Covid-19 Face Mask Protection - What Leaders Fail to Understand
COVID-19 is the disease caused by the SARS-CoV-2 virus.
The World Health Organization (WHO) and US Center for Disease Control (CDC) currently recommend community-wide, simple cloth face masks as a means to control the spread of this virus. Earlier recommendations by these organizations did not support mass masking. Why the about face occurred seems to be less about applying the latest research and more about keeping up good appearances.
Tradition Masquerades as Fact
Confusion about wearing a cloth face mask has existed, ever since the SARS-CoV-2 virus emerged. Does wearing a cloth face mask significantly control the spread of this virus? The current popular answer to this question seems to be "Yes". My reading of research, however, leads me to conclude that science has not established such a clear answer.
Instead of taking action based on solid evidence, different people, at different times flip flopped on recommending a mask, because they ultimately acted on hope, wishful thinking, or political pressure to create the appearance of doing something that works. As a result, popular expectations to control the spread of the virus have escalated (through the news media's positive spin on uncertainty) to create the widespread fiction that face masks for all are effective.
This is how an unproven tradition has become, in some places, a mandatory requirement to wear a cloth face mask for preventing the spread of SARS-CoV-2. This is also how an unproven tradition has encroached upon intimate personal freedoms, thus robbing adults of individual choices to make responsible life decisions based on independent, informed judgments.
Absence of Evidence
Lisa M. Brosseau, ScD and Margaret Sietsma, PhD wrote a commentary, using 52 professional references, where they state the following:
- Sweeping mask recommendations—as many have proposed—will not reduce SARS-CoV-2 transmission, as evidenced by the widespread practice of wearing such masks in Hubei province, China, before and during its mass COVID-19 transmission experience earlier this year. Our review of relevant studies indicates that cloth masks will be ineffective at preventing SARS-CoV-2 transmission, whether worn as source control or as PPE [Personal Protective Equipment].
- Overall, the body of research on mask efficacy in real-world settings is small and scattershot. And because SARS-CoV-2 was completely unknown to humanity just five (extremely long) months ago, there is no data on the efficacy of any type of mask wearing in any setting (healthcare or home) for this virus.
- In sum, given the paucity of information about their performance as source control in real-world settings, along with the extremely low efficiency of cloth masks as filters and their poor fit, there is no evidence to support their use by the public or healthcare workers to control the emission of particles from the wearer.
Lisa M. Brosseau, ScD, and Margaret Sietsema, PhD (2020). Commentary: Masks-for-all for COVID-19 Not Based on Sound Data, CIDRAP (Center for Infectious Disease Research and Policy), https://www.cidrap.umn.edu/news-perspective/2020/04/commentary-masks-all-covid-19-not-based-sound-data
The previous reference confirms my own findings in examining earlier studies on the subject of face-mask protection. I will not list all references that I consulted, but I will choose one to illustrate the types of shortcomings that I have come across.
Consider, for example, a 2010 study by Samy Rengasamy, Benjamin Eimer, Ronald E. Shaffer, Simple Respiratory Protection—Evaluation of the Filtration Performance of Cloth Masks and Common Fabric Materials Against 20–1000 nm Size Particles, The Annals of Occupational Hygiene, Volume 54, Issue 7, October 2010, Pages 789–798, https://doi.org/10.1093/annhyg/meq044 [Downloaded 05/12/2020]
Throughout this entire study, statements about the effectiveness of improvised face masks are very tentative, as shown by the researchers' frequently citing other studies that recommend further research.
Conclusive, confident statements never appear, as can be seen in the following quotes:
- Results obtained in the study show that common fabric materials may provide marginal protection against nanoparticles including those in the size ranges of virus-containing particles in exhaled breath.
Notice the phrases, "may provide" and "marginal protection", which indicate that we just do not know.
- ... household materials are not designed for respiratory protection and their use may provide a false sense of protection because their effectiveness against larger and <1000 nm size particles including viruses is not well understood. This indicates that further studies are needed to better understand the filtration performance of cloth masks and common fabric materials against a wide range of particle sizes, including the size of many viruses.
Notice the phrases, "may provide", "false sense of protection", and "not well understood", which, again, show that we just do not know.
- The knowledge on the filtration performance of improvised materials for particulates is limited ....
"Limited" -- in other words, we just do not know yet.
- For many fabric materials including shirt, sheet, towel, and handkerchief, the effectiveness factor decreased with decreasing particle size from 4800 to 410 nm, indicating further decrease in the respiratory protection for virus-containing particles <410 nm.
"nm" stands for nanometre, which is one billionth of a meter or a fraction of an inch equaling 0.00000004 (four one hundred millionths) of an inch. In other words, to equal an inch, something this small would have to be placed end to end four hundred million times.
410 nanometres, then, equals 0.0000164 (one hundred, sixty-four thousandths) of an inch. Something this small would have to be placed end to end one hundred and sixty-four thousand times to equal an inch.
The size of a single coronavirus is 125 nanometers, four times smaller than the stated limit in the previous quote. This means that the size of a coronavirus is a fraction of an inch equaling 0.00000496 (496 millionths) of an inch, which means that 496 million coronaviruses stacked end to end would equal one inch. Even the tiniest grains of sand stacked 496 million times end-to-end would stretch over fifteen miles. (I encourage readers to look up the size of a virus, the size of a sand grain, and do this calculation for yourselves.)
Realizing the size of a virus is necessary, in order to fully appreciate the challenge of trying to contain and control viruses with simple barriers.
- Some individuals may improvise fabric materials for emergency respiratory protection to reduce inhalation of infectious aerosols, indicating the need for further studies to assess their filtration performance against a wide range of particle sizes.
Again notice the word, "may", and the phrase, "need for further studies".
For someone seeking factual reassurance, these are tiresome re-wordings of the same basic idea that we just do not know, couched in scholarly pretext that might deceive policy makers into accepting ignorance as false authority to do what has not yet been substantiated. Careful wording about ignorance in a professional journal is not a valid statement of authority to do what the authority cannot substantiate.
The rational response to such a study should be, "We just do not know, and so we cannot force rules onto others as though we do know."
In accordance with a truly rational response, policy makers and law makers would allow adults to make their own informed decisions, based on honest information about the state of current knowledge.
Adults typically are allowed to make health decisions about smoking, drinking alcohol, choosing what foods to eat, driving a motor vehicle, having sex, and other activities. The choice, therefore, to wear or not to wear a mask is an individual choice, just as in these other activities.
"Evidence of Absence"
Ironically, the more common appeal to rationality appears to be irrational, as illustrated in a comment by Shuo Feng, Chen Shen, NanXia, Wei Song, Mengzhen Fan, Benjamin J. Cowling (2020). Rational Use of Face Masks in the COVID-19 Pandemic, The Lancet: Respiratory Medicine, https://doi.org/10.1016/S2213-2600(20)30134-X [Downloaded 05/12/2020]
These highly credentialed experts, writing in a prestigious medical journal, have put forth the following claim:
However, there is an essential distinction between absence of evidence and evidence of absence.
These experts are referring to evidence that face masks can provide effective protection against respiratory infections in the community. They, thus, are saying that absence of evidence that masks provide such protection is not evidence of absence of protection by face masks.
If the only rational way to know whether face masks provide protection is evidence that they indeed do so, then the absence of such evidence is, indeed, the evidence that the masks do not provide such protection. Consequently, absence of evidence here is precisely evidence of absence of any such protection. The only way to know of such protection is through evidence that such protection exists. The evidence here is weak or non-existent.
Hence, there is no such distinction between "absence of evidence" and "evidence of absence", as these authors claim. They play with words to confuse readers into believing that an unsubstantiated belief deserves treatment as fact. They then use such confusion in an appeal to tradition, when they write the following:
- However, face masks are widely used by medical workers as part of droplet precautions when caring for patients with respiratory infections. It would be reasonable to suggest vulnerable individuals avoid crowded areas and use surgical face masks rationally when exposed to high-risk areas. As evidence suggests COVID-19 could be transmitted before symptom onset, community transmission might be reduced if everyone, including people who have been infected but are asymptomatic and contagious, wear face masks.
Merely pointing out the widespread use of masks is not pointing out evidence of mask effectiveness.
Merely stating that a suggestion is reasonable is not citing evidence.
Switching the category where the word, "evidence", applies (from face-mask protection to how COVID-19 is transmitted) is improper logic. In one breath, the researchers talk about "evidence", referring to face-mask protection, while, in the next breath, they talk about "evidence", now referring to the mechanism of COVID-19 transmission.
Evidence for how COVID-19 is transmitted is not evidence for how face masks protect. Confusing the categories of evidence like this, to imply that one category of evidence constitutes another category of evidence, is clearly absurd.
Desperation Replaces Justification
Dr Don Milton at the University of Maryland is one of the authors in the following study:
Milton, D. K., Fabian, M. P., Cowling, B. J., Grantham, M. L., & McDevitt, J. J. (2013). Influenza virus aerosols in human exhaled breath: particle size, culturability, and effect of surgical masks. PLoS pathogens, 9(3), e1003205. https://doi.org/10.1371/journal.ppat.1003205 [downloaded 05/12/2020]
Elsewhere, Milton has been quoted as saying:
In normal times we'd say that if it wasn't shown statistically significant or effective in real-world studies, we don't recommend it. ... But in the middle of a pandemic, we're desperate. ... The thinking is that even if it cuts down transmission a little bit, it's worth trying.
This comment, from a doctor and knowledgeable researcher, confirms my own conclusion that science has not been the basis of decisions to enact mandatory wearing of cloth face masks during the alleged COVID-19 pandemic.