Masks - The New Old Superstitious Talisman of Disease

Pick up any contemporary "history" book that discusses the Black Death that raged through Central Europe in the middle of the Fourteenth Century. In most revisionist texts, one will invariably find a rather jauntily arrogant explanation of how the ignorant masses blamed the disease on a variety spiritual or material causes. The history author usually, however tacitly, alludes to "them" versus us smarter and more sophisticated modern types who, with our superior knowledge know so much better, and therefore, behave so much better. 

But is it true? Are we less superstitious today than a few hundred years ago? I look around today and find very little to differentiate the collective mind of today, and that of the 14th Century - indeed, in terms of wisdom, I see a degradation of the collective societal mind. What we have certainly gained in technology, we have done so at the expense of wisdom. Much of the degradation can, of course, be traced to the dawn of the failed "Enlightenment" movement - a misnomer of Biblical proportions.

Modern writers today look down their noses at the Central Europeans of the Middle Ages and they even invented a pejorative for the period - the "Dark Ages" - a term now seldom used by anyone but the most ignorant of history. Most of these kinds of writers point to the common use of talismans and charms of the period used to ward away disease; these writers point to the widespread belief in such talismans and charms as the ultimate proof of the ignorance of those people.

As an epitome of that ignorance, some contemporaries point to the chilling dress of the 18th Century Doctor Schnabel von Rom whose long-beaked mask, long cloak and goggles surely are examples of laughable ignorance (oh, we are so much better than that...). 

The queer looking mask and dress was actually a considered response to the generally accepted cause of the Plague and other forms of disease which were based on the theories of "miasma" and "mal'aria."

As described from a 17th Century text, "miasma" was the "...effluvia arising from the ground and floating in the atmosphere, considered to be infectious or injurious to health..." in other words, "bad air" (modern Latin "miasma" (noxious vapors) and from Greek "miasmatos.")

And "mal'aria" as used by the Italian physician Francisco Torti (1658-1741) "mala aria," again - "bad air" (from Latin malo/malus "bad" + Italian aria "air").

So bad air caused disease. The theory of miasma held that if air smelled foul, then it bore disease. So, how does one protect against foul smelling air? Make a long-beaked mask, fill it with flowers and spices and strap it to your head.  Will it work? Hell, no, but "it's better than nothing," right? Sound familiar? Look around your local grocery store. See all those people wearing bandanas, handkerchiefs, polo-necks, loop-masks and other useless face pieces? What is the difference between the "superstitious" 18th Century Central European wearing a useless bird-looking mask based on ignorance and fear and modern US citizen wearing a stupid looking and equally useless bandana? Both are decisions based on nothing but fear and ignorance.

As you walk around and see the healthy mask-wearing public, what more is it but the visible testimony of modern day ignorance-based superstition? Never laugh at the ignorant peasants of the "Dark Ages" again.

As the nutty 2020 mask-craze emerged and was developed, I was given a list of articles by someone who believed the articles were scientific proof of the effectiveness of community masks in curbing the current virus (links to all of the previous articles are given below). Each article rose and/or fell on its own merits, but NONE of the articles thus far, that were believed to be scientific evidence for masking, withstood even the most simple test of applicability or validity. 

As of today, August 4, 2020 - there is no science to support the goofy superstition of community mask wearing - it's all a load of Schnabel. And that is why a couple days ago, Jaap van Dissel, Chief Epidemiologist with the Dutch Public Health Institute RIVM shocked the unwashed masses when he announced this information that has been established science for some 80 years and is only news to the gullible. 

This is my 8th Article Review in the series, I hope you find it useful.

Article Under Review

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)

The article can be summarized in one sentence by the authors:

These observations confirm that there is a substantial probability that normal speaking causes airborne virus transmission in confined environments.

Well - I have no argument with that conclusion. But it doesn't speak to the issue of people walking around with dirty loose fitting bandanas, filthy ear-loops (often hanging under their nose), and N95s over long scraggly beards, or the blatant lies of some Governors such as Colorado's Governor Polis who claimed that science proved that community mask wearing reduces the spread of the disease by 65%.

Contrary to what my colleague believes, the Stadnytskyi paper has NOTHING whatsoever to do with masks, the efficacy of masks, the utility of masks, the applicability of masks, and there is no mention of masks or respirators or protection anywhere in the report.

The authors of the article (who appear to have done a fine job in their observations), provide ZERO evidence for the community mask craze since that was not their intent or goal.

Once again, it seems that someone is trying to reference scientific studies they either have never read, or failed to understand, but presume that if they reference scientific papers, then it MUST necessarily support their desired outcome.

The authors of the Stadnytskyi paper are investigating the particle size distribution and fate of airborne particulates generated during the act of speaking. That is, the Stadnytskyi paper is a discussion about the physics of particles, and has nothing to do with masks at all.

In one small sense, the article represents "porcupine science" in that the work appears to be a duplication of hundreds of other such studies over the last 100 years. It, of course, does have the added advantage of using better technology, and finer instrument resolution and so the work by the authors was not entirely wasted - and they did really fine job in their work, and I certainly don't mean to detract from that.

Now, what Stadnytskyi et al accidentally did was to tacitly underscore an underlying problem in terminology. In their paper, Stadnytskyi discusses the fact that ejecta during speech are not stable, static things, but rather, the materials of the ejecta change- the particles change size with time, thus altering their characteristics (thus altering their potential for infectivity). The materials ejected change size, and this brings about a question of distinction between how medical personnel and Industrial Hygienists view particles, and why that can lead to an apparent confusion in the minds of the general public between what medical personnel are saying and what Industrial Hygienists are saying and why they are different.

As an industrial Hygienist, many of the terms I use will be the same terms used by the medical industry, but the terms may actually have different meanings. The terms used by the IH are well established and can be found in such early Industrial Hygiene texts as Hatch and Gross's 1964 classic work from the American Industrial Hygiene Association (back when we were relevant) titled "Pulmonary Deposition and Retention of Inhaled Aerosols."[1] I've been the contracting Industrial Hygienist for the National Center for Atmospheric Research in Boulder for some 20 years or more, and I was lucky enough to secure a copy of Richard Cadle's original "Measurement of Airborne Particles"[2] Both of these books are not just historically wonderful, but still important and relevant today. Herein lies some of the pedigree of the terms used by Industrial Hygienists. And herein lies some of the disconnect between what medical doctors are saying, what Industrial Hygienists are saying and what the poor untrained individual in the street is hearing.

The medical folks often speak of "respiratory droplets" and "aerosols" and use broad definitions for these terms. For medical folks, "respiratory droplets" tend to be kind of big things and drop out from suspension quickly, not inhaled and not really a player in the "airborne infection" scenario (except as "splash and spray" in close contact with diseased people in health care settings). By contrast, aerosols are synonymous with droplet nuclei, and are the particle size distribution of infectious airborne transmission and can travel long distances while retaining their infective properties. So, in the medical literature, really only those particles smaller than about 5 μm are part of the airborne infection transmission scenario.

Industrial Hygienists, on the other hand, use terms based on the properties of the particles in question and we are more likely to speak of "respirable," "thoracic," "total inhalable" etc. We recognize that humans can inhale particles as large as 100 μm which, although that size range is mostly scrubbed out in the nasal passages, they are nevertheless important from an infection control and transmission perspective in the general population.

Another key issue raised by Stadnytskyi was the effect the environment has on the fate of the ejecta. In Stadnytskyi's paper, the authors are essentially working in stagnant air environments. 

When dealing with stagnant-air environments, we see that the "hang-time" for particles in the air is a inverse log function of size: (Marr, L (2020):

Although stagnant-air conditions are an important parameter to understand one particular aspect of the ejecta, we do not live, work and breathe in stagnant-air environments.  Consider that a human sitting in a calm room whose air temp is a nice comfortable 20°C produces a buoyant thermal plume whose upward velocity is greater than the settling velocity of a unit density particle with an AD of 50 μm.

As a result, even slight drafts as low as 5 cm/sec are sufficient to carry a 5 μm particle 65 m and at 20 cm/sec, that distance is 270 m (after Marr L, 2020). Now, normally, we don't live in laminar air flows any more than we live in stagnant air conditions, but rather we are swimming in turbulent air and so these long distances that can be travelled are not always achieved, but nevertheless, the "hang-time" is still extended (and as Stadnytskyi et al point out in their paper, as the hang-time increases, the aerodynamic diameter of the particle decreases, extending its hang-time/travel potential even more). 

Considering that the 5 μm size range is probably the most significant particle size faction for the viral transmission, these particle dynamics are just one of the factors that makes community mask wearing (and even "social distancing" as it is being practiced) a political joke. 

So, while reading the Stadnytskyi paper, I was inspired to think of three things:

1) People often reference "scientific" papers they have never read, or are not competent to understand, and then reference those papers out of tautology to advance an otherwise unsupportable position.

2) The use of similar terms by different professions to indicate completely different things - e.g. when the medical folks talk about droplets and aerosols, and how some controls may be effective in health care settings, these observations are not necessarily translatable in terms germane to the broader discussion under completely different settings in completely different conditions.

3) The similarities in the superstitious population of today and their eagerness to don "magical dress" in the misguided belief that such garb and rituals will stem the spread of a disease, and those of the superstitious populations of the Middle Ages into the 18th Century and their eagerness to don magical dress and adopt useless rituals. However, at least the people of the Middle Ages and into the 18th Century were working off the best information available to them - unlike the fear-driven superstitious mask-wearing population of today who reject known science, and maintain their superstitious practices regardless of facts.

Caoimhín P. Connell, Forensic Industrial Hygienist, August 4, 2020

Other COVID-19 discussions by CP Connell:

 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

References:

[1] Hatch Theodore F, Gross Paul, ""Pulmonary Deposition and Retention of Inhaled Aerosols" Academic Press, 1964, published through the collaborative efforts of George Clayton (American Industrial Hygiene Association) and the US Atomic Energy Commission. 

[2] Cadle Richard D, (National Center for Atmospheric Research) "The Measurement of Airborne Particles" J. Wiley & Sons Pubs. (1975)