Are Masks Necessary, Effective and Safe? Part 1

Introduction

In response to a recent article about churches and Covid compliance, I was asked “What if we did not wear masks and someone got Covid?” The question was based upon the belief that Covid is going to kill everyone and that masks will protect us from that. I believe both these assumptions to be fallacious and this paper is an attempt to address this. Please note, this is not an attack on people who prefer to wear masks as that it is their choice. I do believe that they should be informed of the risks and hazards (as with the injections). I am against compulsory mask mandates. I am going to be asking three things in this article:

  1. Does the Covid outbreak necessitate that the public wear masks?
  2. Would mask-wearing reduce the spread of Covid?
  3. Would mask-wearing cause any other medical issues?

In other words, are masks necessary, effective and safe? I will be looking at each of these in turn. I believe that any mask mandate must satisfy all three criteria. 2 out of 3 is not enough. I believe, however, that the mandates satisfy zero out of three. They are no more necessary than they are for protecting us against a common cold or the seasonal influenza. If we did wear them, it would not protect the wearer or the people around. It would also bring additional long term serious side effects.

Science, Reason and Common Sense

I am not a scientist. I am reliant on scientists to provide accurate and reliable information but in the end, I take a common sense approach especially where the scientific data is disputed or unclear. It is obvious to any casual observer that putting cloth against your nose and mouth does at the very least restrict your breathing to some degree. As a non-scientist, I would like to know how much it restricts your breathing and what the consequences of that restriction will be. Those questions can only be answered with more scientific data. I have tried to put together statements from various scientists, doctors and medical professionals in one place and I hope it will be easy reading. I have also provided the links so people can follow this for themselves and do their own research. It is appropriate to consider some historical and scientific observations. Did mask works in the Spanish flu? Did they ever work against the seasonal flu? How and why do surgeons wear masks and what does this mean for the general public? And can studies on mask-wearing be trusted and bias-free?

Did Masks Protect Against the Flu?

There were mask mandates in the days of the Spanish flu but, like today, there was rebellion and non-compliance with the mandates. Berkeley Library informs us that the masks did not work.

Mask skepticism was officially sanctioned by the Surgeon General of the US Navy in a 1919 report:

“No evidence was presented which would justify compelling persons at large to wear masks during an epidemic. The mask is designed only to afford protection against a direct spray from the mouth of the carrier of pathogenic microorganisms … Masks of improper design, made of wide-mesh gauze, which rest against the mouth and nose, become wet with saliva, soiled with the fingers, and are changed infrequently, may lead to infection rather than prevent it, especially when worn by persons who have not even a rudimentary knowledge of the modes of transmission of the causative agents of communicable diseases.”

Did Masks Work? May 3rd 2020.

I will be elaborating on these points and their application to Covid 19 in this article. The Surgeon General refers to masks that “become wet with saliva, soiled with the fingers, changed infrequently may lead to infection rather than prevent it” are similar to observations of Covid masks in our day. I have seen people coughing or sneezing into their masks and I have also seen people pulling dirty masks out of their pockets before donning them. Even by pulling them out with their hands, they could be soiling them. I do not need a peer reviewed study to know that this is unhygienic and unsafe.

Seasonal Flu: We have never worn masks to prevent the regular seasonal influenza and Cambridge University Press explained why back in 2010:

While there is some experimental evidence that masks should be able to reduce infectiousness under controlled conditions [7], there is less evidence on whether this translates to effectiveness in natural settings. There is little evidence to support the effectiveness of face masks to reduce the risk of infection. 

Cambridge University Press, January 22nd 2010

I will return later to specifically speak about the application of this to Covid 19. The point here is that “the science” has not supported mask wearing among the general public historically.

But don’t surgeons and doctors wear masks?

We cannot dispute that masks are used by surgeons, dentists and other experts when performing medical procedures. Does this validate the use of masks among the general population? Dr. Jim Meehan answers with a very loud “NO”

Based on extensive review and analysis, there is no question in my mind that healthy people should not be wearing surgical or cloth masks. Nor should we be recommending universal masking of all members of the population. 

The premise that surgeons wearing masks serves as evidence that “masks must work to prevent viral transmission” is a logical fallacy that I would classify as an argument of false equivalence, or comparing “apples to oranges.”

Principia Scientific, January 29th 2021

Please note that I have selected two important snippets from Meehan’s short article and I would highly recommend reading it all for context and clarity. Meehan makes several important points and shows why this argument is false equivalence. He points out that if the surgeons were sick, they would not perform operations at all. He states that surgeons never wear cloth masks (like the ones available on the high street today). He also reminds us that doctors and surgeons perform in stationary (non-energetic) and well-ventilated environments. They have to discard and change their masks every few hours for hygiene purposes. Whilst these professionals have been given training and official instruction on how to wear a mask and for how long, the general public have not been given sufficient guidance.

Guidance and Training on Mask Wearing

If this is the deadliest virus in history, I would expect there to be guidance and facilities for the proper usage, washing and disposal of masks. The CDC have themselves acknowledged this in their article favouring masks:

In lower-income settings, it is more likely that reusable cloth masks will be used rather than disposable medical masks because of cost and availability (38). There are still few uncertainties in the practice of face mask use, such as who should wear the mask and how long it should be used for. In theory, transmission should be reduced the most if both infected members and other contacts wear masks, but compliance in uninfected close contacts could be a problem (12,34). Proper use of face masks is essential because improper use might increase the risk for transmission (39). Thus, education on the proper use and disposal of used face masks, including hand hygiene, is also needed.

CDC, May 2020

If this needed advice has been given, has it been widely circulated? If it has, it is not being followed. Not only am I seeing people pull dirty masks out of their pockets before putting them on and wearing them for hours on end – I have also seen many discarded face masks littering the streets. They also advise that “improper use presents an increased risk of transmission” which may account for many cases in the last two years which could have been prevented.

Are Masks Effective for Surgeons?

The assumptions that masks are effective even in surgical environments have been disputed. A 1975 study concluded that

The wearing of a surgical face mask had no effect upon the overall operating room environmental contamination and probably work only to redirect the projectile effect of talking and breathing.

Ritter MA, Eitzen H, French ML, Hart JB. The operating room environment as affected by people and the surgical face mask. Clin Orthop Relat Res. 1975 Sep;(111):147-50. doi: 10.1097/00003086-197509000-00020. PMID: 1157412. Source

Moving forward to 1989, a study on masks during cardiac catherization concluded that:

No infections were found in any patient, regardless of whether a cap or mask was used. Thus, we found no evidence that caps or masks need to be worn during percutaneous cardiac catheterization.

Laslett LJ, Sabin A. Wearing of caps and masks not necessary during cardiac catheterization. Cathet Cardiovasc Diagn. 1989 Jul;17(3):158-60. doi: 10.1002/ccd.1810170306. PMID: 2766345.

Another study by Skinner and Sutton in 1991 informed us that

It has never been shown that wearing surgical face masks decreases postoperative wound infections. On the contrary, a 50% decrease has been reported after omitting face masks. ”

Tunevall TG. Postoperative wound infections and surgical face masks: a controlled study. World J Surg. 1991 May-Jun;15(3):383-7; discussion 387-8. doi: 10.1007/BF01658736. PMID: 1853618.

Another medical study in 2009 on masks and wound infections concluded:

No significance difference in the incidence of postoperative wound infection was observed between masks group and groups operated with no masks (1.34, 95% CI, 0.58-3.07). There was no increase in infection rate in 1980 when masks were discarded. In fact there was significant decrease in infection rate (p < 0.05).

Bahli ZM. Does evidence based medicine support the effectiveness of surgical facemasks in preventing postoperative wound infections in elective surgery? J Ayub Med Coll Abbottabad. 2009 Apr-Jun;21(2):166-70. PMID: 20524498.

Another by Lipp and Edwards affiliated to the School of Care Sciences at the University of Glamorgan concluded:

Surgical face masks have recently been advocated as a protective barrier between the surgical team and the patient, but the role of the surgical face mask as an effective measure in preventing surgical wound infections is questionable…

From the limited results it is unclear whether wearing surgical face masks results in any harm or benefit to the patient undergoing clean surgery.

Lipp A, Edwards P. Disposable surgical face masks: a systematic review. Can Oper Room Nurs J. 2005 Sep;23(3):20-1, 24-5, 33-8. PMID: 16295987.

So from the Spanish flu until Covid 19, the overwhelming evidence was that masks were ineffective for the public and highly questionable for medical personnel.

Refuting Some General Arguments for Masks

The above evidence puts to rest common argument made by those in favour of mask mandates. The first argument is that the WHO and the CDC changed their policy in favour of masks because it was expedient. These mask advocates argue that they always knew that masks were effective but they did not want to tell the public that at the time. That was because the CDC feared that would it trigger panic buying when PPE was in short supply. Once masks became available, they were (apparently) able to tell the truth and issue mask mandates. If this is true, where was the evidence for mask effectiveness prior to 2020 and how do they account for nearly 100 years of scientific advice against them? This argument is so weak and unfounded that I am not going to spend any more time on it.

The second argument is that the science changed in 2020 because not enough studies were done previously. Due to the Covid outbreak, studies were apparently needed and these studies proved it to be effective. But the fact is that many studies were done prior to this time to review their effectiveness on various settings and the conclusion was always the same. The evidence was against masks or at least lacking any positive proof. I will come back to some of these studies shortly.

Are Studies on Public Mask-Wearing Reliable?

I trust the aforementioned studies because they were performed in controlled environments like surgical theatres. Studies performed among the general public are different kettle of fish. Denis G. Rancourt, Professor of Physics at the University of Ottawa Canada, criticises all such studies on mask wearing among the public. He warns that it is “impossible to obtain unambiguous and biasfree results.” He cites several reasons for this including:

Mask compliance and mask adjustment habits would be unknown.
• Mask-wearing is associated (correlated) with several other health behaviours.
• The results would not be transferable, because of differing cultural habits.
• 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.
• 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.

Principia Scientific, May 25th 2020 (please see link for full list and references)

As the professor points out, there are too variables in studies among the public. An example of point 5 is a study by the Lancet in January 2021 where “the authors made use of online survey responses of mask usage from thousands of individuals across the country over time to measure the relationship between mask wearing and community transmission control.” This was not an objective study because it relies on the respondents having entirely unbiased perspectives and motives. The Lancet is known by many to the “gold standard” when it comes to scientific research and one of their earlier studies in June 2020 concluded that masks really were effective in preventing transmission of Coronavirus. This study was influential in changing CDC and WHO policy on masks who then advocated mask wearing. Consequently, governments around the world issued mask mandates to their citizens.

The June 2020 Lancet Study

The Lancet study was published in June 2020 and it contradicted all the previous advice. Between the Spanish flu and early 2020, the consensus in the scientific community was against wearing face masks. Even as late as January 2020 (a few months before the Lancet study) the American Medical Association advised:

Face masks should be used only by individuals who have symptoms of respiratory infection such as coughing, sneezing, or, in some cases, fever… Face masks should not be worn by healthy individuals to protect themselves from acquiring respiratory infection because there is no evidence to suggest that face masks worn by healthy individuals are effective in preventing people from becoming ill. 

Journal of American Medical Association, January 28th 2020

Shortly after the Lancet study, a report by The National Center for Biotechnology Information concluded that “There is no good evidence that facemasks protect the public against infection with respiratory viruses, including COVID‐19.” How did this one study by the Lancet overturn 100 years of scientific advice in one day? The plot thickens when we consider that it comes from a respected scientific journal. That does not guarantee the study is correct and it was criticised by the Swiss Policy Research organisation who pointed out several “serious flaws”. The SPR states that the Lancet misrepresented several studies including non-Covid studies. Vancouver Coastal Health appears to concur and say that only seven studies (out more than 20) cited by the Lancet relate to Covid-19.

Can The Lancet Be Trusted?

It is worth noting that this is not the first time that the credibility of the Lancet has been questioned. Prior to this, they were rightly criticised for retracting a study on hydroxychloroquine (HCQ). This study alleged that people were dying or developing heart related complications after using HCQ to treat Covid but later they requested the study to be retracted. According to the Guardian

The lead author, Prof Mandeep Mehra, from the Brigham and Women’s hospital in Boston, Massachusetts decided to ask the Lancet for the retraction because he could no longer vouch for the data’s accuracy.

The journal’s editor, Richard Horton, said he was appalled by developments. “This is a shocking example of research misconduct in the middle of a global health emergency,” he told the Guardian.

The Guardian, June 4th 2020

The Health Site aptly said “this takes the lid off what could very well be the first COVID-19 research scandal”. As with their study on masks, the Lancet study on masks caused a big societal and political change. It prevented a potential, cost effective treatment being made available to the public. It seriously begs the question as to what else the Lancet could get wrong. I would encourage my readers not to take my word for it. It is important to do you own research and I have included links for anyone who wants to look into this in more depth.

MIT and Other Mask Studies

Another study was published by the Massachusetts Institute of Technology on Medrxiv which advocated that mask mandates decreased hospitalisations in US counties. That study (as acknowledged on their own site) was later withdrawn because rates of Covid 19 had increased since the original study. It has also been pointed out that studies like this are built on assumptions that the mandates received sufficient compliance and enforcement. Just because a mandate is passed does not guarantee that everyone will comply and it also does not guarantee that it will be enforced. This makes the data too variable and the results will be questionable. A later study (May 2021) on the same site concluded that:

Mask mandates and use are not associated with slower state-level COVID-19 spread during COVID-19 growth surges. Containment requires future research and implementation of existing efficacious strategies.

Danmask 19

Another study in Denmark May 2020 reached a similar conclusion. This became known as the Danmask 19 and the Observer reported on this:

The ‘Danmask-19 trial’ was conducted in the spring with over 6,000 participants, when the public were not being told to wear masks but other public health measures were in place. Unlike other studies looking at masks, the Danmask study was a randomised controlled trial – making it the highest quality scientific evidence.

The Spectator, November 19th 2020

The conclusion of the study was:

The recommendation to wear surgical masks to supplement other public health measures did not reduce the SARS-CoV-2 infection rate among wearers by more than 50% in a community with modest infection rates, some degree of social distancing, and uncommon general mask use. The data were compatible with lesser degrees of self-protection.

Annals of Internal Medicine, March 2021

This study takes us back full circle to the official position on masks during the Spanish flu. We could go citing studies ad nauseam, ad infinitum and get nowhere.

A Personal Perspective

For now, I am going to add my own personal perspective: Whilst some studies can be objective, they can also be misused to obfuscate things that would otherwise be clear and simple. They can also be misused to “validate” a predetermined outcome. A case in point is a recent study advocates that confirms that wearing masks makes you more attractive. That is just laughable! In online discussion, a research professional referred me to this Lancet study and argued the science has been updated. This was very long, technical and tedious document for a non-scientist (with limited time and energy) to plough through. The phase “blinding people with science comes to mind” but I took the challenge. I tried to digest the study and also read other professional criticisms on the study. After this, I came away completely unsatisfied and left wondering if this research professional had done her job. It was frustrating because it took her less than 5 minutes to throw this study at me but it took me hours to analyse it. It appears that either she did not read it herself or if she had, she had failed to notice or mention the errors. Many casual readers would not even attempt it. They would give up after seeing the length of the study and the overwhelming use of technical language. To be fair, I got quite overwhelmed with much of it so I had to seek some assistance. Casual readers would conclude “this comes from a professional, reputable source so it must be correct.” Many people with an axe to grind rely on this and hope that people don’t dig deep or start thinking for themselves. For this reason, I take any study arguing for the effectiveness of masks with a pinch of salt.

In Part 2 of this series I am going to be focusing more directly on whether masks are necessary and safe. Please click here to go there.

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