About those masks…
An oft-heard refrain from the masker crowd cites an imperative to "follow the science," implicitly suggesting those uneasy about being forced to wear masks are somehow intellectually deficient, or willfully ignorant.
Truth is, the maskers need to check their mask-muffled privilege, as the science is NOT on their side.
There are three essential elements to consider when making an honest appraisal of mask utility.
First, what is the nature of the infectious agent we're hoping to halt?
Regarding the nature of the coronavirus; like all viruses, it is incredibly small, tiny to the point of being submicroscopic, meaning even a lighted microscope can't see them, it takes specialized equipment to do so.
Because of its size, there is not a mask material that can prevent its movement AND permit the wearer to breathe. It's one or the other, not both.
"But Joe," you might say, "why do surgeons wear masks in the operating room?"
They realize the inability of masks to prevent virus transmission. They wear them hoping to halt the transmission of bacteria, and the occasional fleck of spittle that escapes from folks’ mouths from time to time.
You see, compared to a virus, bacteria are lumbering giants, more than 100 times larger and can be interdicted by masking. However, with the coronavirus, mandating mask use is like trying to use a chain link fence to catch a gnat. Masks are wholly ineffective against something as tiny and virulent as the coronavirus, but, that doesn’t mean they have no usefulness at all. They are still the banner of choice for gleeful virtue signaling and de jure discrimination against the “bare-faced.”
Second in our trio of essential elements to consider, is the virulence of the infectious agent. How much of it is necessary to create a successful infection in a host?
Mask mandate advocates anchor their argument on a “stopping most is better than stopping none” principle, which holds significant common-sense appeal for those who have not closely examined this second essential element of our appraisal of mask utility.
Mask efficiency is only a small part of the equation, because the minimal infective dose (MID) must also be considered. Simply defined, MID answers the question “how much of fill-in-the-blank does it take to get me sick?”
For example, if it takes a large number of pathogen-laden droplets for the illness to take hold, then even partial blocking by a mask or cloth can be enough to make a significant difference.
On the other hand, if the illness’s MID is met or exceeded by the transmission of a single aerosolized particle, (which we now know masks cannot prevent) then the mask is of no practical use. If one bullet strikes you, then stopping an infinite number of other bullets is meaningless - you’re still wounded (or dead!) from the one that got through.
Finally, is the suggested protocol capable of having a significant impact on the infectious agent in question.
Despite the evidence showing mask use cannot halt the transmission of the coronavirus (it’s too small), and stopping some, but not all, virus-laden particles will still leave you infected, can widespread mask use still have a beneficial effect overall?
Um... no. As the MID reveals, masks can't prevent the transmission of the viral aerosol, and, as every RCT study has shown, a single particle with a viral load is enough to infect a host, making mask wearing either a fashion statement, performance art, or simply your way of telling everyone how caring (and terrified!) you are.
Not to mention, there has been no major study to date that has addressed the disposal of contaminated masks. Now laden with at least some level of infectious agent, and a horrifyingly disgusting amount of ordinary bacteria, these used masks are a significant vector for further infection, not to mention just being profoundly gross! Public health officials have not yet deemed used masks to be “medical waste,” so their disposal is entirely uncontrolled and unmeasured.
Given what we know about the contagious nature of both bacteria and viruses, one might be forgiven for wondering if mask mandates aren’t creating a larger problem (infectious waste) than the one they are meant to minimize.
But, I must concede that mask mandates do serve one, very useful purpose - they help the rest of us to identify those among us with a propensity toward “boxcar stuffing,” and also those who might be relied upon to inform on their neighbors, Soviet-style, should the totalitarian Left ever get their grubby hands on the levers of power again. So, there's that benefit, but certainly not the one the maskers intended.
The nonsense has gone far enough. In states that have had mask mandates in place, the spread of the virus is unchanged. In states without mandates, the spread remains unchanged. Finally, the last nail in the coffin of the mandate-mavens, is the fact that here, in my state of Nebraska, we have not mandated masks, and have seen a steady decline in overall infections despite a great deal more testing. If we didn’t need masks to achieve this trendline, (see graph accompanying this article) then masking up now would be a mindless pursuit of some ephemeral “we’re all in it together,” notion, as described by the Douglas County Health Director, Dr. Adi Pour, when she floated to idea of mandating masks to further “our sense of community.”
Sorry Adi. Not me.
Find below a comprehensive compendium with links and annotations of the studies cited above, so all you "What's your source" automatons, don't get your knickers in a twist. Your homework has been done for you, complete with links (all underlined).
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.
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
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.
"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
"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
Clinical Infectious Diseases, Volume 65, Issue 11, 1 December 2017, Pages 1934–1942, https://doi.org/10.1093/cid/cix681
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
"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
"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."
From Dr. Denis Rancourt PhD, author of the paper from which this article is written:
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.
[The] Precautionary Principle [has been] 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.
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?
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
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
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).
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
Coburn, B. J. et al. (2009) "Modeling influenza epidemics and pandemics: insights into the future of swine flu (H1N1)", BMC Med 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
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
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
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,
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
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.
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
Leung, N.H.L. et al. (2020) "Respiratory virus shedding in exhaled breath and efficacy of face masks", Nature Medicine (2020).
Lowen, A. C. et al. (2007) "Influenza Virus Transmission Is Dependent on Relative Humidity and Temperature", PLoS Pathog 3(10): e151.
Paules, C. and Subbarao, S. (2017) "Influenza", Lancet, Seminar| Volume 390, ISSUE 10095, P697-708, August 12, 2017.
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 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
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
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).
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.
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.
Zwart, M. P. et al. (2009) "An experimental test of the independent action hypothesis in virus-insect pathosystems", Proc. R. Soc. B. 2762233-2242
Many thanks to Dr. John Dale Dunn for his compilation of sources and his numerous, patient, and long-suffering answers to my endless questions over the years.