Masking the Truth

Listening to people speaking in shops and walking around reflects what the general population is thinking. 

The latest discussions have been focused on "masks" and their use. 

The Zeitgeist -The lesser informed Joe-on-the-street speaks about how they're wearing masks to protect them against the "coronavirus." Then a "better informed" individual corrects them and explains, with aplomb, that they are wearing a mask to protect everyone else. Neither position is correct.

Invariably, if someone who actually knows the dynamics and limitations of respiratory protection and the dynamics of exposure and infection control foolishly enters the discussion to provide facts, they are ridiculed by the mask wearers who engage in "argumentum ad populum" and respond with "…everybody knows that wearing masks saves lives and prevent the spread of the virus."

Perhaps everybody does think that, but does that make it true? Usually the response to that question is "Well, the CDC and other authorities say it's so, and therefore it must be true."

But does the CDC actually say that? On Thursday, February 27, 2020, the Director of the US Centers for Disease Control (CDC), Dr. Robert Redfield, told Congress "There is no role for these masks in the community."

On Friday, February 28, 2020, Dr. Michael Ryan, the executive director of the health emergency program at the World Health Organization stated, "There are limits to how a mask can protect you from being infected," he added "The most important thing everyone can do is wash your hands, keep your hands away from your face and observe very precise hygiene." 

These sentiments were repeated one day later by the US Surgeon General, Dr. Jerome Adams who said (his emphasis): "Seriously people- STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus,…" Dr. Adams went on to say (the emphasis is mine): "The best way to protect yourself and your community is with everyday preventive actions, like staying home when you are sick and washing hands with soap and water, to help slow the spread of respiratory illness. "  

These thoughts are not found in just the public sector, Dr. Jeffrey Klausner, Professor of Medicine and Public Health at University of California, Los Angeles stated “I don’t think there’s any evidence that wearing a surgical mask has any benefit to protect someone in general from exposure, or from being infected,…” Dr. Klausner went on to say that wearing masks is kind of a psychological tool to be used to keep awareness at an elevated level, but offering no actual protection to people or the community. "So it may be kind of an awareness tool, but in terms of its direct benefits, there’s no data." Dr. Klausner added.

Similarly, Dr. William Schaffner of the Vanderbilt University School of Medicine, told CNN that buying masks is a "psychological thing" rather than a viable defense. "The coronavirus is coming, and we feel rather helpless," he said. "By getting masks and wearing them, we move the locus of control somewhat to ourselves."

Dr. Lisa Brosseau, a national expert on respiratory protection and infectious diseases and former professor at the University of Illinois at Chicago, and Dr. Margaret Sietsema an assistant professor at the University of Illinois at Chicago and also an expert on respiratory protection stated:

We do not recommend requiring the general public who do not have symptoms of COVID19-like illness to routinely wear cloth or surgical masks because:

There is no scientific evidence they are effective in reducing the risk of SARS-CoV-2 transmission.

 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.

We don't have to go very far from home to find other experts saying the same things. Today, (May 2, 2020) I was out diligently violating the "stay-at-home orders (and simultaneously violating the mandatory "face mask" rule) at a large super-store. The masked couple next to me were struggling to free a shopping cart when the woman grabbed her mask and ripped it off and said "I don't need this stupid thing!"

I calmly said to her "Ma'am, I'm a scientist, and an expert in respiratory protection and you really don't need a mask." She locked me in her gaze and said "I'm a registered respiratory nurse, and I KNOW I don't need this mask!"

Airborne Transmission vs. Airborne Transmission - In the "Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)" The World Health Organization states something that some people may find confusing: "Airborne spread has not been reported for COVID-19 and it is not believed to be a major driver of transmission based on available evidence; however, it can be envisaged if certain aerosol-generating procedures are conducted in health care facilities."

Well, demmit… is it airborne or isn't it airborne?

When discussing transmission of a disease, there is a difference between "airborne transmission" and "droplet transmission."

At the moment, the general thought is that SARS-CoV-2 is not transmitted via the airborne route, but is transmitted via airborne droplets. Airborne droplets are not necessarily the same as "airborne transmission."

"Aerosols" come in a wide range of particle sizes. When we speak or sneeze or cough, we produce droplets which enter the surrounding air. In the late 1800's Carl Flügge demonstrated that microorganisms could exist in those droplets and could result in the transmission of those infectious entities to another person. The term "Flügge particles" are those particles that are large enough to drop out of the air quickly.   

These are the droplets that are the primary concern for Health Care Workers (HCW) since they are in close proximity with infectious (or potentially infectious) individuals, and their risk of infection is therefore higher. Except, importantly, initial data from China, as reported by the WHO, showed that even among HCW, the primary route of infection occurred in the home of the HCW, not in the occupational setting.

William F. Wells further differentiated between large and small droplets (I have a copy of Wells' classic 1955 book, "Airborne Contagion and Air Hygiene"). Wells thus makes the distinction between airborne transmission and droplet transmission. A discussion of particle size issues are found in my earlier write-up titled "Size Matters" (https://www.forensic-applications.com/misc/Size_Matters.pdf ). Droplets larger than about one micron (μm) can be generally thought to fall to the ground within a few seconds in still air. Or, similarly, they can impact on another surface before eventually evaporating.

Aerosolized droplets smaller than about one μm may evaporate more quickly, leaving behind the infectious particles that were contained in that droplet along with a soup of proteins, salts and other biological goo. 

These remaining constituents are the droplet nuclei. They can remain airborne for hours and they can be transmitted for very long distances- much further than the 6 feet endorsed by the other anti-scientific fad "social distancing" or even further than the some 26 feet recently reported by a group of researchers at MIT. 

Now, I hate to be gross, but… actually, that's a lie - boys like being gross - according to the WHO-China joint report, viral shedding was reported via the fecal route from some patients, and viable virus has been identified in a number of cases. So what happens during the violent "whoosh!" of a toilet full of poop being flushed? Yep… a massive cloud of aerosols. I will leave the rest up to your imagination.

The problem that we run into is that the working definition of an "aerosol" is a term of art, and may be used by different professionals in different ways.

Humidity and Longevity - Knowledge concerning the lability of viruses in the air, and viability of bacterium in the air is not new. In 1934, the Massachusetts Department of Public Health[i] reported that humidity was an important factor in the longevity of organisms that were experimentally aerosolized. They found the same reduction of E. coli from a spray humidified air conditioned room after 35 minutes, as in 165 minutes when the spray humidifier was turned off (they controlled for other alternative explanations). They went on to discover that when they increased the relative humidity from 45% to 90% under the same conditions, they could double the reduction of viable airborne E. coli. 

Soon it was reported[ii] that low relative humidities favored longevity for other airborne bacteria. Shortly thereafter (1943), researchers[iii] working with the Ectromelia Orthopoxvirus (mousepox) and Orthomyxovirus (influenza) reported that the influenza virus lost virulence faster in humid air than in air with lower relative humidity. In what some may consider "porcupine science" other, more recent (2013) researchers[iv] have confirmed the relationship between relative humidity (or absolute humidity) and virulence (Noti JD, Blachere FM, et al. (2013))

I have not seen anyone address the ramifications of these issues in the current hysteria surrounding the SARS-CoV-2 pandemic. Especially in states like my State, Colorado, with very low atmospheric relative humidity. I challenge my colleagues to think about aerosol dynamics and what is going on at the user-mask interface.

Imagine if you will, the case of an infectious individual in public who is capable of shedding the virus. The individual coughs (or speaks or sneezes), releasing infectious aerosols. That person is wearing a "mask" (and it really doesn't matter if it is one of the useless home-made bandanas, or one of the more sophisticated, (but equally useless) loose fitting NIOSH Approved N95 masks). That infectious person coughs/sneezes/speaks into the mask. A certain, portion of the aerosols are trapped in the filter matrix of the mask. Those aerosols trapped in the fabric of the mask WILL dry out (some faster, some slower, depending on the relative humidity in the ambient air and what the wearer does with the mask).

Watch these people with their "masks;" they reach up and touch the mask to put them on; they reach up and remove it to speak on their phone, they reach up and put it back on,, they reach up to adjust it, they handle vegetables, they put the mask on their forehead to scratch their nose, they shove the mask up to take a drag off their cigarette, they touch the mask to put the mask around their neck (which is where the really cool people wear a mask), they take the mask off and put the mask in a purse (with their money and credit cards they are going to give to someone to touch), etc. 

Whether it is an infectious person or not, as a person wears that mask throughout the day (and then wear the same one tomorrow and the next day, and the next), they are concentrating the infectious particles inside and outside that mask. Every time a person inhales through that useless mask, to some extent, they are filtering out a portion of the airborne contagion around them (including TB, poliovirus, influenza virus, measles virus, not to mention an host of bacteria). Each time they manipulate the mask (which, being a keen observer, I watch with great amusement the wearing practices of "mask-wearers), they are disturbing that infectious reservoir which they are then sharing as a cloud of highly concentrated particles with you, me, and all the other mask-wearing people (who are then concentrating the new loading on their masks).

But such is not the case of healthy people who are smart enough to not wear masks. They are not walking around town developing their own private collections of pathogenic microorganisms.

Now, imagine the infectious person coughs, speaks or sneezes without a mask. Often, those infectious particles are going to be released and dispersed into the air (a large percentage will be quickly diluted and carried away on drafts) and the remaining aerosols will fall out of circulation.   

Which is the better situation? 

Considering that the wearing of masks absolutely does not protect the general public wearer, what really is the percentage of infectious carriers that concern us? Being infected by SARS-CoV-2 is not the same thing as being sick or even being infectious. With only 0.4% of the US population being a confirmed case, what percent of those are actually infectious? Certainly less than 0.4%. 

The general wearing of masks is not only lacking in any kind of evidence to justify its practice, but there is all the reason to conclude that the general wearing of masks has an higher probability of making matters worse.

Most of my colleagues know my unchanging position on the use of (useless) masks, in fact four years ago I wrote a piece on such practices (see https://www.forensic-applications.com/misc/Respirators_on_Pig.pdf), and so two nights ago when I was rummaging through a house looking for a dead body that had been there for about six days, some of my colleagues were surprised to see me wearing an half-face APR with HEPA cartridges. When asked why I was wearing a "mask," I answered blithely - "…endotoxins, m'lad, endotoxins."

REFERENCES

[i] Massachusetts State Department of Health, Annual Report for 1934 (1934, pp 166-167)

[ii] Williamson AE, Gotaas HB, Aerosol sterilization of airborne bacteria (Industrial Medicine 1942, 11- 40-45)

[iii] Edward DG, Elford WJ, et al Studies on air-borne virus infection … (Journal of Hygiene, 1943, 43:1010)

[iv] Noti JD, Blachere FM, et al High humidity leads to loss of infectious influenza virus from simulated coughs PLoS ONE 8(2): e57485. https://doi.org/10.1371/journal.pone.0057485

Other references available on demand.

Other COVID-19 discussions by CP Connell:

Napoleon's Coffee - How to misplace focus on details during the SARS-CoV-2 pandemic. February 22, 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