We shall not cease from exploration
And the end of all our exploring
Will be to arrive where we started
And know the place for the first time.
— T.S. Eliot, “Little Gidding”
This two-part review is not meant to cast doubt on the seriousness of the SARS-CoV-2 infection, but to hold up to scientific and logical scrutiny the dominant narrative that has frantically promoted mandatory face coverings for the general public as an effective means of protection against the viral spread. Open-minded inquiry quickly uncovered evidence that this narrative is not only skewed, but unscientific, as we will see in even greater clarity. One of its noticeable features has been to denounce anyone who questions the dominant view as ignorant, deluded, a conspiracy theorist or a deliberate purveyor of misinformation. This is deeply disturbing in a free and democratic society. It also raises the question, if the pro-mask forces are unwilling to debate the issue on substance, just how strong their case really is. If they are truly “following the science,” why won’t they discuss the issue on exactly those terms?
In Part I, Science Gives Way to the Talisman, we noted the previous longstanding scientific and public health consensus against ubiquitous masking as an infection-control method, a view that was initially maintained by public health leaders when Covid-19 hit – but then abandoned. Following this came a blizzard of several hundred studies that appeared to prove the efficacy and benefits of wearing masks in reducing viral transmission (but with no mention of any potential harms). These studies seemed to “seal the deal” regarding masking, ending any need for further discussion.
Strangely, however, none of these studies were randomized controlled trials (RCT), the gold-standard of reliability in scientific testing and the only research method that can establish causal relationships between a selected behaviour or intervention and an outcome. The pro-mask studies were of an observational type and could demonstrate at best only a temporal association (i.e., correlation) between mask-wearing and infection rates – but were nonetheless hailed as definitive. Yet there was still room for doubt, because large-scale RCTs had been performed examining mask-wearing in relation to influenza viruses. And the bulk of these high-quality studies in the pre-Covid era failed to support the efficacy of mask-wearing to stop the spread of viral infection.
Why does this matter today? Because even as countries around the world reopen, the conflict over mask-wearing appears fated to continue. Even though mask mandates are being discarded or even outlawed in many U.S. states, and are soon to be dropped in Alberta, there is widespread resistance to allowing people once again to show their faces wherever they go and whatever they do.
Other Canadian provinces, left-leaning big-city mayors and various groups of medical experts are all demanding that mask mandates remain in place until some utopian goal is reached – such as zero recorded Covid-19 cases (as unrealistic an idea as, say, fully eradicating influenza). If we are to be subjected to prolonged political conflict over mask-wearing – and if many of us continue to feel a lingering urge to mask up just in case – then surely it is worth understanding whether masks even work, or whether wearing them might present health risks of their own, unrelated to Covid-19.
Randomized Controlled Trials (RCT) of Masking During Covid-19
A search by C2C Journal of the scientific literature since early 2020 has found two RCTs specific to mask wearing during the Covid-19 pandemic.
The first was a large Danish study, approved by an ethics committee and published in March 2021 in Annals of Internal Medicine. It tracked over 6,000 participants across the country, divided roughly equally between people who wore surgical masks and those who did not, from April to June 2020. Universal mask wearing was not yet recommended by the Danish authorities and mask use remained generally uncommon, thereby avoiding ethical concerns that otherwise might have been raised by the need to persuade a control group not to wear masks, and freeing the study results from the impact of governmental regulation.
Another strength is that this study used not only the results of the common PCR test as its primary outcome to measure infection results, but also the participant’s antibody count, an arguably more reliable measure than nasal swab sampling. Importantly, all participants spent at least three hours per day outside their homes, i.e., were not isolated from social interaction with potentially infected individuals.
As with previous RCTs testing the efficacy of facemasks against influenza virus (discussed in Part I), the Danish scientific team found no statistically significant difference in the spread of SARS-CoV-2 between the experimental and control groups. Specifically, the researchers reported: “SARS-CoV-2 infection occurred in 40 participants (1.8%) in the mask group and 53 (2.1%) in the control group.” These results, it stated, were “compatible with a possible 46% reduction to 23% increase in infection among mask wearers,” which, as the researchers concluded, makes their findings practically inconclusive. Such low precision of the detected impact of mask wearing, varying from being beneficial against the infection to making it worse, impedes drawing a more definite conclusion. Among the study’s limitations was the reliance on self-reported data, but that seems inevitable in population-based studies.
The other RCT is a micro study performed in a laboratory setting. It used four participants whose saliva, captured on a petri dish, was analyzed following exposure to the virus. It found nodifference in the median viral emission between the mask-free individuals and the mask wearers. That study, however, was ultimately retracted after the researchers admitted they had misinterpreted part of their findings but were, rather strangely, denied the customary opportunity to correct and update their paper.
Clearly then, despite claims that RCTs are inappropriate for studying mask effectiveness against Covid-19, it is both possible and would be of incalculable benefit to the public and policy-makers to perform just such studies – as was done with influenza. And the fact that the two conducted RCTs, one in a community setting and the other in a laboratory setting, were found inconclusive should only elevate the urgency of running additional and even better RCTs. Instead, and very strangely again, RCTs seem to be under a general halt in the scientific community.
The final point on the epidemiological evidence is the odd juxtaposition between the fact that most RCTs do not find facemasks to be beneficial against other respiratory illnesses while nearly all observational studies concerning Covid-19 do. That is why in reviews such as this, where accumulative data from both RCTs and observational studies are analyzed, the evidence for mask effectiveness is generally said to be “inconclusive.”
To rationalize this observation, some have suggested that experimental epidemiological studies might underestimate the benefits of mask-wearing whereas observational studies overestimate them. If that is the case, then because the pre-Covid-19-era RCTs have been roundly ignored and virtually no Covid-era RCTs were conducted at all, the world has been subjected to a seriously skewed view of what masks can accomplish against this viral pandemic.
Looking broadly, the Covid-19 crisis has generated literally tens of thousands of scientific papers on nearly all aspects of the disease in question. This should certainly appear to justify more than two RCTs evaluating the efficacy of one of the most heavily relied-upon, onerous and contentious public health measures. The fact that this has not been done is a matter of considerable curiosity, to say the least.
The Microscopic Mechanics of Masks
There is, further, a common pro-mask argument based on “mechanistic” evidence of masks’ protective properties (see again this review). Covid-19 is said to propagate both through small respiratory aerosols, with a diameter of less than 5 micrometers (μm, one-millionth of a metre) and larger droplets, 5-10 μm in size. Technically, any kind of mask can impede the spread of aerosols and droplets, with various masks providing different degrees of protection. Although leakage is possible due to poor fit of certain mask types (reducing protective capacity by up to 30 percent), it is generally established that masks provide a physical barrier against splashes and sprays of fluids.
Masks do not, however, function as a “strainer” but rather as a filter, meaning there is far more to a mask than its pore size. Various mask fibres perform different types of filtration (such as gravitational sedimentation, inertial impaction or interception) and these processes play a role in catching airborne particles. The review cited above notes that N95 masks have the best so-called particle filtration efficiency, with surgical masks having a lower degree of such efficiency. Cloth facemasks, which are not regulated, are “expected” to be even less efficient. That was why the CDC recommended using masks with two or more layers to limit the spread of Covid-19.
This, too, seems like strong, if not decisive, evidence in favour of facemasks. And yet the conclusions provided by mechanical studies have not been supported by RCTs. On the contrary, several RCTs have shown no advantage of wearing N95 versus surgical masks in protecting individuals against clinical respiratory illness, including coronaviruses (see this systematic review of RCTs). This seemingly makes no sense given the assertions of the N95 type’s filtration advantage over surgical masks – unless of course the mechanistic studies were focused on the wrong variable, i.e., filtration efficiency is not determinative, or masks in general are not especially useful.
Moreover, recall that the studies discussed above merely state that cloth masks are “expected” to have less particle filtration efficiency. But just how much less is unknown, because to date there has been no known scientific study describing and evaluating the mechanical properties and effectiveness of cloth masks or facial coverings in reducing the transmission of droplets and aerosols containing Covid-19.
This in itself is remarkable if not shocking, since hundreds of millions of people worldwide – possibly billions – habitually wear those cloth coverings and expect them to be life-protecting. So it is fair to say that the body of mechanics-focused research that is meant to provide further evidence in favour of masking does little but cast even greater doubt on the rationale for universal public masking.
The Serious Adverse Effects of Mask Wearing
Public health decisions are not intended to be based solely on scientific evidence. Science aims to observe, explain and predict as many natural phenomena as possible, yet it is not absolute and its models frequently fail to be verified. Hence, in the realm of policy making, especially regarding public health-related issues, it is commonly understood that any proposed medical intervention should undergo thorough cost-benefit analysis prior to implementation.
Enforcement of masks on the general public should not have been an exception. Yet – again astoundingly – no known cost-benefit analysis has ever been done on the issue anywhere worldwide. Nor, until two months ago, was a comprehensive investigation conducted to evaluate the adverse effects of mask wearing in the context of the Covid-19 pandemic. This should be considered a stunning omission since, in the pre-Covid-19 era, convincing evidence had been accumulated that the wearing of masks carries risks and can be harmful (see, for example, this and this study). And recall the WHO’s earlier warning about self-contamination (discussed in Part I).
The new literature review of April 2021 is devastating to the common view of masking as all-benefit, no-risk. Prepared by eight German scientists, it includes 31 RCTs and 13 observational studies, was published by the International Journal of Environmental Research and Public Health and is entitled Is a Mask That Covers the Mouth and Nose Free from Undesirable Side Effects in Everyday Use and Free of Potential Hazards? Notably, the review provided quantitative evaluation of all types of masks including unregulated cloth masks. It reports undesired side effects across no fewer than 14 medical disciplines, including neurology, psychology, sports medicine, pediatrics and microbiology.
The review leaves very little room for doubt that prolonged mask wearing by the general public can be unsafe. In fact, it is claimed to lead to “psychological and physical deterioration” with a “negative effect on the basis of all aerobic life, external and internal respiration, with an influence on a wide variety of organ systems and metabolic processes with physical, psychological and social consequences for the individual human being.”
The overarching negative consequences of mask wearing include an increase in dead space volume (by 80 percent in one study), a reduction in the user’s blood oxygen levels, a 30-fold increase in carbon dioxide retention and greater average breathing resistance (by 128 percent) due to excessive moisturization of masks.
In essence, wearing a mask induces changes in the person’s physiology of breathing – one of the most basic and critical biological functions. In particular, it leads to expansion of dead space volume, which is the amount of the inhaled air that does not participate in gas exchange. It’s normal to have some 150 millilitres of dead space per inhalation (out of 500 ml that is typically inhaled and exhaled in each respiratory cycle), but an increase of 80 percent greatly diminishes the effectiveness of gas exchange in lungs.
Such breathing-related changes, in turn, lead to a host of other negative medical effects: increased heart rate, elevated blood pressure and irritation of the respiratory tract which could lead to asthmatic reactions. While these may strike many people as minor irritants to be endured during a pandemic, they are medically serious. In the long run, the effects are expected to be illness-provoking and include vascular damage, coronary heart disease (metabolic syndrome) and neurological diseases such as epileptic seizures. The review states: “Even slightly but persistently increased heart rates encourage oxidative stress with endothelial dysfunction, via increased inflammatory messengers, and finally, the stimulation of arteriosclerosis of the blood vessels has been proven.”
This summary of the previous findings is distressing enough, yet is not exhaustive. The initial physiological effects of mask wearing are also recognized to lead to non-physical consequences, including the impairment of the wearer’s brain function. The view that wearing a mask, especially for a long period of time, quite simply compromises one’s ability to think is among the review’s most firmly stated conclusions and is worth quoting at length:
“Confusion, disorientation and even drowsiness…and reduced motoric abilities…with reduced reactivity and overall impaired performance…as a result of mask use have also been documented…
The scientists explain these neurological impairments with a mask-induced latent drop in blood gas oxygen levels O2 (towards hypoxia) or a latent increase in blood gas carbon dioxide levels CO2 (towards hypercapnia). In view of the scientific data, this connection also appears to be indisputable.
In a mask experiment from 2020, significant impaired thinking (p < 0.03) and impaired concentration (p < 0.02) were found for all mask types used (fabric, surgical and N95 masks) after only 100 min of wearing the mask. The thought disorders correlated significantly with a drop in oxygen saturation (p < 0.001) during mask use.” (Emphasis added.)
In addition to covering these grave cognitive harms, the German review also discusses the psychological dimension, finding that habitual mask wearing can cause a combination of exhaustion, discomfort, anxiety, panic, anger, distraction and a feeling of imprisonment.
The idea that experiencing difficulty breathing and a needlessly elevated heart rate while inhaling one’s own C02 for hours or days on end is bad for one’s health and wellbeing seems like unassailable logic and sheer common sense. Yet it was ignored, if not actively suppressed, by the political class, public health officials, widely quoted medical professionals and the news and social media in the frenzied campaign to impose and then sustain public mask mandates. And some scientists in joining this moralistic crusade cast aside their professional impartiality, even-handedness and intellectual curiosity.
Dissenting scientific voices were silenced and even cancelled by their peers. Among those are Denis Rancourt, a former tenured Full Professor of Physics at the University of Ottawa. The prolific researcher had amassed a publication record of over 100 papers in leading peer-reviewed journals in physics, chemistry, geology, materials science, soil science and environmental science. Rancourt’s scientific “h-index” of 39 placed him just one point short of the international rating for “outstanding scientist” in the Nobel Prize category. But all of that would count for nothing once Rancourt concluded that the orthodoxy on masking was wrong.
In April 2020, Rancourt wrote Masks Don’t Work: A Review of Science Relevant to Covid-19 Social Policy. The article was published by ResearchGate, a popular networking site for academics, gathering an unprecedented 400,000 reads – but was later taken down. Since then Rancourt has written another dozen articles opposing the general narrative around the Covid-19 virus and pandemic while ResearchGate has all-but erased his existence, leaving only the remnants of his publicly presented lab on its website and moving his original profile into “archives.”
On his personal blog, Rancourt explained the censorship he suffered. The note he received from ResearchGate’s two managing directors stated that he was de-platformed because his widely read paper “goes against the public health advice and/or requirements of credible agencies and governments” which they “thought…had the potential to cause harm.” In other words, instead of free-wheeling scientific inquiry like Rancourt’s stimulating broader debate, aimed at informing and strengthening public policy, the people in charge of a major scientific website appear to believe that it is current public policy orthodoxy which must dictate the bounds of science itself. And that a nebulous and entirely unsupported (i.e., unscientific) worry about the “potential” for harm must outweigh and shut down the search for truth.
On balance, it is Rancourt who evidently has truth on his side for, as we have seen, the risks of mask-wearing are extensively documented. These harmful effects are particularly evident – bluntly starring into people’s faces – in sports. There have been several vivid recent accounts of young athletes forced to wear masks during competitions falling into distress, events that were captured on video and covered by local TV stations.
Earlier this spring, for example, a young cross-country runner collapsed at a New Mexico state championship. The teenager, who had never suffered a collapse in his five-year running experience, was taken to hospital and was reported to have excessive C02 in his lungs, a lack of oxygen, elevated liver enzymes and high red blood count. Recalling the last minute of the race, the runner said, “I realized I’m going to fall, I got super dizzy, I was losing my balance and I could feel my legs almost giving out from under me every step,” and then, “I don’t feel like I’m getting enough air under the mask.” This was not the only time when masked school-age athletes needed emergency care.
Indeed, the German review makes it very clear that mask wearing has long been recognized as a destructive practise for athletes – and as much or more so for children. Respiratory problems are especially severe in children due to the high oxygen demand associated with their early developmental stages. In one of the studies cited by the German team, masks in children were shown to trigger headaches in 50 percent of cases, difficulty concentrating in 50 percent, joylessness in 49 percent, learning difficulties in 38 percent, fatigue in 37 percent, anxiety in 25 percent and even nightmares in 25 percent.
Finally, wearing masks may actually increase the risk of catching other diseases. The surfaces and interior fibres of warm and humid masks provide an ideal environment for the accumulation of germs. As was shown in the reviewed experimental studies, after only two hours of wearing masks the pathogen density can increase ten-fold and after six hours the following viruses can be detected: adenovirus, bocavirus, respiratory syncytial virus and influenza viruses. And these are consequences observed in medical personnel who are conscious of avoiding self-contamination. While the WHO is by now likely to be discredited in the eyes of many people, its original caution about masks is evidently well-founded.
After its exhaustive scientific enterprise, the German review team arrived, in effect, back at the beginning: reiterating the longstanding skepticism towards mass-masking that prevailed until March 2020. Opening with a pointed reminder of the World Medical Association’s 1948 Geneva Declaration (revised in 2006), the German team’s conclusion can only be read as a full-throated denunciation of the mask frenzy of the past 15 months:
“…Every doctor vows to put the health and dignity of his patient first and, even under threat, not to use his medical knowledge to violate human rights and civil liberties. Within the framework of these findings, we, therefore, propagate an explicitly medically judicious, legally compliant action in consideration of scientific factual reality against a predominantly assumption-led claim to a general effectiveness of masks, always taking into account possible unwanted individual effects for the patient and mask wearer concerned, entirely in accordance with the principles of evidence-based medicine and the ethical guidelines of a physician.” (Emphasis added.)
It is worth repeating three devastating words from the German review: “assumption-led claim.” In the researchers’ considered opinion, that is the crux of the entire campaign to subject billions of people to the burdens and harms of habitual mask-wearing.
It Is Time to Unmask
Perhaps upon finishing this read there will still be some facemask proponents who maintain that mask wearing is warranted because, even if they are not as effective as first hoped, they might still do some good – perhaps saving even one life. They can point out that in a public health crisis, with thousands dying and hundreds of thousands infected, anything even marginally beneficial, especially something inexpensive and simple to use by anyone, is surely worth doing. Objections based on human rights, freedom and individual responsibility, as often argued, can be dismissed as frivolous or irrelevant, or set aside until normality returns.
Nonetheless, as we have seen, the risks of this practice on a broad population scale are substantially greater and more palpable than their benefits, which turn out to be largely assumed and remain unsupported by gold-standard scientific evidence. And these risks are not merely transient but of potentially life-shortening or life-threatening consequence.
If the benefits themselves are exaggerated or even chimerical – if masks are more like a “talisman” (in the words of a prominent WHO physician quoted in Part I) than a plausible means to control the spread of infection – then the case for masking weakens further. Once it is clearly seen that masks are harmful – and not just in one or two ways, but in a dozen or more – then the “where’s the harm” and “even one life” arguments collapse and the failure to clearly establish the net benefits of masking becomes unconscionable. If masks are bad for you and don’t even protect you, they shouldn’t be worn.At that point, the message becomes clear: it is time to unmask.
It is time to unmask because the facemask mandate for the general public – which was always an egregious assault on civil liberties – is unsupported by either the highest-quality science or a rational evaluation of the relevant risks (not only the risk of transmitting Covid-19). It is time to unmask because masks have not been shown to be effective at preventing people from catching Covid-19. It is time to unmask because the negative health consequences of wearing masks are so detrimental that continuing to wear them (especially at a time when the risks of Covid-19 have been driven down to immaterial) is not merely irrational but borders on self-destruction.
As for the scientific community’s role, the public and policy-makers should insist on having more Covid-19-related experimental studies – prominently to include RCTs – and cost-benefit analyses around the imposed public health measures. The public deserves to knowin tangible terms the price attached to employing either approach. This reflects the basis of any decision-making, at both personal and societal levels.
It is obvious that scientists are faced with some serious challenges with regard to this pandemic; there’s no doubt that the infamous and ever-growing cancel culture has penetrated their métier and is actively carrying out its destructive work. Arguably science has always been vulnerable to political influence, or even manipulation by the ruling class, yet the pandemic crisis has either greatly exacerbated this trend or illuminated it more starkly – perhaps both.
Had scientists remained professionally impartial, while the political and public health establishment were actually true to their unapologetic motto to “just follow science,” it is likely that we would not have seen ubiquitous mask mandates. Or, if we had, that they would have been discarded in the face of countervailing evidence – like the studies and reviews cited above.
The failure of science and government regulators to develop any kind of standard for an effective, practical and low-cost mask type to be universally used during this pandemic further undermines the integrity of the imposed mask rules. The notion that Covid-19 transmission can be halted by – to take just one of many real-world examples – pulling a mucous-laden bandana over one’s face while standing in a ski area lift lineup seems ludicrous. Yet that practice last winter satisfied government and corporate rules in B.C., Alberta and much of the U.S.
Canada is not the only country that remains largely oblivious to the truth about masks; governments around the world are maintaining the same shroud of ignorance. Yet some countries have proved more willing than others to unmask and return to normal. The United States is the most prominent example. And while the increasing vaccination rates are frequently regarded as the main or even sole ground for relaxing or discarding mask wearing, it should not be so. Because, at bottom, masks just do not work.
Maria (Masha) V. Krylova is a Social Psychologist and writer based in Calgary, Alberta who has a particular interest in the role of psychological factors affecting the socio-political climate in Russia and Western countries.
Source of main image: Shutterstock/ Cavan-Images