Research does not support face mask orders

OPINION

BY LEN CABRERA AND JENNIFER CABRERA

This article is the second in a two-part series. The first article, which covers the potential for cognitive impairment and other risks from CO2 build-up in masks, is here.

Section 27.08(5) of Alachua County’s Charter spells out limitations on emergency orders: “Such executive orders shall be limited to those necessary to eliminate or contain conditions that threaten the health, safety, or welfare of the citizens of the county” (emphasis added). County commissioners have not made a case for the necessity of mask wearing by the general public, and they can’t, because there is little evidence showing that such a policy prevents transmission of COVID-19.

The World Health Organization (WHO) also seems to have caved to popular opinion and political pressure, exemplified by Oxford Professor Trisha Greenhalgh, who was quoted by Vox saying that the public should wear masks “on the grounds that we have little to lose and potentially something to gain.” The problem is that there is very little evidence that there is much  to gain, and there is more to lose than mask advocates care to admit.

The WHO’s April 6 guidelines recommended that members of the general public “only need to wear a mask if you are taking care of a person with COVID-19” or “if you are coughing or sneezing.” The updated June 5 guidelines say, “governments should encourage the general public to wear masks in specific situations and settings as part of a comprehensive approach to suppress SARS-CoV-2 transmission.”

But what are those specific situations? What reasoning do the guidelines provide? What exactly are the benefits of mask-wearing by the general public?

Alachua County wants people to wear masks in grocery stores, but the WHO guidelines (Table 2, page 7) specifically say masks should only be worn by the general population in grocery stores if there is “known or suspected widespread transmission and limited or no capacity to implement other containment measures such as physical distancing, contact tracing, appropriate testing, isolation and care for suspected and confirmed cases” (emphasis added). Are the county commissioners admitting that they have not made the proper arrangements to have sufficient testing resources or hospital beds available?

Despite the WHO’s new position on encouraging face masks, the June 5 guidelines state:

• “There is limited evidence that wearing a medical mask by healthy individuals in households… or among attendees of mass gatherings may be beneficial as a measure preventing transmission.”
• “cluster randomized controlled trials… showed no impact on risk of laboratory-confirmed influenza.”
• “There is no direct evidence (from studies on COVID-19 and in healthy people in the community) on the effectiveness of universal masking of healthy people in the community to prevent infection with respiratory viruses, including COVID-19.”
• “At the present time, the widespread use of masks by healthy people in the community setting is not yet supported by high quality or direct scientific evidence and there are potential benefits and harms to consider.”

As if those caveats were not enough, senior officials from the WHO seem to contradict their own guidance to encourage masks. In a June 3 press conference, WHO infectious disease epidemiologist Michael Ryan said masks should primarily be used “for purposes of source control–in other words, for people who may be infectious.” In a June 5 press conference, WHO Director-General Tedros Adhanom said, “Masks can also create a false sense of security, leading people to neglect measures, such as hand hygiene and physical distancing. I cannot say this clearly enough: Masks alone will not protect you from COVID-19.”

“Potentially something to gain”

A meta-review published in The Lancet looked at 172 studies on COVID-19, SARS, and MERS. It concluded that masks only reduce the risk of infection by 14 percent.

Mask proponents counter that the masks are not intended to prevent the wearer from being infected, but to stop the spread. Vox claims that a change from 50 percent to 80 percent of the population wearing masks reduces COVID-19 spread by (only) 8.4 percent, but we could not verify this number using the links in the Vox article.

The studies cited by Vox, which they claim show benefits of mask wearing, are based on models that assume masks work. For example, a paper by the Epidemiology and Modeling Group at the University of Cambridge begins by assuming that masks are 50% effective at stopping exhaled virus. This is the same assumption made by the mask4all “mind-blowing” simulation video. The paper backing their video buries the assumption in two places: “The factor by which β was reduced was conservatively set to 2” and “A susceptible individual may become exposed if they interact with an infectious individual at rate β.” 

The Cambridge authors admit they “make assumptions and simplifications about the effectiveness of facemasks,” and they also say the effectiveness number is based on bacterial studies, which are irrelevant since “the largest virus is smaller than the smallest bacterium,” according to WebMD.

Other papers offer pure speculation, like one in the American Association for the Advancement of Science that argues six feet is not far enough for social distancing. The authors argue for masks on the basis that they stop virus-containing droplets (5-10 microns), but then they admit that “SARS-CoV-2 virions are contained in submicron aerosols, as is the case for influenza virus.” The larger droplets fall to the ground quickly, so masks would theoretically be most useful in stopping aerosols; however, actual tests of cloth face masks show they allow between 74% and 90% penetration by aerosols. 

Mask wearing should be based on actual science, not mathematical models. Most of the federal and state response to COVID-19 was based on the Institute for Health Metrics and Evaluation (IHME) model from the University of Washington, despite many medical experts warning against it (including Dr. Bendavid and Dr. Bhattacharya, Dr. David Katz,  Dr. Michael Osterholm, and Dr. Scott Atlas). A review of those predictions by Cornell University found that “deaths fell outside the IHME prediction intervals as much as 70% of the time.” Those were 95% confidence intervals, so only 5% of actual observations should have fallen outside the predictions.

Paul Hunter, professor in medicine at the University of East Anglia, did a review of 31 studies with 4 other researchers. He told Vox, “Randomized-controlled trials are supposed to trump observational studies… and randomized-controlled trials have all been pretty much negative on face masks in the community.”

Denis Rancourt did a similar review of medical literature and concluded, “extensive randomized controlled trial (RCT) studies… all show that masks and respirators do not work to prevent respiratory influenza-like illnesses.” Some of the results he cited:

• N95-masked health-care workers were significantly more likely to experience headaches; masks provide no benefit for cold symptoms (Jacobs, J. L. et al., 2009).
• Masks do not prevent transmission of influenza virus by health-care workers or community members in households (Cowling, B. et al., 2010).
• None of the 17 studies reviewed established a conclusive relationship between mask/respirator use and protection against influenza infection (bin-Reza et al. 2012).
• No statistically-significant protective effect of masks or respirators against respiratory infection was found (Offeddu, V. et al. 2017).

Rancourt wrote, “no study exists that shows a benefit from a broad policy to wear masks in public.” His work is echoed by Dr. Brosseau and Dr. Sietsema in an article for the Center for Infectious Disease Research and Policy. They do not recommend masks for the general public because “there is no scientific evidence they are effective in reducing the risk of SARS-CoV-2 transmission.” They argue that mask wearing did not affect COVID-19 transmission in Hubei, China. The article says, “studies demonstrate that cloth or homemade masks will have very low filter efficiency (2% to 38%)… there is no evidence to support their use by the public or healthcare workers to control the emission of particles from the wearer.”

Even if the mask did prevent spread, it would only do so for about 20 minutes. Quebec’s public health director Horacio Arruda told the Montreal Gazette that masks get saturated with moisture from the mouth and nose. Once wet, the masks are even less effective barriers against viruses. He said masks work for medical professionals because they follow strict guidelines for taking them on and off and discard them after each use. Even if you believe masks are effective, that mask your grocery store clerk or restaurant server is wearing probably stopped doing anything hours ago.

In addition, there is widespread confusion about the purpose of different types of masks. N95 respirators, particularly those with exhalation valves, are designed to protect the wearer. Masks with exhalation valves provide NO outgoing filtering, and we’ve seen them used by servers in restaurants.

It’s no wonder that the Occupational Safety and Health Administration (OSHA) Guidance on Preparing Workplaces for COVID-19 (OSHA 3990-03 2020) lists masks and other personal protective equipment as the “least effective protection measure.” The Advertising Standards Authority in the United Kingdom banned ads for face masks because they’re  “misleading, irresponsible and scaremongering.”

Several national health services do not recommend masks:

• The Danish Health Authority “does not encourage healthy individuals who go about their daily business to wear mouth or face masks as it is uncertain that they have any effect on virus transmission… Furthermore, mouth or face masks can cause more harm than good.”
• “There is no evidence that the extensive use of masks by healthy people will help reduce infections.” (Finish Institute for Health and Welfare)
• “There is no scientific basis for recommending the general use of face masks in the population” (Norwegian Institute of Public Health)
• “Face masks are not needed in everyday life.” (Public Health Agency of Sweden)
• UK National Health Service only recommends face coverings on public transport or when visiting a hospital.

Even in surgical settings, there is no evidence that masks protect the patient. This study by Tunevall states, “It has never been shown that wearing surgical face masks decreases postoperative wound infections. On the contrary, a 50% decrease had been reported after omitting face masks.” Brosseau concludes, “Despite these findings, it has been difficult for surgeons to give up a long-standing practice.”

“Little to lose” or “significant unforeseen harm”?

In early March, the UK Telegraph wrote, “There is no reliable scientific evidence to suggest [face masks] work at scale and experts, always alert to the law of unintended consequences, worry they may cause significant unforeseen harm.” Mask proponents do not seem concerned about those consequences, which include impaired thinking or coordination, weakened immune systems, increased spread of viruses, and increased liability for businesses.

We covered confusion, headaches, and suppression of the immune system due to build-up of CO2 inside the mask (hypercapnia) in a separate article. 

Repeatedly taking the mask on and off can actually increase the spread of viruses. Even Dr. Fauci admitted in a 60 Minutes interview: “People who wear masks tend to touch their face more often to adjust them, which can spread germs from their hands.” We’ve all seen mask-wearers constantly adjusting the mask and then touching surfaces in stores and restaurants. 

Denis Rancourt’s literature review concluded with several “potential harms,” including “sources of enhanced transmission,” masks collecting and retaining “pathogens that the mask wearer would otherwise avoid,” and “dangers of bacterial growth on a used and loaded mask.” Dr. Russell Blaylock warns, “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.”

These potential harms present interesting liability issues for employers (even without potential accidents from the cognitive effects of hypercapnia). Also, according to CDC Guidance, employees are supposed to wash their hands “after putting on, touching, or removing cloth face coverings.” That means they must wash their hands every time they touch the mask. Each masked employee represents a potential fine or lawsuit if they are seen touching their face mask.

OSHA Guidance says personal protective equipment (including masks) must be “properly removed, cleaned, and stored or disposed of, as applicable, to avoid contamination of self, others, or the environment.” According to Florida Administrative Code Rule 64E-16.002, used masks are considered biomedical waste (“Any solid or liquid waste which may present a threat of infection… wastes which contain human disease-causing agents”). Are companies that offer masks to customers or employees also responsible for the proper disposal of those masks? Are they ensuring proper decontamination of employee masks that get reused or proper storage before cleaning?

By law (29 USC 654(a)(1)), an employer is required to provide a workplace “free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees.” There are various ways face masks can present hazards in the workplace. Just because the government encourages or requires masks, employers are not protected from the liabilities that come with them.

It’s easy for the Alachua County Commission to mandate masks under the assumption that “we have little to lose and potentially something to gain,” as Trisha Greenhalgh said. The commissioners will not be held responsible for any injuries or illnesses their policy could cause. Even if the County is sued, any penalties will be paid by taxpayers, not the commissioners themselves.

It is clear that research does not support claims that masks are effective in limiting the spread of COVID-19. It cannot be argued that ineffective measures are “necessary to eliminate or contain conditions that threaten the health, safety, or welfare of the citizens of the county,” as is required by the County Charter, so the emergency order that mandates masks should be revoked, and it would be best to do so before a business is sued for one of the many downsides of forcing all their employees and customers to wear masks.