Are Masks an Effective Public Health Tool?

In his recent press conference, Governor Hogan coined the phrase which has now become a socially acceptable meme among Marylanders…”Wear the Damn Mask.”  Similarly, headlines quote Joe Biden as saying that “The single most effective thing we can do to stop the spread of Covid is wear a mask.”  Those who chose not to wear masks while they do their shopping, or even just walking on the street “bare faced” are called “anti-science” and have been subject to jeers and threats from other community members, being forced to leave stores, and even having the police called on them.  On December 7, it was reported that Maryland State Police have charged or arrested 132 Marylanders for COVID-related violations, including mask and social distancing violations.  We are told to follow the science…but what does the science actually tell us about mask wearing?  

Here, we offer a selection of the wide body of relevant scientific literature regarding mask-wearing, so that you may read the science for yourself:  

Danish mask study concludes that “in this community-based, randomized controlled trial conducted in a setting where mask wearing was uncommon and was not among other recommended public health measures related to COVID-19, a recommendation to wear a surgical mask when outside the home among others did not reduce, at conventional levels of statistical significance, incident SARS-CoV-2 infection compared with no mask recommendation.”

(Annals of Internal Medicine; November 18, 2020 https://www.acpjournals.org/doi/10.7326/M20-6817)

Face masks should be used only by individuals who have symptoms of respiratory infection such as coughing, sneezing, or, in some cases, fever. Face masks should also be worn by healthcare workers, by individuals who are taking care of or are in close contact with people who have respiratory infections, or otherwise as directed by a doctor. Face masks should not be worn by healthy individuals to protect themselves from acquiring respiratory infection because there is no evidence to suggest that face masks worn by healthy individuals are effective in preventing people from becoming ill.” (Journal of the American Medical Association (JAMA); April 21, 2020 Volume 323, Number 15 https://jamanetwork.com/journals/jama/fullaticle/2762694r)

A recent careful examination of the literature, in which 17 of the best studies were analyzed, concluded that, “None of the studies established a conclusive relationship between mask/respirator use and protection against influenza infection.” (bin-Reza F et al. The use of mask and respirators to prevent transmission of influenza: A systematic review of the scientific evidence. Resp Viruses 2012;6(4):257-67. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779801/)

Available evidence shows that (cloth masks)… may even increase the risk of infection due to moisture, liquid diffusion and retention of the virus. Penetration of particles through cloth is reported to be high.” “Altogether, common fabric cloth masks are not considered protective against respiratory viruses and their use should not be encouraged.”

(https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html)

Textile materials (that can be used for cloth masks) can contain harmful chemicals and dyes (i.e. formaldehyde). There is no research available regarding the safety of breathing through such materials but formaldehyde is a gas that can irritate a person’s eyes, nose, throat and lungs, or trigger an asthma attack, even at low concentrations. Prolonged exposure to formaldehyde can cause cancer.” (https://ww2.arb.ca.gov/resources/fact-sheets/formaldehyde and https://www.gao.gov/new.items/d10875.pdf)

If widespread masking continues, then the potential for inhaling mask fibers and environmental and biological debris continues on a daily basis for hundreds of millions of people. This should be alarming for physicians and epidemiologists knowledgeable in occupational hazards.” (Borovoy, et al, 2020; Masks, false safety and real dangers, Part 1: Friable mask particulate and lung vulnerability.  https://childrenshealthdefense.org/wp-content/uploads/Masks-false-safety-and-real-dangers-Part-1-Friable-mask-particulate-and-lung-vulnerability.pdf)

Neither surgical nor cotton masks effectively filtered SARS–CoV-2 during coughs by infected patients… the size and concentrations of SARS–CoV-2 in aerosols generated during coughing are unknown. Oberg and Brousseau demonstrated that surgical masks did not exhibit adequate filter performance against aerosols measuring 0.9, 2.0, and 3.1 μm in diameter. Lee and colleagues showed that particles 0.04 to 0.2 μm can penetrate surgical masks. The size of the SARS–CoV particle from the 2002–2004 outbreak was estimated as 0.08 to 0.14 μm; assuming that SARS-CoV-2 has a similar size, surgical masks are unlikely to effectively filter this virus.” (https://annals.org/aim/fullarticle/2764367)