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Mask Wearing Has No Scientific Evidence Based Justification

Nearly three years after the start of COVID-19 in early 2020, people are still showing up in my clinic wearing single and double masks, with tremendous fear of getting an infection with COVID-19 or Influenza.  As of the end of 2022, some “so called” experts started telling people in the public to wear masks again, and patients in droves are showing up masked to their medical appointments in the last four weeks.

Before the COVID-19 pandemic, the existing available data about respiratory viruses including influenza and various types of coronavirus showed no evidence or justification for wearing masks to prevent the spread of infection of a respiratory virus.  The legitimate reason for use of a mask is during surgery to lend protection from blood and body fluid splatter between patient and providers or with specific types of filtration masks designed to specifically protect from certain types of bacterial infections.  

Review of the Medical Literature:

Here are key anchor points to the extensive scientific literature that establishes that wearing surgical masks and respirators (e.g., “N95”) does not reduce the risk of contracting a verified illness:

  • Jacobs, J. L. et al. (2009) “Use of surgical face masks to reduce the incidence of the common cold among health care workers in Japan: A randomized controlled trial,” American Journal of Infection Control, Volume 37, Issue 5, 417 – 419. https://www.ncbi.nlm.nih.gov/pubmed/19216002. N95-masked health-care workers (HCW) were significantly more likely to experience headaches. Face mask use in HCW was not demonstrated to provide benefit in terms of cold symptoms or getting colds.
  • Cowling, B. et al. (2010) “Face masks to prevent transmission of influenza virus: A systematic review,” Epidemiology and Infection, 138(4), 449-456. https://www.cambridge.org/core/journals/epidemiology-and-infection/article/face-masks-to-prevent-transmission-of-influenza-virus-a-systematic- review/64D368496EBDE0AFCC6639CCC9D8BC05. None of the studies reviewed showed a benefit from wearing a mask, in either health care worker or community members in households (H). See summary Tables 1 and 2 therein.
  • bin-Reza et al. (2012) “The use of masks and respirators to prevent transmission of influenza: a systematic review of the scientific evidence,” Influenza and Other Respiratory Viruses 6(4), 257–267. https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1750-2659.2011.00307.x “There were 17 eligible studies. … None of the studies established a conclusive relationship between mask/respirator use and protection against influenza infection.”
  • Smith, J.D. et al. (2016) “Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis,” CMAJ Mar 2016 https://www.cmaj.ca/content/188/8/567 “We identified six clinical studies . . . In the meta-analysis of the clinical studies, we found no significant difference between N95 respirators and surgical masks in associated risk of (a) laboratory-confirmed respiratory infection, (b) influenza-like illness, or (c) reported work-place absenteeism.”
  • Offeddu, V. et al. (2017) “Effectiveness of Masks and Respirators Against Respiratory Infections in Healthcare Workers: A Systematic Review and Meta-Analysis,” Clinical Infectious Diseases, Volume 65, Issue 11, 1 December 2017, Pages 1934–1942, https://academic.oup.com/cid/article/65/11/1934/4068747 “Self-reported assessment of clinical outcomes was prone to bias. Evidence of a protective effect of masks or respirators against verified respiratory infection (VRI) was not statistically significant.”
  • Radonovich, L.J. et al. (2019) “N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical Trial,” JAMA. 2019; 322(9): 824–833. https://jamanetwork.com/journals/jama/fullarticle/2749214 “Among 2862 randomized participants, 2371 completed the study and accounted for 5180 HCW-seasons. … Among outpatient health care personnel, N95 respirators vs medical masks as worn by participants in this trial resulted in no significant difference in the incidence of laboratory-confirmed influenza.”
  • Long, Y. et al. (2020) “Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis,” J Evid Based Med. 2020; 1- 9. https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.12381 “A total of six RCTs involving 9,171 participants were included. There were no statistically significant differences in preventing laboratory-confirmed influenza, laboratory-confirmed respiratory viral infections, laboratory-confirmed respiratory infection, and influenza-like illness using N95 respirators and surgical masks. Meta-analysis indicated a protective effect of N95 respirators against laboratory-confirmed bacterial colonization (RR = 0.58, 95% CI 0.43-0.78). The use of N95 respirators compared with surgical masks is not associated with a lower risk of laboratory-confirmed influenza.”

Conclusion: Masks Do Not Work

No randomized controlled (RCT) study with verified outcome shows a benefit for health care workers or community members in households to wearing a mask or respirator. There is no such study in existence.

Likewise, no study exists that shows a benefit from a broad policy to wear masks in public.

If there were any benefit to wearing a mask, because of the blocking power against droplets and aerosol particles, then there should be more benefit from wearing a respirator (N95) compared to a surgical mask, yet several large meta-analyses, and all the RCT, prove that there is no such relative benefit.

No Evidence or Justification for Mask Wearing

Despite the news media with all their hype, all of the scientific studies done in the world up until 2020 demonstrated that there was absolutely no justification for mask wearing to prevent spread of respiratory illness including influenza and corona-viruses.  The guidelines of the World Health Organization (WHO) and the US Center for Disease Control and Prevention (CDC) also showed that there was no need for wearing masks in the general public. The practice of wearing masks did not, and to this day, have any professional justification.  

In 2020, the recommendation around the world for wearing masks suddenly changed without any new professional support to confirm their effectiveness against respiratory infection.   The vast majority of studies during the pandemic suffered from very low quality and many biases.  

Only Two High Quality Mask Studies Exist

Since the start of the pandemic only two high-quality studies have been completed, one looking at a population of over 3000 people in Denmark, and the other with over 342,000 adults completed in Bangladesh.  The study in Bangladesh found some marginal benefit for people over age 50 years old, but overall both studies show that there is no significant benefit for wearing masks to prevent infection with influenza or the corona-virus specifically.

In fact, the results of both of these studies demonstrate that the wearing of masks actually may do more harm than good.   In addition to these studies, several observational studies demonstrated that wearing a mask can cause headaches, concentration difficulty, shortness of breath, decrease in blood oxygen levels, increase in the level of carbon dioxide, bacterial contamination from the mask itself and the existence of substances suspected being carcinogenic as result of lack of regulations and the production of masks.

Wearing a mask for a prolonged period of time can become problematic because of the accumulation of carbon dioxide levels that may exceed permitted standards, might cause tiredness, blurriness, sleepiness and deficiency in judgment, as well as thinking.  

Masks Adversely Affect Social, Mental and Emotional Health

An additional issue I personally found to be a problem in my office, masks create communication difficulty with people who have impaired hearing and need to read lips is a major factor.  Additional studies demonstrated the negative effect of wearing masks on communication and especially with children’s mental and emotional development.

There are a few particular situations in which wearing masks is justified.  In the context of medical treatment when a patient with a respiratory disease is closely examined by medical staff who will be spending prolonged periods of time with that patient, and certainly in the cases of active infectious COVID-19 there is justification for wearing a mask by both the therapist and the patient. However, research still demonstrates the spread to be very low if the contact is less than three hours in length.

As a physician who has practiced medicine for over 20 years, when the patient comes to me with leg pain there is no reason for him or for me to wear a mask.  If a patient comes in with anemia, there is also no reason to wear a mask.    In the medical encounter, the relationship that exist between the doctor and the patient has great significance.  Masks interfere with that relationship and the empathy that should exist between them.  Mask wearing when none is justified creates a subconscious barrier and changes the social and emotional dynamics between the patient and doctor.  Currently, there is a directive for mask-wearing in medical, health and welfare facilities around the world in a number of countries and in a number of hospitals which actually has no scientific justification.

Untrustworthy Medical Journals and Bias

The medical profession and providers within this profession rely heavily on articles published in high-quality journals to provide evidence based guidance and direction for our decisions and actions.  However, in the last three years, bias in these publications has been very significant and misleading in these leading journals.  It has essentially made them untrustworthy.  

Because of this, doctors have passed through a kind of brainwashing by the medical establishment.  They have been receiving inaccurate, misleading and contradictory information from previously trusted sources now swayed by bias, political, governmental and monetary influence, so doctors themselves struggle to know what is right and what is not.

Perhaps most worrisome is the continued refusal to have open professional discussion, and the disdain for different positions backed by poor quality research and data not consistent with the norms of medicine and science.  This has had long-term negative consequences for the medical profession and consequences that every doctor in the world should be concerned about.

As I mentioned above, no study exists that shows a benefit from any broad policy to wear masks in public. There is good reason for this. It would be impossible to obtain unambiguous and bias-free results because:

  • Any benefit from mask-wearing has only a very small effect, since undetected in controlled experiments, which would be swamped by the larger effects, notably the large effect from changing atmospheric humidity.
  • Mask compliance and mask adjustment habits would be unknown and impossible to account for.
  • Mask-wearing is associated (correlated) with several other health behaviors; see Wada (2012).
  • The results would not be transferable, because of differing cultural habits.
  • Compliance is achieved by fear, and individuals can habituate to fear-based propaganda, and can have fundamentally different basic responses.
  • Monitoring and compliance measurement are near-impossible, and subject to large errors.
  • Self-reporting (such as in surveys) is notoriously biased, because individuals have the self-interested belief that their efforts are useful.
  • Progression of the epidemic is not verified with reliable tests on large population samples, and generally relies on non-representative hospital visits or admissions.
  • Several different viruses and strains of viruses causing respiratory illness generally act together, in the same population and/or in individuals, and are not resolved, while having different epidemiological characteristics.

Unless you’re going in to perform surgery, please, for your health and mine, stop wearing a mask.

I Wish I Would Have Know This Sooner . . .

After graduation from medical residency, I served for four years as my AirForce Reserve unit’s biological/chemical weapons expert & physician. My job was to understand the risks of all the known biologic and chemical weapons that could be used on a human being, including severe viral and bacterial diseases that could pose a threat. My training was specifically focused on how to prevent and treat the effects of these illnesses in those under my care, military or otherwise.

I spent four years reading and researching where and when various types of masks, respirators and protective equipment would and should be used. Never once was a surgical or cloth mask ever found to be effective. Even N95 masks failed the rigors of these encounters.

This week our fearless Dr. Fauci says it’s “common sense” to wear two masks. So, my question to him and all of the other emperors of medicine is, what about three masks?

Even better yet, 10 masks makes even more “common sense!!” Where does this stop? (I stop at 11, because, my ears flop over at 12 masks.)

I’m thinking that 100 masks is 100% effective right?

I guess those filtered gas masks really aren’t essential then?!

One surgical mask decreases risk by 1-2% (yes, that’s the benefit of a mask that we’ve been required to wear). You’re more likely to have a 40% COVID risk reduction by throwing salt over your shoulder when you leave the house . . . (that’s the actual placebo effect).

The whole reason for mask wearing is to decrease “asymptomatic” transmission of COVID-19. That means, masks are supposed to decrease your risk of spreading or inhaling this virus when you or the person near you have no symptoms. Initially, we recommended wearing masks, because we did not know how infective the COVID-19 virus was to humans. We also knew that there was limited access to the N95 masks used in the hospital setting.

However, in the last 12 months, we’ve learned a great deal and we have a tremendous amount of data about treating this virus in the outpatient setting. You can follow Dr. Nally’s COVID-19 treatment protocol here.

How Contagious is COVID-19?

What’s the actual risk of spreading the virus when you have no symptoms? It’s about 0.06% if you have prolonged contact (3 hours continuous face-to-face) with a person within six hours of that person having onset of symptoms (i.e. – fever, sore throat, fatigue, headache, loss of taste or smell, or runny nose). It is very rare to be infected at all with COVID-19 asymptomatically if you contact a person 6-9 hours before they have symptoms.

In fact, a recent study revealed there were no positive tests (or asymptomatic spread) among 1,174 close contacts of asymptomatic cases.  So, why are we still wearing masks? Because it is politically convenient, increases fear, and increases your likelihood of getting a vaccine.

Are There Unintended Consequences of Mask Wearing?

Is wearing a mask to decrease a minimal risk by 1% more worth the risk? Increased bacterial and fungal infections that are on the rise as a consequence of chronic and continued daily mask wearing.

I’m seeing patients with increased frequency of facial rashes, fungal infections, non COVID-19 induced bacterial infections. Reports are coming from my colleagues, all over the world, that suggest bacterial pneumonias are on the rise.

Why? Because we are wearing and re-wearing of dirty masks. Untrained members of the public are wearing medical masks, repeatedly… in a non-sterile fashion… They’re becoming contaminated. They’re pulling them off of their car seat, off the rearview mirror, out of their pocket, from their countertop, and they’re reapplying a mask that should be worn fresh and sterile every single time. And, there is no way around this when 330 million people are required to wear a mask to go to Wal-Mart or Costco.

In a recent report in Emerging Infectious Diseases, the U.S. Centers for Disease Control and Prevention (CDC) suggests what experts have stated all along: There is no conclusive evidence that cloth masks protects users from coronavirus, especially since most people do not use them correctly and do not keep them clean.

The report actually says, “To our knowledge, only 1 randomized controlled trial has been conducted to examine the efficacy of cloth masks in healthcare settings, and the results do not favor use of cloth masks. More randomized controlled trials should be conducted in community settings to test the efficacy of cloth masks against respiratory infections.”

So, why, again, are we wearing these masks?

Masks Are Symbolic

Over the last few months, our fearless infectious disease leader, Dr. Anthony Fauci,  and the Ivory Tower of medical journals, the New England Journal of Medicine, have clearly informed us that mask wearing by the healthy is little more than symbolic ‘Virtue Signaling.’

For those Karen’s and Felicia’s who have tried to shout me down like a Tourette’s tick with ‘Social Media Science,’ in Wal-Mart, in the big box stores, at the gas station and at the burger shop, lets look closely at what the New England Journal of Medicine said on May 21, 2020.

We know that wearing a mask outside health care facilities offers little, if any, protection from infection. Public health authorities define a significant exposure to COVID-19 as face-to-face contact within 6 feet with a patient with symptomatic COVID-19 that is sustained for at least a few minutes (and some say more than 10 minutes or even 30 minutes). The chance of catching COVID-19 from a passing interaction in a public space is therefore minimal. In many cases, the desire for widespread masking is a reflexive reaction to anxiety over the pandemic.

So, why have we been ordered to wear are masks everywhere by mayors and governors and city officials across the country?  Symbolism.  Pure and simple symbolism.  From that same NEJM article:

It is also clear that masks serve symbolic roles. Masks are not only tools, they also serve as a talisman [an object that acts as a charm to avert evil and bring good fortune] that may help increase health care workers’ perceived sense of safety, well-being, and trust in their hospitals.

The Surgeon General was widely mocked and ridiculed for suggesting in March that masks might even increase the spread of the virus.  Yet, here, in the “journal of all medical journals,” the NEJM provides the same warning to mask-wearers:

What is clear, however, is that universal masking alone is not a panacea. A mask will not protect providers caring for a patient with active COVID-19 if it’s not accompanied by meticulous hand hygiene, eye protection, gloves, and a gown. A mask alone will not prevent health care workers with early COVID-19 from contaminating their hands and spreading the virus to patients and colleagues. Focusing on universal masking alone may, paradoxically, lead to more transmission of COVID-19 if it diverts attention from implementing more fundamental infection-control measures.

However, suddenly on June 17th, 2020, Dr. Fauci suddenly changed his tune, and contrary to all the scientific evidence and over 50 years of medical literature on the subject, said wearing a mask is “better than nothing.” Within weeks, executive orders for mask wearing were signed across the nation. 

The argument should have been over.  Anyone advocating for universal mask wearing by the healthy, according to all the mask wearing literature, is merely engaging in virtue signaling, not actual public health.

Cities and states across the nation have mandated mask wearing (some even advocate using bananas). I’m not telling you to break the law.  I am saying that the mask mandate has done nothing to “slow the spread” as so many people have now bought into.  Research demonstrates that homemade masks do little to stop the spread of viral infections.  It also demonstrates that properly fitted surgical masks worn correctly decrease this risk of viral spread in a highly controlled setting at the very best by only 2-5%.

In the most recent comprehensive review of the mask wearing literature, the authors stated, “The evidence is not sufficiently strong to support widespread use of face-masks as a protective measure against COVID-19. However, there is enough evidence to support the use of face-masks for short periods of time by particularly vulnerable individuals when in transient higher risk situations.”

What is effective is washing your hands regularly with soap and water, avoiding those who are actually sick or have fevers over 101 degrees, eating a healthy diet that prevents diabetes risk and getting adequate sleep.  Those at high risk for infection can and should be vigilant about avoiding exposure to those who are sick.

For the rest of us, it’s time to unmask.  I, myself, struggle daily to maintain enough virtue in my bones for myself, let alone signal others about it all day long.