Defacing Mask Science

Literature Review Number 7 of the COVID-19 Series: Masks and Respiratory Protection for Health Care Professionals. 

A colleague of mine fanatically supports the current craze of community face-mask practices. In support of that irrational decision, that colleague provided me with a series of articles she believed lends scientific support to the craze of community mask wearing. 

 This review addresses one of those articles. The article does address the issue, but unfortunately, as detailed below, does so with dishonesty.

 To be succinct, as of today, July 11, 2020, and certainly after the publication of the article under discussion, there STILL is no science to back the current community face-mask craze.

Article Under Review

Rossettie S, Perry C, Pourghaed M, Zumwalt M, "Effectiveness of manufactured surgical masks, respirators, and home-made masks in prevention of respiratory infection due to airborne microorganisms" The Southwest Respiratory and Critical Care Chronicles 2020;8(34):11–26

Summary

All too often, I find people referencing "scientific" studies or "scientific" papers they believe support an a priori position they choose to hold - as opposed to actual scientists who, philosophically speaking, should choose positions based on the available evidence and data. This is the difference between Scientism and Science.

Very often, an assumption that the "scientific paper" supports the pre-conceived political position comes from the fact that the believer referencing the "study" has never actually read the paper being referenced, or the believer lacks the technical competence to understand what is being said in the paper, or both. (In the article under review, either the authors never read their references, or with foreknowledge, they dishonestly represented the cited references).

Now, this error can occur regardless of whether the "scientific article" is good science or bad science. Thus, for example, as seen in my series of article reviews (a list is given below), some of the articles I was asked to review were junk science, and some of the articles were really good articles representing good science, but simply didn't say what my colleague falsely believed they said.  

 The article under review, Rossettie et al, would have been a good article if the authors had just been honest and didn't rely on deception to forward a political agenda. The article isn't science per se, and doesn't present any new information. Rossettie et al, did a reasonably good job at meeting their apparent goal, which was to perform a literature review, and summarize the findings of other researchers who have addressed the issue of the transfer of infectious droplets to Health Care Professionals (HCP) in occupational settings. Rossettie et al provide a review of numerous articles (many of which are already included in my series of article reviews). That is, Rossettie et al is a meta-review of papers and reviews.

 Dishonesty

The article would have been a good literature review if the authors hadn't compromised their own integrity when Rossettie et al tip-toed into the political realm and provided subjective political opinion regarding community mask wearing and then dishonestly impugn to others their own politics by referencing sources that have NOTHING to do with the political point being made by Rossettie et al. To wit:

Nonetheless, proper usage of respirators, surgical masks, and even homemade masks all make it more difficult to transfer a virus to the mucous membranes on the mouth and nose after touching a fomite (an object with the virus); all of these have at least some minor protective function against large respiratory droplets.

(Ref: ASTM F2100-19: Standard specification for performance of materials used in medical face masks. West Conshohocken, PA: ASTM International; 2019. doi:10.1520/F2100-19.)

The problem here is that if one goes to the cited ASTM reference, we find that NOWHERE within the citation is the issue of homemade masks addressed. NOWHERE does the ASTM standard address the transfer of a virus to mucous membranes on the nose or mouth. NOWHERE does the ASTM standard address the touching or formation of fomites. NOWHERE does the ASTM standard characterize any aspect of the protective function of the device (homemade or otherwise) against large respiratory droplets. Rossettie et al simply invented the position and then falsely impugned the opinion on to the ASTM committee. 

Rossettie et al, like others who try and push the political agenda of community face mask wearing, must invent and fabricate scientific support for the position, and hope and pray that their readers will not double check any of their references for veracity. And it begs the question - if Rossettie et al was willing to be dishonest about this reference, what other references are they willing to misrepresent in their assessment?

That is, if this were just one incident, then perhaps we could overlook the reference as an innocent oversight. Unfortunately, there are other examples. For example:

These face masks may also help the wearer to keep contaminated fingers/hands away from the mouth and nose.

(Ref: United States Department of Labor. OSHA fact sheet: respiratory infection control: respirators versus surgical masks | Occupational Safety and Health Administration. https://www.osha.gov/Publications/respirators-vs-surgicalmasks-factsheet.html )

When we go to the cited OSHA reference we see that NOWHERE in the cited reference is the issue of contaminated fingers, etc discussed by OSHA. It simply doesn't exist, and again, Rossettie et al are banking on the fact that 99.99% of the time, people who read their article will simply believe the tautology and not bother to check references. 

Dishonesty and deception are constant ploys by the face-mask advocates to make it look like everybody agrees with them, when in fact, there is literally no scientific support for the practice.

Furthermore, even within their own review, they note that virtually all their references actually have exactly the opposite opinion. Thus, also from OSHA (and actually supported by the reference):

 … surgical masks are not designed to seal tightly against the user’s face, which means that during inhalation, much of the potentially contaminated air can pass through gaps between the face and the mask edge, circumventing the effective functioning of the mask’s filter material. As a result, surgical masks cannot be relied upon to completely protect patients or medical workers against airborne infectious agents.

 For example, improper donning (putting on) of respirators could negate the advantage of the otherwise tight seal and improper doffing (taking off) could lead to contamination and transmission of the infectious disease.

 And…

 Reusing face masks does increase the potential for contamination, but complete lack of protection may present greater infectious risks. Individuals reusing masks must consciously avoid touching their masks and carefully remove them in between uses to avoid contamination. Bacteria from the nasopharynx tract can accumulate on the filter and COVID-19 microparticles can potentially transmit onto the outer surface of a worn face mask.Furthermore, masks which are soiled, damaged, or difficult to breathe in should be immediately disposed of in all situations.

 And…

 Cloth and Homemade Masks

Updated and layered forms of the cloth masks were worn by HCP and the public throughout the 1900s during outbreaks of diphtheria, scarlet fever, and tuberculosis. The cloth masks were believed to lower rates of respiratory infections during these times. However, despite the use of cloth masks during the 1918 Spanish influenza pandemic, the number of influenza cases continued to rise. (Brooks WA. The open air treatment of influenza. The American Journal of Public Health 1918; 8: 276–750. https://dx.doi.org/10.2105/AJPH.8.10.746)

So, if one would like a simple synopsis of the difference between a respirator and a surgical mask, and a quick review of some of the studies that have been done regarding various materials that are sometimes used in the manufacturing process of surgical masks for HCPs, and one would like to know the general difference between an ASTM product evaluation versus a NIOSH certification, then I would recommend reading the Rossettie et al, article. However, anywhere that community face-mask issues are raised or homemade masks are discussed - read carefully, because, the authors have an agenda they are trying to push even at the expense of their own credibility.

There is nothing earth shattering or new and there is no new research being discussed - Rossettie et al appear to desire to provide a brief synopsis of surgical mask and the ramifications to the HCP in the event of a shortage of commercial products.

As a side-bar, I would have to find a technical question in the first sentence of their article when they reference paintings from the 18th Century as depicting the first documented use of medical masks. Perhaps so, I don't know, but perhaps not to the extent that Pliny the Younger and Galen of Pergamon (First Century AD) both described masks (without necessarily attributing the masks to the medical field). 

 Finally, what the article definitely does NOT do, is what my colleague falsely believes to be true, which is that the article does not provide any scientific support for the nutty and foolish community mask wearing craze. For which there is NO scientific support at all.

 Caoimhín P. Connell, Forensic Industrial Hygienist, July 11, 2020

Previous reviews by CP Connell-

The following list of articles was updated on January 5, 2021.

How to Peddle Backward - What happened to the 2020 Flu Epidemic? A summary of the US Crude Mortality Rate's refusal to cooperate with the popular narrative.

WHO thought this was a good idea... (Comments regarding the December 1, 2020, "Mask use in the context of COVID-19".)

 The Failing Mask Cure Aid a review of Bundgaard H, Bundgaard JS, Raaschou-Pedersen DET, et al, "Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers, A Randomized Controlled Trial" (Ann. Int. Med. Nov 18, 2020, https://doi dot org/10.7326/M20-6817).

 Don't be a Maskhole, Karen A review of Zeng N, Li Z, Ng S, Chen D, Zhou H, Epidemiology reveals mask wearing by the public is crucial for COVID-19 control. (Medicine in Microecology, https://doi.org/10.1016/j.medmic.2020.100015):  

 Masks, and the new Doctor Schnabel von Rom: Review of Stadnytskyi V, Bax CE, Bax A, Anfinru P, The airborne lifetime of small speech droplets and their potential importance in SARS-CoV-2 transmission (Approved by PNAS May 2020: https://www.pnas.org/cgi/doi/10.1073/pnas.2006874117)

Pathological Science - Zhang et al and the PNAS: Zhang R, Annie Y Zhang L, Wang Y, Molinae M: Identifying airborne transmission as the dominant route for the spread of COVID-19 (fast-tracked through the PNAS on June 11, 2020)

Defacing Mask Science - Rossettie S, Perry C, Pourghaed M, Zumwalt M, "Effectiveness of manufactured surgical masks, respirators, and home-made masks in prevention of respiratory infection due to airborne microorganisms" The Southwest Respiratory and Critical Care Chronicles 2020;8(34):11–26

Masks - Don't look behind the curtain: Review of Vivek Kumar, Sravankumar Nallamothu, Sourabh Shrivastava, Harshrajsinh Jadeja, Pravin Nakod, Prem Andrade, Pankaj Doshi, Guruswamy Kumaraswamy "On the utility of cloth facemasks for controlling ejecta during respiratory events "

 Size matters! A Brief Description of filtering mechanisms and size.

Materials v. Masks: A review of Konda A, Prakash A, Moss GA, Schmoldt M, Grant GD, Guha S "Aerosol Filtration Efficiency of Common Fabrics Used in Respiratory Cloth Masks" (American Chemical Society, April 2020)

"Junk Science: In Favor of Community Face Masks - a return to Lysenkoism" A review of: Jeremy Howard, Austin Huang, Zhiyuan Li, Zeynep Tufekci, Vladimir Zdimal, Helene-Mari van der Westhuizen, Arne von Delft, Amy Price, Lex Fridman, Lei-Han Tang, Viola Tang, Gregory L. Watson, Christina E. Bax, Reshama Shaikh, Frederik Questier, Danny Hernandez, Larry F. Chu, Christina M. Ramirez, Anne W. Rimoin Face Masks Against COVID-19: An Evidence Review NOT PEER-REVIEWED | Posted: 13 May 2020

Wishful Science - A review of Anna Davies, BSc, Katy-Anne Thompson, BSc, Karthika Giri, BSc, George Kafatos, MSc, Jimmy Walker, PhD, and Allan Bennett, MSc Testing the Efficacy of Homemade Masks: Would They Protect in an Influenza Pandemic? (Disaster Med Public Health Preparedness. 2013;7:413-418)

If Manikins Could Fly… A Review of Eikenberry SE, Mancuso M, Iboi E, Phan T, Eikenberry K, Kuang Y, Kostelich E, Gumel AB "To mask or not to mask: Modeling the potential for face mask use by the general public to curtail the COVID-19 pandemic" (Infectious Disease Modelling 5 (2020) pp. 293-308)

Review of Cheng VC, Wong S, Chuang V, So S, et al "The role of community-wide wearing of face mask for control of coronavirus disease 2019 (COVID-19) epidemic due to SARS-CoV-2" (Journal of Infection April 30, 2020;16:13)

Gassed Masks! Reactivation of viruses and deoxygenation during mask wearing.

Masking the Truth - A discussion of aerosols and droplets

We R0 New York City - A discussion of the basic reproduction number.

The epidemic of ignorance: Lessons from "Flattening the Curve" April 14, 2020

Think Tanks! The Dangers of Group-Think April 13, 2020