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.