A Perspective on Universal Masking in the COVID Era

With government-mandated universal masking becoming increasingly common around the world, a Perspective by Dr. Michael Klompas M.D. et al that appeared on May 21, 2020 in the New England Journal of Medicine provides an interesting alternative to the "no mask, no service, big fine" mantra being touted in many jurisdictions.  While this article pertains specifically to the use of masks in a health care setting, the views expressed can be extrapolated into the public arena.

 

The authors open by noting that as the SARS-CoV-2 pandemic exploded, health care systems around the world took actions to protect both patients and health care workers from the virus.  One of these measures is the use of face masks.  They state that masks form a core component of the personal protective equipment (PPE) which also includes gloves, gowns and eye shields that clinicians need when dealing with symptomatic patients who are suffering from any type of respiratory viral infection.  

 

The authors suggest that there are two situations in which masks may provide benefits to the wearer in a health care setting:

 

1.) During the care of a patient with unrecognized COVID-19 - in this setting, a mask will reduce risk only slightly since masks do not provide protection from droplets that enter the eyes or from fomites on the patient or in the patient's environment that health providers may pick up on their hands and carry to their mucous membranes (largely because mask wearers tend to touch their face more often).

 

2.) Transmission from asymptomatic and mildly symptomatic health care workers - masks worn by health care workers with these conditions may reduce the likelihood of transmission to patients and other health care providers.

 

Here is a comment from the authors about the wearing of masks in health care settings:

 

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

 

While that is certainly understandable given that health care workers have face-to-face contact with COVID-19 patients for extended periods of time, the authors offer this view on the wearing of masks outside of health care facilities:

 

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

 

In their conclusion, the authors state that masks serve a symbolic role; they provide health care workers (and the general public) with a perceived sense of safety and well-being.  The greatest contribution made by the expanded use of masks lies in reducing the transmission of anxiety, an emotion that has grown exponentially thanks to the use of fear by governments during the pandemic.

It is becoming increasingly obvious that the greatest casualty of this pandemic is science.  It has rarely been more apparent that there are very few researchers who agree with their peers when it comes to studying the SARS-CoV-2 virus and the measures that we should be taking to control the spread of the coronavirus responsible for the COVID-19 pandemic.

If you wish to read a very interesting analysis on masking, here is a link to a paper by Dr. John Hardie entitled "Why Face Masks Don't Work: A Revealing Review" which summarizes a great deal of research on the use of masks for infection control.  Interestingly, this paper suddenly disappeared from the internet and can now be found on the Wayback Machine.  Here is a key quote from the paper:

1.) The filter material of surgical masks does not retain or filter out submicron particles;

 

2.) Surgical masks are not designed to eliminate air leakage around the edges;

 

3.) Surgical masks do not protect the wearer from inhaling small particles that can remain airborne for long periods of time.

Let's close with the first page of a recent letter that was sent to the World Health Organization aka the Bill and Melinda Gates Health Organization by the Ontario Civil Liberties Association (OCLA) in Canada, regarding WHO's ever-changing stance on masking:

Here is a key quote:

"We believe that the WHO recommendation is harmful to public health, and harmful to the very fabric of society. The recommendation is used by governments as a ready-made justification to impose mask use in the general population. The resulting legislative dictates and policies of coercion broadly violate civil, political and human rights. We ask that your ill-conceived recommendation be retracted immediately.

The context is one where: 

 

• Viral respiratory diseases, based on rapid mutations, have co-evolved with powerful, complex, and adaptive immune systems of breathing animals for some 300 million years and with human ancestors for some 5 million years, in the absence of vaccines.

 

• There was no statistically significant increase in winter-burden all-cause mortality in 2019-2020, compared to the last many decades of reliable data for Northern mid-latitude nations.

 

• A sharp peak in all-cause mortality by week occurred synchronously in several jurisdictions, across continents and oceans, immediately following the WHO declaration of the pandemic.

 

• The said peak can be attributed to government preparedness response to COVID- 19, impacting immune-vulnerable institutionalized persons in those jurisdictions.

 

In your document, you state 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 and there are potential benefits and harms to consider.  Even this introductory statement of yours has two problems.  First, it contains the palpable bias that “there must be benefits”.  Second, more importantly, you fail to mention that several randomized controlled trials with verified outcomes (infections) were specifically designed to detect a benefit, and did not find any measurable benefit, for any viral respiratory disease. This includes the many randomized controlled trials that find no difference between open-sided surgical masks and respirators.

 

That is why the WHO cannot collect and rely on potentially biased studies to make recommendations that can have devastating effects on the lives of literally billions. Rather, the WHO must apply a stringent standards threshold, and accept only randomized controlled trials with verified outcomes. In this application, the mere fact that several such quality studies have not ever confirmed the positive effects reported in bias-susceptible reports should be a red flag."

Let's close with this quote from OCLA's letter:

"The WHO’s pronouncements, unfortunately, have a disproportionate influence on our easily corralled governments."