COVID-19 Masks: How Effective and How Safe?
By: John Droz, Jr.
11-21-21 (revision 11-23-21)
Table of Contents
Chapter 1 - Introduction............................................... 3
Chapter 2 - Sample Mask Efficacy Studies .............. 4
Chapter 3 - Sample Mask Safety Studies............... 10
Chapter 4 - Conclusions.............................................. 15
Appendix A: Some Facts and Figures................. 16
Appendix B: What About Conflicting Reports? .... 17
Appendix C: Masks and Vaccination Status .... 18
Appendix D: Some Sample References.............. 19
Note 1: All of this Report's Table of Contents sections above, are clickable links.
In the Report, all of the underlined blue text are all also clickable links.
Note 2: Physicist John Droz, jr is the editor of this report.
Please Email him with any questions, corrections or additions.
Cover graphic credit.
Chapter 1: Introduction
The COVID-19 pandemic is clearly a complex, technical matter. But the good news is that Science exists to give us answers to our technical issues.
As such, every COVID-19 policy (e.g., about masks, vaccinations, therapies, etc.) should be firmly based on real Science. If they are, we will have a high degree of success.
Unfortunately, that is not happening, due to: a) bad actors who see this pandemic as an opportunity to make a financial profit or to gain political power, and b) well-intentioned parties who simply don’t understand how to apply real Science to COVID-19 issues.
Currently the main challenger to real Science, is political science (aka politics). Citizens need to be on high alert for cases where political science is misrepresented as being real Science. That’s a primary objective of all of our reports: to separate the real from the pretender.
This scientific study concluded that “public health has reneged on its core principles."
Whether masks are good or bad comes down to two questions: a) are they meaningfully effective in preventing COVID-19 transmission, and b) are they safe to wear?
To answer those questions, we look to Science. This report — although scientific — is written for lay persons to be able to understand. Yes, a few parts of it are technical, but the topic is technical, so that’s unavoidable.
Science’s answer to both questions is NO. For a quick overview, just read the “Bottom Lines” at the end of each chapter, plus the Conclusion (Chapter 4), as those are written in plain English.
For those who want to delve deeper into the COVID-19 mask issue, about a hundred links are provided for them to do considerably more research, if that is their inclination.
For citizens who would like to get more educated on other aspects of COVID-19 (e.g., vaccinations, therapies, etc.) our webpage of Science-based COVID info is C19Science.info.
Note: we strongly recommend perusing Appendix A: Some Facts and Figures, before reading through the two chapters of studies on efficacy and safety (the two primary concerns).
Note that nothing in this report should be misconstrued as giving medical advice. We recommend that for all medical issues that citizens consult with a licensed physician.
For all medical decisions patients should be well-educated — including getting information from different perspectives — so that with their physician they can make informed health decisions. This is essentially what is spelled out in the Nuremberg Code.
Chapter 2: Sample Mask Efficacy Studies
“We did not observe association between mask mandates or use and reduced COVID-19 spread in US states.”
A meta-analysis review that included 11 studies and 18 random control trials of 26,444 participants. This systematic review found limited evidence that the use of masks might reduce the risk of viral respiratory infections.
This meta-analyses concluded that regular hand hygiene provided a significant protective effect, and face mask use provided a non-significant protective effect.
This study published by the American Institute of Physics found that face masks reduced indoor aerosols by 12% at most — which is not enough to prevent infections.
The use of face masks, either by infected or non-infected persons, does not have a significant effect on influenza transmission.
“There is moderate certainty evidence that wearing a mask makes little or no difference to the outcome of laboratory-confirmed influenza compared to not wearing a mask.”
Study: An Overview on the Role of Relative Humidity in Airborne Transmission of SARS-CoV-2 in Indoor Environment
Relative Humidity (RH) is an important factor responsible for airborne transmission of SARS-CoV-2 virus. In dry indoor areas, chances of airborne transmission are higher than humid areas. Indoor air at 40 to 60 percent RH is the optimum level for human health. Important to set minimum RH standard for indoor environments.
This meta-analysis concluded that evidence of a protective effect of masks or respirators against verified respiratory infection was not statistically significant.
There is no evidence to suggest that wearing a mask during exercise offers any benefit from the droplet transfer from the virus. [This is noteworthy, as the argument is that although masks can not filter out the SARS-CoV-2 virus, that they may be able to filter out droplets that carry the SARS-CoV-2 virus. This study seems to say no.]
Penetration of cloth masks by influenza particles was almost 97 percent and medical masks 44 percent — so cloth masks are essentially useless, and “medical grade” masks don’t provide adequate protection. This study is the first RCT of cloth masks, and the results caution against the use of cloth masks.
[Note: influenza particles are over three times the size of the SARS-CoV-2 virus (see here), so it can be inferred that the filter efficiency for the SARS-CoV-2 virus would be worse.]
The wearing of face masks by non-scrubbed staff working in an operating room with forced ventilation seems to be unnecessary. [An argument from mask proponents is that wearing a mask protects others from you. This study seems to say no.]
A large randomized controlled trial with 8000± participants, found that face masks “did not seem to be effective against laboratory-confirmed viral respiratory infections nor against clinical respiratory infection.”
“Results obtained in the study show that common fabric materials may provide marginal protection against nanoparticles, including those in the size ranges of virus-containing particles in exhaled breath.” [SARS-CoV-2 virus is about .1 micron = 100 nm]
“The study indicates that N95 filtering face piece respirators may not achieve the expected protection level against bacteria and viruses.”
The evidence suggests that transmission probability is strongly driven by indoor air quality — specifically ventilation — and the least by respiratory protection via mask use.
This review looked at the quality of the studies supporting masking. “Of sixteen meta‐analyses, eight were equivocal or critical as to whether evidence supports a public recommendation of masks, and the remaining supported a public mask intervention on limited evidence, primarily on the basis of the precautionary principle.”
“We conclude that the protection provided by surgical masks may be insufficient in environments containing potentially hazardous sub-micrometer sized aerosols.” [Note: the SARS-CoV-2 virus is a sub-micrometer sized particle.]
“We included three trials, involving a total of 2106 participants. There was no statistically significant difference in infection rates between the masked and unmasked group in any of the trials.”
“Two randomized controlled trials were included involving a total of 1453 patients. …in a large trial there was no difference in infection rates between the masked and unmasked group.”
“The filtration efficiency of the filter materials was good, over 95%, for particles above 5 micron in diameter but great variation existed for smaller particles.” Coronavirus is .1± microns, therefore these masks would not offer good protection from that virus.
“The filter efficiencies against influenza virus particles were the lowest.”
[Note: influenza particles are over three times the size of the SARS-CoV-2 virus (see here), so it can be inferred that the filter efficiency for the SARS-CoV-2 virus would be worse.]
“Although surgical mask media may be adequate to remove bacteria exhaled or expelled by health care workers, they may not be sufficient to remove the sub-micrometer size aerosols containing pathogens.” [The SARS-CoV-2 virus is sub-micrometer.]
This meta-analysis was of six Randomized Controlled Trials (RCTs) involving 9,171 participants. The conclusion: “the use of N95 respirators compared with surgical masks is not associated with a lower risk of laboratory- confirmed influenza. It suggests that N95 respirators should not be recommended for the general public.”
“2371 participants completed the study and accounted for 5180 HCW-seasons. ... Among outpatient health care personnel, N95 respirators vs medical masks as worn by participants resulted in no significant difference in the incidence of laboratory-confirmed influenza.”
An article in the New England Journal of Medicine (written by five physicians) came to the conclusion that face masks offer little to no protection in everyday life.
In this meta-analysis of twelve studies, the authors found little data to support the use of face masks to prevent wearers from becoming infected.
Face mask use in healthcare workers has not been demonstrated to provide benefit in terms of colds symptoms or getting colds.
The COVID-19 infection results between mask wearers and the control group were not statistically significant.
“Our findings suggest that a homemade mask should only be considered as a last resort to prevent droplet transmission from infected individuals.” [Note that droplets are significantly larger than the SARS-CoV-2 virus.]
Study: Evaluating the efficacy of cloth face masks in reducing particulate matter exposure
“Our results suggest that cloth masks are only marginally beneficial in protecting individuals from particles <2.5 micron.” [Coronavirus is .1± micron.]
Study: Assessment of Proficiency of Mask Donning Among the General Public in Singapore
The survey was administered to 2499 adults, who were given instructions for proper mask use. Subsequently, only 12.6% passed the Visual Mask Fit (VMF) test. This would indicate that the compliance of children would be lower yet.
Seventeen studies were reviewed in this meta-analysis. “None of the studies we reviewed established a conclusive relationship between mask ⁄ respirator use and protection against influenza infection.”
[Note: influenza particles are over three times the size of the SARS-CoV-2 virus (see here), so it can be inferred that the filter efficiency for the SARS-CoV-2 virus would be worse.]
This study used 5462 peer-reviewed articles and 41 grey literature records. Conclusion: “The COVID-19 pandemic has led to critical shortages of medical-grade PPE. Alternative forms of facial protection offer inferior protection.”
“We found that 60 GSM face mask had particle capture efficiency of 94% for total particles greater than 0.3 microns.” [These are better quality masks than standard cloth masks, so cloth masks would provide little effectiveness for the .1 micron SARS-CoV-2 virus.]
A few studies have considered the filtration efficiency of homemade masks made with different types of fabric; however, there is no broad consensus regarding their effectiveness in minimizing disease transmission.
CHAPTER 2 BOTTOM LINE:
There are multiple variables involved in the mask situation — from type of mask worn, how well it fits, how often a specific mask is worn, how hygienic the wearer is in general, etc.
Let’s look at a worst case scenario: a COVID-19 infected person, three feet away, sneezes on you. Will a mask meaningfully reduce your chances of getting infected?
Clearly any mask will somewhat filter you breathing in the SARS-CoV-2 virus transmitted by aerosol and droplets. However, you will still inhale some of the SARS-CoV-2 virus (the amount would depend on the mask quality).
Further, your face, hair, clothes, hands, etc will all have the SARS-CoV-2 virus on them. Without immediately discarding your clothes and taking a shower, the likelihood of you transmitting the SARS-CoV-2 virus into your respiratory track is almost 100% certain.
So the answer to the question (Will a mask meaningfully reduce your chances of getting infected?) is NO.
Another way to look at the effectivity question is: on average, how much is a mask going to reduce the inhalation of the SARS-CoV-2 virus? Based on the studies cited above (plus the multiple variables involved (also see above), a good scientific guess is:
In other words, the Science says that the benefit of wearing a mask to protect yourself (or others) from COVID-19, is minuscule — so they are NOT meaningfully effective.
The argument could be made that any reduction of the SARS-CoV-2 virus is a benefit, and indeed it is. The question here though, is: are there any adverse health consequences for wearing a mask, especially for children, that would negate any small benefit masks provide?
Only after we know the scientific answer for that, can we approximately determine what the NET benefit is for mask wearing.
Chapter 3 provides sample scientific studies about mask safety.
Chapter 3: Sample Mask Safety Studies
“A survey of peer-reviewed studies shows that universal mask wearing (as opposed to wearing masks in specific settings) does not decrease the transmission of respiratory viruses from people wearing masks to people who are not wearing masks. Further, indirect evidence and common sense suggest that universal mask wearing is likely to increase the spread of COVID-19.”
“Impairments caused by wearing the mask were reported by 68% of the parents. These included irritability (60%), headache (53%), difficulty concentrating (50%), less happiness (49%), reluctance to go to school (44%), malaise (42%), impaired learning (38%), and drowsiness or fatigue (37%).”
Concerned parents sent 6 face masks worn by their children to the University of Florida Lab for analysis of contaminants. This June 2021 report, details the findings:
“The analysis detected the following 11 dangerous pathogens on the masks: Streptococcus pneumoniae (pneumonia), Mycobacterium tuberculosis (tuberculosis), Neisseria meningitidis (meningitis, sepsis), Acanthamoeba polyphaga (keratitis and granulomatous amebic encephalitis), Acinetobacter baumanni (pneumonia, bloodstream infections, meningitis, UTIs—resistant to antibiotics), Escherichia coli (food poisoning), Borrelia burgdorferi (causes Lyme disease), Corynebacterium diphtheriae (diphtheria), Legionella pneumophila (Legionnaires’ disease), Staphylococcus pyogenes serotype M3 (severe infections—high morbidity rates), Staphylococcus aureus (meningitis, sepsis).”
“Bacteria are on average ten times the size of viruses, and have less penetration through masks. Therefore, at least part of the re-circulated flow of bacteria in aerosolized and droplet exhalation does not escape the vicinity of the oral and nasal environment. Bacteria and other microbes are not only retained in this space, but masks themselves are warm, moist repositories of these microbes.”
A bacteria infection from a mask can make the wearer more susceptible to a SARS-CoV-2 viral (or other) infection, as well as set the stage for more serious adverse COVID-19 outcomes. (See also this and this.)
The increased rate of infection in mask-wearers may be due to a weakening of immune function during mask use. Surgeons have been found to have lower oxygen saturation after surgeries even as short as 30 minutes. Low oxygen induces hypoxia-inducible factor 1 alpha (HIF-1). This in turn down-regulates CD4+ T-cells, which are necessary for viral immunity.
This physician writes about some of the emotional and intellectual liabilities that face masks can have on children. Unfortunately, these consequences will not likely be seen until sometime into the future. [Here is a related report.]
“We’re seeing inflammation in people’s gums that have been healthy forever, and cavities in people who have never had them before,” says dentist Dr. Rob Ramondi. “People tend to breathe through their mouth instead of through their nose while wearing a mask. The mouth breathing is causing the dry mouth, which leads to a decrease in saliva — and saliva is what fights the bacteria and cleanses your teeth.” He adds that “saliva is also what neutralizes acid in the mouth and helps prevent tooth decay and gum disease. Gum disease — or periodontal disease — will eventually lead to strokes and an increased risk of heart attacks,” says Dr. Marc Sclafani.
“Healthcare providers may develop headaches following the use of the N95 face-mask.”
This short video shows that even reading a book with a mask on, decreases blood oxygen levels to your brain.
Most healthcare workers develop new headaches, or exacerbation of their pre-existing headache disorders.
95.1% of health care workers had adverse skin reactions to the N95 mask.
Report: Your Mask May Be Causing Candida Growth in Your Mouth
“Now that mask wearing is becoming the norm, we’re more susceptible to mask-induced skin problems. Maskne (mask acne) is more common, but a candida infection is also possible.” [Also see this related article.]
“Pre-adolescent children have undeveloped auricular cartilage with less resistance to defor-mation; prolonged pressure from the elastic loops of the mask at the hollow or, even worse, at the anthelix level can influence the correct growth and angulation of the outer ear.”
This study shows that wearing COVID-19 face masks can produce at least four altered behaviors. This could be particularly troublesome for young children, in formative stages.
“Ventilation, cardiopulmonary exercise capacity and comfort are reduced by surgical masks and highly impaired by FFP2/N95 face masks in healthy individuals.”
Wearing an N95 mask for 4 hours during this operation significantly reduced PaO2 (Partial Pressure Oxygen) and increased respiratory adverse effects in these patients.
Universal mask requirements present difficulties for some people with disabilities who cannot wear masks either at all or for an extended period of time. In addition, some people with disabilities cannot communicate effectively with another person if the other person is wearing a mask. Examples include deaf and hard of hearing people and some people with intellectual, developmental, or processing disabilities.
Face masks — especially as used by younger people — can have their surfaces become contamination sources, which has health consequences. Students are storing them in their pockets, bags, putting them on tables, people are reusing them etc.
“The aim was to find, test, evaluate and compile scientifically proven related side effects of wearing masks. For a quantitative evaluation, 44 mostly experimental studies were referenced, and for a substantive evaluation, 65 publications were found. The literature revealed relevant adverse effects of masks in numerous disciplines. In this paper, we refer to the psychological and physical deterioration as well as multiple symptoms described because of their consistent, recurrent and uniform presentation from different disciplines as a Mask-Induced Exhaustion Syndrome (MIES)… Extended mask-wearing by the general population could lead to relevant effects and consequences in many medical fields.”
“Exercising with face masks may reduce available Oxygen and increase air trapping pre-venting substantial carbon dioxide exchange. The hypercapnic hypoxia may potentially increase acidic environment, cardiac overload, anaerobic metabolism and renal overload, which may substantially aggravate the underlying pathology of established chronic diseases.”
Here a psychologist identifies 18 Ways to Manage Mask Anxiety.
This is an Indonesian “factory” that produces a lot of masks. Does this look a hygienic environment? This is what some of us are getting when we purchase online or in stores that sell them in bulk. The unsanitary manufacture of some masks raises these questions:
“Breathing through N95 mask materials have been shown to impede gaseous exchange and impose an additional workload on the metabolic system of pregnant healthcare workers, and this needs to be taken into consideration in guidelines for respirator use. The benefits of using N95 mask to prevent serious emerging infectious diseases should be weighed against potential respiratory consequences associated with extended N95 respirator usage.”
“Subjects in the mask group were significantly more likely to experience headache during the study period.” [Note: the SARS-CoV-2 virus is about three times the size of the most common cold virus, rhinovirus (see here).]
“Conclusions: In healthy healthcare workers, the respirator did not impose any important physiological burden during 1 hour of use, at realistic clinical work rates. However, the respirator dead-space carbon dioxide and oxygen levels were significantly above and below, respectively, the ambient workplace standards.”
Children are much more likely to improperly use face masks.
CHAPTER 3 BOTTOM LINE:
As stated at the end of Chapter 2: there are multiple variables involved in the mask situation — from type of mask worn, how well it fits, how often a specific mask is worn, how clean the mask is, how hygienic the wearer is in general, etc.
The safety of mask wearing is directly correlated to some of these variables. Unfortunately, there is a reverse correlation with effectiveness: The higher the mask filtration, the more likely it is that the mask wearer will suffer adverse health consequences. (See cited studies.)
Some of the potential problematic health consequences from wearing masks that are identified in the studies above are:
In other words, the Science says that wearing a mask is NOT safe, especially for children.
Chapter 4: Conclusions
To make relevant conclusions here, we need to carefully assess how well masking meets COVID-19 policy objectives. Those objectives are to minimize the chances of:
— a mask wearer getting infected, from a nearby person with COVID-19, and
— a mask wearing party with COVID-19 infecting a nearby person.
In theory, those objectives are commendable. The fly in the soup is that in our zeal to do something, there are other significant considerations that are often not factored in. For example, in implementing any COVID-19 rules and regulations, it is important that they:
THIS REPORT’S BOTTOM LINE:
Mask mandates (especially for children in a school setting), violate all five (5) of the above health care policy caveats. In other words, a mask is unlikely to be a Net Benefit to the wearer or the public.
————————————————————————————————————
A quick overview of the COVID-19 mask policy situation:
iii) The higher the mask filtration, the more negative are the mask health consequences.
iii) Education regarding the importance of optimizing our immune system.
Appendix A: Some Facts and Figures
Additional informative materials worth reading:
— Masks Don’t Work: A Review of Science Relevant to COVID-19 Social Policy.
— Why Masks Don’t Work Against COVID-19.
— Understanding Paticle Size and Aerosol-Based Transmission.
— The Face Mask Folly in Retrospect.
Appendix B: What About Conflicting Reports?
Mask proponents may say:
“You have listed an impressive array of studies that question both the efficacy and safety of masks for COVID-19. However, there are some other studies that conclude that masks are effective and safe for COVID-19 — and some of these come from government agencies. So what are citizens to do when there are seemingly contradictory studies?”
Here are some observations from a lifelong professional scientist… To begin with we need to be clear that Science is not confused here, but rather that scientists are conflicted.
Science is a process, and conflicted scientists just means that they are working their way through the process. Our hope is that they will be competent, objective and thorough when foraging their way down a path through this new wilderness. If they are, we will get to our destination with the least amount of trouble and complications. If not, it will be a harrowing, painful, and expensive trip.
Along the way we will almost always encounter situations where some scientists come to different conclusions. In other words, some will say: we need to go this direction, while others are saying: no, we need to go that way. (Remember the insightful words of Robert Frost.)
So what do citizens do when the experts are giving different directions?
To begin with we need to be clear that the “experts” are not infallible. In fact, experts have a long history of being wrong, and of giving bad advice. As citizens of a democratic society, we have every right to question to basis for policies like mask mandates.
The more that citizens are educated — and question what they are told — the more likely they will know what is the better route for them and their families to take. Although this involves work (an out-of-favor four letter word) on the part of citizens, that’s what this Report is about: to minimize the effort needed to get educated on this topic.
Briefly, to decide which path to take:
iii) Assuming that there are no explanations for the discrepancy found above, then we should give considerably more consideration to studies that found problems. From a Science perspective, studies finding problems carry more weight than the opposite.
Appendix C: Masks and Vaccination Status
Remember that the theoretical objectives for wearing a mask are:
We’ve already shown that masks typically offer no net benefit for both situations. The question now is: does vaccination status (of you or others) change that reality?
To scientifically answer that question, we need to remember two key facts about COVID-19 vaccines:
— They do not provide immunity from being infected with the SARS-CoV-2 virus, and
— They do not prevent transmission from an infected vaccinated person to someone else.
For a more detailed scientific discussion of COVID-19 vaccines, please read this Report.
Appendix D: Some Sample References
Our webpage of Science-based COVID-19 info: C19Science.info
Our Report: What Schools Should Do For COVID-19
Short Efficacy Video: Viral immunologist Dr. Byram Bridle — Do Masks Work?
Short Safety Video: Live Mask Test on Child Using Different Masks
47 plus 32 Studies: Ineffectiveness of COVID masks plus multiple adverse side effects
34 Studies: Analyses of Face Mask Efficacy and Safety
23 Studies: Masks Don't Work — A Review of Science Relevant to COVID-19 Social Policy
42 Studies: Masks are Neither Effective nor Safe — A Summary of the Science
6 plus 6 Studies: Mask Effectiveness and Mask Safety
Multiple Studies: Association of American Physicians and Surgeons — Mask Facts
Multiple Studies: Are Face Masks Effective? The Evidence (looks at studies, pro and con)
Multiple Studies: Masking: A Careful Review of the Evidence
Multiple Studies: Do Masks Work? A Review of the Evidence
Meta-Analysis: Is a Mask Free of Undesirable Side effects and Potential Hazards?
14 Peer-reviewed Studies: Does Mask Wearing Decrease or Increase the Spread of COVID-19?
Study: Masks, false safety and real dangers — Microbial challenges from masks
Study: Analysis of COVID-19 Mask Mandates on Hospitalization and Mortality
Physician’s Analysis: The Risks vs. Benefits of Face Masks
Analysis: Why Is There No Correlation between Masks, Lockdowns, and Covid Suppression?
Resource: Europe's Top Health Officials Say Masks Aren't Helpful in Beating COVID-19
Resource: Sweden’s Top Epidemiologist: We See No Point In Wearing Masks
Resource: Federal Law Prohibits Mandates of Emergency Use COVID Vaccines, Tests, Masks
Hidden Studies: CDC's own studies (10 Clinical Trials) show masking to be ineffective
Exposed Studies: Inside 2 New Studies the CDC Claims Prove Masks Save Lives
Exposed Study: Debunking the CDC's Mask Mandate Study
Exposed Study: CDC double mask “study” a perfect example of politicized junk “science”
Retracted Study: Effectiveness of Surgical and Cotton Masks in Blocking SARS–CoV-2
Retracted Study: Decrease in Hospitalizations for COVID-19 after Mask Mandates in 1083 U.S. Counties
For reference: the Maryland Dept of Health published a reasonable set of K-12 guidances.
For reference: extract of talk from engineer Stephen Petty, on building solutions.
For reference: there are many studies, reports and articles in the Media Balance Newsletter archives. Simply search for “mask” in the 2021 archives and the 2020 archives.
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Jann said:
( December 1st, 2021 @ 8:26 pm )
Great information! Dr Fauci said from the beginning that face masks don't work! Once they seen how easily people were willing giving in, Fauci said wear two masks. So some gave in without questions. The more we give in, the more they throw at us. People so willing to give in without any research. In the meantime the children are suffering and being conditioned early.
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