Opinion | According to the director general of the World Health Organization, Tedros Adhanom Ghebreyesus, life will not be returning to your old normal anytime soon. What’s more, things will only get worse unless the public follow health advice such as wearing masks and social distancing. The somber announcement came during a July 13, 2020, press conference.
This, despite the fact that the WHO’s June 5, 2020, guidance memo1 on face mask use states there’s no direct evidence that universal masking of healthy people is an effective intervention against respiratory illnesses.
What’s more, people are being urged to use cloth masks or bandanas (ostensibly to prevent shortages among health care staff), none of which conform to any kind of quality standards, and according to what little scientific evidence is available have been shown to provide only about half of what little protection you may get from a surgical mask.
No Direct Evidence to Support Universal Mask Usage
SARS-CoV-2 is a beta-coronavirus with a diameter between 60 nanometers (nm) and 140 nm, or 0.06 to 0.14 microns (micrometers).2 This is about half the size of most viruses, which tend to measure between 0.02 microns to 0.3 microns.3
Virus-laden saliva or respiratory droplets expelled when talking or coughing measure between 5 and 10 microns,4 and it is these droplets that surgical masks and respirators can block.
For example, N95 masks can filter particles as small as 0.3 microns,5 so they may prevent a majority of respiratory droplets from escaping. They cannot block aerosolized viruses, however, that are in the air itself. Additionally, many N95 masks only protect the wearer, as they have exhalation ports that allow you to exhale unfiltered air.
Lab testing6 has shown 3M surgical masks can block up to 75% of particles measuring between 0.02 microns and 1 micron, while cloth masks block between 30% and 60% of respiratory particles of this size. As noted in the WHO’s guidance memo:7
Meta-analyses in systematic literature reviews have reported that the use of N95 respirators compared with the use of medical masks is not associated with any statistically significant lower risk of the clinical respiratory illness outcomes or laboratory-confirmed influenza or viral infections …
The use of cloth masks (referred to as fabric masks in this document) as an alternative to medical masks is not considered appropriate for protection of health workers based on limited available evidence …
At present, 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.
Curiously, while cloth masks and face coverings are far less effective for blocking respiratory droplets, the WHO recommends that cloth or nonmedical masks “should only be considered for source control (used by infected persons) in community settings and not for prevention.”8
CDC Policy Review Found No Evidence of Usefulness Either
A policy review paper9 published in Emerging Infectious Diseases in May 2020—the Centers for Disease Control and Prevention’s own journal—has also reviewed “the evidence base on the effectiveness of nonpharmaceutical personal protective measures … in non-healthcare settings,” and they too found no evidence of benefit:
Although mechanistic studies support the potential effect of hand hygiene or face masks, evidence from 14 randomized controlled trials of these measures did not support a substantial effect on transmission of laboratory-confirmed influenza.
Pages 970 to 972 of the review include the following quotes:10
In our systematic review, we identified 10 RCTs [randomized controlled trials] that reported estimates of the effectiveness of face masks in reducing laboratory-confirmed influenza virus infections in the community from literature published during 1946–July 27, 2018. In pooled analysis, we found no significant reduction in influenza transmission with the use of face masks …
Disposable medical masks (also known as surgical masks) are loose-fitting devices that were designed to be worn by medical personnel to protect accidental contamination of patient wounds, and to protect the wearer against splashes or sprays of bodily fluids …
There is limited evidence for their effectiveness in preventing influenza virus transmission either when worn by the infected person for source control or when worn by uninfected persons to reduce exposure.
Our systematic review found no significant effect of face masks on transmission of laboratory-confirmed influenza … In this review, we did not find evidence to support a protective effect of personal protective measures or environmental measures in reducing influenza transmission.
These Mistakes Undermine the Protection Masks May Provide
If and when you do use a mask, you have to follow proper protocols, or else you can nullify what little protection they do offer against potentially infectious respiratory droplets. As detailed in WHO’s guidance memo, you need to make sure your medical mask is:11
- Changed when wet, soiled or damaged
- Untouched. Do not adjust or displace it from your face for any reason. “If this happens, the mask should be safely removed and replaced; and hand hygiene performed”
- Discarded and changed after caring for any patient on contact/droplet precautions for other pathogens
The memo also points out that “Staff who do not work in clinical areas do not need to use a medical mask during routine activities (e.g., administrative staff).” Now, if administrative hospital staff do not need to wear masks, why would healthy individuals need to wear them when walking around, especially in open-air areas?
Broward county, Florida, has gone so far as to issue an emergency order12 mandating masks to be worn inside your own residence. But why, if administrative hospital staff aren’t even advised to wear them at work?
In summary, it is likely that masks are not entirely useless in all circumstances. However, the literature rather strongly suggests the usefulness of masks depends on a significant number of factors—type, fit, length of use, purpose and circumstances—which are effectively impossible to account for in public universal-masking policies.
The science, contrary to the ignorant platitudes we are bombarded with, has NOT proven that universal masking is effective for viral containment, and has instead provided substantial grounds for skepticism of such a policy.
Benefits of Mask Wearing Do Not Include Infection Control
Despite the lack of scientific evidence showing masks do much of anything to prevent the spread of viral infections, the WHO still manages to make a case for universal mask wearing. The “potential benefits” listed, however, have little to do with health, and much more to do with learning submission. According to the WHO, potential benefits of mask wearing include:13
•“Reduced potential stigmatization of individuals wearing masks to prevent infecting others or of people caring for COVID-19 patients in nonclinical settings”—In other words, we should all wear masks to make people caring for COVID-19 patients feel more accepted, as if that’s actually a significant problem.
•“Making people feel they can play a role in contributing to stopping spread of the virus”—I.e., masks, while providing a false sense of security, make people feel like they’re “doing something” to help. Put another way, it makes people feel virtuous and “good.”
•“Reminding people to be compliant with other measures”—In other words, mask wearing is a sign of overall compliance.
•“Potential social and economic benefits”—This is perhaps the most ludicrously strained reason of all. According to the WHO:
Encouraging the public to create their own fabric masks may promote individual enterprise and community integration … The production of non-medical masks may offer a source of income for those able to manufacture masks within their communities. Fabric masks can also be a form of cultural expression, encouraging public acceptance of protection measures in general.
Potential Harms and Risks of Mask Wearing
The WHO also lists a number of potential harms and risks of mask wearing, which “should be carefully taken into account when adopting this approach of targeted continuous medical mask use.” These include:14
- Self-contamination due to the manipulation of the mask by contaminated hands or not changing the mask when wet, soiled or damaged
- General discomfort, as well as facial skin lesions, irritant dermatitis or worsening acne
- False sense of security that may reduce adherence to other well recognized preventive measures such as hand hygiene
- Disadvantages for or difficulty wearing them by specific vulnerable populations such as those with mental health disorders, developmental disabilities, the deaf and hard of hearing community, and children
- Difficulty wearing them in hot and humid environments
Aside from these, several people have demonstrated that masks can rapidly result in the buildup of toxic carbon dioxide, which can have a markedly detrimental impact on health.
In one video, a science teacher tried to evade YouTube censorship by saying children should wear face masks to school—all while holding up handwritten signs informing viewers the tactic was for censorship evasion, and to pay attention to the carbon dioxide metering results, which show carbon dioxide levels behind the mask shoot up above 10,000 parts per million (ppm) after just 10 breaths.
After garnering several hundred thousand views, the video was removed for “violating YouTube community guidelines.”
Del Bigtree of The Highwire has performed an identical demonstration.15 With an N95 mask on, the carbon dioxide level spikes above 8,480 ppm within seconds. Above 5,000 ppm, OSHA warns that “toxicity or oxygen deprivation could occur.”
Carbon dioxide levels between 2,000 ppm and 5,000 ppm are associated with headaches, sleepiness, poor concentration, loss of attention, increased heart rate and slight nausea. The maximum permissible daily exposure limit is 5,000 ppm.
Wearing a standard surgical mask, carbon dioxide levels again reached above 8,000 ppm, although it took longer. Shockingly, wearing a cloth bandana resulted in carbon dioxide buildup near the nose and mouth exceeding 8,000 ppm.
Even wearing a clear plastic face shield (without a mask) resulted in carbon dioxide levels in the 1,500-ppm range, which is associated with drowsiness and poor air quality. The video at the top of this section also addresses many of the potential harms and risks of masks wearing.
Toxic ingredients that can worsen breathing problems are yet another potential hazard of certain masks. For example, surgical masks are made of plastics like polypropylene, a known asthma trigger.16
The 2018 study,17 18 “Hypoxia Downregulates Protein S Expression,” also describes how hypoxia (low oxygen concentration) increases your risk of blood clots by reducing protein S, which is a natural anticoagulant. Wearing a mask, especially for long periods of time, may reduce your oxygen concentration, and considering COVID-19 is already associated with abnormal blood clotting, inducing hypoxia may be ill advised.
PPE Waste Is Becoming an Environmental Hazard
Last but not least, environmentalists are now warning that personal protective equipment (PPE) such as medical face masks may turn into a devastating environmental problem. As reported by The Guardian, June 8, 2020:19
The French non-profit Opération Mer Propre, whose activities include regularly picking up litter along the Côte d’Azur, began sounding the alarm late last month.
Divers had found what Joffrey Peltier of the organization described as ‘COVID waste’—dozens of gloves, masks and bottles of hand sanitizer beneath the waves of the Mediterranean, mixed in with the usual litter of disposable cups and aluminum cans … ‘It’s the promise of pollution to come if nothing is done,’ said Peltier.
In France alone, authorities have ordered two billion disposable masks, said Laurent Lombard of Opération Mer Propre. ‘Knowing that … soon we’ll run the risk of having more masks than jellyfish in the Mediterranean,’ he wrote on social media alongside video of a dive showing algae-entangled masks and soiled gloves in the sea near Antibes.
The group hopes the images will prompt people to embrace reusable masks and swap latex gloves for more frequent handwashing. ‘With all the alternatives, plastic isn’t the solution to protect us from COVID. That’s the message,’ said Peltier.
1 WHO.int Advice on the Use of Masks in the Context of COVID-19.
2 StatPearls July 4, 2020, Etiology.
3 SPhosp.org N95s — Sufficient Protection for COVID-19? (PDF).
4 WHO.int Transmission of SARS-CoV-2, Contact and Droplet Transmission.
5 See Footnote 3.
6 medRxiv April 24, 2020 DOI: 10.1101/2020.04.17.20069567 (PDF).
7 See Footnote 1.
9 Emerging Infectious Diseases May 2020; 26(5).
11 See Footnote 1.
12 Broward County Administrator Emergency Order 20-22 (PDF).
13 See Footnote 1.
15 The Highwire July 7, 2020.
16 Ontario Lung Association, Known Asthma Triggers (PDF).
17 Blood July 26, 2018; 132(4): 452-455.
18 Renegade Tribune July 26, 2020.
19 The Guardian June 8, 2020.
20 Pew Research June 23, 2020.