Efficacy of Masks

There are many who argue that the mandating of treatment, prophylactic or otherwise, on a population with capacity to make decisions, is entirely unethical.

Yet we need not delve into debates concerning the morality of mask mandates if the science behind such a decision disproves their efficacy.

There is no doubt the topic is highly polarised and politicised and perhaps hides a bitter truth on the state of the research that lies behind it or its ability to surface to the mainstream view.

It is entirely sensible to invent and trial plausible ways to mitigate transmission of Sars-Cov-2 Virus given its global spread and impact. Masks represent a potential, easily implementable method of influencing transmission of this pathogen.We must however, as always, be loyal to what the science indicates. It would appear that despite two decades of pandemic preparedness, there is considerable uncertainty as to the value of wearing masks.

Usually, where there lies uncertainty on the value of such global interventions and where the stakes are so high, there should be swift and well-designed studies to seek the answer. This has not been undertaken with regards to masks, until now.

What is obvious is that politics has come first, followed by scientific review.

Previous observational studies within the clinical setting have had mixed results with some suggesting benefit of wearing masks in the reduction of viral transmission1, whilst previous meta-analysis of PPE (Personal Protective equipment) in reducing Influenza spread in Hospitals proved to have no significant benefit2.

It is also unclear whether the observed association between masks and reduction in Covid arises because masks protect uninfected wearers (protective effect) or because transmission is reduced from infected mask wearers (source control).

As pointed out by the Centre of Evidence-Based Medicine6

" It is unwise to infer causation based on regional geographical observations as several proponents of masks have done. "

Their effectiveness in the public in a largely asymptomatic population is a different question requiring its own investigation as currently the World Health Organisation (WHO) admits it lacks evidence that wearing a mask protects healthy persons from SARS-CoV-2

" At present, there is no direct evidence (from studies on COVID-19 and in healthy people in the community) on the effective- ness of universal masking of healthy people in the community to prevent infection with respiratory viruses, including COVID-19 "

In a Norwegian study,it stated

" 200 000 people would need to wear one to prevent one new infection per week "

The measuring of the effectiveness of masks is not an easy task, with many variables to consider but this was the objective of a recent landmark study and the first randomized controlled trial on the subject. The “Danmask-19 Trial”which included more than 6,000 individuals, aimed to prove effectiveness of surgical face masks against SARS-CoV-2 infection specifically. This remains the most well-controlled study on the efficacy on masks.

To qualify for the trial, participants had to spend at least three hours per day outside the home and not be required to wear a mask for occupational reasons. At the end of the study, participants reported having spent a median of 4.5 hours per day outside the home.

For one month, participants in the mask group were instructed to wear a mask whenever they were outside their home. Surgical face masks with a filtration rate of 98% were supplied. In accordance with recommendations from the World Health Organization, participants were instructed to change their mask after eight hours.

Antibody testing was performed before the outset and at the end of the study period. At the end of the month, they also submitted a nasal swab sample for PCR testing.

What They Found

Among mask wearers, 1.8% (42 participants) ended up testing positive for SARS-CoV-2, compared to 2.1% (53) among controls. This suggests adherence makes no difference as they concluded:

" A recommendation to wear a surgical mask when outside the home among others did not reduce, at conventional levels of statistical significance, incident SARS-CoV-2 infection compared with no mask recommendation. "

Interestingly, 1.4% (33 participants) tested positive for antibodies compared to 1.8% (44) of controls. The relevance of this unclear but may suggest improved immunity in those not wearing masks by slightly increase exposure.

During the study period, authorities did not recommend face mask use outside hospital settings and mask use was rare in community settings. This means that study participants’ exposure was overwhelmingly to persons not wearing masks. For this reason, they have stated the findings, should not be used to conclude that a recommendation for everyone to wear masks in the community would not be effective in reducing SARS-CoV-2 infections, because the trial did not test the role of masks in source control of SARS-CoV-2 infection.

This means, there is no proof that wearing a mask will stop you from contracting the disease but there yet remains any evidence to determine if the masks stop someone with Covid from spreading it.

The primary purpose of the maskis to catch the droplets of viral-containing sputum. If the pathogen is aerosolised as is proposed by the CDC, meaning it can suspend in the air then it would of course circumvent or penetrate the mask. For this reason, there is extra precaution taken in hospitals currently where suspected or confirmed Covid-19 patients are undergoing “Aerosol-generating Procedures”. If this is common route of transmission it would render the masks pointless

During this study participants were instructed on proper face-mask use with ones provided to them because in theory Masks can work well when they’re fully sealed, properly fitted, changed often, and have a filter designed for virus-sized particles. What is adopted by the general public is anything but these things conditions. Many forms of home-made masks have doubtful protection and there use and disposal anything but sanitary. Noticing how many people have masks with personalised designs on suggests they are not replacing them and for everyone one discarded, unless done properly represents a potential biohazard4.

Unless frequently replaced (or washed) these masks represent a constantly updating Petri dish where pathogens accumulate, that the user is touching frequently before handling items in shops, posing a potential for increased transmission.

Another take-home point that you get from this study, is that the vast majority — 97.9% of those who didn’t wear masks, and 98.2% of those who did — remained infection free.

The threat globally still remains very low questioning whether intervention is so quintessential when the risk to perceived benefit is still staggeringly small.

Unsurprisingly, they faced challenges when attempting to publish this study, a common theme when the evidence is in contravention to harsh government rules.

They are not the first to suggest the futility of mask wearing in public:

" There is insufficient evidence to support the claim that masks reduce the infectious dose of SARS-CoV-2 and the severity of Covid-19 – NE Journal of Medicine. "

" likely negative impacts outweighed any benefits " – NorwegianPublicHealth

" From a population perspective, one can argue that wearing a facemask would neither be worth the public’s money nor outweigh any potential harms " – TheLancetRespiratoryMedicine

This study aimed to answer a single question, does face mask wearing protect you from Covid? However, the decision to mandate the use of masks in public must be a wholesome one where the cost; financially, socially, environmentally and potential harmful physical effects on the user are taken into account.

Here are some side-effects and considerations as published in the British Medical Journal (BMJ)7:

  • The quality and volume of speech between people wearing masks is considerably compromised and they may unconsciously come closer
  • Wearing a mask makes the exhaled air go into the eyes. This generates an impulse to touch the eyes. If your hands are contaminated, you are infecting yourself
  • Face masks make breathing more difficult. Moreover, a fraction of carbon dioxide previously exhaled is inhaled at each respiratory cycle. Those phenomena increase breathing frequency and deepness, and they 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
  • The innate immunity’s efficacy is highly dependent on the viral load.If masks determine a humid habitat where SARS-CoV-2 can remain active because of the water vapour continuously provided by breathing and captured by the mask fabric, they determine an increase in viral load (by re-inhaling exhaled viruses) and therefore they can cause a defeat of the innate immunity and an increase in infections.

In a study on the use of masks on healthcare workers, in addition to numerous other side effects and complications, they found

" 58.2% of the participants developed trouble breathing on exertion while wearing masks which is probably due to the tight mask causing hypercapnic (high levels of Carbon Dioxide) hypoxic (Low levels of Oxygen) environment leading to numerous physiological alterations such as cardio-respiratory stress and metabolic shift. "

What is becoming clearer with each day is the militancy behind mask-wearing, not as a healthy and logical measure but as a consequence of an ideology routed in fear. Whilst it might soothe the anxieties of the user, it does little else. Emboldened by spineless leaders, based on pseudo-science,a prophylaxis has been forced on the population that is causing more harm than good.

As a complement to the Danish study, data analysis by Yinon Weiss in the Federalist11compares different countries and the times at which they implemented this measure, concluding

" Mask rules appear to have had nothing to do with infection rates, which is what you’d expect if masks don’t work. "

" Weiss points out that, “No matter how strictly mask laws are enforced nor the level of mask compliance the population follows, cases all fall and rise around the same time.”

As the fear continues to grip nations, governments are bearing down with greater pressures to adopt masks in complete contravention to what the evidence tells us with more people wearing masks more often. We have departed from any scientific sense to highly-charged political circus driven by emotion and ulterior motives.

Martin Kulldorff, a professor at Harvard Medical School and a leader in disease surveillance methods and infectious disease outbreaks, describes the current COVID scientific environment this way:

" After 300 years, the Age of Enlightenment has ended."

This virus will not be going away anytime soon therefore we must learning instead how to live with it and mitigate risk by enhancing our immune systems, something that is essential in prospering in the face of a disease threat. We should not abdicate responsibility of our health to Politicians

In an October 28, 2020, Wall Street Journal opinion piece,27 Joseph Ladapo, an associate professor at UCLA’s David Geffen School of Medicine, points out that we really must accept reality and move on with life, unpredictable as it may be. He writes:

" By paying outsize and scientifically unjustified attention to masking, mask mandates have the unintended consequence of delaying public acceptance of the unavoidable truth. "

In countries with active community transmission and no herd immunity, nothing short of inhumane lockdowns can stop the spread of COVID-19, so the most sensible and sustainable path forward is to learn to live with the virus.

Shifting focus away from mask mandates and toward the reality of respiratory viral spread will free up time and resources to protect the most vulnerable Americans …

Until the reality of viral spread in the U.S. … is accepted, political leaders will continue to feel justified in keeping schools and businesses closed, robbing young people of the opportunity to invest in their futures, and restricting activities that make life worthwhile10.”

The masks are one facet of a program of change that is conditioning people to make fear-based decisions and grow ever sceptical of fellow people.

It is not just a small inconvenience it is a key impediment in preventing us returning to any semblance of normality where we can live and thrive together. They are a constant anchor to panic and a barrier to human communication and emotion. It is a hurdle we must overcome.

  1. Wang X ,  Ferro EG ,  Zhou G , et al. Association between universal masking in a health care system and SARS-CoV-2 positivity among health care workers. JAMA. 2020. [PMID: 32663246] doi:1001/jama.2020.12897
  2. Saunders-Hastings P, Crispo JAG, Sikora L, Krewski D. Effectiveness of personal protective measures in reducing pandemic influenza transmission: A systematic review and meta-analysis. Epidemics. 2017 Sep;20:1-20. doi: 10.1016/j.epidem.2017.04.003. Epub 2017 Apr 30. PMID: 28487207.
  3. World Health Organization. Advice on the use of masks in the context of COVID-19: interim guidance. 5 June 2020.
  4. Bamber JH, Christmas T. Covid-19: Each discarded face mask is a potential biohazard. BMJ. 2020 May 21;369:m2012. doi: 10.1136/bmj.m2012. PMID: 32439723.
  5. Should individuals in the community without respiratory symptoms wear facemasks to reduce the spread of COVID-19? Norwegian Institute of Public Health https://www.fhi.no/globalassets/dokumenterfiler/rapporter/2020/should-individuals-in-the-community-without-respiratory-symptoms-wear-facemasks-to-reduce-the-spread-of-covid-19-report-2020.pdf
  6. Tom Jefferson, Carl Heneghan, Masking lack of evidence with politicsJuly 23, 2020, https://www.cebm.net/covid-19/masking-lack-of-evidence-with-politics/
  7. Covid-19: Important potential side effects of wearing face masks that we should bear in mindBMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2003 (Published 21 May 2020), BMJ 2020;369:m2003
  8. Purushothaman, P.K., Priyangha, E. & Vaidhyswaran, R. Effects of Prolonged Use of Facemask on Healthcare Workers in Tertiary Care Hospital During COVID-19 Pandemic.Indian J Otolaryngol Head Neck Surg (2020). https://doi.org/10.1007/s12070-020-02124-0
  9. Our immune systems can cope with Covid-19 – it’s our politicians who can’tAngela Rasmussen, The Guardian, 15 Nov 2020 https://www.theguardian.com/commentisfree/2020/nov/15/immune-systems-covid-19-politicians-virus?fbclid=IwAR2JtuMm77N1FoHYOG_3cXEjQEGfbKOc0LzIO_-U5Gx5xGCemGv_FLWrdcE
  10. Masks Are a Distraction From the Pandemic Reality Viruses inevitably spread, and authorities have oversold face coverings as a preventive measure.By Joseph A. LadapoOct. 28, 2020 7:17 pm ET, WSJ Opinion
  11. These 12 Graphs Show Mask Mandates Do Nothing To Stop COVID, Yinon Weiss, Oct 29 2020 https://thefederalist.com/2020/10/29/these-12-graphs-show-mask-mandates-do-nothing-to-stop-covid/