So diligent hand washing and social distancing are still the most important measures people can take to avoid infection."[Scientific American, 5/12/2020]

Wearing a face mask may give a false sense of security

1. Wearing a face mask may give a false sense of security.
2. People adopt a reduction in compliance with other infection control measures, including social distancing and hands washing.[R]

Inappropriate use of face masks

1. People must not touch their masks, must change their single-use masks frequently or wash them regularly, dispose them correctly and adopt other management measures, otherwise their risks and those of others may increase.[R][R]

Wearing a face mask makes the exhaled air go into the eyes

1. This generates an uncomfortable feeling and an impulse to touch your eyes. If your hands are contaminated and you touch or rub your eyes, you are infecting yourself.[R]

Masks compromise communications and reduce social distancing

1. The quality and volume of speech between two people wearing masks is considerably compromised, so they may unconsciously move closer to improve communications.
2. This increases the likelihood of becoming exposed to respiratory droplets containing infectious viral particles.

Contact tracing studies show that asymptomatic carrier transmission is very rare.

1. Asymptomatic carriers are not a major driver of the disease.[R]
2. Therefore, masks are unnecessary.
3. Furthermore, social distancing is unnecessary.

Face masks and stay at home orders prevent the development of herd immunity (the better term is community immunity).

1. Only herd immunity can prevent pandemics.
2. Only herd immunity will protect the vulnerable members of society.

Lack of Scientific Evidence for Community Wearing of Face Masks

There is no reasonable scientific evidence to support healthy people wearing masks. Russell Blaylock, MD had this to say about the science of masks:

As for the scientific support for the use of face mask, a recent careful examination of the literature, in which 17 of the best studies were analyzed, concluded that,"None of the studies established a conclusive relationship between mask/respirator use and protection against influenza infection."[R] Keep in mind, no studies have been done to demonstrate that either a cloth mask or the N95 mask has any effect on transmission of the COVID-19 virus. Any recommendations, therefore, have to be based on studies of influenza virus transmission. The fact is, there is no conclusive evidence of their efficiency in controlling flu virus transmission.[R]

Here's what a group of physicians wrote regarding Universal Masking in Hospitals in the CoVID-19 Era in the New England Journal of Medicine:

We know that wearing a mask outside healthcare facilities offers little, if any, protection from infection. Public health authorities define a significant exposure to CoVID-19 as face-to-face contact within 6 feet with a patient with symptomatic CoVID-19 that is sustained for at least a few minutes (and some say more than 10 minutes or even 30 minutes). The chance of catching CoVID-19 from a passing interaction in a public space is therefore minimal. In many cases, the desire for widespread masking is a reflexive reaction to anxiety over the pandemic.

The clinical research on this topic is clear: even when handled and worn properly, which is definitely NOT happening in the public spaces, wearing a mask in public offers little or no protection from infection. However, when masks are handled and worn improperly, they are a personal and public health disaster.

The "Hamster Study" is an example of weak science used to support bad recommendations

Here's an example of one of the experimental studies used by some public health authorities to support wearing masks in the community:

Wearing a mask can significantly reduce coronavirus transmission, study on hamsters claims

Does this study of "masking" hamster cages sound like the kind of solid scientific evidence that supports recommendations or mandates for everyone to wear masks during the CoVID-19 pandemic? No. The hamsters were not forced to wear tiny hamster surgical masks, their cages were covered with a barrier made of mask-like material. The experiment was more about walls or barriers than it was masks.

The experiment did not create the same conditions experienced by masked humans. Placing a cloth barrier on hamster cages is nothing like masking the mouth and nose of humans. The way this experiment was set up, inhalations were unimpeded, therefore, arterial oxygen levels would not be expected to lower. Likewise, exhalations were not trapped in a way that would force the hamsters to suffer re-breathing their own carbon-dioxide or subject them to the dangers of re-inhaling the infectious viral particles released with each exhalation.

This study does not provide support for the recommendation for masking all members of the public to reduce transmission of SARS CoV-2. Those citing this study to support wearing masks in the community are inappropriately extrapolating and conflating the experiment's findings to contrive a conclusion the experimental methodology does not allow.

Some studies even question the efficacy of surgical masks in the operating room

Surgical face masks in modern operating rooms--a costly and unnecessary ritual?

Following the commissioning of a new suite of operating rooms, air movement studies showed a flow of air away from the operating table towards the periphery of the room. Oral microbial flora dispersed by unmasked male and female volunteers standing one meter from the table failed to contaminate exposed settle plates placed on the table. The wearing of face masks by non-scrubbed staff working in an operating room with forced ventilation seems to be unnecessary.

Public Health Experts Are Confused and Contradictory on Masks

Since the first days of the pandemic, Fauci, Birx, the CDC, and the WHO have been confusing the public as they flipped, flopped, and contradicted each other on the community wearing of medical masks. We should expect more than confusing, contradictory, unevidenced advice from our public health experts.[R][R] Their lack of evidence and clarity was subverted to the belief that any level of protection was better than none. However, no one seemed to be fully considering the downsides of masks as I have presented them above.

Early in the pandemic - "masks are unnecessary"

In the early onset of the pandemic, nearly all organizations and specialists, including Dr. Anthony Fauci (March 8, 2020), advised against wearing a mask. The science simply did not support community wearing of masks:

"There's no reason to be walking around with a mask," infectious disease expert Dr. Anthony Fauci told 60 Minutes.

While masks may block some droplets, Fauci said, they do not provide the level of protection people think they do. Wearing a mask may also have unintended consequences: People who wear masks tend to touch their face more often to adjust them, which can spread germs from their hands."[R]

Fauci later walked back those comments and tried to explain his comments were taken out of context. Instead of saying he was wrong and pointing to scientific evidence that caused him to change his mind, he obfuscated.

Here's an infographic made by the World Health Organization (WHO) in late 2019.

"For healthy people, wear a mask only if you are taking care of a person with suspected 2019-nCoV infection"

There is no better example of the lack of scientific clarity on community mask wearing than the CDC's flip-flopping on the issue. Initially, the CDC recommended against community mask wear, then reversed that position a few weeks later.

The CDC and WHO appear to be in disagreement on this recommendation. CDC (currently) recommends community mask wear, whereas the WHO does not…and they confirmed this fact again on March 31, 2020:

On the official website of the Canadian government, a page lists many reasons why homemade masks are practically useless while also hindering oxygen intake.

Homemade masks are not medical devices and are not regulated like medical masks and respirators. Their use poses a number of limitations:

  • they have not been tested to recognized standards
  • the fabrics are not the same as used in surgical masks or respirators
  • the edges are not designed to form a seal around the nose and mouth
  • they may not provide complete protection against virus-sized particles
  • they can be difficult to breathe through and can prevent you from getting the required amount of oxygen needed by your body

These types of masks may not be effective in blocking virus particles that may be transmitted by coughing, sneezing or certain medical procedures. They do not provide complete protection from virus particles because of a potential loose fit and the materials used.

Regardless, the debate rages on the internet and in the public spaces everywhere regarding whether or not to wear a surgical mask.

CDC supports homemade cloth masks…but the science does not

Cloth masks have no place in disease mitigation. They have been shown to be ineffective and worse (see below).

The CDC currently recommends (and some states mandate[R][R]) that everyone wear some form of face cover anytime they leave their home and enter the public space.[R] The CDC admits compliments but does not replace the President's Coronavirus Guidelines for America, 30 Days to Slow the Spread.[R]

(None of the studies referenced by the CDC represent clinical research on the public use of face masks.[R])

The CDC even provides detailed instructions for how you can make your own face covers from common household items.[R]

I have no idea where the CDC and state public health advisors obtain their science, but apparently it is not the medical literature.

Cloth masks: Dangerous to your health?

It should be well known that cloth masks, bandannas, or handkerchiefs will do very little to stop the spread of coronavirus. The penetration of cloth masks by particles was almost 97% compared to medical masks with 44%.[R][R] In fact, they may actually increase your risk of becoming ill from CoVID-19 and other influenza-like illnesses.

One study that evaluated the use of cloth masks in a healthcare facility found that health care workers using cotton cloth masks were at increased risk of infection compared with those who wore medical masks. The authors concluded, "Cloth masks should not be used by workers in any healthcare setting."[R][R]

Another reason not to wear a cloth mask. It could burn your face, eyes, and lungs.

Tennessee bought 5 million cloth masks[R] treated with DuPont's Silvadur, an EPA listed hazardous pesticide.[R]

Public health agencies made recommendations but failed to provide guidance on proper handling and wear

The public is untrained in the sterile techniques required to make medical mask wear effective. Medical masks, worn and handled improperly, will not protect the wearer or those with whom they come in contact, instead, they will increase the spread of disease. The public health agencies and experts failed to anticipate how the public might not understand the principles of sterility essential to proper mask wear. And they failed to provide adequate resources, guidance, and instruction to the public.

After seeing the public mis-wearing and mis-handling masks in the real world, it is absolutely clear how misguided and dangerous this recommendation was from the CDC.

I have watched as people continuously touch and fidget with their masks. I watch them pull them down from their mouths and noses and rest it on their chin or neck. In doing so they contaminate the mask and themselves and then increase the spread of disease. The public simply has no idea how to safely cover their faces or wear gloves in a way that might slow the spread of disease.

Medical masks must be properly fitted and sealed around the mouth and nose. Masks must not be touched. Every touch has the potential to contaminate the mask and the hands, thus increasing the spread of disease.

Medical masks are single use devices designed to be worn for a relatively short period of time. Once the mask becomes saturated with moisture from breath, which, if properly fit, takes about an hour, they should be replaced. The more moisture-saturated the mask becomes, the more it blocks oxygen, increases re-breathing of carbon dioxide, re-breathing of viral particles, and becomes a breeding ground for other pathogens.

The longer masks are worn, the more they are touched, and the more contaminated they become. In addition to capturing pathogens on their outer surface, masks also quickly become moist, warm breeding grounds for bacteria and fungi. Thus, these opportunistic pathogens increase the risk of disease as they are inhaled into the airways, transferred to the hands, and end up on anything touched.

Unless medical masks are worn and handled properly, with strict adherence to sterility practices, medical masks worn by the community are prescriptions for disease and disaster.

What the CDC and WHO should have said about when and how to wear medical masks

  • If you are healthy, you only need to wear a mask if you are taking care of a person with COVID-19.
  • Wear a mask if you are infected with CoVID-19 or another infectious disease.
  • Wear a mask if you are coughing or sneezing. Better yet, STAY HOME.
  • If you wear a mask, then you must know how to use it and dispose of it properly.
  • Mask type matters
    • Medical grade surgical masks should be handled properly, never touched, and never reused
    • Medical grade N95 masks/respirators work best
    • Cloth masks, bandannas, scarves, and homemade masks are useless and potentially worse than not wearing a mask

Rigorous sterility maintenance techniques required

  • Masks are effective only when used in combination with frequent washing with soap and water and strict sterility management techniques.
  • Before putting on a mask, clean hands with soap and water. Only use alcohol-based hand cleaners when soap and water are not available.
  • Cover your mouth and nose with the mask and make sure there are no gaps between your face and the mask. Proper wear, fit, handling, and disposal are critical to efficacy.
  • Avoid touching the mask while using it; if you do, clean your hands with alcohol-based hand rub or soap and water.
  • Replace the mask with a new one as soon as it is damp and do not reuse single-use masks.
  • To remove the mask: remove it from behind (do not touch the front of the mask); discard immediately in a closed bin; clean hands with alcohol-based hand rub or soap and water.
  • No mask should be worn and reused (unless it is properly sterilized, which is highly unlikely to occur in the general public)

Experts Speak Out

If you don't believe me, listen to what these experts have to say:

Dr. Brosseau, a national expert on respiratory protection and infectious diseases

In April, Dr. Brosseau, a national expert on respiratory protection and infectious diseases at the University of Illinois at Chicago published an article titled "Masks-for-all for COVID-19 not based on sound data". She wrote:

"Sweeping mask recommendations--as many have proposed--will not reduce SARS-CoV-2 transmission, as evidenced by the widespread practice of wearing such masks in Hubei province, China, before and during its mass COVID-19 transmission experience earlier this year. Our review of relevant studies indicates that cloth masks will be ineffective at preventing SARS-CoV-2 transmission, whether worn as source control or as PPE.

Surgical masks likely have some utility as source control (meaning the wearer limits virus dispersal to another person) from a symptomatic patient in a healthcare setting to stop the spread of large cough particles and limit the lateral dispersion of cough particles. They may also have very limited utility as source control or PPE in households.

If masks had been the solution in Asia, shouldn't they have stopped the pandemic before it spread elsewhere?"

Top immunologist, Prof. Dolores Cahill

Top immunologist, Prof. Dolores Cahill, who has studied coronaviruses for years explains: once you've had the novel Coronavirus, you are immune; masks & social distancing do not affect coronavirus transmission; and how this lockdown was a mistake. Watch the full Dr. Dolores Cahill interview on the Highwire with Del Bigtree

Covid-19: important potential side effects of wearing face masks that we should bear in mind

This is the letter Dr. Cahill wrote to the British Medical Journal:

In their editorial to the BMJ,[1] Greenhalgh et al. advise that surgical masks should be worn in public to prevent some transmission of covid-19, adding that we should sometimes act without definitive evidence, just in case, according to the precautionary principle. The authors quote a definition of the precautionary principle found on Wikipedia, "a strategy for approaching issues of potential harm when extensive scientific knowledge on the matter is lacking."

However, while no single formulation of that principle has been universally adopted,[2] the precautionary principle aims at preventing researchers and policy makers from neglecting potentially-harmful side effects of interventions. Before implementing clinical and public health interventions, one must actively hypothesize and describe potential side effects and only then decide whether they are worth being quantified or not.

Most scientific articles and guidelines in the context of the covid-19 pandemic highlight two potential side effects of wearing surgical face masks in the public, but we believe that there are other ones that are worth considering before any global public health policy is implemented involving billions of people.

The two potential side effects that have already been acknowledged are:

1. Wearing a face mask may give a false sense of security and make people adopt a reduction in compliance with other infection control measures, including social distancing and hands washing.[3]
2. Inappropriate use of face mask: people must not touch their masks, must change their single-use masks frequently or wash them regularly, dispose them correctly, and adopt other management measures, otherwise their risks and those of others may increase.[3,4]

Other potential side effects that we must consider are:

3. The quality and volume of speech between two people wearing masks is considerably compromised, so they may unconsciously move closer. While one may be trained to counteract side effect n.1, this side effect may be more difficult to tackle.

4. Wearing a face mask makes the exhaled air go into the eyes. This generates an uncomfortable feeling and an impulse to touch your eyes. If your hands are contaminated, you are infecting yourself.

5. Face masks make breathing more difficult. For people with COPD, face masks are in fact intolerable to wear as they worsen their breathlessness.[5] Moreover, a fraction of carbon dioxide previously exhaled is inhaled at each respiratory cycle. Those two phenomena increase breathing frequency and deepness, and hence they increase the amount of inhaled and exhaled air. This may worsen the burden of covid-19 if infected people wearing masks spread more contaminated air. This may also worsen the clinical condition of infected people if the enhanced breathing pushes the viral load down into their lungs.

6. The effects described at point 5 are amplified if face masks are heavily contaminated (see point 2)

7. While impeding person-to-person transmission is key to limiting the outbreak, so far little importance has been given to the events taking place after a transmission has happened, when innate immunity plays a crucial role. The main purpose of the innate immune response is to immediately prevent the spread and movement of foreign pathogens throughout the body.[6] The innate immunity's efficacy is highly dependent on the viral load. If face masks determine a humid habitat where the SARS-CoV-2 can remain active due to the water vapour continuously provided by breathing and captured by the mask fabric, they determine an increase in viral load and therefore they can cause a defeat of the innate immunity and an increase in infections. This phenomenon may also interact with and enhance previous points.

In conclusion, as opposed to Greenhalgh et al., we believe that the context of the current covid-19 pandemic is very different from that of the "parachutes for jumping out of aeroplanes",[7] in which the dynamics of harm and prevention are easy to define and even to quantify without the need of research studies. It is necessary to quantify the complex interactions that may well be operating between positive and negative effects of wearing surgical masks at population level. It is not time to act without evidence.


References

Greenhalgh T, Schmid MB, Czypionka T, et al. Face masks for the public during the covid-19 crisis. BMJ 2020;:m1435. doi:10.1136/bmj.m1435

Vu YA, London WM, Vu YA, et al. Precautionary Principle. 2013;:9780199756797-0046. doi:10.1093/obo/9780199756797-0046

Advice on the use of masks in the community, during home care and in healthcare settings in the context of the novel coronavirus (COVID-19)

Desai AN, Aronoff DM. Masks and Coronavirus Disease 2019 (COVID-19). JAMA Published Online First: 17 April 2020. doi:10.1001/jama.2020.6437

Kyung SY, Kim Y, Hwang H, et al. Risks of N95 Face Mask Use in Subjects With COPD. Respir Care 2020;:respcare.06713. doi:10.4187/respcare.06713

Chen Y, Zhou Z, Min W. Mitochondria, Oxidative Stress and Innate Immunity. Front Physiol 2018;9:1487. doi:10.3389/fphys.2018.01487

Potts M, Prata N, Walsh J, et al. Parachute approach to evidence based medicine. BMJ 2006;333:701-3. doi:10.1136/bmj.333.7570.701

JimMeehan

Jim Meehan MD is a physician, accomplished leader, and entrepreneur who provides innovative science and solutions that adhere to open, honest, transparent, and uncompromisingly patient-centered principles. He transforms raw data and scientific research into easy to understand information that educates, informs, and motivates changes in behavior to lead to improved health and wellness. Dr. Meehan believes in educating patients to be scientists of their own health.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of GreenMedInfo or its staff. Originally published on www.meehanmd.com

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Seeing is Believing: Effectiveness of Facemasks

Coronavirus, COVID-19, Simulation, Facemasks, Social Distancing, Flow Visualization, Coughs, Sneezes, Respiratory Droplets, 6-foot Distancing, Homemade Masks, Infectious Diseases, Virus, Engineering, Mechanical Engineering

Using flow visualization of emulated coughs and sneezes, researchers assessed the efficacy of facemasks in obstructing droplets. Loosely folded facemasks and bandana-style coverings provide minimal stopping-capability for the smallest aerosolized respiratory droplets.

By gisele galoustian - 30. June 2020

Currently, there are no specific guidelines on the most effective materials and designs for facemasks to minimize the spread of droplets from coughs or sneezes to mitigate the transmission of COVID-19. While there have been prior studies on how medical-grade masks perform, data on cloth-based coverings used by the vast majority of the general public are sparse.

Research from Florida Atlantic University’s College of Engineering and Computer Science, just published in the journal Physics of Fluids , demonstrates through visualization of emulated coughs and sneezes, a method to assess the effectiveness of facemasks in obstructing droplets. The rationale behind the recommendation for using masks or other face coverings is to reduce the risk of cross-infection via the transmission of respiratory droplets from infected to healthy individuals.

Researchers employed flow visualization in a laboratory setting using a laser light sheet and a mixture of distilled water and glycerin to generate the synthetic fog that made up the content of a cough-jet. They visualized droplets expelled from a mannequin’s mouth while simulating coughing and sneezing. They tested masks that are readily available to the general public, which do not draw away from the supply of medical-grade masks and respirators for healthcare workers. They tested a single-layer bandana-style covering, a homemade mask that was stitched using two-layers of cotton quilting fabric consisting of 70 threads per inch, and a non-sterile cone-style mask that is available in most pharmacies. By placing these various masks on the mannequin, they were able to map out the paths of droplets and demonstrate how differently they perform.

Results showed that loosely folded facemasks and bandana-style coverings stop aerosolized respiratory droplets to some degree. However, well-fitted homemade masks with multiple layers of quilting fabric, and off-the-shelf cone style masks, proved to be the most effective in reducing droplet dispersal. These masks were able to curtail the speed and range of the respiratory jets significantly, albeit with some leakage through the mask material and from small gaps along the edges.

Importantly, uncovered emulated coughs were able to travel noticeably farther than the currently recommended 6-foot distancing guideline. Without a mask, droplets traveled more than 8 feet; with a bandana, they traveled 3 feet, 7 inches; with a folded cotton handkerchief, they traveled 1 foot, 3 inches; with the stitched quilting cotton mask, they traveled 2.5 inches; and with the cone-style mask, droplets traveled about 8 inches.  

“In addition to providing an initial indication of the effectiveness of protective equipment, the visuals used in our study can help convey to the general public the rationale behind social-distancing guidelines and recommendations for using facemasks,” said Siddhartha Verma, Ph.D., lead author and an assistant professor who co-authored the paper with Manhar Dhanak, Ph.D., department chair, professor, and director of SeaTech; and John Frakenfeld, technical paraprofessional, all within FAU’s Department of Ocean and Mechanical Engineering. “Promoting widespread awareness of effective preventive measures is crucial at this time as we are observing significant spikes in cases of COVID-19 infections in many states, especially Florida.”

When the mannequin was not fitted with a mask, they projected droplets much farther than the 6-foot distancing guidelines currently recommended by the United States Centers for Disease Control and Prevention. The researchers observed droplets traveling up to 12 feet within approximately 50 seconds. Moreover, the tracer droplets remained suspended midair for up to three minutes in the quiescent environment. These observations, in combination with other recent studies, suggest that current social-distancing guidelines may need to be updated to account for aerosol-based transmission of pathogens.

“We found that although the unobstructed turbulent jets were observed to travel up to 12 feet, a large majority of the ejected droplets fell to the ground by this point,” said Dhanak. “Importantly, both the number and concentration of the droplets will decrease with increasing distance, which is the fundamental rationale behind social-distancing.”

The pathogen responsible for COVID-19 is found primarily in respiratory droplets that are expelled by infected individuals during coughing, sneezing, or even talking and breathing. Apart from COVID-19, respiratory droplets also are the primary means of transmission for various other viral and bacterial illnesses, such as the common cold, influenza, tuberculosis, SARS (Severe Acute Respiratory Syndrome), and MERS (Middle East Respiratory Syndrome), to name a few. These pathogens are enveloped within respiratory droplets, which may land on healthy individuals and result in direct transmission, or on inanimate objects, which can lead to infection when a healthy individual comes in contact with them.

“Our researchers have demonstrated how masks are able to significantly curtail the speed and range of the respiratory droplets and jets. Moreover, they have uncovered how emulated coughs can travel noticeably farther than the currently recommended six-foot distancing guideline,” said Stella Batalama, Ph.D., dean of FAU’s College of Engineering and Computer Science. “Their research outlines the procedure for setting up simple visualization experiments using easily available materials, which may help healthcare professionals, medical researchers, and manufacturers in assessing the effectiveness of face masks and other personal protective equipment qualitatively.”

-FAU-

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COMPUTER SIMULATION OF CONTAGION SPREAD

             Computer simulation

 

Computer simulation

 

Computer simulation

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Masks Don't Work: A Review of Science Relevant to COVID-19 Social Policy

By D.G. Rancourt - 26. June 2020


Originally published on www.ocla.ca

Summary / Abstract

Masks and respirators do not work.

There have been extensive randomized controlled trial (RCT) studies, and meta-analysis reviews of RCT studies, which all show that masks and respirators do not work to prevent respiratory influenza-like illnesses, or respiratory illnesses believed to be transmitted by droplets and aerosol particles.

Furthermore, the relevant known physics and biology, which I review, are such that masks and respirators should not work. It would be a paradox if masks and respirators worked, given what we know about viral respiratory diseases: The main transmission path is long-residence-time aerosol particles (< 2.5 μm), which are too fine to be blocked, and the minimum-infective-dose is smaller than one aerosol particle.

The present paper about masks illustrates the degree to which governments, the mainstream media, and institutional propagandists can decide to operate in a science vacuum, or select only incomplete science that serves their interests. Such recklessness is also certainly the case with the current global lockdown of over 1 billion people, an unprecedented experiment in medical and political history.

Review of the Medical Literature

Here are key anchor points to the extensive scientific literature that establishes that wearing surgical masks and respirators (e.g., "N95") does not reduce the risk of contracting a verified illness:

Jacobs, J. L. et al. (2009) "Use of surgical face masks to reduce the incidence of the common cold among health care workers in Japan: A randomized controlled trial", American Journal of Infection Control, Volume 37, Issue 5, 417 - 419. https://www.ncbi.nlm.nih.gov/pubmed/19216002

N95-masked health-care workers (HCW) were significantly more likely to experience headaches. Face mask use in HCW was not demonstrated to provide benefit in terms of cold symptoms or getting colds.

Cowling, B. et al. (2010) "Face masks to prevent transmission of influenza virus: A systematic review", Epidemiology and Infection, 138(4), 449-456. doi:10.1017/S0950268809991658 https://www.cambridge.org/core/journals/epidemiology-and-infection/article/face e-masks-to-prevent-transmission-of-influenza-virus-a-systematicreview/64D368496EBDE0AFCC6639CCC9D8BC05

None of the studies reviewed showed a benefit from wearing a mask, in either HCW or community members in households (H). See summary Tables 1 and 2 therein.

bin-Reza et al. (2012) "The use of masks and respirators to prevent transmission of influenza: a systematic review of the scientific evidence", Influenza and Other Respiratory Viruses 6(4), 257-267. https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1750-2659.2011.00307.x

"There were 17 eligible studies. … None of the studies established a conclusive relationship between mask ⁄ respirator use and protection against influenza infection."

Smith, J.D. et al. (2016) "Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis", CMAJ Mar 2016, cmaj.150835; DOI: 10.1503/cmaj.150835 https://www.cmaj.ca/content/188/8/567

"We identified 6 clinical studies ... In the meta-analysis of the clinical studies, we found no significant difference between N95 respirators and surgical masks in associated risk of (a) laboratory-confirmed respiratory infection, (b) influenza-like illness, or (c) reported work-place absenteeism."

Offeddu, V. et al. (2017) "Effectiveness of Masks and Respirators Against Respiratory Infections in Healthcare Workers: A Systematic Review and Meta-Analysis", Clinical Infectious Diseases, Volume 65, Issue 11, 1 December 2017, Pages 1934-1942, https://doi.org/10.1093/cid/cix681 https://academic.oup.com/cid/article/65/11/1934/4068747

 

"Self-reported assessment of clinical outcomes was prone to bias. Evidence of a protective effect of masks or respirators against verified respiratory infection (VRI) was not statistically significant"; as per Fig. 2c therein:

Radonovich, L.J. et al. (2019) "N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical Trial", JAMA. 2019; 322(9): 824-833. doi:10.1001/jama.2019.11645 https://jamanetwork.com/journals/jama/fullarticle/2749214

"Among 2862 randomized participants, 2371 completed the study and accounted for 5180 HCW-seasons. … Among outpatient health care personnel, N95 respirators vs medical masks as worn by participants in this trial resulted in no significant difference in the incidence of laboratory-confirmed influenza."

Long, Y. et al. (2020) "Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta‐analysis", J Evid Based Med. 2020; 1‐ 9. https://doi.org/10.1111/jebm.12381 https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.12381

"A total of six RCTs involving 9 171 participants were included. There were no statistically significant differences in preventing laboratory‐confirmed influenza, laboratory‐confirmed respiratory viral infections, laboratory‐confirmed respiratory infection and influenza-like illness using N95 respirators and surgical masks. Meta‐analysis indicated a protective effect of N95 respirators against laboratory‐confirmed bacterial colonization (RR = 0.58, 95% CI 0.43‐0.78). The use of N95 respirators compared with surgical masks is not associated with a lower risk of laboratory‐confirmed influenza."

Conclusion Regarding that Masks Do Not Work

No RCT study with verified outcome shows a benefit for HCW or community members in households to wearing a mask or respirator. There is no such study. There are no exceptions.

Likewise, no study exists that shows a benefit from a broad policy to wear masks in public (more on this below).

Furthermore, if there were any benefit to wearing a mask, because of the blocking power against droplets and aerosol particles, then there should be more benefit from wearing a respirator (N95) compared to a surgical mask, yet several large meta-analyses, and all the RCT, prove that there is no such relative benefit.

Masks and respirators do not work.

Precautionary Principle Turned on Its Head with Masks

In light of the medical research, therefore, it is difficult to understand why public-health authorities are not consistently adamant about this established scientific result, since the distributed psychological, economic and environmental harm from a broad recommendation to wear masks is significant, not to mention the unknown potential harm from concentration and distribution of pathogens on and from used masks. In this case, public authorities would be turning the precautionary principle on its head (see below).

Physics and Biology of Viral Respiratory Disease and of Why Masks Do Not Work

In order to understand why masks cannot possibly work, we must review established knowledge about viral respiratory diseases, the mechanism of seasonal variation of excess deaths from pneumonia and influenza, the aerosol mechanism of infectious disease transmission, the physics and chemistry of aerosols, and the mechanism of the so-called minimum-infective-dose.

In addition to pandemics that can occur anytime, in the temperate latitudes there is an extra burden of respiratory-disease mortality that is seasonal, and that is caused by viruses. For example, see the review of influenza by Paules and Subbarao (2017). This has been known for a long time, and the seasonal pattern is exceedingly regular.

For example, see Figure 1 of Viboud (2010), which has "Weekly time series of the ratio of deaths from pneumonia and influenza to all deaths, based on the 122 cities surveillance in the US (blue line). The red line represents the expected baseline ratio in the absence of influenza activity," here:

The seasonality of the phenomenon was largely not understood until a decade ago. Until recently, it was debated whether the pattern arose primarily because of seasonal change in virulence of the pathogens, or because of seasonal change in susceptibility of the host (such as from dry air causing tissue irritation, or diminished daylight causing vitamin deficiency or hormonal stress). For example, see Dowell (2001).

In a landmark study, Shaman et al. (2010) showed that the seasonal pattern of extra respiratory-disease mortality can be explained quantitatively on the sole basis of absolute humidity, and its direct controlling impact on transmission of airborne pathogens.

Lowen et al. (2007) demonstrated the phenomenon of humidity-dependent airborne- virus virulence in actual disease transmission between guinea pigs, and discussed potential underlying mechanisms for the measured controlling effect of humidity.

The underlying mechanism is that the pathogen -laden aerosol particles or droplets are neutralized within a half-life that monotonically and significantly decreases with increasing ambient humidity. This is based on the seminal work of Harper (1961). Harper experimentally showed that viral- pathogen -carrying droplets were inactivated within shorter and shorter times, as ambient humidity was increased.

Harper argued that the viruses themselves were made inoperative by the humidity ("viable decay"), however, he admitted that the effect could be from humidity-enhanced physical removal or sedimentation of the droplets ("physical loss"): "Aerosol viabilities reported in this paper are based on the ratio of virus titre to radioactive count in suspension and cloud samples, and can be criticized on the ground that test and tracer materials were not physically identical."

The latter ("physical loss") seems more plausible to me, since humidity would have a universal physical effect of causing particle / droplet growth and sedimentation, and all tested viral pathogens have essentially the same humidity- driven "decay". Furthermore, it is difficult to understand how a virion (of all virus types) in a droplet would be molecularly or structurally attacked or damaged by an increase in ambient humidity. A "virion" is the complete, infective form of a virus outside a host cell, with a core of RNA or DNA and a capsid. The actual mechanism of such humidity-driven intra-droplet "viable decay" of a virion has not been explained or studied.

In any case, the explanation and model of Shaman et al. (2010) is not dependant on the particular mechanism of the humidity- driven decay of virions in aerosol / droplets. Shaman's quantitatively demonstrated model of seasonal regional viral epidemiology is valid for either mechanism (or combination of mechanisms), whether "viable decay" or "physical loss".

The breakthrough achieved by Shaman et al. is not merely some academic point. Rather, it has profound health-policy implications, which have been entirely ignored or overlooked in the current coronavirus pandemic.

In particular, Shaman's work necessarily implies that, rather than being a fixed number (dependent solely on the spatial-temporal structure of social interactions in a completely susceptible population, and on the viral strain), the epidemic's basic reproduction number (R0) is highly or predominantly dependent on ambient absolute humidity.

For a definition of R0, see HealthKnowlege-UK (2020): R0 is "the average number of secondary infections produced by a typical case of an infection in a population where everyone is susceptible." The average R0 for influenza is said to be 1.28 (1.19-1.37); see the comprehensive review by Biggerstaff et al. (2014).

In fact, Shaman et al. showed that R0 must be understood to seasonally vary between humid-summer values of just larger than "1" and dry-winter values typically as large as "4" (for example, see their Table 2). In other words, the seasonal infectious viral respiratory diseases that plague temperate latitudes every year go from being intrinsically mildly contagious to virulently contagious, due simply to the bio-physical mode of transmission controlled by atmospheric humidity, irrespective of any other consideration.

Therefore, all the epidemiological mathematical modelling of the benefits of mediating policies (such as social distancing), which assumes humidity-independent R0 values, has a large likelihood of being of little value, on this basis alone. For studies about modelling and regarding mediation effects on the effective reproduction number, see Coburn (2009) and Tracht (2010).

To put it simply, the "second wave" of an epidemic is not a consequence of human sin regarding mask wearing and hand shaking. Rather, the "second wave" is an inescapable consequence of an air-dryness-driven many-fold increase in disease contagiousness, in a population that has not yet attained immunity.

If my view of the mechanism is correct (i.e., "physical loss"), then Shaman's work further necessarily implies that the dryness-driven high transmissibility (large R0) arises from small aerosol particles fluidly suspended in the air; as opposed to large droplets that are quickly gravitationally removed from the air.

Such small aerosol particles fluidly suspended in air, of biological origin, are of every variety and are everywhere, including down to virion-sizes (Despres, 2012). It is not entirely unlikely that viruses can thereby be physically transported over inter-continental distances (e.g., Hammond, 1989).

More to the point, indoor airborne virus concentrations have been shown to exist (in day-care facilities, health centres, and onboard airplanes) primarily as aerosol particles of diameters smaller than 2.5 μm, such as in the work of Yang et al. (2011):

"Half of the 16 samples were positive, and their total virus concentrations ranged from 5800 to 37 000 genome copies m-3. On average, 64 per cent of the viral genome copies were associated with fine particles smaller than 2.5 µm, which can remain suspended for hours. Modelling of virus concentrations indoors suggested a source strength of 1.6 ± 1.2 × 105 genome copies m-3 air h -1 and a deposition flux onto surfaces of 13 ± 7 genome copies m-2 h-1 by Brownian motion. Over 1 hour, the inhalation dose was estimated to be 30 ± 18 median tissue culture infectious dose (TCID50), adequate to induce infection. These results provide quantitative support for the idea that the aerosol route could be an important mode of influenza transmission."

Such small particles (< 2.5 μm) are part of air fluidity, are not subject to gravitational sedimentation, and would not be stopped by long-range inertial impact. This means that the slightest (even momentary) facial misfit of a mask or respirator renders the design filtration norm of the mask or respirator entirely irrelevant. In any case, the filtration material itself of N95 (average pore size ~0.3-0.5 μm) does not block virion penetration, not to mention surgical masks. For example, see Balazy et al. (2006).

Mask stoppage efficiency and host inhalation are only half of the equation, however, because the minimal infective dose (MID) must also be considered. For example, if a large number of pathogen- laden particles must be delivered to the lung within a certain time for the illness to take hold, then partial blocking by any mask or cloth can be enough to make a significant difference.

On the other hand, if the MID is amply surpassed by the virions carried in a single aerosol particle able to evade mask-capture, then the mask is of no practical utility, which is the case.

Yezli and Otter (2011), in their review of the MID, point out relevant features:

  • most respiratory viruses are as infective in humans as in tissue culture having optimal laboratory susceptibility
  • it is believed that a single virion can be enough to induce illness in the host
  • the 50%-probability MID ("TCID50") has variably been found to be in the range 100-1000 virions 
  • there are typically 103-107 virions per aerolized influenza droplet with diameter 1 μm - 10 μm 
  • the 50%-probability MID easily fits into a single (one) aerolized droplet

For further background:

  • A classic description of dose-response assessment is provided by Haas (1993).
  • Zwart et al. (2009) provided the first laboratory proof, in a virus-insect system, that the action of a single virion can be sufficient to cause disease.
  • Baccam et al. (2006) calculated from empirical data that, with influenza A in humans, "we estimate that after a delay of ~6 h, infected cells begin producing influenza virus and continue to do so for ~5 h. The average lifetime of infected cells is ~11 h, and the half-life of free infectious virus is ~3 h. We calculated the [in-body] basic reproductive number, R0, which indicated that a single infected cell could produce ~22 new productive infections."
  • Brooke et al. (2013) showed that, contrary to prior modeling assumptions, although not all influenza-A-infected cells in the human body produce infectious progeny (virions), nonetheless, 90% of infected cell are significantly impacted, rather than simply surviving unharmed.

All of this to say that: if anything gets through (and it always does, irrespective of the mask), then you are going to be infected. Masks cannot possibly work. It is not surprising, therefore, that no bias-free study has ever found a benefit from wearing a mask or respirator in this application.

Therefore, the studies that show partial stopping power of masks, or that show that masks can capture many large droplets produced by a sneezing or coughing mask-wearer, in light of the above -described features of the problem, are irrelevant. For example, such studies as these: Leung (2020), Davies (2013), Lai (2012), and Sande (2008).

Why There Can Never Be an Empirical Test of a Nation-Wide Mask-Wearing Policy

As mentioned above, no study exists that shows a benefit from a broad policy to wear masks in public. There is good reason for this. It would be impossible to obtain unambiguous and bias-free results:

  • Any benefit from mask-wearing would have to be a small effect, since undetected in controlled experiments, which would be swamped by the larger effects, notably the large effect from changing atmospheric humidity.
  • Mask compliance and mask adjustment habits would be unknown.
  • Mask-wearing is associated (correlated) with several other health behaviours; see Wada (2012).
  • The results would not be transferable, because of differing cultural habits.
  • Compliance is achieved by fear, and individuals can habituate to fear-based propaganda, and can have disparate basic responses.
  • Monitoring and compliance measurement are near-impossible, and subject to large errors.
  • Self-reporting (such as in surveys) is notoriously biased, because individuals have the self-interested belief that their efforts are useful.
  • Progression of the epidemic is not verified with reliable tests on large population samples, and generally relies on non-representative hospital visits or admissions.
  • Several different pathogens (viruses and strains of viruses) causing respiratory illness generally act together, in the same population and/or in individuals, and are not resolved, while having different epidemiological characteristics.

Unknown Aspects of Mask Wearing

Many potential harms may arise from broad public policies to wear masks, and the following unanswered questions arise:

  • Do used and loaded masks become sources of enhanced transmission, for the wearer and others?
  • Do masks become collectors and retainers of pathogens that the mask wearer would otherwise avoid when breathing without a mask?
  • Are large droplets captured by a mask atomized or aerolized into breathable components? Can virions escape an evaporating droplet stuck to a mask fiber?
  • What are the dangers of bacterial growth on a used and loaded mask?
  • How do pathogen-laden droplets interact with environmental dust and aerosols captured on the mask?
  • What are long-term health effects on HCW, such as headaches, arising from impeded breathing?
  • Are there negative social consequences to a masked society?
  • Are there negative psychological consequences to wearing a mask, as a fear-based behavioural modification?
  • What are the environmental consequences of mask manufacturing and disposal?
  • Do the masks shed fibres or substances that are harmful when inhaled?

Conclusion

By making mask-wearing recommendations and policies for the general public, or by expressly condoning the practice, governments have both ignored the scientific evidence and done the opposite of following the precautionary principle.

In an absence of knowledge, governments should not make policies that have a hypothetical potential to cause harm. The government has an onus barrier before it instigates a broad social-engineering intervention, or allows corporations to exploit fear-based sentiments.

Furthermore, individuals should know that there is no known benefit arising from wearing a mask in a viral respiratory illness epidemic, and that scientific studies have shown that any benefit must be residually small, compared to other and determinative factors.

Otherwise, what is the point of publicly funded science?

The present paper about masks illustrates the degree to which governments, the mainstream media, and institutional propagandists can decide to operate in a science vacuum, or select only incomplete science that serves their interests. Such recklessness is also certainly the case with the current global lockdown of over 1 billion people, an unprecedented experiment in medical and political history.

Endnotes:

Baccam, P. et al. (2006) "Kinetics of Influenza A Virus Infection in Humans", Journal of Virology Jul 2006, 80 (15) 7590-7599; DOI: 10.1128/JVI.01623-05 https://jvi.asm.org/content/80/15/7590

Balazy et al. (2006) "Do N95 respirators provide 95% protection level against airborne viruses, and how adequate are surgical masks?", American Journal of Infection Control, Volume 34, Issue 2, March 2006, Pages 51-57. doi:10.1016/j.ajic.2005.08.018 https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.488.4644&rep=rep1&type=pdf

Biggerstaff, M. et al. (2014) "Estimates of the reproduction number for seasonal, pandemic, and zoonotic influenza: a systematic review of the literature", BMC Infect Dis 14, 480 (2014). https://doi.org/10.1186/1471-2334-14-480

Brooke, C. B. et al. (2013) "Most Influenza A Virions Fail To Express at Least One Essential Viral Protein", Journal of Virology Feb 2013, 87 (6) 3155-3162; DOI: 10.1128/JVI.02284-12 https://jvi.asm.org/content/87/6/3155

Coburn, B. J. et al. (2009) "Modeling influenza epidemics and pandemics: insights into the future of swine flu (H1N1)", BMC Med 7, 30. https://doi.org/10.1186/1741-7015-7-30

Davies, A. et al. (2013) "Testing the Efficacy of Homemade Masks: Would They Protect in an Influenza Pandemic?", Disaster Medicine and Public Health Preparedness, Available on CJO 2013 doi:10.1017/dmp.2013.43 https://journals.cambridge.org/abstract_S1935789313000438

Despres, V. R. et al. (2012) "Primary biological aerosol particles in the atmosphere: a review", Tellus B: Chemical and Physical Meteorology, 64:1, 15598, DOI: 10.3402/tellusb.v64i0.15598 https://doi.org/10.3402/tellusb.v64i0.15598

Dowell, S. F. (2001) "Seasonal variation in host susceptibility and cycles of certain infectious diseases", Emerg Infect Dis. 2001;7(3):369-374. doi:10.3201/eid0703.010301 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2631809/

Hammond, G. W. et al. (1989) "Impact of Atmospheric Dispersion and Transport of Viral Aerosols on the Epidemiology of Influenza", Reviews of Infectious Diseases, Volume 11, Issue 3, May 1989, Pages 494-497, https://doi.org/10.1093/clinids/11.3.494

Haas, C.N. et al. (1993) "Risk Assessment of Virus in Drinking Water", Risk Analysis, 13: 545-552. doi:10.1111/j.1539-6924.1993.tb00013.x https://doi.org/10.1111/j.1539-6924.1993.tb00013.x

HealthKnowlege-UK (2020) "Charter 1a - Epidemiology: Epidemic theory (effective & basic reproduction numbers, epidemic thresholds) & techniques for analysis of infectious disease data (construction & use of epidemic curves, generation numbers, exceptional reporting & identification of significant clusters)", HealthKnowledge.org.uk, accessed on 2020-04-10. https://www.healthknowledge.org.uk/public-health-textbook/research-methods/1a-epidemiology/epidemic-theory

Lai, A. C. K. et al. (2012) "Effectiveness of facemasks to reduce exposure hazards for airborne infections among general populations", J. R. Soc. Interface. 9938-948 https://doi.org/10.1098/rsif.2011.0537

Leung, N.H.L. et al. (2020) "Respiratory virus shedding in exhaled breath and efficacy of face masks", Nature Medicine (2020). https://doi.org/10.1038/s41591-020-0843-2

Lowen, A. C. et al. (2007) "Influenza Virus Transmission Is Dependent on Relative Humidity and Temperature", PLoS Pathog 3(10): e151. https://doi.org/10.1371/journal.ppat.0030151

Paules, C. and Subbarao, S. (2017) "Influenza", Lancet, Seminar| Volume 390, ISSUE 10095, P697-708, August 12, 2017. https://dx.doi.org/10.1016/S0140-6736(17)30129-0

Sande, van der, M. et al. (2008) "Professional and Home-Made Face Masks Reduce Exposure to Respiratory Infections among the General Population", PLoS ONE 3(7): e2618. doi:10.1371/journal.pone.0002618 https://doi.org/10.1371/journal.pone.0002618

Shaman, J. et al. (2010) "Absolute Humidity and the Seasonal Onset of Influenza in the Continental United States", PLoS Biol 8(2): e1000316. https://doi.org/10.1371/journal.pbio.1000316

Tracht, S. M. et al. (2010) "Mathematical Modeling of the Effectiveness of Facemasks in Reducing the Spread of Novel Influenza A (H1N1)", PLoS ONE 5(2): e9018. doi:10.1371/journal.pone.0009018 https://doi.org/10.1371/journal.pone.0009018

Viboud C. et al. (2010) "Preliminary Estimates of Mortality and Years of Life Lost Associated with the 2009 A/H1N1 Pandemic in the US and Comparison with Past Influenza Seasons", PLoS Curr. 2010; 2:RRN1153. Published 2010 Mar 20. doi:10.1371/currents.rrn1153 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843747/

Wada, K. et al. (2012) "Wearing face masks in public during the influenza season may reflect other positive hygiene practices in Japan", BMC Public Health 12, 1065 (2012). https://doi.org/10.1186/1471-2458-12-106

Yang, W. et al. (2011) "Concentrations and size distributions of airborne influenza A viruses measured indoors at a health centre, a day-care centre and on aeroplanes", Journal of the Royal Society, Interface. 2011 Aug;8(61):1176-1184. DOI: 10.1098/rsif.2010.0686. https://royalsocietypublishing.org/doi/10.1098/rsif.2010.0686

Yezli, S., Otter, J.A. (2011) "Minimum Infective Dose of the Major Human Respiratory and Enteric Viruses Transmitted Through Food and the Environment", Food Environ Virol 3, 1-30. https://doi.org/10.1007/s12560-011-9056-7

Zwart, M. P. et al. (2009) "An experimental test of the independent action hypothesis in virus- insect pathosystems", Proc. R. Soc. B. 2762233-2242 https://doi.org/10.1098/rspb.2009.0064

Author:

D.G. Rancourt - Former tenured and Full Professor of physics at the University of Ottawa, Canada. Known for applications of physics education research. Published over 100 scientific articles in the areas of metal physics, materials science, measurement methods, and earth and environmental science, and many social commentary essays. Author of the book Hierarchy and Free Expression in the Fight Against Racism.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of GreenMedInfo or its staff.

===

Masks Don't Work: A review of science relevant to COVID-19 social policy

By D. G. Rancourt, PhD - 25. June, 2020 - from a April 2020 paper


Summary / Abstract

Masks and respirators do not work.

There have been extensive randomized controlled trial (RCT) studies, and meta-analysis reviews of RCT studies, which all show that masks and respirators do not work to prevent respiratory influenza-like illnesses, or respiratory illnesses believed to be transmitted by droplets and aerosol particles.
Furthermore, the relevant known physics and biology, which I review, are such that masks and respirators should not work. It would be a paradox if masks and respirators worked, given what we know about viral respiratory diseases: The main transmission path is long-residence-time aerosol particles (< 2.5 μm), which are too fine to be blocked, and the minimum-infective-dose is smaller than one aerosol particle.
The present paper about masks illustrates the degree to which governments, the mainstream media, and institutional propagandists can decide to operate in a science vacuum, or select only incomplete science that serves their interests. Such recklessness is also certainly the case with the current global lockdown of over 1 billion people, an unprecedented experiment in medical and political history.

Review of the Medical Literature

Here are key anchor points to the extensive scientific literature that establishes that wearing surgical masks and respirators (e.g., “N95”) does not reduce the risk of contracting a verified illness:

  • Jacobs, J. L. et al. (2009)
    “Use of surgical face masks to reduce the incidence of the common cold among health care workers in Japan: A randomized controlled trial”, American Journal of Infection Control, Volume 37, Issue 5, 417 - 419.
    https://www.ncbi.nlm.nih.gov/pubmed/19216002
    • N95-masked health-care workers (HCW) were significantly more likely to experience headaches. Face mask use in HCW was not demonstrated to provide benefit in terms of cold symptoms or getting colds.
       
  • Cowling, B. et al. (2010)
    “Face masks to prevent transmission of influenza virus: A systematic review”, Epidemiology and Infection, 138(4), 449-456. doi:10.1017/S0950268809991658
    https://www.cambridge.org/core/journals/epidemiology-and-infection/article/face-masks-to-prevent-transmission-of-influenza-virus-a-systematic- review/64D368496EBDE0AFCC6639CCC9D8BC05
    • None of the studies reviewed showed a benefit from wearing a mask, in either HCW or community members in households (H). See summary Tables 1 and 2 therein.
       
  • bin-Reza et al. (2012)
    “The use of masks and respirators to prevent transmission of influenza: a systematic review of the scientific evidence”, Influenza and Other Respiratory Viruses 6(4), 257–267.
    https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1750-2659.2011.00307.x
    • “There were 17 eligible studies. ... None of the studies established a conclusive relationship between mask ⁄ respirator use and protection against influenza infection.”
       
  • Smith, J.D. et al. (2016)
    “Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis”, CMAJ Mar 2016, cmaj.150835;
    DOI: 10.1503/cmaj.150835
    https://www.cmaj.ca/content/188/8/567
    • “We identified 6 clinical studies ... In the meta-analysis of the clinical studies, we found no significant difference between N95 respirators and surgical masks in associated risk of (a) laboratory-confirmed respiratory infection, (b) influenza-like illness, or (c) reported work-place absenteeism.”

      

  • Offeddu, V. et al. (2017)
    “Effectiveness of Masks and Respirators Against Respiratory Infections in Healthcare Workers: A Systematic Review and Meta-Analysis”, Clinical Infectious Diseases, Volume 65, Issue 11, 1 December 2017, Pages 1934–1942,
    https://doi.org/10.1093/cid/cix681 https://academic.oup.com/cid/article/65/11/1934/4068747
    • “Self-reported assessment of clinical outcomes was prone to bias. Evidence of a protective effect of masks or respirators against verified respiratory infection (VRI) was not statistically significant”; as per Fig. 2c therein:
Rancourt - Masks Don’t Work - Fig. 2C
  • Radonovich, L.J. et al. (2019)
    “N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical Trial”, JAMA. 2019; 322(9): 824–833.
    doi:10.1001/jama.2019.11645
    https://jamanetwork.com/journals/jama/fullarticle/2749214
    • “Among 2862 randomized participants, 2371 completed the study and accounted for 5180 HCW-seasons. ... Among outpatient health care personnel, N95 respirators vs medical masks as worn by participants in this trial resulted in no significant difference in the incidence of laboratory-confirmed influenza.”
       
  • Long, Y. et al. (2020)
    “Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis”, J Evid Based Med. 2020; 1-9.
    doi.org:10.1111/jebm.12381
    https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.12381
    • “A total of six RCTs involving 9 171 participants were included. There were no statistically significant differences in preventing laboratory-confirmed influenza, laboratory-confirmed respiratory viral infections, laboratory-confirmed respiratory infection and influenza-like illness using N95 respirators and surgical masks. Meta-analysis indicated a protective effect of N95 respirators against laboratory-confirmed bacterial colonization (RR = 0.58, 95% CI 0.43-0.78). The use of N95 respirators compared with surgical masks is not associated with a lower risk of laboratory-confirmed influenza.”

Conclusion Regarding that Masks Do Not Work

No RCT study with verified outcome shows a benefit for HCW or community members in households to wearing a mask or respirator. There is no such study. There are no exceptions.
Likewise, no study exists that shows a benefit from a broad policy to wear masks in public (more on this below).

Furthermore, if there were any benefit to wearing a mask, because of the blocking power against droplets and aerosol particles, then there should be more benefit from wearing a respirator (N95) compared to a surgical mask, yet several large meta-analyses, and all the RCT, prove that there is no such relative benefit.

Masks and respirators do not work.

Precautionary Principle Turned on Its Head with Masks

In light of the medical research, therefore, it is difficult to understand why public-health authorities are not consistently adamant about this established scientific result, since the distributed psychological, economic and environmental harm from a broad recommendation to wear masks is significant, not to mention the unknown potential harm from concentration and distribution of pathogens on and from used masks. In this case, public authorities would be turning the precautionary principle on its head (see below).

Physics and Biology of Viral Respiratory Disease and of Why Masks Do Not Work

In order to understand why masks cannot possibly work, we must review established knowledge about viral respiratory diseases, the mechanism of seasonal variation of excess deaths from pneumonia and influenza, the aerosol mechanism of infectious disease transmission, the physics and chemistry of aerosols, and the mechanism of the so-called minimum-infective-dose.
In addition to pandemics that can occur anytime, in the temperate latitudes there is an extra burden of respiratory-disease mortality that is seasonal, and that is caused by viruses. For example, see the review of influenza by Paules and Subbarao (2017). This has been known for a long time, and the seasonal pattern is exceedingly regular.
For example, see Figure 1 of Viboud (2010), which has “Weekly time series of the ratio of deaths from pneumonia and influenza to all deaths, based on the 122 cities surveillance in the US (blue line). The red line represents the expected baseline ratio in the absence of influenza activity,” here:

Rancourt - Masks Don’t Work - Figure 1


The seasonality of the phenomenon was largely not understood until a decade ago. Until recently, it was debated whether the pattern arose primarily because of seasonal change in virulence of the pathogens, or because of seasonal change in susceptibility of the host (such as from dry air causing tissue irritation, or diminished daylight causing vitamin deficiency or hormonal stress). For example, see Dowell (2001).
In a landmark study, Shaman et al. (2010) showed that the seasonal pattern of extra respiratory-disease mortality can be explained quantitatively on the sole basis of absolute humidity, and its direct controlling impact on transmission of airborne pathogens.
Lowen et al. (2007) demonstrated the phenomenon of humidity-dependent airborne-virus virulence in actual disease transmission between guinea pigs, and discussed potential underlying mechanisms for the measured controlling effect of humidity.
 
The underlying mechanism is that the pathogen-laden aerosol particles or droplets are neutralized within a half-life that monotonically and significantly decreases with increasing ambient humidity. This is based on the seminal work of Harper (1961). Harper experimentally showed that viral-pathogen-carrying droplets were inactivated within shorter and shorter times, as ambient humidity was increased.
Harper argued that the viruses themselves were made inoperative by the humidity (“viable decay”), however, he admitted that the effect could be from humidity-enhanced physical removal or sedimentation of the droplets (“physical loss”): “Aerosol viabilities reported in this paper are based on the ratio of virus titre to radioactive count in suspension and cloud samples, and can be criticized on the ground that test and tracer materials were not physically identical.”
The latter (“physical loss”) seems more plausible to me, since humidity would have a universal physical effect of causing particle / droplet growth and sedimentation, and all tested viral pathogens have essentially the same humidity-driven “decay”. Furthermore, it is difficult to understand how a virion (of all virus types) in a droplet would be molecularly or structurally attacked or damaged by an increase in ambient humidity. A “virion” is the complete, infective form of a virus outside a host cell, with a core of RNA or DNA and a capsid. The actual mechanism of such humidity-driven intra-droplet “viable decay” of a virion has not been explained or studied.
In any case, the explanation and model of Shaman et al. (2010) is not dependant on the particular mechanism of the humidity-driven decay of virions in aerosol / droplets. Shaman’s quantitatively demonstrated model of seasonal regional viral epidemiology is valid for either mechanism (or combination of mechanisms), whether “viable decay” or “physical loss”.
The breakthrough achieved by Shaman et al. is not merely some academic point. Rather, it has profound health-policy implications, which have been entirely ignored or overlooked in the current coronavirus pandemic.
In particular, Shaman’s work necessarily implies that, rather than being a fixed number (dependent solely on the spatial-temporal structure of social interactions in a completely susceptible population, and on the viral strain), the epidemic’s basic reproduction number (R0) is highly or predominantly dependent on ambient absolute humidity.
For a definition of R0, see HealthKnowlege-UK (2020): R0 is “the average number of secondary infections produced by a typical case of an infection in a population where everyone is susceptible.” The average R0 for influenza is said to be 1.28 (1.19–1.37); see the comprehensive review by Biggerstaff et al. (2014).
In fact, Shaman et al. showed that R0 must be understood to seasonally vary between humid- summer values of just larger than “1” and dry-winter values typically as large as “4” (for example, see their Table 2). In other words, the seasonal infectious viral respiratory diseases that plague temperate latitudes every year go from being intrinsically mildly contagious to virulently contagious, due simply to the bio-physical mode of transmission controlled by atmospheric humidity, irrespective of any other consideration.
Therefore, all the epidemiological mathematical modelling of the benefits of mediating policies (such as social distancing), which assumes humidity-independent R0 values, has a large likelihood of being of little value, on this basis alone. For studies about modelling and regarding mediation effects on the effective reproduction number, see Coburn (2009) and Tracht (2010).
To put it simply, the “second wave” of an epidemic is not a consequence of human sin regarding mask wearing and hand shaking. Rather, the “second wave” is an inescapable consequence of an air-dryness-driven many-fold increase in disease contagiousness, in a population that has not yet attained immunity.
If my view of the mechanism is correct (i.e., “physical loss”), then Shaman’s work further necessarily implies that the dryness-driven high transmissibility (large R0) arises from small aerosol particles fluidly suspended in the air; as opposed to large droplets that are quickly gravitationally removed from the air.
Such small aerosol particles fluidly suspended in air, of biological origin, are of every variety and are everywhere, including down to virion-sizes (Despres, 2012). It is not entirely unlikely that viruses can thereby be physically transported over inter-continental distances (e.g., Hammond, 1989).
More to the point, indoor airborne virus concentrations have been shown to exist (in day-care facilities, health centres, and onboard airplanes) primarily as aerosol particles of diameters smaller than 2.5 μm, such as in the work of Yang et al. (2011):
“Half of the 16 samples were positive, and their total virus concentrations ranged from 5800 to 37 000 genome copies m−3. On average, 64 per cent of the viral genome copies were associated with fine particles smaller than 2.5 μm, which can remain suspended for hours. Modelling of virus concentrations indoors suggested a source strength of 1.6 ± 1.2 × 105 genome copies m−3 air h−1 and a deposition flux onto surfaces of 13 ± 7 genome copies m−2 h−1 by Brownian motion. Over 1 hour, the inhalation dose was estimated to be 30 ± 18 median tissue culture infectious dose (TCID50), adequate to induce infection. These results provide quantitative support for the idea that the aerosol route could be an important mode of influenza transmission.”
Such small particles (< 2.5 μm) are part of air fluidity, are not subject to gravitational sedimentation, and would not be stopped by long-range inertial impact. This means that the slightest (even momentary) facial misfit of a mask or respirator renders the design filtration norm of the mask or respirator entirely irrelevant. In any case, the filtration material itself of N95 (average pore size ~0.3−0.5 μm) does not block virion penetration, not to mention surgical masks. For example, see Balazy et al. (2006).
Mask stoppage efficiency and host inhalation are only half of the equation, however, because the minimal infective dose (MID) must also be considered. For example, if a large number of pathogen-laden particles must be delivered to the lung within a certain time for the illness to take hold, then partial blocking by any mask or cloth can be enough to make a significant difference.
On the other hand, if the MID is amply surpassed by the virions carried in a single aerosol particle able to evade mask-capture, then the mask is of no practical utility, which is the case.


Yezli and Otter (2011), in their review of the MID, point out relevant features:

  • most respiratory viruses are as infective in humans as in tissue culture having optimal laboratory susceptibility
  • it is believed that a single virion can be enough to induce illness in the host
  • the 50%-probability MID (“TCID50”) has variably been found to be in the range 100−1000 virions
  • there are typically 103−107 virions per aerolized influenza droplet with diameter 1−10 μm
  • the 50%-probability MID easily fits into a single (one) aerolized droplet
     

For further background:

  • A classic description of dose-response assessment is provided by Haas (1993).
  • Zwart et al. (2009) provided the first laboratory proof, in a virus-insect system, that the
    action of a single virion can be sufficient to cause disease.
  • Baccam et al. (2006) calculated from empirical data that, with influenza A in humans,
  • “we estimate that after a delay of ~6 h, infected cells begin producing influenza virus and continue to do so for ~5 h. The average lifetime of infected cells is ~11 h, and the half-life of free infectious virus is ~3 h. We calculated the [in-body] basic reproductive number, R0, which indicated that a single infected cell could produce ~22 new productive infections.”
  • Brooke et al. (2013) showed that, contrary to prior modeling assumptions, although not all influenza-A-infected cells in the human body produce infectious progeny (virions), nonetheless, 90% of infected cell are significantly impacted, rather than simply surviving unharmed.

All of this to say that: if anything gets through (and it always does, irrespective of the mask), then you are going to be infected. Masks cannot possibly work. It is not surprising, therefore, that no bias-free study has ever found a benefit from wearing a mask or respirator in this application.

Therefore, the studies that show partial stopping power of masks, or that show that masks can capture many large droplets produced by a sneezing or coughing mask-wearer, in light of the above-described features of the problem, are irrelevant. For example, such studies as these: Leung (2020), Davies (2013), Lai (2012), and Sande (2008).

Why There Can Never Be an Empirical Test of a Nation-Wide Mask-Wearing Policy

As mentioned above, no study exists that shows a benefit from a broad policy to wear masks in public. There is good reason for this. It would be impossible to obtain unambiguous and bias-free results:

  • Any benefit from mask-wearing would have to be a small effect, since undetected in controlled experiments, which would be swamped by the larger effects, notably the large effect from changing atmospheric humidity.
  • Mask compliance and mask adjustment habits would be unknown.
  • Mask-wearing is associated (correlated) with several other health behaviours; see Wada (2012).
  • The results would not be transferable, because of differing cultural habits.
  • Compliance is achieved by fear, and individuals can habituate to fear-based propaganda, and can have disparate basic responses.
  • Monitoring and compliance measurement are near-impossible, and subject to large errors.
  • Self-reporting (such as in surveys) is notoriously biased, because individuals have the self-interested belief that their efforts are useful.
  • Progression of the epidemic is not verified with reliable tests on large population samples, and generally relies on non-representative hospital visits or admissions.
  • Several different pathogens (viruses and strains of viruses) causing respiratory illness generally act together, in the same population and/or in individuals, and are not resolved, while having different epidemiological characteristics.

Unknown Aspects of Mask Wearing

Many potential harms may arise from broad public policies to wear masks, and the following unanswered questions arise:

  • Do used and loaded masks become sources of enhanced transmission, for the wearer and others?
  • Do masks become collectors and retainers of pathogens that the mask wearer would otherwise avoid when breathing without a mask?
  • Are large droplets captured by a mask atomized or aerolized into breathable components? Can virions escape an evaporating droplet stuck to a mask fiber?
  • What are the dangers of bacterial growth on a used and loaded mask?
  • How do pathogen-laden droplets interact with environmental dust and aerosols
  • captured on the mask?
  • What are long-term health effects on HCW, such as headaches, arising from impeded
  • breathing?
  • Are there negative social consequences to a masked society?
  • Are there negative psychological consequences to wearing a mask, as a fear-based
  • behavioural modification?
  • What are the environmental consequences of mask manufacturing and disposal?
  • Do the masks shed fibres or substances that are harmful when inhaled?

Conclusion

By making mask-wearing recommendations and policies for the general public, or by expressly condoning the practice, governments have both ignored the scientific evidence and done the opposite of following the precautionary principle.
In an absence of knowledge, governments should not make policies that have a hypothetical potential to cause harm. The government has an onus barrier before it instigates a broad social- engineering intervention, or allows corporations to exploit fear-based sentiments.
Furthermore, individuals should know that there is no known benefit arising from wearing a mask in a viral respiratory illness epidemic, and that scientific studies have shown that any benefit must be residually small, compared to other and determinative factors.

Otherwise, what is the point of publicly funded science?

The present paper about masks illustrates the degree to which governments, the mainstream media, and institutional propagandists can decide to operate in a science vacuum, or select only incomplete science that serves their interests. Such recklessness is also certainly the case with the current global lockdown of over 1 billion people, an unprecedented experiment in medical and political history.

Endnotes:

  • Baccam, P. et al. (2006)
    “Kinetics of Influenza A Virus Infection in Humans”, Journal of Virology Jul 2006, 80 (15) 7590-7599; DOI: 10.1128/JVI.01623-05 https://jvi.asm.org/content/80/15/7590
     
  • Balazy et al. (2006)
    “Do N95 respirators provide 95% protection level against airborne viruses, and how adequate are surgical masks?”, American Journal of Infection Control, Volume 34, Issue 2, March 2006, Pages 51-57.
    doi:10.1016/j.ajic.2005.08.018
    https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.488.4644&rep=rep1&type=pdf
     
  • Biggerstaff, M. et al. (2014)
    “Estimates of the reproduction number for seasonal, pandemic, and zoonotic influenza: a systematic review of the literature”, BMC Infect Dis 14, 480 (2014).
    https://doi.org/10.1186/1471-2334-14-480
     
  • Brooke, C. B. et al. (2013)
    “Most Influenza A Virions Fail To Express at Least One Essential Viral Protein”, Journal of Virology Feb 2013, 87 (6) 3155-
    DOI: 10.1128/JVI.02284-12
    https://jvi.asm.org/content/87/6/3155
     
  • Coburn, B. J. et al. (2009)
    “Modeling influenza epidemics and pandemics: insights into the future of swine flu (H1N1)”, BMC Med 7, 30.
    https://doi.org/10.1186/1741-7015-7-30
     
  • Davies, A. et al. (2013)
    “Testing the Efficacy of Homemade Masks: Would They Protect in an Influenza Pandemic?”, Disaster Medicine and Public Health Preparedness, Available on CJO 2013
    doi:10.1017/dmp.2013.43
    https://journals.cambridge.org/abstract_S1935789313000438
     
  • Despres, V. R. et al. (2012)
    “Primary biological aerosol particles in the atmosphere: a review”, Tellus B: Chemical and Physical Meteorology, 64:1, 15598,
    DOI: 10.3402/tellusb.v64i0.15598
    https://doi.org/10.3402/tellusb.v64i0.15598
     
  • Dowell, S. F. (2001)
    “Seasonal variation in host susceptibility and cycles of certain infectious diseases”, Emerg Infect Dis. 2001;7(3):369–374.
    doi:10.3201/eid0703.010301
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2631809/
     
  • Hammond, G. W. et al. (1989)
    “Impact of Atmospheric Dispersion and Transport of Viral Aerosols on the Epidemiology of Influenza”, Reviews of Infectious Diseases, Volume 11, Issue 3, May 1989, Pages 494–497,
    https://doi.org/10.1093/clinids/11.3.494
     
  • Haas, C.N. et al. (1993)
    “Risk Assessment of Virus in Drinking Water”, Risk Analysis, 13: 545-552. doi:10.1111/j.1539-6924.1993.tb00013.x
    https://doi.org/10.1111/j.1539-6924.1993.tb00013.x
     
  • HealthKnowlege-UK (2020)
    “Charter 1a - Epidemiology: Epidemic theory (effective & basic reproduction numbers, epidemic thresholds) & techniques for analysis of infectious disease data (construction & use of epidemic curves, generation numbers, exceptional reporting & identification of significant clusters)”, HealthKnowledge.org.uk, accessed on 2020-04-10.
    https://www.healthknowledge.org.uk/public-health-textbook/research-methods/1a- epidemiology/epidemic-theory
     
  • Lai, A. C. K. et al. (2012)
    “Effectiveness of facemasks to reduce exposure hazards for airborne infections among general populations”, J. R. Soc. Interface. 9938–948
    https://doi.org/10.1098/rsif.2011.0537
     
  • Leung, N.H.L. et al. (2020)
    “Respiratory virus shedding in exhaled breath and efficacy of face masks”, Nature Medicine (2020).
    https://doi.org/10.1038/s41591-020-0843-2
     
  • Lowen, A. C. et al. (2007)
    “Influenza Virus Transmission Is Dependent on Relative Humidity and Temperature”, PLoS Pathog 3(10): e151.
    https://doi.org/10.1371/journal.ppat.0030151
     
  • Paules, C. and Subbarao, S. (2017)
    “Influenza”, Lancet, Seminar| Volume 390, ISSUE 10095, P697-708, August 12, 2017.
    https://dx.doi.org/10.1016/S0140-6736(17)30129-0
     
  • Sande, van der, M. et al. (2008)
    “Professional and Home-Made Face Masks Reduce Exposure to Respiratory Infections among the General Population”, PLoS ONE 3(7): e2618. doi:10.1371/journal.pone.0002618
    https://doi.org/10.1371/journal.pone.0002618
     
  • Shaman, J. et al. (2010)
    “Absolute Humidity and the Seasonal Onset of Influenza in the Continental United States”, PLoS Biol 8(2): e1000316.
    https://doi.org/10.1371/journal.pbio.1000316
     
  • Tracht, S. M. et al. (2010)
    “Mathematical Modeling of the Effectiveness of Facemasks in Reducing the Spread of Novel Influenza A (H1N1)”, PLoS ONE 5(2): e9018.
    doi:10.1371/journal.pone.0009018
    https://doi.org/10.1371/journal.pone.0009018
     
  • Viboud C. et al. (2010)
    “Preliminary Estimates of Mortality and Years of Life Lost Associated with the 2009 A/H1N1 Pandemic in the US and Comparison with Past Influenza Seasons”, PLoS Curr. 2010; 2:RRN1153. Published 2010 Mar 20.
    doi:10.1371/currents.rrn1153
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843747/
     
  • Wada, K. et al. (2012)
    “Wearing face masks in public during the influenza season may reflect other positive hygiene practices in Japan”, BMC Public Health 12, 1065 (2012).
    https://doi.org/10.1186/1471-2458-12-1065
               
  • Yang, W. et al. (2011)
    “Concentrations and size distributions of airborne influenza A viruses measured indoors at a health centre, a day-care centre and on aeroplanes”, Journal of the Royal Society, Interface. 2011 Aug;8(61):1176-1184.
    DOI: 10.1098/rsif.2010.0686.
    https://royalsocietypublishing.org/doi/10.1098/rsif.2010.0686
     
  • Yezli, S., Otter, J.A. (2011)
    “Minimum Infective Dose of the Major Human Respiratory and Enteric Viruses Transmitted Through Food and the Environment”, Food Environ Virol 3, 1–30.
    https://doi.org/10.1007/s12560-011-9056-7
     
  • Zwart, M. P. et al. (2009)
    “An experimental test of the independent action hypothesis in virus–insect pathosystems”, Proc. R. Soc. B. 2762233–2242
    https://doi.org/10.1098/rspb.2009.0064

Copyright ©2020, Zzesto Branding, All Rights Reserved.

Included this video because the original author Denis Rancourt shared it to Facebook, so it must be relevant. ;)

Mask Exemption Card to Print

Mask Exemption Card

Author:

D. G. Rancourt, PhD

Researcher, Ontario Civil Liberties Association
Working report, published at ResearchGate
Download from OCLA

April 2020 Editor: This is a mirror of a paper by Professor D. G. Rancourt, PhD in which he explains that masks don't work. This editor points out that they also function as a form of self-harm (so your insurance won't cover you when you get brain damage, or suffer a collapsed lung) and actually prevent organic (natural) herd immunity (community immunity) from gaining a foothold.

===

Do Masks Even Work? Can You Be Forced To Wear One? Dr. Kaufman Weighs In

By Spiro Skouras - June 21, 2020

We are beginning to see more and more mask mandates being rolled out, which raises many questions. Does wearing a mask offer protection from the virus? Does wearing a mask for extended periods of time pose any risk to your health? Can the government or employers really make you wear a mask?

In this interview, Spiro is joined by Dr. Andrew Kaufman to discuss these issues in addition to another concerning aspect regarding mandated masks.

Are we being conditioned to accept other mandates? If they can make you wear a mask, what will they make you do next? Mandatory testing? Mandatory vaccination? Do not miss this important interview!

Dr. Andrew Kaufman’s Website
https://www.andrewkaufmanmd.com

Department of Labor & OSHA
https://www.osha.gov/laws-regs/standardinterpretations/2007-04-02-0

Department of Labor & OSHA
https://www.osha.gov/SLTC/covid-19/covid-19-faq.html#cloth-face-coverings

Universal Masking in Hospitals in the Covid-19 Era
https://www.nejm.org/doi/full/10.1056/NEJMp2006372?query=TOC

A Cluster Randomised Trial of Cloth Masks Compared With Medical Masks in Healthcare Workers
https://pubmed.ncbi.nlm.nih.gov/25903751/

The Physiological Impact of Wearing an N95 Mask During Hemodialysis as a Precaution Against SARS in Patients With End-Stage Renal Disease
https://pubmed.ncbi.nlm.nih.gov/15340662/

Masks Don’t Work: A Review of Science Relevant to COVID-19 Social Policy
https://www.rcreader.com/commentary/masks-dont-work-covid-a-review-of-science-relevant-to-covide-19-social-policy

Follow Spiro on BitChute bitchute.com/channel/spiro/ Follow on Twitter https://twitter.com/o_rips

Subscribe to Activist Post for truth, peace, and freedom news. Send resources to the front lines of peace and freedom HERE! Follow us on SoMee, Flote, Minds, Twitter, and HIVE.

===

Sweden’s Top Infectious Disease Expert Says COVID-19 Lockdowns Are Not Based on Science. History Shows He Could Be Right

The debate over COVID-19 lockdowns has thrust Sweden into the global spotlight. Anders Tegnell, the nation’s top infectious disease expert, said he's confident Sweden's approach is the right one.

https://fee.org/media/37461/anders-tegnell-profile.jpg?center=0.44256756756756754,0.49915966386554622&mode=crop&width=900&format=webp&rnd=132343582310000000

Image credit: Frankie Fouganthin on Wikimedia Commons | CC BY 4.0 (https://creativecommons.org/licenses/by-sa/4.0/deed.en)

By Jon Miltimore - 19. May 2020

As nations around the world begin to ease lockdown restrictions passed amid the scariest pandemic since the 1918 Spanish Flu, a new battle is brewing among disease experts and the punditry class.

On one side, are lockdown proponents who compare lockdown skeptics to anti-vaxxers who endanger lives because they are drunk on "freedom" and want to prematurely ease restrictions, which they say could result in a new spike in COVID-19 cases and deaths.

Lockdown skeptics, on the other hand, draw the battlelines differently.

“On one side are ideologues heavily invested in the idea of lockdown, regardless of the cost,” The Wall Street Journal recently described one skeptic’s take. “On the other are scientists with data that the lockdowns are overkill.”

While there is room for middle ground here—I know several medical professionals who say lockdowns made sense initially to “flatten the curve,” but that stage is now over—it’s fair to say the political debate around lockdowns has become largely a two-front war.

As I wrote last week, the costs of lockdowns become clearer every day: nations around the world staggering into recessions and Great Depression-level unemployment. The benefits of the lockdowns, at least for lockdown skeptics, are less easy to quantify.

“There is no correlation between fatalities and lockdown stringency,” columnist Simon Jenkins recently observed in The Guardian. “The most stringent lockdowns—as in China, Italy, Spain, New Zealand and Britain—have yielded both high and low deaths per million.”

The debate over lockdowns has naturally thrust Sweden, which has foregone a hardline approach to the COVID-19 pandemic in favor of a softer one encouraging voluntary action, into the global spotlight. The results of Sweden’s policy have so far been mixed.

While Sweden’s outbreak has to date been deadlier than its Scandanavian neighbors, The New York Times recently conceded that “it’s still better off than many countries that enforced strict lockdowns.”

While Sweden has endured a great deal of criticism for its “laissez-faire” approach, Anders Tegnell, the nation’s top infectious disease expert, recently defended his policies, stating that while a degree of social distancing is the right approach, lockdowns are not grounded in actual science.

“Nothing to do with [them] has a scientific basis,” Tegnell said, according to The Guardian.

It’s an astonishing claim. If the lockdowns are not based on science, what are they based on? As it happens, The New York Times recently traced the history of social US social distancing policy.

The origins apparently stem from a trip President George W. Bush made to the library in the summer of 2005 over concerns about bioterrorism, which prompted him to read The Great Influenza, a book on the Spanish flu pandemic of 1918 written by John M. Barry.

Shortly thereafter, the Bush administration enlisted two federal government doctors, Carter Mecher and Richard Hatchett, to develop ideas to implement during the next pandemic. Mecher⁠— who “had almost no pandemic policy expertise,” according to the Times⁠—then met with Dr. Robert J. Glass, a New Mexico scientist at Sandia who specialized in developing models to explain how complex systems function.

And that’s where the story gets interesting. Via The Times:

Dr. Glass’s daughter Laura, then 14, had done a class project in which she built a model of social networks at her Albuquerque high school, and when Dr. Glass looked at it, he was intrigued.

Students are so closely tied together — in social networks and on school buses and in classrooms — that they were a near-perfect vehicle for a contagious disease to spread.

Dr. Glass piggybacked on his daughter’s work to explore with her what effect breaking up these networks would have on knocking down the disease.

The outcome of their research was startling. By closing the schools in a hypothetical town of 10,000 people, only 500 people got sick. If they remained open, half of the population would be infected.

“My God, we could use the same results she has and work from there,” Dr. Glass recalled thinking. He took their preliminary data and built on it by running it through the supercomputers at Sandia, more typically used to engineer nuclear weapons. (His daughter’s project was entered in the Intel International Science and Engineering Fair in 2006.)

Dr. Mecher received the results at his office in Washington and was amazed.

If cities closed their public schools, the data suggested, the spread of a disease would be significantly slowed, making this move perhaps the most important of all of the social distancing options they were considering.

If the Times is correct, it would appear that federal social distancing policy is to some extent the brainchild of a trip George W. Bush made to the library in the summer of 2005 and a 14-year-old girl’s science project. (You can read more about Laura’s Glass’s science project, which reportedly took third place at the 2006 Intel fair in Indianapolis, in this Albuquerque Journal article.)

To be clear, there’s no direct evidence to my knowledge that this is what Tegnell, who earned a PhD in Medicine from Linköping University in 2003 and a MSc in Epidemiology from the London School of Hygiene and Tropical Medicine in 2004, was referring to when he said the lockdowns are not based on science.

Moreover, there’s nothing to say the lockdowns don’t work simply because the policy stems from George W. Bush and a child’s school project. (The lockdowns will ultimately be judged on their results, not their intellectual genesis.)

Nevertheless, Tegnell’s assertion that there is no “scientific basis” for the lockdowns deserves attention. There’s a tendency to assume central planning is inherently rational and scientific, but this is hardly true. Karl Marx, perhaps the most famous central planner in history, was horribly unscientific in his methods, explained the historian Paul Johnson.

“[Marx] failed precisely because he was unscientific: he would not investigate the facts himself, or use objectively the facts investigated by others,” Johnson observed in the book Intellectuals. “From start to finish, not just Capital but all his work reflects a disregard for truth which at times amounts to contempt. That is the primary reason why Marxism, as a system, cannot produce the results claimed for it; and to call it ‘scientific’ is preposterous.”

For his part, Tegnell says the science of COVID-19 is becoming clear on at least one point, whatever the models of Laura Glass’s hypothetical town said in 2006.

“We feel more and more confident about [not] closing schools,” Tegnell told TV host Trevor Noah in a May interview. “It’s not something that really is going to be effective for this kind of disease. Schools don’t seem to be very much of a motor of this epidemic.”

 

Author:

Jon Miltimore

Jon Miltimore - is the Managing Editor of FEE.org. His writing/reporting has been the subject of articles in TIME magazine, The Wall Street Journal, CNN, Forbes, Fox News, and the Star Tribune.

For additional reading, see:

===

COMMENTARY: Masks-for-all for COVID-19 not based on sound data

People wearing masks on a trainBy Lisa M Brosseau and Margaret Sietsema - 01. April 2020

Dr. Brosseau is a national expert on respiratory protection and infectious diseases and professor (retired), University of Illinois at Chicago.
Dr. Sietsema is also an expert on respiratory protection and an assistant professor at the University of Illinois at Chicago.

_____________________________________

Editor’s Note: The authors added the following statement on Jul 16, 2020

The authors and CIDRAP have received requests in recent weeks to remove this article from the CIDRAP website. Reasons have included: (1) we don’t truly know that cloth masks (face coverings) are not effective, since the data are so limited, (2) wearing a cloth mask or face covering is better than doing nothing, (3) the article is being used by individuals and groups to support non-mask wearing where mandated and (4) there are now many modeling studies suggesting that cloth masks or face coverings could be effective at flattening the curve and preventing many cases of infection.

If the data are limited, how can we say face coverings are likely not effective?

We agree that the data supporting the effectiveness of a cloth mask or face covering are very limited. We do, however, have data from laboratory studies that indicate cloth masks or face coverings offer very low filter collection efficiency for the smaller inhalable particles we believe are largely responsible for transmission, particularly from pre- or asymptomatic individuals who are not coughing or sneezing. At the time we wrote this article, we were unable to locate any well-performed studies of cloth mask leakage when worn on the face—either inward or outward leakage. As far as we know, these data are still lacking.

The guidelines from the Centers for Disease Control and Prevention (CDC) for face coverings initially did not have any citations for studies of cloth material efficiency or fit, but some references have been added since the guidelines were first posted. We reviewed these and found that many employ very crude, non-standardized methods (Anfinrud 2020, Davies 2013, Konda 2020, Aydin 2020, Ma 2020) or are not relevant to cloth face coverings because they evaluate respirators or surgical masks (Leung 2020, Johnson 2009, Green 2012).

The CDC failed to reference the National Academies of Sciences Rapid Expert Consultation on the Effectiveness of Fabric Masks for the COVID-19 Pandemic (NAS 2020), which concludes, “The evidence from…laboratory filtration studies suggests that such fabric masks may reduce the transmission of larger respiratory droplets. There is little evidence regarding the transmission of small aerosolized particulates of the size potentially exhaled by asymptomatic or presymptomatic individuals with COVID-19.” As well, the CDC neglected to mention a well-done study of cloth material filter performance by Rengasamy et al (2014), which we reviewed in our article.

Is wearing a face covering better than nothing?

Wearing a cloth mask or face covering could be better than doing nothing, but we simply don’t know at this point. We have observed an evolution in the messaging around cloth masks, from an initial understanding that they should not be seen as a replacement for physical distancing to more recent messaging that suggests cloth masks are equivalent to physical distancing. And while everyone appears to understand that this messaging suggests that a cloth mask is appropriate only for source control (ie, to protect others from infection), recent CDC and other guidance recommending their use by workers seems to imply that they offer some type of personal protection.

We know of workplaces in which employees are told they cannot wear respirators for the hazardous environments they work in, but instead need to wear a cloth mask or face covering. These are dangerous and inappropriate applications that greatly exceed the initial purpose of a cloth mask. We are concerned that many people do not understand the very limited degree of protection a cloth mask or face covering likely offers as source control for people located nearby.

Do we support cloth mask wearing where mandated?

Despite the current limited scientific data detailing their effectiveness, we support the wearing of face coverings by the public when mandated and when in close contact with people whose infection status they don't know. However, we also encourage everyone to continue to limit their time spent indoors near potentially infectious people and to not count on or expect a cloth mask or face covering to protect them or the people around them. The pandemic is not over and will not likely be over for some time. As states and local jurisdictions reopen, we encourage people to continue to assess and limit their risks. Cloth masks and face coverings likely do not offer the same degree of protection as physical distancing, isolation, or limiting personal contact time.

Will face coverings 'flatten the curve' and stop the pandemic?

We have reviewed the many modeling studies that purport to demonstrate that cloth masks or face coverings have the potential for flattening the curve or significantly decrease the number of cases. These studies fail to recognize several important facts:

  • The filter performance of a cloth material does not directly translate or represent its performance on an individual, because it neglects the understanding of fit.
  • Cloth masks or coverings come in a variety of shapes, sizes, and materials and are not made according to any standards.
  • Transmission is not simply a function of short random interactions between individuals, but rather a function of particle concentration in the air and the time exposed to that concentration.
  • A cloth mask or face covering does very little to prevent the emission or inhalation of small particles. As discussed in an earlier CIDRAP commentary and more recently by Morawska and Milton (2020) in an open letter to WHO signed by 239 scientists, inhalation of small infectious particles is not only biologically plausible, but the epidemiology supports it as an important mode of transmission for SARS-CoV-2, the virus that causes COVID-19.

In summary, though we support mask wearing by the general public, we continue to conclude that cloth masks and face coverings are likely to have limited impact on lowering COVID-19 transmission, because they have minimal ability to prevent the emission of small particles, offer limited personal protection with respect to small particle inhalation, and should not be recommended as a replacement for physical distancing or reducing time in enclosed spaces with many potentially infectious people. We are very concerned about messaging that suggests cloth masks or face coverings can replace physical distancing. We also worry that the public doesn't understand the limitations of cloth masks and face coverings when we observe how many people wear their mask under their nose or even under their mouth, remove their masks when talking to someone nearby, or fail to practice physical distancing when wearing a mask.

References

Anfinrud P, Stadnytskyi V, Bax CE, et al. Visualizing speech-generated oral fluid droplets with laser light scattering. N Engl J Med 2020 (published online Apr 15)

Davies A, Thompson KA, Giri K, et al. Testing the efficacy of homemade masks: would they protect in an influenza pandemic? Disaster Med Public Health Prep 2013 Aug;7(4):413-8

Green CF, Davidson CS, Panlilio AL, et al. Effectiveness of selected surgical masks in arresting vegetative cells and endospores when worn by simulated contagious patients. Infect Control Hosp Epidemiol 2012 May;33(5):487‐94

Johnson DF, Druce JD, Birch C, et al. A quantitative assessment of the efficacy of surgical and N95 masks to filter influenza virus in patients with acute influenza infection. Clin Infect Dis 2009 Jul 15;49(2):275-7

Konda A, Prakash A, Moss GA, et al. Aerosol filtration efficiency of common fabrics used in respiratory cloth masks. ACS Nano. 2020 (published online Apr 24)

Leung NHL, Chu DKW, Shiu EYC, et al. Respiratory virus shedding in exhaled breath and efficacy of face masksNat Med 2020 (published online Apr 3)

Ma QX, Shan H, Zhang HL, et al. Potential utilities of mask-wearing and instant hand hygiene for fighting SARS-CoV-2. J Med Virol 2020 (published online Mar 31)

Morawska L, Milton DK. It is time to address airborne transmission of COVID-19. Clin Infect Dis 2020 (published online Jul 6)

National Academies of Sciences, Engineering, and Medicine. 2020. Rapid expert consultation on the effectiveness of fabric masks for the COVID-19 pandemic. Washington, DC, National Academies Press. Apr 8, 2020

Rengasamy S, Eimer B, Szalajda J. A quantitative assessment of the total inward leakage of NaCl aerosol representing submicron-size bioaerosol through N95 filtering facepiece respirators and surgical masks. J Occup Environ Hyg 2014 May 9;11(6):388-96

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Editor's Note: Also on Jul 16, The following text was changed directly after the "Surgical masks as source control" subhead in the original commentary:

Original: Household studies find very limited effectiveness of surgical masks at reducing respiratory illness in other household members.22-25

Updated: We were able to identify only two household studies in which surgical masks were worn by the index patient only, as source control.24,25 Neither of these found a significant impact on secondary disease transmission, although both studies had important limitations.

The original reference 24 (bin-Reza 2011) was changed to Canini 2010. In an unrelated correction on Jul 16, reference 45 was incorrect and now correctly cites bin-Reza 2012.

__________________________________________________________________

In response to the stream of misinformation and misunderstanding about the nature and role of masks and respirators as source control or personal protective equipment (PPE), we critically review the topic to inform ongoing COVID-19 decision-making that relies on science-based data and professional expertise.

As noted in a previous commentary, the limited data we have for COVID-19 strongly support the possibility that SARS-CoV-2—the virus that causes COVID-19—is transmitted by inhalation of both droplets and aerosols near the source. It is also likely that people who are pre-symptomatic or asymptomatic throughout the duration of their infection are spreading the disease in this way.

Data lacking to recommend broad mask use

We do not recommend requiring the general public who do not have symptoms of COVID-19-like illness to routinely wear cloth or surgical masks because:

  • There is no scientific evidence they are effective in reducing the risk of SARS-CoV-2 transmission
  • Their use may result in those wearing the masks to relax other distancing efforts because they have a sense of protection
  • We need to preserve the supply of surgical masks for at-risk healthcare workers.

Sweeping mask recommendations—as many have proposed—will not reduce SARS-CoV-2 transmission, as evidenced by the widespread practice of wearing such masks in Hubei province, China, before and during its mass COVID-19 transmission experience earlier this year. Our review of relevant studies indicates that cloth masks will be ineffective at preventing SARS-CoV-2 transmission, whether worn as source control or as PPE. 

Surgical masks likely have some utility as source control (meaning the wearer limits virus dispersal to another person) from a symptomatic patient in a healthcare setting to stop the spread of large cough particles and limit the lateral dispersion of cough particles. They may also have very limited utility as source control or PPE in households.

Respirators, though, are the only option that can ensure protection for frontline workers dealing with COVID-19 cases, once all of the strategies for optimizing respirator supply have been implemented.

We do not know whether respirators are an effective intervention as source control for the public. A non-fit-tested respirator may not offer any better protection than a surgical mask. Respirators work as PPE only when they are the right size and have been fit-tested to demonstrate they achieve an adequate protection factor. In a time when respirator supplies are limited, we should be saving them for frontline workers to prevent infection and remain in their jobs.

These recommendations are based on a review of available literature and informed by professional expertise and consultation. We outline our review criteria, summarize the literature that best addresses these criteria, and describe some activities the public can do to help "flatten the curve" and to protect frontline workers and the general public.

We realize that the public yearns to help protect medical professionals by contributing homemade masks, but there are better ways to help.

Filter efficiency and fit are key for masks, respirators

The best evidence of mask and respirator performance starts with testing filter efficiency and then evaluating fit (facepiece leakage). Filter efficiency must be measured first. If the filter is inefficient, then fit will be a measure of filter efficiency only and not what is being leaked around the facepiece.

Filter efficiency

Masks and respirators work by collecting particles through several physical mechanisms, including diffusion (small particles) and interception and impaction (large particles).1 N95 filtering facepiece respirators (FFRs) are constructed from electret filter material, with electrostatic attraction for additional collection of all particle sizes.2

Every filter has a particle size range that it collects inefficiently. Above and below this range, particles will be collected with greater efficiency. For fibrous non-electret filters, this size is about 0.3 micrometers (µm); for electret filters, it ranges from 0.06 to 0.1 µm. When testing, we care most about the point of inefficiency. As flow increases, particles in this range will be collected less efficiently.

The best filter tests use worst-case conditions: high flow rates (80 to 90 liters per minute [L/min]) with particle sizes in the least efficiency range. This guarantees that filter efficiency will be high at typical, lower flow rates for all particle sizes. Respirator filter certification tests use 84 L/min, well above the typical 10 to 30 L/min breathing rates. The N95 designation means the filter exhibits at least 95% efficiency in the least efficient particle size range.

Studies should also use well-characterized inert particles (not biological, anthropogenic, or naturogenic ones) and instruments that quantify concentrations in narrow size categories, and they should include an N95 FFR or similar respirator as a positive control.

Fit

Fit should be a measure of how well the mask or respirator prevents leakage around the facepiece, as noted earlier. Panels of representative human subjects reveal more about fit than tests on a few individuals or mannequins.

Quantitative fit tests that measure concentrations inside and outside of the facepiece are more discriminating than qualitative ones that rely on taste or odor.

Mask, N95 respirator filtering performance

Following a recommendation that cloth masks be explored for use in healthcare settings during the next influenza pandemic,3 The National Institute for Occupational Safety and Health (NIOSH) conducted a study of the filter performance on clothing materials and articles, including commercial cloth masks marketed for air pollution and allergens, sweatshirts, t-shirts, and scarfs.4

Filter efficiency was measured across a wide range of small particle sizes (0.02 to 1 µm) at 33 and 99 L/min. N95 respirators had efficiencies greater than 95% (as expected). For the entire range of particles tested, t-shirts had 10% efficiency, scarves 10% to 20%, cloth masks 10% to 30%, sweatshirts 20% to 40%, and towels 40%. All of the cloth masks and materials had near zero efficiency at 0.3 µm, a particle size that easily penetrates into the lungs.4

Another study evaluated 44 masks, respirators, and other materials with similar methods and small aerosols (0.08 and 0.22 µm).5 N95 FFR filter efficiency was greater than 95%. Medical masks exhibited 55% efficiency, general masks 38% and handkerchiefs 2% (one layer) to 13% (four layers).

These studies demonstrate that cloth or homemade masks will have very low filter efficiency (2% to 38%). Medical masks are made from a wide range of materials, and studies have found a wide range of filter efficiency (2% to 98%), with most exhibiting 30% to 50% efficiency.6-12

We reviewed other filter efficiency studies of makeshift cloth masks made with various materials. Limitations included challenge aerosols that were poorly characterized13 or too large14-16 or flow rates that were too low.17

Mask and respirator fit

Regulators have not developed guidelines for cloth or surgical mask fit. N95 FFRs must achieve a fit factor (outside divided by inside concentration) of at least 100, which means that the facepiece must lower the outside concentration by 99%, according to the OSHA respiratory protection standard. When fit is measured on a mask with inefficient filters, it is really a measure of the collection of particles by the filter plus how well the mask prevents particles from leaking around the facepiece.

Several studies have measured the fit of masks made of cloth and other homemade materials.13,18,19We have not used their results to evaluate mask performance, because none measured filter efficiency or included respirators as positive controls.

One study of surgical masks showing relatively high efficiencies of 70% to 95% using NIOSH test methods measured total mask efficiencies (filter plus facepiece) of 67% to 90%.7 These results illustrate that surgical masks, even with relatively efficient filters, do not fit well against the face.

In sum, cloth masks exhibit very low filter efficiency. Thus, even masks that fit well against the face will not prevent inhalation of small particles by the wearer or emission of small particles from the wearer.

One study of surgical mask fit described above suggests that poor fit can be somewhat offset by good filter collection, but will not approach the level of protection offered by a respirator. The problem is, however, that many surgical masks have very poor filter performance. Surgical masks are not evaluated using worst-case filter tests, so there is no way to know which ones offer better filter efficiency.

Studies of performance in real-world settings

Before recommending them, it's important to understand how masks and respirators perform in households, healthcare, and other settings.

Cloth masks as source control

A historical overview of cloth masks notes their use in US healthcare settings starting in the late 1800s, first as source control on patients and nurses and later as PPE by nurses.20

Kellogg,21 seeking a reason for the failure of cloth masks required for the public in stopping the 1918 influenza pandemic, found that the number of cloth layers needed to achieve acceptable efficiency made them difficult to breathe through and caused leakage around the mask. We found no well-designed studies of cloth masks as source control in household or healthcare settings.

In sum, given the paucity of information about their performance as source control in real-world settings, along with the extremely low efficiency of cloth masks as filters and their poor fit, there is no evidence to support their use by the public or healthcare workers to control the emission of particles from the wearer.

Surgical masks as source control

We were able to identify only two household studies in which surgical masks were worn by the index patient only, as source control.24,25 Neither of these found a significant impact on secondary disease transmission, although both studies had important limitations.

Clinical trials in the surgery theater have found no difference in wound infection rates with and without surgical masks.26-29 Despite these findings, it has been difficult for surgeons to give up a long-standing practice.30

There is evidence from laboratory studies with coughing infectious subjects that surgical masks are effective at preventing emission of large particles31-34 and minimizing lateral dispersion of cough particles, but with simultaneous displacement of aerosol emission upward and downward from the mask.35

There is some evidence that surgical masks can be effective at reducing overall particle emission from patients who have multidrug-resistant tuberculosis,36 cystic fibrosis,34 and influenza.33 The latter found surgical masks decreased emission of large particles (larger than 5 µm) by 25-fold and small particles by threefold from flu-infected patients.33 Sung37 found a 43% reduction in respiratory viral infections in stem-cell patients when everyone, including patients, visitors, and healthcare workers, wore surgical masks.

In sum, wearing surgical masks in households appears to have very little impact on transmission of respiratory disease. One possible reason may be that masks are not likely worn continuously in households. These data suggest that surgical masks worn by the public will have no or very low impact on disease transmission during a pandemic.

There is no evidence that surgical masks worn by healthcare workers are effective at limiting the emission of small particles or in preventing contamination of wounds during surgery.

There is moderate evidence that surgical masks worn by patients in healthcare settings can lower the emission of large particles generated during coughing and limited evidence that small particle emission may also be reduced.

N95 FFRs as source control

Respirator use by the public was reviewed by NIOSH: (1) untrained users will not wear respirators correctly, (2) non-fit tested respirators are not likely to fit, and (3) improvised cloth masks do not provide the level of protection of a fit-tested respirator.

There are few studies examining the effectiveness of respirators on patients. An N95 FFR on coughing human subjects showed greater effectiveness at limiting lateral particle dispersion than surgical masks (15 cm and 30 cm dispersion, respectively) in comparison to no mask (68 cm). 35Cystic fibrosis patients reported that surgical masks were tolerable for short periods, but N95 FFRs were not.34

In summary, N95 FFRs on patients will not be effective and may not be appropriate, particularly if they have respiratory illness or other underlying health conditions. Given the current extreme shortages of respirators needed in healthcare, we do not recommend the use of N95 FFRs in public or household settings.

Cloth masks as PPE

A randomized trial comparing the effect of medical and cloth masks on healthcare worker illness found that those wearing cloth masks were 13 times more likely to experience influenza-like illness than those wearing medical masks.38

In sum, very poor filter and fit performance of cloth masks described earlier and very low effectiveness for cloth masks in healthcare settings lead us conclude that cloth masks offer no protection for healthcare workers inhaling infectious particles near an infected or confirmed patient.

Surgical masks as PPE

Several randomized trials have not found any statistical difference in the efficacy of surgical masks versus N95 FFRs at lowering infectious respiratory disease outcomes for healthcare workers.39-43

Most reviews have failed to find any advantage of one intervention over the other.23,44-48 Recent meta-analyses found that N95 FFRs offered higher protection against clinical respiratory illness49,50and lab-confirmed bacterial infections,49 but not viral infections or influenza-like illness.49

A recent pooled analysis of two earlier trials comparing medical masks and N95 filtering facepiece respirators with controls (no protection) found that healthcare workers continuously wearing N95 FFRs were 54% less likely to experience respiratory viral infections than controls (P = 0.03), while those wearing medical masks were only 12% less likely than controls (P = 0.48; result is not significantly different from zero).51

While the data supporting the use of surgical masks as PPE in real-world settings are limited, the two meta-analyses and the most recent randomized controlled study51 combined with evidence of moderate filter efficiency and complete lack of facepiece fit lead us to conclude that surgical masks offer very low levels of protection for the wearer from aerosol inhalation. There may be some protection from droplets and liquids propelled directly onto the mask, but a faceshield would be a better choice if this is a concern.

N95 FFRs as PPE

A retrospective cohort study found that nurses' risk of SARS (severe acute respiratory syndrome, also caused by a coronavirus) was lower with consistent use of N95 FFRs than with consistent use of a surgical mask.52

In sum, this study, the meta-analyses, randomized controlled trial described above,49,51 and laboratory data showing high filter efficiency and high achievable fit factors lead us to conclude that N95 FFRs offer superior protection from inhalable infectious aerosols likely to be encountered when caring for suspected or confirmed COVID-19 patients.

The precautionary principle supports higher levels of respiratory protection, such as powered air-purifying respirators, for aerosol-generating procedures such as intubation, bronchoscopy, and acquiring respiratory specimens.

Conclusions

While this is not an exhaustive review of masks and respirators as source control and PPE, we made our best effort to locate and review the most relevant studies of laboratory and real-world performance to inform our recommendations. Results from laboratory studies of filter and fit performance inform and support the findings in real-world settings.

Cloth masks are ineffective as source control and PPE, surgical masks have some role to play in preventing emissions from infected patients, and respirators are the best choice for protecting healthcare and other frontline workers, but not recommended for source control. These recommendations apply to pandemic and non-pandemic situations.

Leaving aside the fact that they are ineffective, telling the public to wear cloth or surgical masks could be interpreted by some to mean that people are safe to stop isolating at home. It's too late now for anything but stopping as much person-to-person interaction as possible.

Masks may confuse that message and give people a false sense of security. If masks had been the solution in Asia, shouldn't they have stopped the pandemic before it spread elsewhere?

Ways to best protect health workers

We recommend that healthcare organizations follow US Centers for Disease Control and Prevention (CDC) guidance by moving first through conventional, then contingency, and finally crisis scenarios to optimize the supply of respirators. We recommend using the CDC's burn rate calculator to help identify areas to reduce N95 consumption and working down the CDC checklist for a strategic approach to extend N95 supply.

For readers who are disappointed in our recommendations to stop making cloth masks for themselves or healthcare workers, we recommend instead pitching in to locate N95 FFRs and other types of respirators for healthcare organizations. Encourage your local or state government to organize and reach out to industries to locate respirators not currently being used in the non-healthcare sector and coordinate donation efforts to frontline health workers.

Authors:

Lisa M Brosseau, ScD, and Margaret Sietsema, PhD

Vergani_Fotografia / iStock

References

  1. Lee KW, Liu BYH. On the minimum efficiency and the most penetrating particle size for fibrous filters. J Air Pollut Control Assoc 1980 Mar 13;30(4):377-81
  2. Martin SB Jr, Moyer ES. Electrostatic respirator filter media: filter efficiency and most penetrating particle size effects. Appl Occup Environ Hyg 2000 Nov 30;15(8):609-17
  3. Reusability of facemasks during an influenza pandemic.News conference, Apr 27, 2006
  4. Rengasamy S, Eimer B, Shaffer RE. Simple respiratory protection—evaluation of the filtration performance of cloth masks and common fabric materials against 20-1000 nm size particles.Ann Occup Hyg 2010 Jun 28;54(7):789-98
  5. Jung H, Kim J, Lee S, et al. Comparison of filtration efficiency and pressure drop in anti-yellow sand masks, quarantine masks, medical masks, general masks, and handkerchiefs.Aerosol Air Qual Res 2014;14(14):991-1002.
  6. Grinshpun SA, Haruta H, Eninger RM, et al. Performance of an N95 filtering facepiece particulate respirator and a surgical mask during human breathing: two pathways for particle penetration. J Occup Environ Hyg 2009 Jul 22;6(10):593-603
  7. Oberg T, Brosseau LM. Surgical mask filter and fit performance. Am J Infect Control 2008 May;36(4):276-82
  8. Willeke K, Qian Y, Donnelly J, et al. Penetration of airborne microorganisms through a surgical mask and a dust/mist respirator. Am Ind Hyg Assoc J 1996;57(4):348-55
  9. Brosseau LM, McCullough NV, Vesley D. Mycobacterial aerosol collection efficiency of respirator and surgical mask filters under varying conditions of flow and humidity. Appl Occup Environ Hyg 1997;12(6):435-45
  10. Chen CC, Willeke K. Aerosol penetration through surgical masks. Am J Infect Control 1992 Aug;20(4):177-84
  11. McCullough NV, Brosseau LM, Vesley D. Collection of three bacterial aerosols by respirator and surgical mask filters under varying conditions of flow and relative humidity. Ann Occup Hyg 1997 Dec;41(6):677-90
  12. Rengasamy S, Eimer B, Szalajda J. A quantitative assessment of the total inward leakage of NaCl aerosol representing submicron-size bioaerosol through N95 filtering facepiece respirators and surgical masks. J Occup Environ Hyg 2014 11(6):388-96
  13. Davies A, Thompson KA, Giri K, et al. Testing the efficacy of homemade masks: would they protect in an influenza pandemic?Disaster Med Public Health Prep 2013 Aug;7(4):413-8
  14. Cherrie JW, Apsley A, Cowie H, et al. Effectiveness of face masks used to protect Beijing residents against particulate air pollution.Occup Environ Med 2018 Jun;75(6):446-52
  15. Mueller W, Horwell CJ, Apsley A, et al. The effectiveness of respiratory protection worn by communities to protect from volcanic ash inhalation. Part I: filtration efficiency tests.Int J Hyg Environ Health 2018 July;221(6):967-76
  16. Bowen LE. Does that face mask really protect you?Appl Biosaf 2010 Jun 1;15(2):67-71
  17. Shakya KM, Noyes A, Kallin R, et al. Evaluating the efficacy of cloth facemasks in reducing particulate matter exposure.J Expo Sci Environ Epidemiol 2017 May;27(3):352-7
  18. van der Sande M., Teunis P, Sabel R. Professional and home-made face masks reduce exposure to respiratory infections among the general population. PLOS One 2008 Jul 9;3(7):0002618
  19. Derrick JL, Gomersall CD. Protecting healthcare staff from severe acute respiratory syndrome: filtration capacity of multiple surgical masks. J Hosp Infect 2005 Apr;59(4):365-8
  20. Chughtai AA, Seale H, MacIntyre CR. Use of cloth masks in the practice of infection control—evidence and policy gaps. Int J Infect Control 2013 Jun;9(3)
  21. Kellogg WH, MacMillan G. An experimental study of the efficacy of gauze face masks.Am J Public Health 1920;10(1):34-42
  22. Saunders-Hastings P, Crispo JA, Sikora L, et al. Effectiveness of personal protective measures in reducing pandemic influenza transmission: A systematic review and meta-analysis.Epidemics 2017 Sep;20:1-20
  23. Cowling B J, Zhou Y, Ip DKM, et al. Face masks to prevent transmission of influenza virus: a systematic review. Epidemiol Infect 2010 Jan 22;138(4):449-56
  24. Canini L, Andreoletti L, Ferrari P, et al. Surgical mask to prevent influenza transmission in households: a cluster randomized trial. PLOS One 2010 Nov 17;5(11):e13998
  25. MacIntyre CR, Zhang Y, Chughtai AA, et al. Cluster randomised controlled trial to examine medical mask use as source control for people with respiratory illness.BMJ Open 2016 Dec 30;6(12):e012330
  26. Meleny FL. Infection in clean operative wounds: a nine year study. Surg Gynecol Obstet 1935;60:264-75
  27. Orr NWM. Is a mask necessary in the operating theater? Ann R Coll Surg Engl 1981;63:390-2
  28. Mitchell NJ, Hunt S. Surgical face masks in modern operating rooms—a costly and unnecessary ritual? J Hosp Infect 1991;18(3):239-42
  29. Tunevall TG. Postoperative wound infections and surgical face masks: a controlled study. World J Surg 1991 May-Jun;15(3):383-7
  30. Belkin NL. Masks, barriers, laundering, and gloving: Where is the evidence?AORN J 2006 Oct 25;84(4):655-63
  31. Johnson DF, Druce JD, Birch C, et al. A quantitative assessment of the efficacy of surgical and N95 masks to filter influenza virus in patients with acute influenza infection.Clin Infect Dis 2009 Jul 15;49(2):275-7
  32. Driessche KV, Hens N, Tilley P, et al. Surgical masks reduce airborne spread of Pseudomonas aeruginosa in colonized patients with cystic fibrosis.Am J Respir Crit Care Med 2015 Oct 1;192(7):897-9
  33. Milton DK, Fabian MP, Cowling BJ, et al. Influenza virus aerosols in human exhaled breath: particle size, culturability, and effect of surgical masks.PLoS Pathog 2013 Mar;9(3):e1003205
  34. Stockwell RE, Wood ME, He C, et al. Face masks reduce the release of Pseudomonas aeruginosa cough aerosols when worn for clinically relevant periods.Am J Respir Crit Care Med 2018 Nov 15;198(10):1339-42
  35. Hui DS, Chow BK, Chu L, et al. Exhaled air dispersion during coughing with and without wearing a surgical or N95 mask.PloS One 2012;7(12)e50845
  36. Dharmadhikari AS, Mphahlele M, Stoltz A, et al. Surgical face masks worn by patients with multidrug-resistant tuberculosis: impact on infectivity of air on a hospital ward.Am J Respir Crit Care Med 2012 May 15;185(10):1104-9
  37. Sung AD, Sung JA, Thomas S, et al. Universal mask usage for reduction of respiratory viral infections after stem cell transplant: a prospective trial.Clin Infect Dis 2016 Oct 15;63(8):999-1006
  38. MacIntyre CR, Seale H, Dung TC, et al. A cluster randomised trial of cloth masks compared with medical masks in healthcare workers.BMJ Open 2015 Apr 22;5(4):e006577
  39. Loeb M, Dafoe N, Mahony J, et al. Surgical mask vs N95 respirator for preventing influenza among healthcare workers: a randomized trial. JAMA 2009 Nov 4;302(17):1865-71
  40. MacIntyre CR, Wang Q, Cauchemez S, et al. A cluster randomized clinical trial comparing fit‐tested and non‐fit‐tested N95 respirators to medical masks to prevent respiratory virus infection in health care workers. Influenza Other Respir Viruses 2011;5(3):170-9
  41. MacIntyre CR, Wang Q, Rahman B, et al. Efficacy of face masks and respirators in preventing upper respiratory tract bacterial colonization and co-infection in hospital healthcare workers—authors' reply. Prev Med 2014 Aug;65:154
  42. MacIntyre CR, Wang Q, Seale H, et al. A randomized clinical trial of three options for N95 respirators and medical masks in health workers. Am J Resp Crit Care Med 2013;187(9):960-6
  43. Radonovich LJ, Simberkoff MS, Bessesen MT, et al. N95 respirators vs medical masks for preventing influenza among health care personnel: a randomized clinical trial. JAMA 2019 Sep 3;322(9):824-33
  44. Gralton J, and McLaws ML. Protecting healthcare workers from pandemic influenza: N95 or surgical masks?. Crit Care Med 2010 Feb;38(2):657-67
  45. binReza F, Chavarrias VL, Nicoll A, et al. The use of masks and respirators to prevent transmission of influenza: a systematic review of the scientific evidence. Influenza Other Respir Virus 2012 Jul;6(4):257-67
  46. Bunyan D, Ritchie L, Jenkins D, et al. Respiratory and facial protection: a critical review of recent literature. J Hosp Infect 2013 Nov;85(3):165-9
  47. Smith JD, MacDougall CC, Johnstone J, et al. Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis. CMAJ 2016 May 17;188(8):567-74
  48. Jefferson T, Jones M, Ansari LAA, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Part 1 - Face masks, eye protection and person distancing: systematic review and meta-analysis. medRxiv 2020 Mar 30
  49. Offeddu V, Yung CF, Low MSF, et al. Effectiveness of masks and respirators against respiratory infections in healthcare workers: a systematic review and meta-analysis. Clin Infect Dis 2017 Aug 7;65(11):1934-42
  50. Long Y, Hu T, Liu L, et al. Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta‐analysis. J Evid Based Med 2020 (published online Mar 13)
  51. MacIntyre CR, Chughtai AA, Rahman B, et al. The efficacy of medical masks and respirators against respiratory infection in healthcare workers. Influenza Other Respir Viruses 2017;11(6):511-7
  52. Loeb M, McGeer A, Henry B, et al. SARS among critical care nurses, Toronto.Emerg Infect Dis 2004 Feb;10(2):251-5