And he causeth all, both small and great, rich and poor, free and bond, to receive a mark in their right hand, or in their foreheads: And that no man might buy or sell, save he that had the mark, or the name of the beast, or the number of his name.
Revelations 13:16-17
I was a child of the eighties and the nineties. It was a strange time to grow up, which came with some equally strange entertainment. Highlights of children’s entertainment from the era included The Goonies and Teenage Mutant Ninja Turtles. But nothing quite screams early nineties like the eco-friendly cartoons that were prolific at the time, most notoriously Captain Planet and the Planeteers of Ted Turner fame and its many lower budget offshoots.
The idea makes a lot of sense. Environmentalism was practically a fad in the nineties, so why not merge children’s entertainment with an environmental PSA campaign? Instead of having Superman save the earth by punching aliens in the Face, you can have Captain Planet save the earth by punching polluters in the face for that pitch perfect permutation of punching and propaganda.
There was only one problem. See, General Zod never hired good, honest, hard-working Americans of the sort you would see in television commercials just before election. Have Captain Planet punch people involved in one of the more environmentally destructive industries; things such as rare-earth mining, coal-fired plants, or agricultural land clearing, and the network will find itself having to deal with angry parents working in those industries demanding to know why their children’s entertainment is condemning their means of making a living.
The solution is to have Captain Planet punch people and objects that couldn’t possibly provide gainful employment. This resulted in some truly ridiculous villains, such as a Frankenstein’s monster that eat ionizing radiation and an anthropomorphic rat voiced by Jeff Goldblum that wanted to poison people for fun. After all, what else are you going to use Jeff Goldblum’s voice talents for? These villains were just as cartoonishly evil as their Superman counterparts, but as this is a children’s cartoon that works well enough.
But for the truly clever writers there were ways to give the villains of these eco-cartoons sensible motives. One example that always stood out to me was an episode were one of the recurring villains constructs a rather nicely appointed arcology for residents to move into. Actually, I think this is from Widget the World Watcher, which is like Captain Planet only worse. Except in this case, as this arcology idea is actually pretty clever. If you do not follow science fiction, you have my condolences. But in any case, an arcology is a giant self-contained, self-sustaining city. These things are massive structures that often contain their own entire ecosystem and can be an entire nation state unto themselves. They’re one of the many ideas that can make science fiction stories interesting and engaging, but I digress.
In the plot of the episode, the villain is operating an arcology as a for profit business. In this case, because the arcology’s systems maintain the atmosphere, the owner of the arcology literally sells the air purified by the structure to its residents. It is a rather sound, if scummy, business strategy. As motives go this is head and shoulders above most of the plots encountered in these cartoons; the villain wants to get rich and has adopted a surprisingly sustainable if unethical means of earning an income. Naturally, this thing is regarded as nothing short of an abomination in the eyes of our environmentalist heroes, and they proceed to rectify the situation. I honestly can’t remember how, but it’s a children’s cartoon so of course they prevail in the end.
The whole thing is constructed around a blindingly obvious clean air aesop. Breathing should be a right, so it’s important that the air is kept clean so that future generations can freely breathe the air. After all, it would be terrible if people were forced to go about something as simple and as necessary as breathing on someone else’s terms. Sometimes I adore the nineties in all of its cringe-worthy campiness.
And there is good reason to adore the nineties. As it stands, I am presently required to breathe the air on someone else’s terms. This isn’t because of pollution. Our air is clean. This is partly due to our own good environmental stewardship, and partly due to the fact that we have exported most of our heavy industry to China, which has proceeded to poison its air in pursuit of becoming the lowest bidder on the planet. It is an arrangement that has put the U.S. in crippling debt to an amoral totalitarian regime. But the point remains that our air is clean and safe to breath.
At present, it is not permissible to breath the air in the presence of the public without a state approved apparatus, for the state has deemed that human beings now exhale the foulest of miasma, which can only be cleansed with the proper equipment. Apparatus, however, might be overselling the quality of the mandated gear. While it is impermissible to breath the air directly, one may breathe the air through a cotton cloth, or a surgical Mask, or a neck gaiter, or a scarf, or a gas mask, or any number of other improvised face coverings. The only consistent rule seems to be that your face has now become just as obscene as your genitals and thus you must wear two separate pairs of underwear when in public to conceal all of your orifices lest you offend. I would also recommend wearing pants in public, but as I am not the CDC my recommendations are optional.
If it isn’t obvious by now, I am referring to our newly founded state religion. It might not have a name, but it clearly manifests itself in the nearly ubiquitous mask mandates that permeate society. When compared to other COVID restrictions, the mask mandates aren’t as tyrannical as movement restrictions, nor are they as destructive as business closures, but they are the most intimately personal of the many tyrannies inflicted on the population in the War on Coronavirus. It’s the fascism you are required to wear on your face.
While I cannot speak for everyone, I can certainly speak for myself when I say I despise these Masks in the very fiber of my being. Face masks are uncomfortable, dehumanizing, degrading and most importantly forced upon the wearer without their consent. It is a mark of ownership placed on your face by those more powerful than you. It is the ultimate expression of human hubris, the declaration by those in power that it is their right to do whatever they please with your face, and should you object to this power grab you are branded as selfish and dangerous. And this is all cloaked in an appeal to public safety.
The apologist excuse for this most deep and personal violation of our basic human rights is that wearing a mask is easy. But just because something is easy doesn’t make it right, nor does it mean that it doesn’t carry far reaching consequences. Even more importantly, the premise that these masks do anything to protect either yourself, or those around you, patently is false. To don a mask is not to protect those around you, but to uphold a lie, and to facilitate the slavery of your very soul.
A Pseudoscientific Farce
N95 respirators are face coverings that by definition filter out 95% of any particles 0.3 um or larger before they can reach the nose or mouth of the user. They are typically used to protect workers from hazardous particles and aerosols that are produced from various industrial activities, such as grinding tool steel or spray-painting large surfaces. A surgical variant is also marketed for medical environments. Given that the coronavirus has been measured to be anywhere from 0.05 um to 0.14 um in diameter, the application of an N95 respirators to protect against COVID is already questionable. That being said, N95 respirators are a genuinely functional piece of technology, at least when used for their intended application, and a description of their functionality and use will provide an excellent contrast against that which is non-functional.
N95 respirators are composed of multiple layers of adhesive polymer mesh designed to capture particles in the air flowing through the mesh. The respirators also contain a layer of charged polypropylene fibers that enable electrostatic capture of particulates. The respirators are designed to be molded and fit to the user’s face, typically using a combination of a deformable metal nosepiece and elastic bands to secure the respirator to the head.
One does not simply don an N95 masks. There are a number of restrictions that come with using these devices:
- The device must be specifically fit to the user’s face and fit tested prior to use. This must be done every time one dons the respirator.
- The respirators often will not work if the wearer has facial hair, as it interferes with the seal, or if the wearer is a child, as it cannot be molded to their faces properly.
- The respirator must be kept clean. Should it become soiled or dirty for any reason, most manufacturers instruct the wearer to discard and replace the respirator in question.
- If it wasn’t already obvious, the respirators should not be shared between multiple people.
- And the real killer, N95 respirators are one use only, and typically that one use cannot exceed a period of 8 hours. This means anyone using them to comply with the mask mandate is going to be going through at least one new N95 respirator per day if they expect the specified effectiveness from the device, and that is assuming the it is effective against COVID at all. There are work arounds being explored for this limitation due to the global shortage of these devices, but those work arounds are complicated, of questionable reliability and intended for use by medical institutions, not the everyman.
The real catch is that most people are not using N95 respirators, they are using something along the lines of this:
Behold what I have been using to protect myself from coronavirus for over a year. According to the manufacturer, this mask is composed of
Now suppose I didn’t hold both face masks and the mask mandate in universal contempt and instead tried to follow the official guidance on masks use rather than making the bare minimum effort to observe our new state religion. One might think this would entail wearing a new N95 respiratory every day and diligently following the instructions listed above, but that assumption would be wrong. Because of the global shortage of N95 respirators and their single use nature, the official advice is to actually avoid using N95s in favor of whatever random improvised face covering you can come by so as to preserve the respirators for medical professionals. Thus, the wear random crap approach is perfectly consistent with official guidance.
This is all secondary to the real question, and that is: does any of this nonsense actually work? The best way to answer this question is to make like Mythbusters and put these stupid talismans to the test, or more accurately, make like the audience of Mythbusters and watch someone else put them to the test. It is time to hit the medical literature and determine if there is any actual empirical evidence for the constant insistence that we surrender our faces to the state.
The gold standard for medical experiments is randomized controlled trials (RCT). There are surprisingly few such experiments relevant to mask use in a pandemic, perhaps because until two years ago nobody realized such experiments were going to be central to the question of basic bodily autonomy. Rather than go through each RCT independently, I am going to refer to some meta-analyses and work from there, starting with Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings – Personal Protective and Environmental Measures by Xiao et al. [2]. Here is an excerpt from the abstract.
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.
Already things are looking bad for the hypothesis that masks can mitigate the spread of viral infections.
In this review, we did not find evidence to support a protective effect of personal protective measures or environmental measures in reducing influenza transmission. Although these measures have mechanistic support based on our knowledge of how influenza is transmitted from person to person, randomized trials of hand hygiene and face masks have not demonstrated protection against laboratory-confirmed influenza, with 1 exception (18).
Note that reference 18 refers to a hand hygiene study conducted in Egypt, not a mask study. By mechanistic studies, I assume Xiao is referring to papers like Low-cost measurement of face mask efficacy for filtering expelled droplets during speech by Fischer et al. [3] where it was shown that a mask can block at least some of the droplets that impinge on it. Xiao appears to be cognizant of these studies and is claiming that despite these promising results, the masks are ineffective at mitigating the spread of viral pathogens. This becomes even more clear in light of an earlier paragraph.
Influenza virus is believed to be transmitted predominantly by respiratory droplets, but the size distribution of particles responsible for transmission remains unclear, and in particular, there is a lack of consensus on the role of fine particle aerosols in transmission (2,3).
I case you were curious as to know what the purpose of a surgical mask is if it does not protect against viral infection, Xiao has an answer.
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 (36). 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.
If it wasn’t already clear surgical mask offer no protection against viral infections further elaboration is provided.
We did not find evidence that surgical-type face masks are effective in reducing laboratory-confirmed influenza transmission, either when worn by infected persons (source control) or by persons in the general community to reduce their susceptibility (Figure 2).
The comment about source control is particularly important. I have encountered many claims that the true purpose of mask is to protect others from the wearer rather than the wearer from others, but if Xiao is to be believed masks do not function in this capacity either. They don’t offer the user any protection, and they don’t offer any protections of others from the user. There is one limitation to this paper.
We did not consider the use of respirators in the community. Respirators are tight-fitting masks that can protect the wearer from fine particles (37) and should provide better protection against influenza virus exposures when properly worn because of higher filtration efficiency.
This limits the above meta-analysis to cloth masks and surgical masks. Thus, there is still the possibility that actual respirators might be effective. Good luck trying to get your hands on enough N95s for that possibility to even matter.
The next meta-analysis is Efficacy of surgical masks or cloth masks in the prevention of viral transmission: Systematic review, meta-analysis, and proposal for future trial by Nanda et al. [4]. As it appears there is only a grand total of a dozen RCTs on mask use, this paper necessarily goes over all of the same RCTs that Xiao, so one would assume it would provide all of the same insights. However, this paper is pitched in a rather unusual way which becomes apparent as soon as you examine the abstract.
Results: Fourteen studies were included in this study. One preclinical and 1 observational cohort clinical study found significant benefit of masks in limiting SARS-CoV-2 transmission. Eleven RCTs in a meta-analysis studying other respiratory illnesses found no significant benefit of masks (±hand hygiene) for influenza-like-illness symptoms nor laboratory confirmed viruses. One RCT found a significant benefit of surgical masks compared with cloth masks.
At first glance, these appear to be mixed results, with three studies demonstrating the effectiveness of masks against 11 studies that find no such benefit. In actuality, these are nearly the same results as obtained by Xiao; 11 RCTs found masks to be ineffective while the remaining RCT was inconclusive. The results only looked mixed because a single preclinical trial and a single cohort study were pooled with the RCTs on the grounds that they examine SARS-CoV-2 specifically. This seems a strange choice to me, but let’s roll with it for the moment. How exactly do these three exceptions come about?
The first exception is a pre-clinical trial that was conducted on hamsters. It is summarized by Nanda as:
The preclinical study used hamsters infected with SARS-CoV-2 placed in cages adjacent to healthy hamsters to investigate noncontact transmission of SARS-CoV-2.17 A fan was used to transmit the virus between the cages. In the control (no barrier between the cages), hamsters were infected at a 66.7% rate after 7 days (10/15) compared to 16.7 (2/12) when a barrier of surgical face masks was put on both cages. The rate rose to 25% (6/24) when masks were only placed on the cage of healthy hamsters.
I suppose this is promising, but using this material as a wall partition seems to be a wildly divergent to wearing it directly on one’s face for hours on end. In particular, I would expect a layer of polyvinyl chloride to remain dryer and cooler when used in this way than one placed directly over one’s face. In the latter case, I would expect the creation of an environment that would be far more hospitable to COIVD which would result in the masks becoming saturated with COVID an arguably becoming as much if not more of the liability as the infected person wearing it. The picture I have included should make it clear how this “mask material” is actually being used in this experiment.
The second exception is a retrospective cohort study. It is summarized by Nanda as follows:
The clinical study was a nonrandomized retrospective observational cohort study.20 The authors retrospectively analyzed 335 people from 124 families with proven SARS-CoV-2 to evaluate masking practices in the households to assess if they were predictors of secondary transmission. They determined that if one or more members of the household (either the index case or their contacts) wore a mask before development of symptoms, there was a 79% reduction in transmission (OR = 0.21, 95% CI: 0.06-0.79). They counted all types of masks regardless of whether it was a N95 mask, disposable surgical mask, or clothmask. Due to the retrospective, nonrandomize and observational nature of the study there were many areas for potential bias to arise summarized in Figure 3.
If that sounds a bit obtuse, this study was basically just a glorified survey. A description of the methodology from the original source material is as follows [6]:
A three part structured questionnaire was developed. The first part included demographic and clinical information of the primary case. The second part was mainly focused on the primary case’s knowledge about and attitudes toward COVID-19, and their self-reported practices (mask wearing, social distancing, living arrangements) and activities in the home. The third part was about self-reported behaviours of all family members, as well as the family’s accommodation and household hygiene practices from 4 days before the illness onset to the day the primary case was isolated, including room ventilation, room cleaning and disinfection. Close contact was defined as being within 1 m or 3 feet of the primary case, such as eating around a table or sitting together watching TV. The frequency of contact, disinfection and ventilation was measured.
Personally, I don’t think a study that boils down to a questionnaire should be included with a selection of randomize controlled trials. There are two additional catches that come with this study. First, this survey was taken in Beijing, China. Call me burger chomping capitalist American pig, but I simply do not trust any kind of self-reporting survey results out of China due to the censorious nature of the PRC. Second, this is a study on household transmission, as in COVID transmission between family members living under the same roof. This means that to reproduce the results of this survey, assuming you even believe they are true, you would need to be wearing a face mask within your own house. It is probably best if you don’t give the CDC this idea.
The last exception is a genuine RCT, A cluster randomized trial of cloth masks compared with medical masks in healthcare workers by MacIntyre et al. [7]. The experiment as follows:
From the eligible wards 1868 HCWs were approached to participate. After providing informed consent, 1607 participants were randomised by ward to three arms: (1) medical masks at all times on their work shift; (2) cloth masks at all times on shift or (3) control arm (standard practice, which may or may not include mask use). Standard practice was used as control because the IRB deemed it unethical to ask participants to not wear a mask. We studied continuous mask use (defined as wearing masks all the time during a work shift, except while in the toilet or during tea or lunch breaks) because this reflects current practice in high-risk settings in Asia.8
The masks in question are described as:
Masks used in the study were locally manufactured medical (three layer, made of non-woven material) or cloth masks (two layer, made of cotton) commonly used in Vietnamese hospitals.
The study examines both cloth masks and disposable medical masks. It also has a control arm as described by MacIntyre.
Standard practice was used as control because the IRB deemed it unethical to ask participants to not wear a mask.
The results of this RCT are shown in the figure below.
The RCT does actually obtain a reduced attack rate for the medical masks. However, it also obtains an increased attack rate for cloth masks. This is most pronounced for influenza-like illnesses (ILI), for which medical masks cut the attack rate by one-third, but where cloth masks triple the attack rate. Thus, we have a situation where choosing the correct masks may protect the wearer, but choosing the incorrect masks is actively counterproductive to a rather severe degree.
MacIntyre does not agree with this assessment and blames the results on sloppy controls.
The study design does not allow us to determine whether medical masks had efficacy or whether cloth masks were detrimental to HCWs by causing an increase in infection risk. Either possibility, or a combination of both effects, could explain our results. It is also unknown whether the rates of infection observed in the cloth mask arm are the same or higher than in HCWs who do not wear a mask, as almost all participants in the control arm used a mask.
Because of MacIntrye’s assessment of his own controls, he is unwilling to make a claim regarding masks in the absolute sense. Instead, he limits the conclusion of the paper to claiming that medical masks are more effective than cloth masks by up to one order of magnitude in the case of ILI. If you take MacIntyre’s assessment at face value and conclude the efficacy of the masks cannot be determined in the absolute since, then when combined with Nanda’s other 11 CRTs we are back in the situation where none of the CRTs demonstrate that masks were effective at mitigating viral transmission.
MacIntyre does cover the masks maintenance required to obtained the results of his RCT, which I believe is worth examining.
Participants in the medical mask arm were supplied with two masks daily for each 8 h shift, while participants in the cloth mask arm were provided with five masks in total for the study duration, which they were asked to wash and rotate over the study period. They were asked to wash cloth masks with soap and water every day after finishing the shifts. Participants were supplied with written instructions on how to clean their cloth masks.
The medical masks being disposable were simply discarded. If we are to take MacIntyre’s results at face value, one would need to go through one medical masks every four hours to reproduce them. This is bad enough when they are only worn during one’s work shift, having to also wear them every time one goes out into public is only going to increase that number of masks one has to go through on a regular basis. The cloth masks were subject to a rather thorough maintenance procedure involving both a rotation through the five separate masks and periodic extensive cleaning. It didn’t seem to do the wearers any good.
After going through the three exceptions, we come back full circle to the conclusion reached in Nanda’s study [4].
A total of 11 cluster randomized control trials (c-RCTs) studying mask use in preventing transmission of respiratory illnesses21–31 were identified and synthesized in a meta-analysis. The results of the metaanalysis show no statistically significant benefit of surgical-mask use when used with or without hand hygiene for influenza like illness symptom reporting nor laboratory confirmed viral illnesses.
I have listed to six forest plots provided in the paper in the six figures above. The ultimate results of this meta-analysis are that there was no evidence that masks were effective at mitigating the spread of influenza like viruses or any other kind of virus. Nanda comes across as almost apologetic in this study and seems disappointed with these conclusions, although maybe I am reading into something that is not really there. Nanda does make a reasonable suggestion for following up this meta-analysis.
There is currently no published evidence from randomized trials studying facemasks to prevent SARS-CoV-2 transmission. This finding is important as it shows we have no in practice evidence and identifies a gap in the research.
This is a good point. That being said, the operating theory behind masks is largely based around the masks blocking particles or aerosols that contain the virus rather than blocking the transmission of the virus directly. If this is how the masks protect the wearer, it really should not matter which kind of virus is hitching a ride on errant aerosols, regardless of whether they are being exhaled by the wearer for source control or are impinging on the wearer’s mask for personal protection. Thus, one would expect the results for other airborne viral agents to translate to that of COVID-19. Nanda does suggest two studies that may resolve the shortcoming with the RCTs that he has evaluated.
There are only two trials on the centralized WHO COVID-19 trials register investigating the use of face masks in the community to prevent SARS-CoV-2 transmission. A Danish study (NCT04337541)33 is investigating reduction inCOVID-19 infection using medical grade face masks outside the healthcare system. It will compare medical grade NANDA ET AL. 109 face mask use to the control of “government advice,” where it is currently not mandatory. As this study is not a cluster randomized control trial, it will not see the effects of being surrounded by other mask wearers in the protection fromCOVID-19 but can investigate protection for the wearer only. The Bandim Health Project is setting up a cluster-RCT (NCT04471766)34 in Guinea Bissau studying locally made the effect of cloth face masks versus no masks on incidence of COVID-19 in an urban population. It is not clear how they will cluster patients yet and this study is not currently recruiting.
The Danish study Nanda refers to is Face masks for the prevention of COVID-19-rationale and design of the randomized controlled trial DANMASK-19 by Bundgaard et al. [8] which at the time Nanda wrote his paper was still just a proposal for a RCT. But at time of writing this study has been completed and released as Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers also by Bundgaard et al. [9]. We are now in possession of a RCT that directly evaluates the effect of masks on COVID-19 rather than a COVID surrogate, and it is even designed to evaluate the effects on people going out and about in their daily routine rather than being limited to a hospital or college campus setting. It does not evaluate for source control, but I guess you can’t have everything.
The RCT is described as follows.
Eligible participants were randomly assigned 1:1 to the mask or control group using a computer algorithm and were stratified by the 5 regions of Denmark (Supplement Table 1). Participants were notified of allocation by e-mail, and study packages were sent by courier (Part 7 of the Supplement). Participants in the mask group were instructed to wear a mask when outside the home during the next month. They received 50 three-layer, disposable, surgical face masks with ear loops (TYPE II EN 14683 [Abena]; filtration rate, 98%; made in China).
The RCT participants seem to have been given the “good” masks, that is surgical masks of the same construction as those that proved considerably more effective than the cloth masks in MacIntyre’s study. Not enough of them were provided to go through them at a rate of one per four hours in this study. Only enough were provided for two masks on the average day and one mask on the weekends. Still, it’s an RCT, it studies COVID-19 directly and it evaluates masks use for the conditions most of the public operate under. Here are the results:
In this community-based, randomized controlled trial conducted in a setting where mask wearing was uncommon and was not among other recommended public health measures related to COVID-19, 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. We designed the study to detect a reduction in infection rate from 2% to 1%. Although no statistically significant difference in SARS-CoV-2 incidence was observed, the 95% CIs are compatible with a possible 46% reduction to 23% increase in infection among mask wearers. These findings do offer evidence about the degree of protection mask wearers can anticipate in a setting where others are not wearing masks and where other public health measures, including social distancing, are in effect.
Translation: no protection effect could be measured. It obtained the same results as the two meta-analyses did. Still, the author wants you to know that just because the masks provided no measurable protection, that doesn’t mean we should treat the masks as if they provide no measurable protection. I continue to find it amazing how apologetic these authors are in regard to their own null results.
The findings, however, 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. During the study period, authorities did not recommend face mask use outside hospital settings and mask use was rare in community settings (22). This means that study participants’ exposure was overwhelmingly to persons not wearing masks.
I suspect source control is the hill the mask mandate fanatics are going to die on. Still, we wouldn’t want to jump to any conclusions. It is not like we forced every man, women and child on the planet to wear these masks without their consent on far sketcher evidence than this or anything.
This is only half the picture, as I have yet to mentioned the side effects, which are rather important. If, for example, you have an effective treatment for migraines, it could be the best treatment in the world, but if it carries a significant risk of causing aneurysms nobody is going to use it because the benefit isn’t even remotely worth the risks. This is how you properly evaluate nearly anything in life, you consider both the benefits and the drawbacks of a given course of action and actually make sure the benefits outweigh the drawbacks. If you aren’t considering any of the drawbacks associated with a given course of action, you are liable to make a terrible and short-sighted decision.
This begs the question, are there any known side effects to wearing face masks all day? People have only been forced to wear these things for 8 hours at a time, several days a week for over a year and often over their own personal objections. What could possibly go wrong with this scenario?
To answer this question, I have consulted Is a Mask That Covers the Mouth and Nose Free from Undesirable Side Effects in Everyday Use and Free of Potential Hazards by Kisielinski et al. [10]. Good news everyone: there are only 15 different side effects reported from masks use in this paper alone, certainly not enough to be a serious problem. Let’s dive in, shall we.
First, this a review of other academic papers. Here is a summary of what is covers.
A total of 65 scientific papers on masks qualified for a purely content-based evaluation. These included 14 reviews and two meta-analyses. Of the mathematically evaluable, groundbreaking 44 papers with significant negative mask effects (p = 50%), 22 were published in 2020 (50%), and 22 were published before the COVID-19 pandemic. Of these 44 publications, 31 (70%) were of experimental nature, and the remainder were observational studies (30%). Most of the publications in question were English (98%). Thirty papers referred to surgical masks (68%), 30 publications related to N95 masks (68%), and only 10 studies pertained to fabric masks (23%).
Later the paper further elaborates:
The possible side effects and dangers of masks described in this paper are based on studies of different types of masks. These include the professional masks of the surgical mask type and N95/KN95 (FFP2 equivalent) that are commonly used in everyday life, but also the community fabric masks that were initially used.
While this paper is a veritable trove of information, I found it rather disorganized, with information on similar topics scattered throughout different sections of the paper. I have reorganized the highlights to better consolidate individual topics. The first set of side effects, as you might have guessed, is that wearing a mask makes it harder to breath.
In a recent intervention study conducted on eight subjects, measurements of the gas content for oxygen (measured in O2 Vol%) and carbon dioxide (measured in CO2 ppm) in the air under a mask showed a lower oxygen availability even at rest than without a mask. A Multi-Rae gas analyzer was used for the measurements (RaeSystems®) (Sunnyvale, California CA, United States). At the time of the study, the device was the most advanced portable multivariant real-time gas analyzer. It is also used in rescue medicine and operational emergencies. The absolute concentration of oxygen (O2 Vol%) in the air under the masks was significantly lower (minus 12.4 Vol% O2 in absolute terms, statistically significant with p 18].
The atmosphere behind a mask is both oxygen poor and carbon dioxide rich, with a 12% drop in oxygen levels and a 30-fold increase in CO2 levels. But wait, it gets even better.
Exhaled air contains over 250 substances, including irritant or toxic gases such as nitrogen oxides (NO), hydrogen sulfide (H2S), isoprene and acetone [170]. For nitrogen oxides [47] and hydrogen sulfide [46], pathological effects relevant to disease have been described in environmental medicine even at a low but chronic exposure [46–48]. Among the volatile organic compounds in exhaled air, acetone and isoprene dominate in terms of quantity, but allyl methyl sulfide, propionic acid and ethanol (some of bacterial origin) should also be mentioned [171].
Turns out exhaled air contains a considerable number of toxins, which mask users are constantly rebreathing. Nothing like being forced to rebreathe your own filth just to go out in public. It also puts our clean air efforts to waste, as we spent the past several decades mitigating industrial pollution only to construct a miniature toxic atmosphere directly in front of everyone’s faces. Captain Planet would be most displeased.
Masks and respirators don’t merely create a noxious atmosphere that one is forced to breath from, they make the act of breathing itself considerably more difficult. Consider
Experiments show an increase in airway resistance by a remarkable 126% on inhalation and 122% on exhalation with an N95 mask [60]. Experimental studies have also shown that moisturization of the mask (N95) increases the breathing resistance by a further 3% [61] and can, thus, increase the airway resistance up to 2.3 times the normal value.
and
The average dead space volume during breathing in adults is approximately 150–180 mL and is significantly increased when wearing a mask covering the mouth and nose [58]. With an N95 mask, for example, the dead space volume of approximately 98–168 mL was determined in an experimental study [59]. This corresponds to amask-related dead space increase of approximately 65 to 112% for adults and, thus, almost a doubling. At a respiratory rate of 12 per minute, the pendulum volume respiration with such a mask would, thus, be at least 2.9–3.8 L per minute. Therefore, the dead space amassed by the mask causes a relative reduction in the gas exchange volume available to the lungs per breath by 37% [60].
Kisielinski never defines the term dead space is his paper, so I will do the honors. Dead space is the volume of inhaled air that does not take place in gas exchange, and therefore neither provides the blood with oxygen or removes carbon dioxide from the blood. Even without a mask, some inhaled air will remain in the mouth or trachea instead of reaching the lungs and therefore not participate in gas exchange with the bloodstream. With the addition of a mask, there is now a large pocket of trapped air between the face and the mask that appears to make this effect worse. In the case of an N95 respirator, it is not only over twice as difficult to inhale, but a third of that inhalation never reaches alveoli to be used in respiration and the air that does make it to the alveoli is oxygen poor and CO2 rich.
All of these restrictions of breathing do have a measurable effect on both the oxygen and CO2 levels in the blood.
In addition to the increase in the wearer’s blood carbon dioxide (CO2) levels (p 13,15,17,19,21–28], another consequence of masks that has often been experimentally proven is a statistically significant drop in blood oxygen saturation (SpO2) (p 18,19,21,23,29–34]. A drop in blood oxygen partial pressure (PaO2) with the effect of an accompanying increase in heart rate (p 15,23,29,30,34] as well as an increase in respiratory rate (p 15,21,23,35,36] have been proven. A statistically significant measurable increase in pulse rate (p 30]. In another experimental study (comparative study), surgical and N95 masks caused a significant increase in heart rate (p 35]. Moisture penetration was determined via sensors by evaluating logs (SCXI-1461, National Instruments, Austin,TX, USA).
Further in the paper.
The documented mask-induced changes in blood gases towards hypercapnia (increased carbon dioxide/CO2 blood levels) and hypoxia (decreased oxygen/O2 blood levels) may result in additional nonphysical effects such as confusion, decreased thinking ability and disorientation [23,36–39], including overall impaired cognitive abilities and decrease in psychomotoric abilities [19,32,38–41].
But hey, it only interferes with breathing, a process absolutely essential to life. What could possibly go wrong? As it turns out, just about everything.
This largely explains the impairment of respiratory physiology reported in our work and the resulting side effects of all types of masks in everyday use in healthy and sick people (increase in respiratory rate, increase in heart rate, decrease in oxygen saturation, increase in carbon dioxide partial pressure, fatigue, headaches, dizziness, impaired thinking, etc.) [36,58].
Getting into the details.
A link between disturbed breathing and cardiorespiratory diseases such as hypertension, sleep apnea and metabolic syndrome has been scientifically proven [56
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