Covid-19 Knowledge Update: Part 7
Much to the annoyance of some on our marketing team, I loathe the idea of steering clear of controversial and politicized topics. This week, I will discuss the use of face masks during the COVID-19 pandemic and dive into some frequently arising questions (some of which are legitimate and some not) regarding their use. Are masks safe and effective, or are they simply a political tool to strip us of our freedoms? Oh boy, I can already envision a few hate-filled emails coming my way. Anger be damned, let’s get straight to it.
Are Facemasks “Dangerous”?
A report out of China released in May that was picked up by some English language news sites reported that two teenage boys in China had died during gym class while wearing face masks. Immediately jumping to conclusions of causation due to correlation, many media outlets and individuals spread this information like wildfire, portraying masks as a health hazard.
The English-language reports mentioned above rightly did not claim with any certainty that wearing face masks was what had killed the boys, and all three carried quotations from Cao Lanxiu, a professor at Shanxi University, in the city of Taiyuan. Cao told Chinese news media that she believed it was unlikely the wearing of the face masks was any more than coincidental in the boys’ deaths.
Further, as per Snopes, the causation of the boys’ deaths was impossible to determine due to the refusal of autopsy by families of the deceased. This hasn’t stopped many from trumpeting claims that face masks cause an “immediate strain” on breathing. It may have all been worth it for this one hilarious tweet in response to Bill Mitchell, a former Republican member of the House of Representatives in Illinois. Bill said: “I put on a mask and literally within seconds, I am struggling to breathe.”
It’s worth noting that Mitchell runs a YouTube channel called “Your Voice America” that is actively pushing the QAnon conspiracy, and is one of few politicians who has actually managed to get himself permanently banned from Twitter. Perhaps, it is time to stop listening to political figures such as him regarding the matters of science and start actually looking at the science. Also, please do not misconstrue this as support for this individual’s political opposition; there are many instances where the left cites “science” quite incorrectly to make their point, claims consensus based on cherry-picked interviews with MDs or scientists who voice their predetermined positions, or flat out denies or ignores science. Politicians and political activists on all sides will inevitably skew and distort evidence to fit their own narratives and agendas.
I’ve seen videos and posts from various people I already didn’t trust, due to their proclivity and intensity in spreading false information and conspiracy theories, claiming that they had seen “significant drops” in measured blood oxygen levels (SpO2) after wearing face masks, sometimes after mere minutes (or so they claimed). One conspiracy theorist in the “therapeutic water” industry, who distributes hydrogen water but also many other scam products, claimed his SpO2 plummeted to levels that would have required hospitalization in just 15 minutes. Of note, this individual is frequently suspended from Facebook after repeatedly being put on time out for false and potentially community endangering claims, and I have personally been the target of his slander, as have the tablets. Without naming him, as we are under an NDA, he approached me about purchasing a private label of the hydrogen tablet technology. Before I could get any sense of his ethical values, his company’s intentions or backstory, etc., he made demands for me to acknowledge and support various conspiratorial views he held, or else he could not “financially support me.” I declined, he became enraged, while he committed himself to spreading false information, sowing seeds of doubt regarding efficacy of the hydrogen tablets and claiming harm due to their use (without providing any evidence). He is such a small voice with virtually no audience and was banned from Facebook shortly after for a significant period of time, losing what audience he had, so I didn’t deem him to be a substantial threat. However, it is of note that he is one of the many videos claiming “immediate harm” from wearing a mask that I have seen shared by others.
Notably, others have posted videos of working out in masks while they measured their SpO2 and noted no reduction, and one MD in the UK ran 22 miles while wearing a mask and reported that his SpO2 was consistently maintained at about 98%. Moreover, I have worn N95’s for up to 12 hours straight while doing complex technical formulation work on the hydrogen tablets with no loss in cognitive function, and have routinely needed to wear masks for entire days as I oversaw and watched production of the tablets in early batches. Of course, many professionals across manufacturing and within the medical and dental communities wear masks all day, every day, with no complaints. Regardless, in the name of investigating something rather than simply drawing conclusions, I decided to do a pair of workouts both with and without a mask, and to measure my heart rate and SpO2 with a pulse oximeter. The results are displayed below:
Hard/Moderate 30-Minute Heavy Bag Workout
HR: 57 BPM
HR: 153 BPM
HR: 64 BPM
Hard/Moderate 30-Minute Plyometrics and Weights
HR: 67 BPM
HR: 155 BPM
HR: 59 BPM
As you can see, there was no evidence from my own workouts that a mask may lead to lower SpO2.
Why do so many anti-maskers believe masks are dangerous? Many believe that masks prevent CO2 from escaping and/or O2 from entering through the mask. As confusing as this notion is, considering masks are used in many occupations, all day and every day, another common argument from the “anti-mask” contingency goes even one step further and states that masks are both harmful and ineffective. The argument as follows:
- Masks cannot stop the virus from escaping, as the virus is too small.
- Masks cause shortages of oxygen, leading to rapidly plummeting SpO2 levels, hypoxia, and even suffocation.
One thing to consider, the novel coronavirus, or SARS-CoV-2, ranges between 60 and 140 nanometers in size,1 whereas the oxygen molecule measures 292 picometers.2 This means that oxygen is 205 to 479 times smaller than the novel coronavirus. If a mask cannot stop the virus from escaping due to the mesh size, it certainly cannot stop oxygen from entering.
Additionally, CO2 is 334 picometers in size,3 meaning CO2 is 179 to 419 times smaller than the novel coronavirus. This means that if a mask is insufficient at blocking the virus from exiting through its material, it certainly cannot block CO2 from escaping through.
Anti-maskers need to pick one. Either face masks are ineffective and safe, or they are effective and potentially dangerous. The second statement comes with a massive caveat, since there is a range in sizes of the mesh where a mask could be both effective and safe, and that range is 179 times the size of CO2. This is a very large range of error, so it cannot be assumed that if masks are effective, they are also dangerous. Facts matter, and knowing the facts helps people form legitimate positions and opinions.
Are Face Masks Effective?
This is a loaded question that can lead to different answers, depending on multiple considerations, such as the type of mask used, the route of viral spread, and the definition of effectiveness. Because there are many considerations, the short answer is both “yes” and “no” can be correct, depending on the interpretation and context. That said, in a holistic sense of risk reduction, the answer is, “Yes, masks are effective; however, they are not some miracle protection.”
What Measures are Ineffective?
Face shields are ineffective; do not bother wearing a plastic face shield. If your employer tries to force you to wear a face shield for corporate compliance, you should advise them that face shields are ineffective. Masks with built-in exhalation valves are useless. Do not bother buying or wearing a mask with exhalation valves built in.
No masks are definitively effective in reducing an individual’s risk of becoming infected with the novel coronavirus; they have only been demonstrated to reduce the risk of spreading it once infected.4 When you wear a mask, the goal is to partially protect others from being infected by you, whether you happen to be pre-symptomatic, asymptomatic, or just plain symptomatic and an asshole, and not to protect yourself from others. This is why the “Why do others care if I’m not wearing a mask if they are wearing a mask; isn’t their mask effective?” argument is so utterly asinine.
What Measures are Partially or Highly Effective?
Different mask materials have various levels of effectiveness in stopping aerosols, the fine particles that may be as small as 60–140 nanometers. N95 masks are likely the most effective commercially available mask option, able to stop 95% of particles 100nm in size, and 99.5% of particles that are larger than 750nm in size. 5 This means that N95 masks are likely to stop all droplets and the majority of aerosols. Unfortunately, N95 masks continue to be in short supply. Therefore, most people are utilizing cloth masks, which are either made commercially or constructed out of fabrics at home. If you decide to make your own mask, consider using HEPA vacuum bags. One recently published study found that masks made from reusable HEPA filter vacuum bags were more effective than N95 masks.6 The study also found that single-layer fabric masks could stop about 35–45% of fine particles, and multiple layers increased that filtration by an additional 11%. This means that cloth masks are potentially allowing roughly half of the particulates to get through, which could be sufficient for viral transmission.
A limitation in the study above, and of most other studies on cloth masks, is that “mask fit” is not considered, with potential gaps allowing an even higher percentage of fine airborne viral particles to escape. According to an opinion piece posted on the University of Michigan website and co-written by two professors (one of whom is retired) and experts on respiratory protection and infectious disease spread from the University of Illinois, widespread mask use is not supported by sound science. Of course, this was written in April, when we believed primary transmission was by fine airborne particles. This was before there was a complete reversal to widespread reporting of droplets being the main culprit (and omission of any airborne threat), to the current silent reversal acknowledging that both airborne particles and droplets play a role in COVID-19 transmission.
Droplets, while airborne, are larger, typically measuring above 5 microns, and can only travel roughly 6 feet before dropping to the ground. In contrast, smaller airborne particles can travel dozens of feet and stay suspended in the air for hours. It is likely that cloth masks are filtering out most droplets and some airborne particulates, which may or may not help to reduce spread, but could play an important role in reducing the viral load and, as such, the severity of symptoms. This would suggest the following:
- Wearing an N95 or homemade mask from a reusable vacuum bag is ideal.
- Wearing a cloth mask is better than wearing no protection, but shouldn’t give you significant confidence.
- If wearing a cloth mask or homemade mask made from a vacuum bag, you should ensure that the fit is tight enough for efficacy.
- Masks should always cover both your nose and mouth.
- Wearing a plastic face shield is utterly useless.
- Wearing a mask with an exhalation valve is utterly useless
One mask-based technology that could be a game changer is a Canadian-designed mask that, in addition to filtering out particulates, deactivates 99% of the novel coronavirus particulates it comes in contact with via an antimicrobial layer. This could potentially reduce the risk of coming in contact with the virus from touching the surface of your mask, and then touching your face. . This is important, as many people touch and adjust their masks numerous times throughout a day. Each point of contact leads to the potential of transferring viral matter onto a face mask, then having a small percentage of it be sucked into your airways. This route of contamination could decrease the effectiveness of cloth masks in viral spread, but it would also lead to a higher prevalence of viral load reduction and, as such, lower disease severity. Mass production of masks containing this type of an antimicrobial layer would dramatically increase the effectiveness of masks in terms of viral spread.
Are Face Masks “A Violation of Freedom?”
This is an odd one for me. First off, of course they are. That said, so is almost everything else we adhere to in society, from forced taxation, to public decency laws, or even laws that prohibit and punish heinous acts, such as murder and rape. Of course, rather than descend into what could be labeled a false equivalency, I’d rather address closely related subjects that draw very little support or controversy within the political groups opposing masks.
Where are these outcries regarding traffic regulations, such as speeding tickets and seat belt enforcement, which oppose our freedom and were imposed for public safety (other than from within a few in the Libertarian party)? Incidentally, a Libertarian mayor recently dismissed all traffic tickets in her city.
Why are the anti-maskers not screaming about laws regarding public smoking? Yes, there are some outcries from some segments of the Republican party in some areas, but the movement has nowhere near the attention and widespread support of the anti-mask crowd. Interestingly, smoking bans seem to get more attention from those supporting civil liberties than traffic law violations, despite tobacco deaths being one of the leading causes of death in the USA, estimated at around 480,000 each year,7 whereas traffic deaths amount to less than 40,000 deaths each year.8 Of course, as I have previously written, without measures, I would expect COVID-19 deaths to reach around 600,000 in the USA per year with no vaccine. At the time of this writing, the USA is at around 250,000 reported deaths, after roughly 8 months of the pandemic and having employed numerous measures. It seems that the less intrusive a policy is and the more lives it will save, the more outraged many become over their freedom.
In watching the recent U.S. elections, I wonder where are all these anti-maskers in the voting polls? Shouldn’t they be making up the most extreme contingent of the Libertarian party? Shouldn’t they be equally as outraged about traffic violations, tobacco restrictions, and even taxation in general? Taxes, in effect, take our money and allocate it to causes we have little to no control over. That is the ultimate assault on freedom. I suspect that for many of these individuals, the issue isn’t their “freedom” or their “health” — it is being contrarian to authorities to the point of oppositional defiant disorder (ODD). Masks are simply a topical and new subject that they can use to lash out. Contrarianism is great, but default and reactive contrarianism without critical and analytical thought, of both the position you intend to oppose and why you intend to oppose it, is simply destructive. Most individuals outgrow this mental stage sometime in their late teens or early 20s. Of course, mob mentality can override personal maturity, even for adults.
This could also be an overreaction to the hyperbolic and ironically ineffective rhetoric employed by many in the left-leaning media, such as the majority of CNN anchors. The fervent proclamation of masks being an unmatched tool, nay, duty, that no one should question or forget, coupled with one of CNN’s most vocal advocates for face masks, Chris Cuomo (brother of the Democratic Governor of New York, Andrew Cuomo), being repeatedly caught in public without a mask, and even having been warned by his building manager for multiple violations. For anyone that forms the knee-jerk reaction that since Fox reported it, therefore it must be fake news, Chris Cuomo has admitted he did it and made a mistake, on air at CNN. Although this was only when challenged by one of his guests (a member of the Trump campaign). All of this was after he was caught disobeying quarantine when he had an active case of COVID-19 earlier in the year, before trying to subdue that news with his own narrative of “emerging from quarantine” days later. Many people trumpeting hyperbolic talking points in which they themselves do not adhere need to look in the mirror regarding addressing blame on those who refuse to acknowledge any importance to their position. The Chris Cuomos of the world should be ashamed for the role they have played.
Strap in if you’re fine with controversial topics, as next week I will dive into where we are at with vaccine development, what it means for timelines for getting back to normal, what we should expect, and what we should question. If the mask topic offended you, my prediction is that you’ll probably want to skip next week’s article.