Why does wearing a mask for a few minutes in a shop bother you?
It may be just a few minutes for you when you pop into your Waitrose for a croissant, but millions of children across the world are being forced to wear them all day long, hundreds of days. Millions of workers are being forced to wear them for eight-hour shifts every work day, many of them in hot weather, and they can’t just loosely drape a scarf over their mouth. Wearing masks in such situations is intolerable to many people. It isn’t ‘just a few minutes’.
You people just have to suck it up, because masks work.
The scientific evidence base does not support the wearing of face masks to stop Covid-19. This is why Anders Tegnell, Sweden’s chief state epidemiologist, has ‘dismissed the scientific evidence for mask-wearing as “astonishingly weak”’.
See the Part 5.4 for an in-depth look at the literature, and Part 4 for in-depth analyses of the influential DELVE and Royal Society reports in 2020 which greatly influenced the UK government’s switch to forcing masks on people.
Nonsense, the ever-reliable Guardian had a story saying that masks cut Covid by 53%, and the study they were talking about was in the British Medical Journal, so where do you get off saying they don’t work?
That meta-analysis was hopeless. The authors themselves admitted that the
risk of bias across the six studies [ie. the studies chosen for the meta-analysis] ranged from moderate to serious or critical.
Even Professor Stephen Reicher, the zero-Covid fanatic, felt forced to apologise for promoting this story on social media once he realised how bad the study was (it included many garbage studies, including even ‘attitude’ and studies, and telephone interviews).
The even more extreme zero-Covid Communist Party member Prof Susan Michie published an article in the BMJ the same day saying the study was poor and should be disregarded:
the quality of the current evidence would be graded—by GRADE criteria11—as low or very low, as it consists of mainly observational studies with poor methods (biases in measurement of outcomes, classification of PHSM, and missing data), and high heterogeneity of effect size.
And the BMJ also published an editorial, the same day again, saying the study lacked serious data:
Among 35 studies good enough to evaluate, only one was a randomised trial, and it was too small… The others were all observational studies, including natural experiments, and the effects are likely to result from “bundles” of protective behaviours rather than single interventions.
Pharmacy Professor David Seedhouse and several scientific and academic colleagues wrote of this study:
We dug a little deeper and found that several of the papers cited by Talic et al are telephone surveys covering multiple variables, with questionable methodology. For example, one study investigated the effectiveness of mask-wearing in families in their homes of laboratory-confirmed Covid-19 cases in Beijing and concluded that face mask use was ’79 per cent effective in reducing transmission’. Strangely, the paper contains a passage that seems to undermine the whole study: “As the compliance of UFMU (universal face mask use) would be poor in the home, there was difficulty and also no necessity for everyone to wear masks at home.” This seems to imply that the use of face masks by family members in their households included in the study was sporadic and that therefore the study has no scientific merit.
What about country-level analyses? Don’t the countries that use masks have less cases and less deaths? Didn’t places that introduced mask mandates find that cases and deaths fell?
This is completely the opposite of the truth. There is no correlation between mask use and a reduction in cases or deaths in a country or state. In an article called ‘Mask mandate and use efficacy for COVID-19 containment in US States’ in the International Research Journal of Public Health (v.5 (55), 2021), the authors Guerra and Guerra conclude that
We did not observe association between mask mandates or use and reduced COVID-19 spread in US states… Our main finding is that mask mandates and use likely did not affect COVID-19 case growth. Mask mandates were associated with greater mask use but ultimately did not influence total normalized cases or post-mandate case growth… initial association between masks and lower COVID-19 growth rates that dissipated during the Fall-Winter 2020-21 wave is likely an artifact of fewer normalized cases begetting faster growth in states with coincidental low mask use.
For a less academic article, see this examination of twelve countries.
In ‘Masks, false safety and real dangers, Part 2: Microbial challenges from masks’ by Borovoy et al, in Primary Doctor Medical Journal (9 Oct 2020), an informal country-level analysis of mask use against Covid deaths was performed:
In July 2020, the Council of Foreign Relations conducted a survey of 25 countries, with the following question to their citizens: “Have you always worn a face mask outside the home in the last seven days?” The “Yes” responses ranged from 1% in Finland and Denmark, to 93% in Singapore. We then examined each of the same 25 countries for prevalence of mask use versus Covid-19 deaths per 1 million population. This data was gathered from Worldometers statistics. That data is shown in Table 1, also represented in Graph 1… As we see from the above data [in Table 1], there was no significant correlation with mask use and either increase or reduction of deaths from COVID-19; thus masking could not have caused a significant reduction in deaths. In fact, two of the countries with the highest COVID-19 deaths also had high rates of mask use: Spain at 87% mask use and Brazil at 90% mask use. Again, masking could not have caused a significant reduction in deaths.
Ian Miller does regular comparisons of countries and states looking at correlations between mask mandates and cases/deaths, and consistently finds no correlations whatsoever,
See, for example, these Substack posts:
Also see his must-read Twitter account for regular analysis of countries and states in regard to the effectiveness of masks. This recent graph he posted of Germany vs Sweden basically destroys all the mask nonsense once and for all (at least, in a rational world it would). Germany requires, by law, everyone to wear high-quality N95 masks, and there is high compliance, whereas Sweden doesn’t require masks and most people don’t wear them.
Masks work because they filter out the Covid virus, meaning my breath goes through the mask and comes out Covid-free on the other side, and vice-versa.
No. SARS-CoV-2 is vastly smaller than the holes in your piece of cloth. Did you really think that a bit of cloth placed over your face was going to stop every microscopic virus that is between 60-140 nanometres in length (a nanometre is one millionth of a millimetre)? Pull up your shirt or dress over your eyes – you can literally see the holes with your naked eye.
But I read on pro-mask site that the virus is usually attached to a Flugge droplet, an aerosol, or a bit of protein, and these are much bigger.
It is true that when they come out of someone’s mouth, virions are almost always attached to something else that is larger, most usually fine aerosols, ie. tiny water droplets, as well as larger water droplets. But aerosol droplets are microscopically small too. In ‘Particle sizes of infectious aerosols: implications for infection control’ by Fennelly in Lancet Respiratory Medicine (v.8 (9), 1 Sep 2020, pp.914-24), the author points out that ‘most particles [ie. aerosols] in exhaled breath are smaller than 4 μm, with a median between 0·7 and 1·0 μm’. (μm means micron, which is one-thousandth of a millimetre. Also, one micron = 1000 nanometres (nm).)
In an examination of the size of the holes in cloth masks titled ‘Optical microscopic study of surface morphology and filtering efficiency of face masks’ by Neupane et al, in PeerJ (v.7, 26 June 2019), it was found that ‘The pore size of masks ranged from 80 to 500 μm’.
This is between 80 to 714 times as big as a typical Covid-carrying fine aerosol. As many have mockingly pointed out, this is like trying to carry sand in a shopping trolley, or stopping a mosquitos with a chain-link fence.
Bear in mind also that many of the tiny virus-carrying aerosols will be following the air flow around the fibres and through the holes. It’s not like randomly shooting a whole load of ping pong balls all at once at a wall with some holes in it.
Having said that, these analogies are somewhat misleading, as even the worst cloth mask will trap some of your aerosols, whereas shopping trolleys aren’t going to carry any sand, and no mosquitos get stopped by a chain-link fence (for one thing, they have a sensory system and can fly around the wire. Then again, pro-mask debunkers never mention the fact that many aerosols will follow the air flow, so they are kind of like mosquitos, to some degree).
That’s why your cloth mask becomes wet after a while, it is trapping some of the moisture in your breath. But not much. Try this. Put a pan full of water on the hob and boil the water. Put one side of T-shirt over the pan. Cover the sides of the pan with the shirt (making sure the T-shirt doesn’t catch fire from the hob). Don’t stretch the material, just have it how it normally is, otherwise the holes will get even bigger. Watch how much steam goes through the cloth. It’s most of it. The cloth doesn’t even get very wet. Cloth masks generally don’t stop much water vapour, and they won’t be stopping many of the aerosols that contain virions.
Have you got any close-up photos of cloth masks?
Here are some close-up images of cloth masks captured by Neupane under the microscope. (The yellow line at the bottom of photo A is 500 microns and applies to all the images.)
Some pro-mask sites claim that the holes in cloth masks are more like ‘small tunnels than windows’. These sorts of images show that this is not true. (And even if it was true, the aerosols would mostly follow the air flow through the tunnels.)
Here are some more photos taken by Neupane in a different paper called ‘A smartphone microscopic method for rapid screening of cloth facemask fabrics during pandemics’ in PeerJ. (v.8, July 30 2020). (The yellow line at the bottom of photo E is 400 microns and applies to all the images.)
Do the aerosols that get through the mask just fall straight to the ground?
No, this only applies to larger droplets. Fine aerosols can float about in the air for long periods. Bear in mind also that aerosols very quickly evaporate, so the aerosol a virion is attached to becomes smaller and smaller, which means it can stay in the air for even longer. Some virions even become free floating particles attached to nothing at all. As this City Journal article states (‘Do We Need Mask Mandates?’ Harris, 22 March 2021): ‘One widely cited model estimates that droplets with diameters smaller than about 100 microns (a micron is a thousandth of a millimeter) evaporate before reaching the ground, leaving their contents as long-lasting aerosols; particles smaller than about five microns can stay aloft indefinitely and travel beyond droplet range’.
There’s a useful graphic here with visual representations of the typical size of various particles like virions, bacteria, blood cells, dust, sand crystals, etc. (I can’t vouch for the accuracy of all of it.)
But maybe fine aerosols don’t have much virus in them compared to the larger droplets?
No, the fine aerosols have far more virus in them – according to ‘Influenza Virus Aerosols in Human Exhaled Breath: Particle Size, Culturability, and Effect of Surgical Masks’ by Milton, et al, in PLoS Pathogens (v.9 (3), March 7 2013), ‘fine particles [ie. aerosols] contained 8.8 fold more viral copies than did coarse particles’.
It doesn’t hurt to wear a mask. There are no downsides. So why don’t you just do it just in case?
There are numerous ways in which wearing a mask has considerable downsides. I cannot cover them all here, but here are a few. (Note that the scientific studies on masks have mostly ignored mask harms – as a Cochrane meta-analysis of the literature states, ‘Harms were poorly measured and reported’.)
Wearing a mask that covers your airways for long periods, or even any period, is a very unpleasant experience for many people. It makes breathing difficult, and the better the mask, and the closer it fits to your face, the more difficult the breathing. It is very unhygienic, and for many people they feel, reasonably enough, degraded, dehumanised, humiliated and defeated. Over history, forcing people to wear masks is something that is usually used as a punishment and/or a sign of submission, to reduce or remove their ability to engage in normal human communication, and even to change or reduce their identity.
See, for example, this page of slavery images, which features numerous instances of forced mask wearing.
There is also the obvious example of the Islamic tradition of masking women, which indicates their submission.
Consider also the ‘scold’s bridle’, a punishment mask developed in Britain in the 16th century, designed to humiliate women who were considered shrews, gossips, gluttons, eavesdroppers, or liars. This practice spread to Europe – such masks were known as ‘Schandmaske’ in Germany, which meant the ‘mask of shame’ – and the practice then spread to the New World with the Puritans.
Given the aggressive and spiteful behaviour of modern states in forcing masks on people against their wills, and despite the lack of evidence of benefit, it is entirely reasonable for people to feel that being forced to wear mask is also in this case a sign of submission. For such people wearing a mask is an unjustified intrusion upon their bodily workings, and every second they spend in a mask is intolerable. It is like being forced to wear special clothing by a victorious army of hostile invaders. In fact, it is even worse because you are having to cover your airways in doing so.
Even for people who don’t feel as strongly as that, wearing a mask is still very unpleasant and most people dislike having them on, especially when they have to be worn for long periods. These are disutilities than cannot just be ignored in any calculation of the harms and benefits of masks. Even if you think the harm for each person is not great, when you multiply that by millions of people, by hundreds upon hundreds of days, you are looking at a significant overall harm, which has to be weighted against the benefits of wearing a mask, which is… zero.
There is also the huge downside that masks cover most of your face, and this disrupts the normal face-to-face communication that is so integral to the human race and human communications. And preventing people from being able to see the faces of human beings not only hinders communication, but is in itself a bad thing, because seeing the faces of other people around them is a basic human need for almost everyone. You can’t see facial expressions, you can’t see emotions, you can’t see smiles, frowns, puzzlement, etc. You can’t hear them very well. You can’t properly connect with a masked human. Depriving people of that for long periods is like putting them in solitary confinement, which for good reason is considered even worse than normal imprisonment. So these are also massive disutilities.
For some academic studies on face mask harms, see Part 5.1.b.
Why the fuss about kids wearing masks?
As Julia Donaldson, the author of The Gruffalo and a former Children’s Laureate in the UK said, face masks in schools are ‘alien – even dystopian’. She said of children being forced to wear masks that ‘I don’t think they should be sacrificed like this… Because of the climate of fear, people have readily accepted something I regard as unacceptable, and that I fear may now be seen as a normal part of life’.
In ‘Mandatory Masking of School Children is a Bad Idea’ in the Orange County Register (13 July 2021), Neeraj Sood (Director of the COVID Initiative at the USC Schaeffer Center for Health Policy and Economics) and Jay Bhattacharya (a professor of medicine at Stanford University) say
the long-term harm to kids from masking is potentially enormous. Masking is a psychological stressor for children and disrupts learning. Covering the lower half of the face of both teacher and pupil reduces the ability to communicate. In particular, children lose the experience of mimicking expressions, an essential tool of nonverbal communication. Positive emotions such as laughing and smiling become less recognizable, and negative emotions get amplified. Bonding between teachers and students takes a hit. Overall, it is likely that masking exacerbates the chances that a child will experience anxiety and depression, which are already at pandemic levels themselves.
Is there any harder evidence of masks harming children?
A database set up by German academics (called ‘Corona children studies “Co-Ki”: First results of a Germany-wide registry on mouth and nose covering (mask) in children’, Schwarz et al) collected many examples of masks harms in school children. The academics say
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/kindergarten (44%), malaise (42%) impaired learning (38%) and drowsiness or fatigue (37%).
The percentages are somewhat meaningless as this is a self-selected sample, and we can’t be sure that all the problems mentioned were caused by masks, but as the database had over 20,000 people on it, this is very concerning and should have seen the scientific establishment scurrying to conduct more research. Of course the opposite happened, and the academic establishment tried to poo-pooh the database as ‘non-scientific’. The very same establishment that promoted as major evidence a shallow look at two hairdressers (see Part 5.4).
“Those masks are not made for constant wearing and talking behind it,” he writes. “They get moist. We breathe our CO₂ in and out, in and out. Students complain of a red rash around their mouths from sitting behind that mask all day. Almost every lesson they ask me, “When will this end?” If they have to, they prefer to take lessons from home. Myself and fellow teachers also suffer. We force our voice to be heard when we wear a mask. I feel more tired. I expect that many colleagues and students will call in sick with voice problems, exhaustion, colds.
During April to October 2020 in the US, emergency room visits linked to mental health problems (e.g. anxiety) for children aged 5-11 increased by nearly 25% and increased by 31% for those aged 12-17 years old as compared to the same period in 2019.
This is a result of lockdowns and non-pharmaceutical interventions (NPIs) in general, not just masks, but no doubt masks contribute strongly to these results. Remember that many US states have required all-day mask-wearing for children since March 2020.
Do masks harm the development of children?
Yes. Not being able to see faces is even more important for young children, because this is crucial for their socialisation and mental development. In many US states school pupils having been wearing masks all day for 18 months, and this is very damaging for their development. We are damaging a generation of children, as well as making life very unpleasant for them. Many children greatly dislike wearing masks. This is child abuse.
Children’s education is also disrupted by masks. If you can’t see your teacher’s face for the whole day, or the faces of your classmates, your learning will be retarded.
Masks also greatly hinder children’s intellectual, and especially emotional development, which relies on being able to see people’s faces.
Babies learn an enormous amount of information from faces. From language to social cues, developmental psychologists say faces are a learning tool in the same way that books are. But with the coronavirus pandemic prompting orders and recommendations around the country to wear masks in public, young children are losing out on the crucial visual tools they need for language learning, said Dr. Lisa Scott, professor of psychology at the University of Florida.
Scott is calling on policymakers and educators to implement the use of transparent face masks — like face shields or clear masks — for caregivers and teachers of infants and young children. When learning language, babies use the mouth to help them learn the differences between sounds, such as “ba” and “da” — particularly in noisy environments, Scott said. And while wearing masks doesn’t mean they won’t learn language, it will be more challenging.
Kathleen M. Pike, PhD is Professor of Psychology and Director of the Global Mental Health WHO Collaborating Centre at Columbia University, and she says
Joy, anger, fear, surprise, sadness, contempt, disgust. These basic building blocks of emotional experience are written all over our faces. Legendary psychologist Paul Ekman has devoted his life’s work to studying non-verbal emotional expression across cultures. His research suggests that we can largely recognize how people around the world are feeling by simply reading their faces. All of humanity expresses these seven core feelings in ways that we universally comprehend. We depend on facial expression to know and understand each other. With physical distancing, increased anxiety, and disrupted routines due to COVID19, we are primed to seek emotional connection by simply seeing each other’s facial expressions.
She then says
Masks block a lot more than COVID-19 droplets. We depend on non-verbal behavior, and particularly facial expression, to express ourselves and communicate to others. Those feelings above, and many more, get expressed on our faces. In some contexts, non-verbal communication accounts for the majority of what we understand in our social exchanges. With our faces half-covered, we lose key non-verbal information, and other information, like raised eyebrows and shoulder shrugs become highly ambiguous without cues from the mouth. This loss of information is like talking on your phone in a zone with weak cell service. You know… those times when you only hear every third word and eventually the call drops. The effect leaves us feeling less able to communicate and less able to understand each other.
The Telegraph reports: ‘Dr Yvonne Wren, director of the Bristol Speech & Language Therapy Research Unit, and a senior research fellow at the University of Bristol, said:
“We know that the deaf community is affected by masks, but it’s going to affect speech and language development for all children. All children are going to get a much less clear signal. They won’t see people’s faces and won’t see whether they are smiling and looking stern. When we’re talking we often fill in the blanks and use the context of facial expressions to understand the message. It means they are going to get more confused and we know children don’t learn as well when they are in an emotional state”.
In a press release from the American Academy of Pediatrics, Dr. Alice Kuo, President of the Southern California chapter of the AAP, said: ‘For example, wearing masks throughout the day can hinder language and socio-emotional development, particularly for younger children’.
But not to worry, the New York Times, in an article reluctantly published to deal with this major issue, has a solution, which is to completely change the results of millions of years of human evolution:
Sarah Gaither, an assistant professor of psychology and neuroscience at Duke University, said in an email, “With mask wearing now being required in most school settings, children and adults should start practicing being more explicitly verbal by stating their emotions out loud.” Children will get better at reading people’s eyes, she suggested, and at understanding emotional content from tone of voice.
Alternatively, we could just take off these ridiculous religious encumbrances and save ourselves the bother of pointlessly reinventing human life.
In ‘Rapid Response: Psychosocial, biological, and immunological risks for children and pupils make long-term wearing of mouth masks difficult to maintain’, by Peteers et al, in British Medical Journal 370, 9 Sep 2020, the authors say
Facemasks prevent the mirroring of facial expressions, a process that facilitates empathetic connections and trust between pupils and teachers. This potentially leads to a significant increase in socio-psychological stress. During childhood and puberty the brain undergoes sexual and mental maturation through hormonal epigenetic reprogramming [18-21]. Several studies show that long-term exposure to socio-psychological stress leaves neuro-epigenetic scars that are difficult to cure in young people and often escalate into mental behavioural problems and a weakened immune system.
For a review of the relations between schoolchildren, masks and teachers, see ‘Un-masking Children: Part 1 of 4. The Role of Children in COVID-19 Transmission in Schools’ in Rational Ground (Burns, 11 May 2021).
For one sceptical American teacher’s take on masks in schools, see ‘What They Did to the Kids’, by Alex Gutentag in Tablet (22 Nov 2021).
As a teacher for special needs and underprivileged students, I saw the effects of school closures up close. It was a moral crime… Masks have become a constant reminder of potential transmission, and mask mandates have given rise to a wide array of new educational materials, such as dystopian singalongs and call-and-response routines that teach young children to cover their faces in order to keep their friends safe. In some schools, students are rewarded with “mask breaks” and can be suspended for mask noncompliance. Back-to-school activities that once had names like “All About Me” now have names like “Me Behind the Mask”.
In a survey conducted by the UK’s Department for Education in March 2021 it was found that ‘80% of pupils reported that wearing a face covering made it difficult to communicate, and more than half felt wearing one made learning more difficult (55%)’ (p. 8).
A different survey for the UK’s Department for Education in April 2021 ‘found that almost all secondary leaders and teachers (94%) thought that wearing face coverings has made communication between teachers and students more difficult, with 59% saying it has made it a lot more difficult’ (quoted on p. 9 of the DfE review above).
In ‘Masked education? The benefits and burdens of wearing face masks in schools during the current Corona pandemic’ by Spitzer , in Trends in Neuroscience and Education (Sep 2020), the author says
covering the lower half of the face reduces the ability to communicate, interpret, and mimic the expressions of those with whom we interact. Positive emotions become less recognizable, and negative emotions are amplified. Emotional mimicry, contagion, and emotionality in general are reduced and (thereby) bonding between teachers and learners, group cohesion, and learning – of which emotions are a major driver.
How are young adults affected?
A CDC study called ‘Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020’ by Czeisler et al in the CDC’s Morbidity and Mortality Weekly Report (August 14, 2020, v. 69 (32), pp.1049-57) said that the level of anxiety and depression in young adults aged 18-24 has increased by 63% since government restrictions began, and their use of antidepressants has increased by 25%:
The young adults also reported the highest levels of symptoms of anxiety and depression — 62.9 percent reported either or both. Their rates of having started or increased substance use to cope with pandemic-related stress or emotions was way up there as well at 24.7 percent (it was equal or higher only among the essential workers and the unpaid caregivers).
The study also found that a quarter of them think about suicide.
But aren’t masks good because they ‘send a signal’?
They certainly send a signal, but this is a bad thing. Masks increase fear and anxiety unnecessarily. They remind us, as they are supposed to, to spend our lives being be scared and worried about a disease that isn’t worth worrying about for most people. They remind the people who don’t believe the fear-mongering about Covid to fear the state. They also turn ordinary people into state agents, because they make it easy for non-believers to be identified and shamed by mask-wearers.
The head of the UK government’s Behavioural Insights Team has admitted that this is one of the reasons they like mask-wearing:
Prof David Halpern, chief executive of the Government’s Behavioural Insights Team, known as the Nudge Unit, who also sits on Sage, said “Most of the heavy lifting [on mask enforcement],” he says, “is done when we look at each other and think ‘Why aren’t you wearing a mask?’ and frown.”
Halpern also said that ‘the British are particularly good at this’.
The UK Government’s January 2022 face mask Evidence Summary from the DfE confirms that this sort of thinking is still in operation:
Wearing face coverings is comparatively cheap and easy to implement and supervise. It can be a visible outward signal of safety behaviour and a reminder of COVID-19 risks; [p. 6]
So masks make people fear the compliant masses. They make people who don’t want to wear masks wear them out of fear of other people, including friends and family. They tear apart the normal bonds of society, because instead of our different beliefs being kept in our heads, allowing us to rub along, they are forced out into the open where they are attacked and shamed, forcing you to comply or suffer.
Some scientists have explicitly admitted that an important function of masks is that they act as a symbol, though of course these scientists frame this in a positive way, eg. ‘a symbol of social solidarity in the global response to the pandemic’ (in ‘Wearing face masks in the community during the COVID-19 pandemic: altruism and solidarity’ by Cheng et al in the Lancet, April 16, 2020).
So you’re saying masks are about enforcing compliance to the state/the establishment?
Yes. Masks are used by governments, and those influencing the government (eg. academics, unions, tech billionaires), as a psychological tool to signal compliance. If you find that you don’t agree with your government’s approach to Covid-19, then seeing most people around you in a mask tells you that you are in a small minority. It tells you not to bother questioning, because you’re just an isolated fool. Even though most people may just be wearing the mask because they have been told to, and may also disagree with the government’s approach, you don’t know that. All you can see is that they are wearing the mask, so there must be something wrong with you if you don’t. There’s danger if you don’t obey, danger that’s going to come directly from the scary people around you. It’s a symbol that says you’d better obey unless you want some serious trouble.
Here’s an example, from an editorial in the New England Journal of Medicine (‘Universal Masking in Hospitals in the Covid-19 Era’ by Klompas et al, v.382, May 21 2020) of scientists talking about masks as useful symbols, although of course they are deluded enough to think that masks will reduce worry.
“It is also clear that masks serve symbolic roles. Masks are not only tools, they are also talismans that may help increase health care workers’ perceived sense of safety, well-being, and trust in their hospitals. Although such reactions may not be strictly logical, we are all subject to fear and anxiety, especially during times of crisis. One might argue that fear and anxiety are better countered with data and education than with a marginally beneficial mask, particularly in light of the worldwide mask shortage, but it is difficult to get clinicians to hear this message in the heat of the current crisis”.
Wearing a mask is just ‘doing your bit’.
Masks discourage people from doing normal things, and encourages them to stay inside and watch TV or use the internet. This is not always the intention of those implementing mask mandates: the British government clearly intended the opposite effect in summer 2020 when it encouraged masking as a way to end social distancing and get people outside and back to work and back to the shops, but not surprisingly this didn’t work very well. But other governments and health agencies and tech companies (who benefit from people staying inside) may have different motives.
Whatever the motive of those pushing masks, they discourage people from going outside, from meeting others, from shopping, from pursuing their hobbies, interacting normally with others, going to restaurants and pubs, playing sport, going to school, going to their University classes, going to concerts or the theatre, and so on. All this has significant effect on people’s mental and physical health, and causes great damage to society. Masks scare people and kept them inside, and so masks should only ever be considered as a last resort in a dire emergency when there is solid-gold evidence of their effectiveness (and maybe not even then).
To come at it in another way, mask-wearing is a major way in which the Covid hysteria is maintained, which makes masks partly responsible for the continuation of the murderous lockdowns, which have killed so many people over the world. As I have said since they were introduced, masks are murder.
C’mon, it’s not like it’s killing anyone.
As psychologist Dr Gary Sidley said of the fear engendered by masks
‘There is plenty of evidence to suggest that fear of attending hospital with non-coronavirus problems is contributing to the premature death of many people. In the first four months of the year, the Office of National Statistics estimated that almost 13,000 excess deaths were not attributable to SARS-CoV-2, a finding likely to be associated with the fact that admissions to Accident & Emergency departments were 128,000 lower in March 2020 as compared to March 2019. The Royal College of Paediatrics stated they had evidence of parents too scared to take their ill children to hospital. A senior oncologist predicted that treatment delays could cause up to 30,000 excess cancer deaths. And the health impact on older people – lonely and isolated, too scared to leave their homes – is as yet difficult to quantify.
Some people like wearing a mask, so they can’t be that bad.
Not many people choose to wear masks when they don’t have to, and those that do are doing so because they are scared, not because they like covering their mouth with a dirty rag.
Masks increase social decay and social isolation. We don’t see other people as people so much, we see them as moving figures in a landscape, as non-playing characters in a video game. We already live in a society that is becoming increasingly anonymous and disjointed (especially in the cities), and wearing masks increase this process enormously. It’s telling that the people who spent years lecturing us that we aren’t isolated islands and we must connect with others are now the most keen to push masks, which does the very opposite. They atomise us. They literally dehumanise us, in that we no longer see others as quite as human as we used to.
But surgeons wear masks to protect their patients from viruses when operating on them. So they must work, and you should stop complaining about them, as surgeons don’t complain.
First of all, note that an operation involves someone’s body being cut open and their internals exposed for a period, sometimes a long period. The situation is hardly analogous to going to a deli.
There are several reasons why surgeons started wearing masks. One is to protect themselves from blood and other bodily fluids which could spray or splash into their mouth, just as they wear special gowns to protect their clothes from these fluids. The masks can also prevent saliva droplets or bits of food or other gunk from dropping from the surgeon’s mouth, nose or facial hair into what is basically an open wound.
Another important reason they were originally worn is that it was hoped they would stop bacteria from the surgeon getting into open wounds. In the early part of the twentieth century ‘haemolytic streptococci isolated from wounds and puerperal fever were found to be identical with those carried in the throats of the surgical and obstetric teams’, and it was thought that masks could help stop this sort of infection happening.
Note, though, that the focus here was on bacteria (a major health threat at the time), not viruses. As far as I can tell from my research into this topic it was not originally thought that masks would protect against virus particles.
But a mask filters out the bacteria and viruses from a surgeon’s breath and prevent them going onto their patients’ openings.
They mostly don’t. As I said, it was hoped that surgical masks would stop bacteria, but stopping viruses wasn’t even an original aim. As a 2008 British government report called ‘Evaluating the protection afforded by surgical masks against influenza bioaerosols: Gross protection of surgical masks compared to filtering facepiece respirators’ said, ‘surgical masks are not intended to provide protection against infectious aerosols… There is a common misperception amongst workers and employers that surgical masks will protect against aerosols’.
While a surgical mask may be effective in blocking splashes and large-particle droplets, a face mask, by design, it does not filter or block very small particles in the air that may be transmitted by coughs, sneezes, or certain medical procedures. Surgical masks also do not provide complete protection from germs and other contaminants because of the loose fit between the surface of the mask and your face.
More recently some surgical masks have incorporated N95-style electrostatic filters in them, which are designed (like N95s), to filter out most virions and bacteria, but they still have their traditional loose fit, which means this filtering effect is mostly negated. In addition their filter usually has a weaker electrostatic charge than an N95. (For details see ‘Face masks against COVID-19: Standards, efficacy, testing and decontamination methods’ by Ju et al in Advances in colloid and interface science (v.292, June 2021).)
There is, though, also a newer mask called a ‘surgical N95’, which has a tight fit as well as an N95 filter – see the later sections on respirator masks like the N95 for more on this sort of mask.
Has there been research on the effectiveness of surgical masks?
There has been quite a bit of research on this. Not as much as you might expect, but enough for us to conclude that surgical masks probably do nothing much to prevent virions from being transmitted to their patients. See Part 5.2 for a literature review on the effectiveness of surgical (aka medical) masks in a surgical context, although I will mention here a seminal 1981 study titled ‘Is a mask necessary in the operating theatre?’, published in the Annals of the Royal College of Surgeons of England, which said
No masks were worn in one operating theatre for 6 months. There was no increase in the incidence of wound infection… The conclusion is that the wearing of a mask has very little relevance to the wellbeing of patients undergoing routine general surgery and it is a standard practice that could be abandoned.
The study also noted that ‘A review of the very considerable literature on prevention of infection in theatre shows a heavy bias in favour of history and hypothesis’.
MedPage Today in ‘ICAAC: Surgical Masks Don’t Prevent Infection’ (Phend, 16 Sep 2009) reported that
Although surgical masks were the face of the 2003 SARS epidemic in Asia, they don’t protect against pandemic H1N1 (swine flu) or any other respiratory infection, C. Raina MacIntyre, MBBS, PhD, of the University of New South Wales in Sydney, Australia, and colleagues warned. Last month, MacIntyre presented a preliminary version of these findings to an Institute of Medicine panel deliberating guidelines for personal protective equipment standards for healthcare workers. Aside from her trial, there was little but anecdotal testimony. “There are many guidelines – quite sweeping guidelines – about the use of masks without really a shred of high-level evidence to support them,” said MacIntyre.
Bear in mind that when a doctor really wants to prevent the transmission of a serious disease they wear specially-designed protective headgear, or biohazard-type suits. They don’t wear standard surgical masks in such cases, and they certainly don’t wear trendy masks with roses on them that they bought off the internet.
(Also bear in mind that surgeon’s masks aren’t sterile when they put them on, as is commonly supposed. For example, in ‘Gaps in asepsis due to surgical caps, face masks, external surfaces of infusion bottles and sterile wrappers of disposable articles’ by Gräf and von Imhoff in Zentralblatt fur Bakteriologie, Mikrobiologie und Hygiene. Serie B (v.179 (6), Dec 1984, pp.508-28), the authors found that ‘The surfaces of 25% of the examined disposable surgical masks and caps were considerably contaminated with saprophytic germs’ even before they were used.)
Aren’t you anti-maskers just selfish? You just can’t be bothered to save people’s lives.
An important reason why masks are a dismal failure is that a lot of the air simply goes in and out around the loose-fitting edges of the mask, rather than through the mask itself. As a group of fluid engineering researchers at the University of Waterloo showed,
most common masks, primarily due to problems with fit, filter about 10 per cent of exhaled aerosol droplets. The remaining aerosols are redirected, mostly out the top of the mask where it fits over the nose, and escape into the ambient air unfiltered.
Or, as these Edinburgh researchers put it in an article titled ‘Face Coverings, Aerosol Dispersion and Mitigation of Virus Transmission Risk’ by Viola et al in Engineering in Medicine and Biology (v.2, 20 Jan 2021, pp.26-35),
the effectiveness of the masks should mostly be considered based on the generation of secondary jets rather than on the ability to mitigate the front throughflow.
As these aerosol experts said in their study on face masks titled ‘Performance of an N95 Filtering Facepiece Particulate Respirator and a Surgical Mask During Human Breathing: Two Pathways for Particle Penetration’ by Grinshpun et al, in Journal of Occupational and Environmental Hygiene (v.6 (10), Oct 2009, pp.593-603),
we concluded that the future efforts in designing new RPDs [respiratory protection devices] for health care environments should be increasingly focused on the peripheral design rather than on the further improvement of the filter media. The faceseal leakage was found to represent the main pathway for the submicrometer particles penetrating into the respirator/mask. Thus, we believe that the priority in product development should be given to establishing a better fit that would eliminate or minimize the faceseal leakage.
Face mask leakage can actually be seen on the many videos where someone takes a lungful of smoke or visible cold air and then breathes out with a mask on.
Most of the breath goes out the sides, and only some goes through the mask itself.
The finer the mesh, or the more layers of mask, the more the air goes in and out of the sides, because a finer mesh or more layers makes it a harder job for your air to get out through the mask, so it takes the easier route of going out the sides where there’s nothing stopping it. This air isn’t filtered at all by your mask, whether going in or coming out. This is why serious masks are supposed to have a tight fit around the face. But this is pretty much impossible to do with standard masks, especially the virtue-signalling designer cloth ones with patterns on them.
But even without side leakage, cloth masks are ineffective. As this review titled ‘Masks-for-all for COVID-19 not based on sound data’ by two University of Chicago experts on respiratory protection for the Center for Infectious Disease Research and Policy at the University of Minnesota (April 2020) says,
In sum, cloth masks exhibit very low filter efficiency. Thus, even masks that fit well against the face will not prevent inhalation of small particles by the wearer or emission of small particles from the wearer.
But coughing and sneezing…?
One of the weirdest things about the mask studies that mask proponents use as evidence for the effectiveness of masks is that many of them are just studies on coughing and sneezing. These studies generally show that masks greatly reduce the distance aerosols and other particles travel from the mouth when you cough or sneeze. No joke, that’s what they’re looking at.
It’s hard to overstate the idiocy of this. First of all, no-one doubts that covering your mouth with a piece of cloth will prevent droplets and particles from flying off everywhere. Have these people never heard of handkerchiefs? But, more importantly, where did they get the idea that maskless people are just going to be coughing and sneezing without doing anything to cover their mouths? Virtually no-one does this, especially in these paranoid times. So how far a cough or sneeze can travel unimpeded by anything is just a total irrelevancy. Maskless people will cover their mouths when they have to cough or sneeze, just like they always have done.
The other weird thing about the pro-maskers’ focus on how masks help with coughs and sneezes is… are they just expecting people to cough and sneeze into their masks? Because this seems to be the assumption underlying a lot of their talk. But they rarely quite come out and say explicitly “You should cough and sneeze directly into your masks”. Some actually do say this, but most don’t quite say, they just imply it. Probably because it is deeply bizarre, and unrealistic, and unhygienic. What kind of weirdo sneezes into their mask? That’s whole lot of saliva and snot and bacteria that you’ve just deposited right onto the surface that’s going to be covering your face, in some cases for the next six or so hours if you’re working an all-day shift where you’re expected to wear a mask all day. Or you’re at a school that is forcing you to wear a mask. You may sneeze again later, especially if you have hay fever, and you could end up sneezing dozens of times a day. Who the hell does this? Or coughs a bunch of phlegm onto the inside of their mask? Anyone who does such things is in the grip of a serious delusion. How is it being health-minded to soak your face in a stew of bacteria and viruses and mucus and spit for hours? If you really do do this, you should replace your mask every time, because a wet mask is supposed to be replaced.
But let’s face it, most people, even the mask fanatics, aren’t going to orally ejaculate into their mask, they’re going to remove their mask, or push it aside, and use their hand, or a tissue, or a handkerchief. And then they’ll put their mask back on, which goes completely against the mask protocols. And you will know that all their careful studies measuring sneeze distances were about as useful as counting how many eyes of newt you’ve got.
I bet some scientists cough and sneeze into their masks.
You may be right. Here is a bizarre story about scientists boasting to a news station about how great masks are by showing the difference between coughing into a petri dish without a mask, and with a mask. Growths occurred after a few days in the former petri dish but not the latter. What this shows, although the scientists fail to appreciate this, is that if you cough into a mask (who actually does this? Perhaps these scientists do) you are coughing a whole load of bacteria into the cloth that you will be wearing next to your mouth for the rest of the day, and maybe the next few days if you don’t get around to washing or replacing it. Why would anyone think this is a good thing?
I expect the American Medical Association has a rather different view than you.
Nope. The Journal of the American Medical Association, published by, yes, the American Medical Association, has a Patient Page dedicated to masks. (JAMA’s ‘Patient Pages’ are a described by them as ‘public service’ with information and recommendations about various medical matters.) On this page they say – and this page is still current as of January 2022 – ‘Face masks should not be worn by healthy individuals to protect themselves from acquiring respiratory infection because there is no evidence to suggest that face masks worn by healthy individuals are effective in preventing people from becoming ill’. (They recommend face masks only be used by people with respiratory symptoms, those caring for them, and health care workers.)
But lots of doctors are telling us to wear masks?
Here’s something to ask any doctor who says this. Ask them if they would be willing to walk into a room with no windows or ventilation which is full of smoke, with just a cloth face mask on. (Smoke particles are generally bigger than virions.) Then you’ll find out what they really think. You will find that they will soon start drastically qualifying what they say, for example, ‘Well, masks only have a small effect, but every bit counts’, etc.
If you think this question might come across as too blunt, then ask your doctor instead about some of the studies listed in the literature review, particularly Macintyre’s 2015 BMJ study, the only randomized controlled trial ever done on cloth masks. Or ask them to cite a randomlized controlled trial on any sort of masks that shows that masks work. You’ll soon find them getting evasive and hustling you out of the room.
Don’t masks at least stop ‘spray-talkers’ and sneezers from spreading the virus?
The one thing we all agree on is that a face mask does probably stop at least some of the larger saliva droplets that some people spray out when they talk from going into someone else’s mouth or eyes. (And the droplets from coughs and sneezes, for that matter, but as I said earlier, who is seriously going to cough or sneeze into a mask?) But that is a very different matter than stopping smaller aerosols, which are the main method of SARS-CoV-2 transmission. As the National Academies of Sciences Rapid Expert Consultation on the Effectiveness of Fabric Masks for the COVID-19 Pandemic says,
The evidence from these laboratory filtration studies suggests that such fabric masks may reduce the transmission of larger respiratory droplets. There is little evidence regarding the transmission of small aerosolized particulates of the size potentially exhaled by asymptomatic or presymptomatic individuals with COVID-19.
A review article in City Journal titled ‘Do We Need Mask Mandates?’ (Harris, 22 March 2021), says
So while masks may stop short-range, face-to-face spread from large droplets, they are likely less effective—and perhaps completely ineffective—at stopping airborne spread from aerosols.
These issues have been around for a long time. In a 1920 paper titled ‘An experimental study of the efficacy of gauze face masks’ by Kellogg and Macmillan, in the American Journal of Public Health (v.10 (1), Jan 1920, pp.34-42), the failure of mask-wearing in San Francisco during the 1918 influenza epidemic was noted, and the authors said
The reason for this apparent failure of the mask was a subject for speculation among epidemiologists, for it had long been the belief of many of us that droplet borne infections should be easily controlled in this manner. The failure of the mask was a source of disappointment, for the first experiment in San Francisco was watched with interest with the expectation that if it proved feasible to enforce the regulation the desired result would be achieved. The reverse proved true. The masks, contrary to expectation, were worn cheerfully and universally, and also, contrary to expectation of what should follow under such circumstances, no effect on the epidemic curve was to be seen. Something was plainly wrong with our hypotheses.
Wasn’t stopping large droplets was the original point of masks in 2020?
Yes, stopping large droplets, sent out of the mouth by talking, as well as by sneezing and coughing, was all that many mask advocates initially claimed. Their original selling point was that masks would stop these larger droplets, and that would stop transmission in its tracks.
If stopping large droplets was the original point, why did it matter whether you covered your nose?
Good question. I’ve never seen this discussed, but I expect that we would get more nonsense about sneezes as an answer.
Wasn’t large droplets also why it was said that masks protect others from you, not you from them?
Yes. Your infected droplets would be stopped by your mask. But if someone without a mask spray-talks or coughs the virus onto your mask, you may then breathe in those virus particles from your mask. So that’s why initially the mask advocates were saying a mask is to protect others, not you.
So not wearing a mask is selfish?
The propagandists who advise the governments, like the UK’s Nudge Unit, liked this idea, because it meant that it didn’t matter if you said ‘I’m not worried about getting Covid’ – the issue was that you were putting other people at risk. So whether you were bothered about getting Covid or not didn’t come into it.
See, for example, this April 2020 Lancet paper:
People often wear masks to protect themselves, but we suggest a stronger public health rationale is source control to protect others from respiratory droplets… This measure shifts the focus from self-protection to altruism.
(‘Wearing face masks in the community during the COVID-19 pandemic: altruism and solidarity’ by Cheng et al, April 16, 2020.)
Once aerosol transmission came into the picture, though, this messaging faded away, without ever being formally repudiated by health authorities, because the original asymmetry no longer existed: masks were no better at keeping aerosols in than out. (And, let’s face it, most mask-wearers, other than some of the young virtue-signallers, are wearing a mask because they believe it protects them as much as it protects others.)
We will see later in Part 4 that British government mask reports, even in 2022, still talk as though stopping droplets is the main point of masks.
Do masks stop the virus particles they trap from ever getting out of the mask again?
No. Even when masks traps a virion it doesn’t destroy the virion, or lock it away in a deep dungeon where it can never get out. The virion is loosely held by the mask fibres, but it will be regularly blown upon by the wearer’s breath which will pull it away from the fibre. Eventually the virion can break free of the fibre holding it and be carried by a breath out into the surrounding environment. So for many virions the mask merely delays its passage into the surrounding air.
Dr Roger Koops, an experienced biochemist (who worked for years in Quality Assurance/Control and issues related to Regulatory Compliance), explains:
The virus is not somehow magically “glued” to the mask but can be expelled, whether or not there is still moisture. This can happen the next time a person breathes, speaks, coughs, sneezes, hisses, grunts, etc. So, the virus can be expelled out into the environment from the face covering… the face covering acts as an intermediary in transmission. It can alter the timing of the virus getting into the environment, but it now acts as a contact source and airborne source; virus can still get into the environment. Since we know that the stability is good on most covering and mask materials, it does nothing to break down the virus until the covering is removed… as more virus molecules accumulate, more are expelled. The face covering is not some virus black hole that sucks the virus into oblivion.
The same is true of breathing in. Even those virions which your mask has trapped are not forever locked away from entering your lungs. Many virions will only be loosely held by a fibre, and this connection will be broken down by repeated breaths in and out, and after a while some of them will detach from the mask fibres and be pulled into your lungs by a breath.
Of course many of the virions that are trapped in your mask will stay there all day, but don’t think that all of them will. The longer you wear a mask the more trapped virions there will be that detach from your mask and enter your lungs or the air around you.
Consider the situation where 13 million masks in Switzerland had to be recalled because they had gone mouldy. The people who had been forced to wear them before the recall said that they got a strong mould smell from the masks:
Hospital staff in Bern then complained of burning eyes and breathing problems’. “They smelled like a moldy bathroom … Almost unbearable!” said one employee in an interview with Euronews.
This vividly demonstrates how masks do not permanently trap all pathogens, such as virions, bacteria, and fungi, within the mask’s fibres. Some stay loosely attached to the fibres for a while before being breathed in or out.
Why was stopping larger droplets all that the pro-maskers claimed early on?
The reason for this was this was received wisdom at the WHO, and at many other health institutions, was that the main method of transmission for respiratory disease was large droplets rather than fine aerosols. For example, a 2008 British government report called ‘Evaluating the protection afforded by surgical masks against influenza bioaerosols: Gross protection of surgical masks compared to filtering facepiece respirators’, which was put together by the Health and Safety Laboratory for the Health and Safety Executive, said:
The main route of transmission of influenza is believed to be via direct contact with large droplets. The relative importance of aerosols in transmission is considered to be minor, but it cannot be ruled-out.
It turned out that WHO and all these other health institutions were wrong, as they have been wrong about so many things. A large group of determined scientists, who knew large droplets were not the most important method of transmission eventually forced WHO and other health authorities to acknowledge, in summer 2020, that aerosol spread was a major method of transmission.
This was partly achieved by 239 academics led by Donald Milton, who we will be meeting in Part 3, and Lidia Morawska publishing a letter about the issue in the journal Clinical Infectious Diseases (v.71 (9), 1 Nov 2020, pp.2311–3), entitled ‘It Is Time to Address Airborne Transmission of Coronavirus Disease 2019 (COVID-19)’.
One obvious reason to believe that aerosol transmission was happening was that people were getting sick after being in the same room as someone who was infected without there being any close or sustained contact, and there were plenty of other good reasons too.
Once it was finally acknowledged that aerosol spread was very important (although WHO dragged its feet over formally acknowledging this, as did the CDC) then the promotion of basic cloth masks, which don’t stop aerosols, should have been greatly downgraded or discontinued (especially given the numerous and major downsides to them).
This, of course, didn’t happen. Some of the scientists who pushed the aerosol spread theory genuinely believed that masks would stop aerosols as well as large droplets. (Prof Trish Greenhalgh, for instance, has strongly pushed the aerosol theory, and is also a fanatical mask advocate.) Many others knew or suspected they didn’t stop aerosols, but wanted them anyway. So masks continued to be stupidly or even dishonestly pushed as a simple, quick and important solution to getting rid of Covid.
Wasn’t it around then that the WHO started advocating masks?
Yes, the WHO came on board at that time with the promotion of masks despite the fact that they had now started to accept that aerosol spread was a factor, and despite the fact that they knew there was no good evidence for the effectiveness of masks in stopping aerosols (as they admitted in their influential mask review published on 5th June 2020; see below for more on this). But real science was swept away at this point by political game-playing, and the promotion of masks at that time by health authorities, governments and the media, backed by the WHO’s cynical stamp of approval, not to mention the CDC’s earlier switch on masks on April 3, went into overdrive despite the fact that the new consensus about how Covid spreads made masks irrelevant.
The mask push was driven into overdrive a bit later in 2020 by a ludicrous article in Nature Medicine (v. 27, Oct 2020, pp.94–105) by the Institute for Health Metrics and Evaluation COVID-19 Forecasting Team, titled ‘Modeling COVID-19 scenarios for the United States’. They claimed that 130,000 (possibly even 170,000) lives could be saved in the USA by public mask use.
We find that achieving universal mask use (95% mask use in public) could be sufficient to ameliorate the worst effects of epidemic resurgences in many states. Universal mask use could save an additional 129,574 (85,284–170,867) lives from September 22, 2020 through the end of February 2021, or an additional 95,814 (60,731–133,077) lives assuming a lesser adoption of mask wearing (85%), when compared to the reference scenario.
This paper wasn’t based on any serious real-life work, it was based on IHME’s computer modelling of scenarios. And despite their prestige with the media, IHME’s modelling in the Covid era has turned out to be complete junk. Moreover, the authors simply assume that mask-wearing works, rather than providing any evidence to think they do, so it simply circular reasoning to point to this paper as evidence that masks work.
(The Wall St Journal also ran a piece criticising the study in regards to the estimates of mask-wearers at the time.)
So how much of Covid spread does depend on spray-talking then?
Spray-talking is unlikely to be a major source of Covid transmission, and anyone who is worried about getting it that way can just keep their distance. Or stay inside and hide under the bed.
Is keeping your distance still a good idea in general if spray droplets are not the main method of transmission?
Keeping your distance will reduce the chances of the terrified from getting Covid via aerosol transmission, because even though aerosols can travel further than droplets, they become greatly dispersed the further they travel, like with cigarette smoke. So you are still more likely to get it from being close up to someone than further away. But no amount of distancing can guarantee you’ll never get Covid from aerosols, and the more time goes on the more likely you are to get it. Take the case of Independent SAGE member Christina Pagel, a zero-Covid fanatic, who thought that her social distancing and mask-wearing meant that she would never get Covid. She did.
Overall, though, social distancing is an extremely damaging practice – more on this in the Social Distancing FAQ (to come).
What about fomite transmission?
‘Fomite’ transmission, ie. getting infected through touching contaminated surfaces, can also occur, but is now considered to be far less important as a source of infection– the CDC said on 5th April 2021 that ‘the relative risk of fomite transmission of SARS-CoV-2 is considered low’. So you can stop disinfecting your groceries now.
How do we know that spray-talking is less important than aerosols?
It turns out that the science about these things was pretty poor. Hundreds of billions of dollars has been spent on disease research over the last century, yet our understanding of some of the basic mechanisms of how diseases spread was a mess. It’s not just me who thinks this, this Royal Society article from 12 Oct 2021 titled ‘How did we get here: what are droplets and aerosols and how far do they go? A historical perspective on the transmission of respiratory infectious diseases’ by Randall et al also thinks so: ‘The COVID-19 pandemic has exposed major gaps in our understanding of the transmission of viruses through the air. These gaps slowed recognition of airborne transmission of the disease’.
A useful popular summary of how things changed around with Covid can be found in this Wired article ‘The 60-Year-Old Scientific Screwup That Helped Covid Kill’ by Megan Molteni (13 May 2021) (but please ignore the melodramatic overstatements in it).
See also this Nature news piece titled ‘Mounting evidence suggests coronavirus is airborne — but health advice has not caught up’ (Lewis, 8 July 2020).
And ‘Airborne transmission of SARS-CoV-2: The world should face the reality’ by Morawskaa and Caob in Environment International (v.139, June 2020).
Scientific opinion has now swung strongly over to the view that aerosol spread is the main method of transmission. The Wired article has some examples of recent research supporting this, eg: ‘Li’s elegant simulations showed that when a person coughed or sneezed, the heavy droplets were too few and the targets—an open mouth, nostrils, eyes—too small to account for much infection. Li’s team had concluded, therefore, that the public health establishment had it backward and that most colds, flu, and other respiratory illnesses must spread through aerosols instead’.
An influential paper in the Lancet (v.397 (10285), May 1 2021, pp.1603-1605) entitled ‘Ten scientific reasons in support of airborne transmission of SARS-CoV-2’ set out ‘ten streams of evidence [that] collectively support the hypothesis that SARS-CoV-2 is transmitted primarily by the airborne route’.
A University of California study argued that not only does SARS-CoV-2 spread via aerosols, but most other respiratory diseases do as well (previously it was believed that only a few diseases, such as measles, spread this way).
SARS-CoV, MERS-CoV, influenza, measles, and the rhinoviruses that cause the common cold can all spread via aerosols that can build up in indoor air and linger for hours, an international interdisciplinary team of researchers reported in a review published in Science Aug. 27.
Over the last century and at the beginning of this pandemic, it was widely believed that respiratory viruses, including SARS-CoV-2, mainly spread through droplets produced in coughs and sneezes of infected individuals or through touching contaminated surfaces. However, droplet and fomite transmission of SARS-CoV-2 fails to account for the numerous superspreading events observed during the COVID-19 pandemic or the much higher transmission that occurs indoors vs. outdoors…
The team reviewed numerous studies of superspreading events observed during the COVID pandemic and found the studies consistently showed that airborne transmission is the most likely transmission route rather than surface contacts or contact with large droplets.
An editorial review by Tang et al in the British Medical Journal titled ‘Covid-19 has redefined airborne transmission’ (v.373, 14 April 2021) says
It is now clear that SARS-CoV-2 transmits mostly between people at close range through inhalation. This does not mean that transmission through contact with surfaces or that the longer range airborne route does not occur, but these routes of transmission are less important during brief everyday interactions over the usual 1 m conversational distance. In close range situations, people are much more likely to be exposed to the virus by inhaling it than by having it fly through the air in large droplets to land on their eyes, nostrils, or lips. The transmission of SARS-CoV-2 after touching surfaces is now considered to be relatively minimal.
This JAMA Insights paper titled ‘Indoor Air Changes and Potential Implications for SARS-CoV-2 Transmission’, by Allen et al (v.325 (20), April 16 2020, pp. 2112-3) says
First, SARS-CoV-2 is primarily transmitted from the exhaled respiratory aerosols of infected individuals. Larger droplets (>100 μm) can settle out of the air due to gravitational forces within 6 feet, but people emit 100 times more smaller aerosols (<5 μm) during talking, breathing, and coughing. Smaller aerosols can stay aloft for 30 minutes to hours and travel well beyond 6 feet. Second, high-profile and well-described SARS-CoV-2 outbreaks across multiple space types (eg, restaurants, gyms, choir practice, schools, buses) share the common features of time indoors and low levels of ventilation, even when people remained physically distanced.
In my own view the situation with hospitals suggests strongly that Covid transmission is mainly by fine aerosols rather than direct saliva droplets. Hospitals are not full of people up close talking to each other. The vast majority of patients are confined to their beds for almost all the time. The staff are all wearing masks, which stop droplet spray. Some patients have visitors, but the visitors mostly wear masks and anyway mainly sit away from the patient in a chair beside the bed. Hospitals have zealously enforced social distancing, with plastic screens everywhere. Hospitals are the polar opposite of crowded mosh-pits; there is very little opportunity for spray-talk transmission in hospitals. Despite all this hospitals are prime Covid spreaders. The same applies to care homes. Given that ‘fomite’ transmission is less important, and given that most masks are of little use against aerosol spread, that leaves aerosol transmission as the prime suspect in hospital (and care home) Covid spread. (This argument, I was pleased to note, appears as reason number five on the aforementioned Lancet paper.)
Also note that SARS-CoV-2 has relentlessly spread to billions of people all over the world despite the widespread and long-term use of masks and social distancing in many countries, which have made no difference. This is what you would expect if SARS-CoV-2 was primarily spread by aerosols, which masks and social distancing don’t have much effect upon, but not what you’d expect if larger droplets were the main transmission source.
Didn’t WHO produce an influential document in June 2020 making a case for masks? Why should I believe you over them?
You didn’t actually read that document, did you? I did, at the time, and did an analysis of it. The original (non-updated) version of that document can be read here, and my analysis is here.
The document not only makes no good case at all for mask use, it actually admits that there isn’t much a case. First of all, note that it doesn’t go through any studies in any detail, it merely summarises what it thinks the literature has found. And what it thinks the literature has found is… not much at all:
There is limited evidence that wearing a medical mask by healthy individuals in households, in particular those who share a house with a sick person, or among attendees of mass gatherings may be beneficial as a measure preventing transmission… Results from cluster randomized controlled trials on the use of masks among young adults living in university residences in the United States of America indicate that face masks may reduce the rate of influenza-like illness, but showed no impact on risk of laboratory-confirmed influenza. At present, there is no direct evidence (from studies on COVID-19 and in healthy people in the community) on the effectiveness of universal masking of healthy people in the community to prevent infection with respiratory viruses, including COVID-19. [p. 6]
Their conclusion was
At the present time, the widespread use of masks by healthy people in the community setting is not yet supported by high quality or direct scientific evidence. [p. 6]
So why did WHO recommend masks despite finding there was no evidence for their use? Their reasons were vague:
taking into account  the available studies evaluating pre- and asymptomatic transmission,  a growing compendium of observational evidence on the use of masks by the general public in several countries,  individual values and preferences, as well as  the difficulty of physical distancing in many contexts, WHO has updated its guidance to advise that to prevent COVID-19 transmission effectively in areas of community transmission, governments should encourage the general public to wear masks in specific situations and settings as part of a comprehensive approach to suppress SARS-CoV-2 transmission. [p. 6]
Nothing was said about .  and  were pretty meaningless.  was irrelevant as evidence. So they basically had, by their own admission, no good reason to recommend masks. But the priestly caste of the scientific community had become fixated on masks at the time, as had Western governments and health bodies, and WHO was pressured politically to change its tune, so it did. (There were many stories at the time about WHO being leaned upon.)
Note also that nowhere in this document is there any support expressed for making masks compulsory. It merely says that governments should encourage their use.
Some have alleged that WHO’s decision to support masks despite the lack of evidence was political.
Yes, and not just ‘conspiracy theorists’. BBC reporter Deb Cohen reported ‘We had been told by various sources WHO committee reviewing the evidence had not backed masks but they recommended them due to political lobbying. This point was put to WHO who did not deny’.
What about the higher-quality masks like N95s? Aren’t these supposed to be better at stopping aerosol-borne viruses? What are they anyway?
Better quality masks, or respirators, are known as N95, PPF2 or PPF3. These terms are government standards, not commercial names. N95 is a U.S. government standard, regulated by the National Institute for Occupational Safety and Health. The ‘N’ refers to ‘not resistant to oil’. FFP2 and FFP3 are EU standards, and is currently in use in the UK. ‘FFP’ stands for ‘filtering facepiece’.
The N95 standard requires the respirator to filter out at least 95% of particles that are 0.3 microns (300 nanometres) in size. (That’s what the ‘95’ stands for.) This is actually the size that the respirator is least good at filtering: it will normally perform better for particles that are smaller and larger than 0.3 microns. This allows the respirator to trap virions, bacteria, dust, haze, pollen, smoke and smog, and so on. (In theory, at least, and under ideal conditions.)
The FFP2 standard is roughly equivalent to the N95: FFP2 masks filter out 94% of particles that are 0.3 microns in size. FFP3 is a higher standard again: FFP3 masks are required to filter out 99% of 0.3 micron particles. FFP1 is a lower standard, it requires 80% filtration.
(There are also standards on the ‘inward leakage’ – more about this here.)
What’s a KN95 mask?
KN95 is a Chinese standard, and is like a lower-quality version of the N95. In theory a KN95 mask will filter out 95% of 0.3 micron particles just like the N95. In practice many KN95s are poor quality, or even fakes, and don’t work anywhere near like they’re supposed to. For example
Researchers at ECRI, a not-for-profit organization that for decades has advised hospitals, government organizations and other healthcare stakeholders on product safety, found that 60 to 70 percent of imported KN95 masks do not filter 95 percent of aerosol particulates, contrary to what their name suggests.
Despite this a lot of American mask mandates allow or even prefer the KN95 in order to preserve N95 supplies for the medical profession.
What’s KF94 mask?
KF94 mask is a Korean standard that is similar to N95 (‘KF’ stands for ‘Korean filter’).
What’s an R95?
An R95 is just like an N95, except that it’s also resistant to oily particles (it will last about a day in conditions with oily particles).
What’s a P95?
A P95 is just like an R95, except that it’s also very resistant to oily particles (it will last for about 40 hours of use).
What’s are N99 and N100 masks?
These are like N95s but have 99% and 99.97% efficiency.
What’s a P2 mask?
P2 is an Australian standard that is similar to N95 and FFP2.
What are these masks made of?
N95 respirators are made of four plies of polypropylene media: an outer veil that is moisture resistant, a double-ply filtration layer, and an inner layer that is in contact with the skin. ‘The efficiency of the respirator lies in the middle filtration layer, which is developed through the processes of melt blowing and electrostatic charging’.
Masks made using this sort of technology are often called ‘non-woven’, because the very thin plastic strands/fibres in them are not made by normal weaving techniques, but by industrial ‘melt-blowing’ and ‘spunbond’ processes. Often different layers are made using a different process. (For details see ‘Face masks against COVID-19: Standards, efficacy, testing and decontamination methods’ by Ju et al in Advances in colloid and interface science (v.292, June 2021).)
(The differences between melt-blown and spunbond processes are explained here.)
Yes, the key to the superior filtering performance of respirators is that they have an inner layer of fibres that have a slight electrostatic charge. This attracts small particles and causes them to stick to the fibres. Without the electrostatic charge these filters would be far, far less good at trapping tiny particles.
Why are N95s so efficient at filtering out the smaller particles? It has something to do with “Brownian motion,” or a phenomenon that causes particles smaller than 0.3 microns to move in a haphazard, zig-zagging motion. This makes it more likely for the particles to get caught inside the fibers of the N95. Plus, the masks use electrostatic absorption, which means that rather than passing through the fiber, the particles are trapped.
“Although these particles are smaller than the pores, they can be pulled over by the charged fibers and get stuck,” Jiaxing Huang, a materials scientist at Northwestern University, told USA Today.
Why do some of these masks have valves?
Respirators can come with or without a valve, which will open for a strong breath in and/or out (depending on the design). There is no filtration for the air that goes out the valve.
Doesn’t that mean valved masks don’t work?
Yes. The NHS even put out a safety alert for valved FFP3 masks in August 2021, which said that
The exhalation valves do not filter exhaled breath. Current infection control guidance states that: “Valved respirators should not be worn by a healthcare worker/operator when sterility directly over the surgical field is required”.
The British Association of Oral Surgeons also recommend against the use of valved masks, even FFP3 masks:
Valved FFP3 masks may represent a risk by directing unfiltered exhaled breath toward a patient… FFP3 masks with an exhalation valve may be more comfortable for the user but, by design, they allow unfiltered breath to be directed toward a patient during close contact.
N95 respirators with exhalation valves are not effective in reducing the spread of COVID-19 and are not permitted to be used as a face covering.
(Note that an exhale valve is fine if the purpose of the mask is to prevent the wearer breathing in, for example, wood dust.)
So the N95 and FFP2/3 masks are better than cloth masks then?
In theory all these masks are far better than your basic cloth mask. Cloth masks have large holes in them, whereas the gaps between the strands in respirators are smaller.
What size gaps are there in the N95 filter?
This is a trickier question than it seems. First of all, note that a lot supposed fact-checking sites and debunking pro-mask newspaper articles simply say the answer is 0.3 microns, for example, ‘The N95 filter is indeed physically around the 0.3 micron size’. That’s not really right, and it looks like a lot of them are simply mixing this up with the fact that these masks are tested again particles that 0.3 microns in size.
First of all, we need to note that outer layers of N95s are usually made of spunbond fibres, while the crucial inner layer is made of melt-blown fibres. The spunbond layers have relatively larger fibres and larger gaps. In ‘Face masks against COVID-19: Standards, efficacy, testing and decontamination methods’ by Ju et al in Advances in colloid and interface science (v.292, June 2021), the authors say ‘In general, this spunbonded PP layer has a fiber diameter of 20 μm and a pore size of up to 100 μm’. The pore sizes actually vary greatly, but this is little better than many cloth masks.
The thickness of the fibres in the melt-blown layer vary much more than the spunbond fibres, but they are on average much thinner – they have a ‘fiber diameter in the range of 1–10 μm’. The pore sizes here are much smaller, around 20μm (not 3μm as many sites tell you). 20μm is still far bigger than the 0.7–1μm of the typical aerosol-carrying droplet.
Here’s some microscopic images from Ju et al of N95 layers.
However, the issue is more complex than that. These fibres are in random arrangements; they don’t form regular geometric patterns like a chain-link fence. Also, even within the one layer you’ve often got multiple layers of strands, so even if an aerosol gets through one gap, it may still be stopped after that. And there are multiple layers in the mask, which will further reduce the chances of an aerosol getting through. Plus there is the fact that very small particles like fine aerosols move in a random zig-zag motion as they are buffeted by the small air particles around them – this is ‘Brownian motion’, and in this context it’s called ‘diffusion’ – which further increases their chances of getting caught. (Note that diffusion also happens with cloth masks, even though some writers, such as in the Popular Mechanics piece above, present it as something that is unique to respirators, and part of why they are better than cloth masks.)
However, although these features make some difference, the fact is that even with them N95s wouldn’t be very good at filtering. What makes the biggest difference with an N95 filter is the electrostatic charge that is applied to the fibres, which attracts the aerosols. (Note that the main charge is in the middle melt-blown layer – the spunbond layers only have a weak charge.)
I have seen numerous scientific papers say that it is the charge that is by far the most important factor. They all give different numbers for how much worse the filtering efficiency is without the charge, as the matter is not that precise, and you get different results for different masks, but the general idea is that an N95 would only stop 5–30% of 0.3 micron test particles, rather than the 95% it is supposed to, without the charge. (‘Filtering efficiency’ generally refers to how good the filter is by itself at stopping aerosols, ie. not counting side leakage, but some authors use it to refer to tests that also measure side leakage.)
A paper that specifically studied this topic is ‘Experimental Study of Electrostatic Aerosol Filtration at Moderate Filter Face Velocity’ by Sanchez et al, in Aerosol Science and Technology (v.47 (6), 2013), in which the authors tested charged and uncharged filters:
A substantial increase in overall collection efficiency was observed when electrostatically charged filter media were used. Uncharged filter media displayed a local minimum in collection efficiency (30%) around 200 nm [nanometres] at a filter face velocity of 0.5 m/s. Filter efficiencies were approximately 85%, down to 30 nm [nanometres], in the presence of electrostatically charged filter fibers.
Surgical masks, with the same sort of melt-blown layer as N95s but a weaker charge (Ju et al confirm this), typically only have a 30-50% filtering efficiency (ie. against 0.3 micron particles), and this is despite them still having a charge, only not as strong a charge as an N95. Ju et al also claim that that spunbond layer by itself with its weaker charge only has a filtering efficiency of 6-10%, despite having some charge.
The effect of removing the electric charge from surgical masks by dipping them in isopropanol was investigated in ‘Filtration Performance of FDA-Cleared Surgical Masks’ by Rengasamy et al, Journal of the International Society for Respiratory Protection (v.26 (3), Spring-Summer 2009, pp.54-70). They found that all surgical masks with electrostatic filters had their performance significantly affected by removing the charge (see Fig. 8).
So does the meme about stopping mosquitos with a chain-link fence doesn’t apply to N95s?
It doesn’t apply to N95s. The gaps are smaller, and the electrostatic charge makes the gap size far less relevant anyway. (The meme was mostly directed at cloth masks, but some people tried to apply it to N95s as well.)
Doesn’t Germany require the use of these higher-quality masks?
Yes. For example, the Berlin government requires FFP2 or equivalent masks (without valves) to be worn by anyone over six in almost every circumstance – for details see here.
Some American Universities require KN95 masks (for example, see here).
These masks sound great, shouldn’t we be wearing these instead of the rubbish ones?
Yeah, really great, except they only work on paper, not in reality. In reality they are just as bad as the basic masks, and possibly worse. If you’ve never tried one, buy one and put it on. Although they have a tighter fit than a typical cloth mask their sides are still easily forced by your breath to come slightly off your skin, and so most of your inhalations and exhalations will go in and out the sides. In fact, often more of the air goes in and out of the gaps than with a basic mask because these masks are so much harder to breathe through.
Anyone who wears glasses will find this out as their glasses will fog up from the air that comes out around the nose. There is a piece of bendable metal there for the bridge of the nose, but although careful manipulation of the metal may lessen the amount of air that comes out here, it only reduces it somewhat, and anyway, the air will just go out another gap instead.
For a visually compelling test get a lighted cigarette, put the respirator on, pull it aside and inhale some cigarette smoke, then put the mask back in place, and exhale. You will soon see where all the smoke goes.
To sum up, respirator masks are supposed to filter out 94–95% of viruses (99% in the case of FFP3), and this is scientifically supported, but that only happens if all your breath goes through the mask. As your breath doesn’t go through the mask in any great quantity, those figures are irrelevant.
Germany also shows that the respirator masks do nothing in the real world. Remember the Germany-Sweden comparison graph from earlier? Germany forces requires everyone by law to wear respirator masks. That’s not exactly what you’d call a success.
If this is such a simple failure why isn’t the medical establishment aware of these issues?
The medical establishment is perfectly well aware of all this. If you read articles on masks in medical magazines you will see it endlessly acknowledged that even the respirator masks are useless if air can escape through the sides of the respirator mask, for example,
high filtration efficiency and a good fit are needed to enhance protection against aerosols because tiny airborne particles can find their way around any gaps between mask and face.
(From ‘Covid-19 has redefined airborne transmission’, by Tang et al, British Medical Journal (v.373, 14 April 2021.)
N95 masks need to be fit-tested to be efficacious and are uncomfortable to wear for more than an hour or two.
(From ‘Disease Mitigation Measures in the Control of Pandemic Influenza’ by Ingelsby et al, in Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science (v.4 (4), 2006.)
And another (in ‘Experimental investigation of indoor aerosol dispersion and accumulation in the context of COVID-19: Effects of masks and ventilation’ by Shah et al in Physics of Fluids 33 (7), 21 July 2021):
leakages are observed to result in notable decreases in mask efficiency relative to the ideal filtration efficiency of the mask material, even in the case of high-efficiency masks.
Fit is critical to the level of protection offered by respirators. For an N95 respirator to provide the promised protection, it must fit the participant.
(From ‘Comparing the fit of N95, KN95, surgical, and cloth face masks and assessing the accuracy of fit checking’ by O’Kelly et al, PLoS One. (v.16 (1), 22 Jan 2021.)
How do ordinary people cope with this issue?
They don’t. In ‘Assessment of Proficiency of N95 Mask Donning Among the General Public in Singapore’ (JAMA Network Open, v.3 (5), 20 May 2020)
Yeung and colleagues gave 3M Vflex N95 masks along with “multilingual pictorial instructions” to randomly selected adults, then performed a visual mask fit test and user seal check… Only 90 participants [out of 714] passed the visual mask fit test. About three-quarters performed strap placement incorrectly, 61% left a “visible gap between the mask and skin,” and about 60% didn’t tighten the nose-clip.
Bear in mind that these people knew they were being observed on how well they could fit their mask, so they had far more motivation than a person ordinarily has to do a good job with it, but they still couldn’t.
In a study examining people’s attempts to fit N95s themselves, titled ‘Comparing the fit of N95, KN95, surgical, and cloth face masks and assessing the accuracy of fit checking’ in PLoS One (v.16 (1), Jan 22, 2021), O’Kelly et al say
most N95 respirators failed to fit the participants adequately. Fit check responses had poor correlation with quantitative fit factor scores. KN95, surgical, and fabric masks achieved low fit factor scores, with little protective difference recorded between respiratory protection options. In addition, small facial differences were observed to have a significant impact on quantitative fit.
This was despite the fact that ‘Three out of the seven participants worked in a healthcare or healthcare-related field and had received a degree of mask fit education’.
Does the media know about this?
The better-informed health reporters in the media know about this serious issue, but they usually bury this information; for example, these are the last two sentence in a BBC story about the mask rules introduced at the end of November 2021:
It is also possible to buy FFP2 and FFP3 masks used by healthcare workers which offer higher protection. However, these must be fitted correctly to work.
(There are, no doubt, less well-informed health reporters who don’t have clue.)
Do governments know about this?
Of course; at least, the scientific advisors know, even if many politicians don’t.
A 2014 British government review titled ‘The Use of Facemasks and Respirators during an Influenza Pandemic: Scientific Evidence Base Review’, commissioned by the Department of Health and produced by Public Health England, concluded that
The effectiveness of masks and respirators is likely to be linked to consistent, correct usage and compliance; this remains a major challenge – both in the context of a formal study and in everyday practice. Given the potential loss of effectiveness with incorrect usage, general advice should be to only use masks/respirators under very particular, specified circumstances, and in combination with other personal protective practices.
What do hospitals do about this problem?
These failures with respirators are why healthcare establishments like hospitals usually require their staff to get their respirators ‘properly fitted’ to try to avoid these problems. This is a time-consuming procedure. This involves either a quantitative fit, or a qualitative fit.
The qualitative fit test requires the wearer to pass a smell test to check whether the respirators have been properly fitted. Here is some description of it from workplacetesting.com:
During the qualitative test, the test subject is exposed to a non-toxic irritant, the fit test challenge agent, such as smoke. The mask wearer will then be asked to perform a series of exercises including head movements, speaking and breathing deeply. The worker is asked to alert the test monitor if the irritant breaches the seal of the mask during these exercises. The quantitative test employs a small tube or other device to take air samples from within the face plate during testing. This air sample is then evaluated to determine if, and at what level, the challenge agent was detected within the sealed airspace. Any contaminants detected within the sealed faceplate will lower the mask’s overall fit factor. A mask deemed unsuitable because of a low fit factor may not be used by the subject employee.
Here is another description of the qualitative fit test from StatNews:
The [smell] challenge is also made while the user moves his or her head from side to side, up and down, and while reciting the Rainbow Passage — a script designed to get the mouth and jaw moving in different ways. The goal is to test how the mask performs during simulated work activity that includes movement and talking.
continuously measures the concentration of particles inside and outside a mask while it is worn (see Fig 1). For a mask with an established level of filtration ability, such as an N95 or KN95 respirator, a higher number of particles inside of the mask is indicative of poor fit. When gaps are present in the fit of the mask, unfiltered air is allowed to enter the mask, raising particle levels. Quantitative fit testing machines use these particle concentrations to calculate a fit factor via a standard formula.
Here are the CDC’s Standard Respirator Testing Procedures.
What guarantees that the masks continue to have a good seal after the test?
A good question. A respirator may work well at the time of testing, but what guarantees a proper fit and seal beyond the occasion of the testing?
Quantitative tests render the mask unusable after the test, so a new mask must be worn. What guarantees that this one fits properly?
Qualitative tests, on the other hand, though they do not destroy the mask, are unreliable. In ‘Correlation of qualitative and quantitative results from testing respirator fit’, by Hardis et al, in the American Industrial Hygiene Association Journal (v.44 (2), Feb 1983, pp.78-87), the authors report that only ’23 to 46% of the poorly fitting full face masks were detected by qualitative methods’, that is of the masks that failed the quantitative tests, only a quarter to a half of the failures were picked up by the qualitative tests. So passing a qualitative test doesn’t even give much assurance at the time that the mask is properly fitted, let alone later on.
The big problem is that respirators are very hard to breathe through, and almost certainly the wearer will, through small unconscious movements, slightly adjust the position of the mask on the face (even via head movements only) so that air can go in and out the gaps more easily. A couple of rubber bands around the ears hardly guarantees a perfect fit all day long.
Here is a study from Infection Control and Hospital Epidemiology (called ‘Assessment of Healthcare Worker Protocol Deviations and Self-Contamination During Personal Protective Equipment Donning and Doffing’, v.38 (9), 13 June 2017, pp.1077-83) that shows just some of the problems faced here:
Protocol deviations were common during both EVD [Ebola virus disease] and CP [contact precautions] PPE doffing, and some deviations during EVD PPE doffing were committed by the HCWs’ doffing assistant and/or trained observer. Self-contamination was common.
But surely the American Medical Association wants us to use these sorts of masks?
On the contrary, on their ‘Patient Page’ on face masks they say (my italics)
Because N95 respirators require special fit testing, they are not recommended for use by the general public’. This is their diplomatic way of saying what I said above. And they’re saying members of the general public should never wear these masks. The same masks that are required use in Germany. As Yale University says, ‘An N95 is actually a high-efficiency respirator that must fit tightly to work properly.
Are there studies looking at the effectiveness of respirator masks in healthcare settings?
Yes, and they have not made for pretty reading for the N95 advocates.
A 2020 Cochrane review (which are the highest quality reviews in medicine) said
The use of a N95/P2 respirator compared to a medical/surgical mask probably makes little or no difference for the objective and more precise outcome of laboratory-confirmed influenza infection… Restricting the pooling to healthcare workers made no difference to the overall findings.
For a literature review of other articles on this issue see Part 5.3. The evidence is strongly against N95s working in healthcare settings, even thought they are being worn by trained healthcare workers.
I think we just need to develop a way of sticking the mask to your face to prevent the gaps. Maybe using some sort of tape.
No thanks. Try this. Pull the respirator tight over your mouth and hold it down around your lips so there are no gaps or weak points where the air can escape. Making sure, that is, that your breath goes in and out through the mask, not anywhere else. Now try breathing in and out. It’s pretty hard. (You can’t even blow a candle out.) That’s what it would feel like were the mask was properly fitted to your face so that the air really cannot get out any other way, and all your breath went in and out the mask. Breathing would be become laborious. It would require great effort just to stay alive. There’s no way I would wear that for more than a minute, it’s quite frightening. If that’s your vision of the future of human existence, count me out.
It also becomes clear, when you do this, that regardless of all the talk about a proper ‘fit’, you can’t really get any such thing with the mask just on your face normally. Once you let go of the mask with your fingers you can feel it become less of an effort to breathe. It’s still an effort compared to having no mask, and very unpleasant, but it’s not as awful as when the side gaps are closed off (and while you can still feel the warmness of your own breath, your breath isn’t as hot as with the gaps blocked). That tells that you that air is getting in and out the side gaps even if you think it isn’t, even if you think you have a good ‘fit’.
This isn’t just my opinion, and this issue has been known about for a long time. In a thorough 1920 study of mask use in the wake of the influenza epidemic entitled ‘An experimental study of the efficacy of gauze face masks’ by Kellogg and Macmillan, in the American Journal of Public Health (v.10 (1), Jan 1920, pp.34-42), the authors also concluded that the number of layers required to make the masks effective would make breathing too difficult, and anyway would result in the air going in and out the sides of the mask:
When a sufficient degree of density in the mask is used to exercise a useful filtering influence, breathing is difficult and leakage takes place around the edge of the mask.
The FDA admits that ‘the N95 respirator can make it more difficult for the wearer to breathe’.
Dr Quinton Fivelman, Chief Scientific Officer at the London Medical Laboratory, admitted that
“It can be hard to breathe through high filtration FFP masks”.
In general, the issue with effective masks is this. There is no way (with present technology) to get a mask that will filter out all or most of the virions in all your inhalations and exhalations, with no gaps, that anyone in their right mind would want to wear for more than a few minutes.
I should also add that even if such a mask were developed, wearing it more than occasionally would be disastrous for the immune system, which relies on having virions and bacteria coming in that challenge the immune system, helping it to develop and improve.
So you’re saying that respirators are horrible to wear?
Yes. In ‘Investigation of adverse reactions in healthcare personnel working in Level 3 barrier protection PPE to treat COVID-19’, by Yuan et al, in BMJ’s Postgrad Medical Journal (v.97 (1148), 2020, pp.351-4), the authors said
A total of 122 (94.57%) healthcare professionals experienced discomfort while wearing L3PPE to treat patients with COVID-19. The main reasons for adverse reactions and discomfort include varying degrees of adverse skin reactions, respiratory difficulties, heat stress, dizziness and nausea… Our study discovered that the high rates of adverse reactions experienced by healthcare personnel due to the usage of L3PPE in treatment of COVID-19 not only include previously reported skin mucosa discomfort reactions but include multiple adverse reactions linked to the respiratory, nervous and digestive systems.
In ‘Effects of Prolonged Use of Facemask on Healthcare Workers in Tertiary Care Hospital During COVID-19 Pandemic’ by Purushothaman et al in the Indian Journal of Otolaryngology and Head & Neck Surgery (v.73, 20201, pp.59–65) the authors say
This study suggests that prolonged use of facemasks induces difficulty in breathing on exertion and excessive sweating around the mouth to the healthcare workers which results in poorer adherence and increased risk of susceptibility to infection.
Do respirators cause skin problems?
Yes, see part 5.1.b for a review of the literature on this (not that much research has been done, though).
I also look at masks and headaches in Part 2, and other physical harms caused by masks in Part 5.1.
Are we supposed to regularly replace our masks?
Respirators and modern surgical masks are supposed to be disposable and used only once. Cloth masks are not supposed to be disposable, but you shouldn’t wear the same one for more than a few hours, and they should be sterilised every time you use them (this will actually reduce their effectiveness by making the holes bigger – see the question ‘Does washing your cloth mask reduce its ability to trap the virus?’ in Part 2… but then they’re not effective in reality anyway).
Those masks are only effective so long as they are dry. As soon as they become saturated with the moisture in your breath they stop doing their job and pass on the droplets.
Professor Cossart said that could take as little as 15 or 20 minutes, after which the mask would need to be changed.
Numerous SAGE papers have recommended that face masks be changed every four hours, for example ‘it is recommended to change face coverings every 4 hours’ (p. 17).
As masks don’t actually work there isn’t really any point in replacing them on the grounds of effectiveness, because they aren’t effective. They should, however, be replaced or thoroughly sterilised regularly for hygiene reasons.
Is there a problem with poor quality or fake N95s like there is with KN95s?
Yes. Not as much as with KN95s, perhaps, but a problem nonetheless. With mask sales now in the trillions, and enormous money to be made, many far-East factories who made other things started making masks instead, with low or non-existent quality standards:
Factories in China have popped up seemingly overnight to meet the demand. Amid the rush, the high prices masks are commanding have led to what the Wall Street Journal called a “wild west” for mask manufacturing.
One test of Chinese-made N95s found that
Out of the 31 masks tested, 13 Chinese N95 masks fail quality standards for filtration… only 18 masks managed to capture more than 95% of tiny particles. What’s more, many of these failing masks were not just a few percentage points below the standard. On average, the masks that failed the tests captured just 51% of particles. The worst of the worst captured just 24% of particles, which is on par with the filtration ability of a bed sheet.
You’re making light of a measure designed to help protect against an extremely deadly disease.
On the contrary, it is the mask wearers who make light of the disease. If SARS-CoV-2 really is as deadly as they say, and if masks really did filter out most of it from your breath, then it follows that your mask is going to be full of these deadly and terrifying viruses. Yet have you seen a single mask wearer anywhere in the world act like this is true? If it was true then the masks would be extremely dangerous. They should be treated like toxic waste. Not only should you never touch them once they’re on, you should never take them off with your hands; rather you should use disposable gloves. They and the gloves should be placed immediately into special toxic waste bins, like you have in labs and doctor’s surgeries. They should never be placed on any other surface, lest they spread the virus around where it can be picked up by someone else. You should disinfect your face as soon as you’ve taken the mask off, or at least wash it thoroughly with soap and water. (This applies triple if you’re one of these rare and strange mask wearers who sneezes and coughs into their mask.)
But no-one, not even the most extreme mask fanatic, does anything remotely like this. Masks are reworn over and over. They are constantly touched and fiddled with. They are put into pockets or handbags when they are not being worn. They are thrown onto tables and kitchen tops. In cafes and pubs people take them off and put them on the tables, or in their handbags. They hang off car rear-vision mirrors, or they sit on the back seat of the car. They mingle with everything else in the house. They don’t even get washed much, let alone disinfected, and are reworn the next day after spending the night on a bathroom shelf. They get dumped all over the city streets and the countryside. Nobody at all acts like these things are full of a deadly disease, and this is because everyone knows deep down that the disease is not really that big a deal, and the mask-wearing is rather a quasi-religious ritual, not a serious health intervention.
But we agree that masks aren’t 100% effective in stopping aerosol virus spread. But they don’t need to be. They just need to help slow Covid spread somewhat. Or be just one little bit of help in the overall battle.
The evidence base tells us that masks don’t have any effect on Covid spread at all. A great many countries and states have introduced mask mandates and they haven’t slowed the spread. In many of those places cases have gone up with the mandate in place. Ask yourself this: how can Covid still be spreading as much as ever, more than two years after it started, in those countries that have been fanatical about mask use?
Anyway, if masks are only intended to somewhat slow the spread, or to be a minor player in the ‘battle’ against Covid, then the overall case for forcing them on people against their will is greatly diminished. The justification given for making people wear them was that they were very effective at stopping Covid spread, so much so that in the UK the politicians said that we wouldn’t have to socially distance any more if we wore masks. Even then, I would argue, the mask mandates were nowhere near being justified. Once it was accepted that masks were at best bit players in the supposed ‘battle’, there was never any hope that they could be justified, given the enormous individual and social harm they cause.
But masks may make that little bit of extra difference that gets the R0 below 1, and so they could be the difference between Covid either dying our or spreading everywhere.
This never happened, though, did it? The disease hasn’t died out anywhere. It keeps on spreading around despite the enormous amount of mask wearing that has taken place in so many countries. So there’s no reason to think that masks can make just that little bit of difference that gets R0 below 1. This is wishful thinking. Mask-wearing not only doesn’t cause a virus to die out, it doesn’t even slow it down.
You hear this sort of talk a lot in public these days, but here’s an actual example of it in a (pre-Covid) scientific paper (from our soon-t0-be old friend Donald Milton):
if one hypothesized that all transmission were due to aerosol particles <50 µm, and estimated a reproductive number of 1.5 for influenza (i.e. each infection generates 1.5 new infections on average at the start of the epidemic), then the use of surgical masks by every infected case could reduce the reproductive number below 1.
(From ‘Influenza Virus Aerosols in Human Exhaled Breath: Particle Size, Culturability, and Effect of Surgical Masks’ by Milton, et al, in PLoS Pathogens , v.9 (3), March 7 2013.)
as the reproduction number of influenza may not be very high a small reduction in transmissibility of the virus may be sufficient for reducing the reproduction number to a value smaller than 1 and thus extinguishing the epidemic.
(From ‘Professional and Home-Made Face Masks Reduce Exposure to Respiratory Infections among the General Population’, by Sande et al, PLoS One , v.3 (7), 9 July 2008.)
You could, of course, apply this logic to any possible intervention that might possible have a small effect: ‘if we hypothesize an R0 of 1.1, then if we all walked around or sat with our faces pointed upwards to avoid directly inhaling the breath of others then that could be the difference between an R0 of 1.1 and one of 0.9, and so could defeat the virus, so the government must force people to do that until further notice’.
Notice also that even getting the R0 below 1 doesn’t magically cause a disease to die out. If masks really did do this, then as soon as people took their masks off the R0 would go up above 1 again, and start spreading around again. So we’d have to keep wearing masks indefinitely, or at least for a few years until sufficient numbers of people have finally been infected. As we have seen in many countries and US states, wearing masks for years is a reality, which is a completely intolerable situation. But, as has happened with lockdowns, the BS artists are always giving the impression (without ever committing themselves to any explicit predictions) that just a short period of everyone wearing masks will break the back of the disease and then it will go away. Like with the ‘circuit breaker’ lockdowns, this never happens. These periods are, in fact, endless. You’d have to be a fool to still believe this sort of talk.
But maybe masks could be the difference between the health services being overwhelmed and being okay?
This also never happened. The health services in Sweden and US states that didn’t see much mask wearing didn’t get overwhelmed and crash. So there’s no reason to think that masks can make just that little bit of difference that, in an amazing coincidence, was just enough to stop the health services being overwhelmed. They don’t make any difference in their effect on health services, and health services are in a very similar position that they always have been even in non-mask areas. How many more years is this going to go on for before the maskers notice reality?
Even if masks only reduce the virus in your breath by 10%, that’s still 10% less people dying.
No, this doesn’t follow. Even if masks reduced the amount of virus the average person exhales by 10%, it doesn’t follow that there’s any reduction in cases, as that 90% of virus-laden breath may be (and probably still is) enough to infect a similar amount of people as before.
And bear in mind also that most people get the virus eventually, so even if masks stop a few people getting it for a while, they’ll still get it eventually, as Christina Pagel found. (I call this the ‘Pagel Principle’.)
Even if there was, nonetheless, a small reduction in overall case numbers over a long-term period, say 2%, that doesn’t result in a 2% reduction in deaths. Deaths are only a tiny fraction of cases. A 2% reduction in cases is likely to produce at most a 0.006% reduction in deaths (on an IFR of 3 in 1000), and probably far less, as the reduction in cases caused by you wearing your mask to a restaurant is unlikely to have a great effect on what happens in care homes and hospitals, where most Covid deaths happen. So the actual reduction would be even less than 0.006%, say 0.00006% (a hundredth of 0.006%).
Bear in mind that most Covid deaths are in people who would most likely have died soon anyway. (I shall say more about this in another FAQ). This is why places like Sweden which never used masks (or lockdowns) have completely normal numbers of all-cause deaths. The average age of a Covid death is over 80, and care homes are where the highest number of Covid deaths take place. Physical frailty is the biggest predictor of a Covid death. So the number of instances where Covid actually killed someone healthy, with many years of life left, is very small, maybe a hundredth of all Covid deaths (it’s probably far less). So that 0.00006% becomes a 0.0000006% reduction in deaths.
So even if there are 50,000 Covid-related deaths in the UK every year from now on (which is itself very unlikely), wearing masks will save about 0.0003 people a year. So we can expect to save one life every 3333 years by wearing masks. (Even if all this is out by a factor of one hundred, it would still take 33 years to save a life.) In the meantime, even by the UK government’s own admission, ten thousand people or more could be dying every year from lockdowns measures.
Okay, so masks may not work, but they’re a sign that you’re concerned about Covid and you want to do your part.
They’re a sign all right, a sign that you’re participating in mass murder and the destruction of our freedoms.
You can diss masks all you like, I still don’t feel safe without one, and I freak out if I see someone not wearing one.
Get a grip. A mask isn’t going to help you, or them. If you’re that afraid of getting Covid, stay inside and read up on the odds that you’ll die from it.
C’mon, it’s just a bit of cloth.
A blindfold is just a bit of cloth. A noose is just a bit of hemp. A knife is just a bit of metal. What the thing is made of is irrelevant. It’s the use it’s put to that matters. If I stuff a gag into your mouth it doesn’t make it alright if I say ‘It’s just a bit of cloth’.
For Part 2 of the Face Mask FAQs click here.
To go to the main Face Mask FAQs page, click here.
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