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To Mask or Not to Mask

Mask up if you want to. If you are sick with Covid or Influenza (or aren’t sure if you are sick) stay home. If you must travel when sick if you suspect you are sick, definitely mask up. There is evidence that it reduces transfer for a sick person.

With the demonstrated risk of face masks; mask wearing should be a choice, not a legal mandate that includes fines and jail time.

But legally mandating masks is simply wrong. There is no widespread scientific support for forced mask use. If you are support or are a government official thinking about mandating masks because of increasing infections you are looking at the wrong measure. Instead focus on deaths and hospitalization rates, those are the only two that count. If your hospital ICU load is over 50% regionally, or your death rates spike focus on that. Focus on protecting nursing homes, over 40% of deaths have been from people in nursing homes.

Image may contain: text that says 'Regarding effectiveness of masks evidence from 14 randomized controlled trials of these measures did not support substantial effect on transmission of laboratory-confirme influenza. We similarly found limited evidence on the effectiveness of improved hygiene and environmental cleaning." Surh:///2785/'
CDC: https://wwwnc.cdc.gov/eid/article/26/5/19-0994_article
NIH: https://pubmed.ncbi.nlm.nih.gov/32027586/

In a pandemic all masks do is slow the spread, which was meant to flatten the curve. That means keeping hospitalizations below 100% ICU load. The highest load in the USA as of 7/11 is 22% (in new york) Source: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 So you don’t need to worry about flattening the curve. So maybe you are trying to stop deaths?

What about the petri-dish video? It is true it reduces particulates directly in front of the individual. That video doesn’t show real world data as noted below. It doesn’t show numerous other videos show the plume and particles around the individual and trailing the walking individual. If masks worked so well how did it get out of China?

Video from Good Morning America explaining why facemasks should be limited to those who are sick. https://www.goodmorningamerica.com/news/video/realities-facemasks-fight-coronavirus-exposure-69252522

The following are 34 references with links to studies indicating little, or no positive results from wearing a mask to stop the transfer of viruses.

(1) Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection. Further research is needed to inform the widespread use of cloth masks globally. However, as a precautionary measure, cloth masks should not be recommended for HCWs, particularly in high-risk situations, and guidelines need to be updated.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420971

(2) Neither surgical nor cotton masks effectively filtered SARS–CoV-2 during coughs by infected patients.

https://www.acpjournals.org/doi/10.7326/M20-1342

(3) “…evidence from 14 randomized controlled trials of these measures did not support a substantial effect on transmission of laboratory-confirmed influenza. We similarly found limited evidence on the effectiveness of improved hygiene and environmental cleaning. We identified several major knowledge gaps requiring further research, most fundamentally an improved characterization of the modes of person-to-person transmission.”

Source: https://wwwnc.cdc.gov/eid/article/26/5/19-0994_article

(4) We know that wearing a mask outside health care facilities offers little, if any, protection from infection…. In many cases, the desire for widespread masking is a reflexive reaction to anxiety over the pandemic.

Source: https://www.nejm.org/doi/full/10.1056/NEJMp2006372

(5) — There is limited evidence that wearing a medical mask by healthy individuals in households, in particular those who share a house with a sick person, or among attendees of mass gatherings may be beneficial as a measure preventing transmission.(41, 56-61)

https://apps.who.int/iris/rest/bitstreams/1279750/retrieve

(6) Results from cluster randomized controlled trials on the use
of masks among young adults living in university residences
in the United States of America indicate that face masks may
reduce the rate of influenza-like illness, but showed no impact
on risk of laboratory-confirmed influenza.(62, 63) …. At
present, there is no direct evidence (from studies on COVID19 and in healthy people in the community) on the
effectiveness of universal masking of healthy people in the
community to prevent infection with respiratory viruses,
including COVID-19.https://apps.who.int/iris/rest/bitstreams/1279750/retrieve

https://apps.who.int/iris/rest/bitstreams/1279750/retrieve

(7) Our study revealed a decrease in the oxygen saturation of arterial pulsations (SpO2) and a slight increase in pulse rates compared to preoperative values in all surgeon groups. The decrease was more prominent in the surgeons aged over 35.

https://pubmed.ncbi.nlm.nih.gov/18500410/

(8) Wearing an N95 mask for 4 hours during HD significantly reduced PaO2 and increased respiratory adverse effects in ESRD patients.

https://pubmed.ncbi.nlm.nih.gov/15340662/

(9) Wearing N95 masks results in hypooxygenemia and hypercapnia which reduce working efficiency and the ability to make correct decision. Medical staff are at increased risk of getting ‘Severe acute respiratory syndrome'(SARS), and wearing N95 masks is highly recommended by experts worldwide. However, dizziness, headache, and short of breath are commonly experienced by the medical staff wearing N95 masks. The ability to make correct decision may be hampered, too. The purpose of the study was therefore to evaluate the physiological impact of N95 mask on medical staff.

https://clinicaltrials.gov/ct2/show/NCT00173017

(10) “Chronic hypoxia-hypercapnia influences cognitive function” (proper mask wearing is linked to hypoxia)

https://www.ncbi.nlm.nih.gov/pubmed/18331781

(11) N95-masked health-care workers (HCW) were significantly more likely to experience headaches. Face mask use was not demonstrated to provide benefit in terms of cold symptoms or getting colds.

Jacobs, J. L. et al. (2009) “Use of surgical face masks to reduce the incidence of the common cold among health care workers in Japan: A randomized controlled trial,” American Journal of Infection Control, Volume 37, Issue 5, 417 – 419. https://www.ncbi.nlm.nih.gov/pubmed/19216002

(12) A post hoc comparison between the mask versus no-mask groups showed a protective effect against clinical respiratory illness, but not against ILI and laboratory-confirmed viral respiratory infections. (so masks reduced clinical respiratory illness but didn’t stop influenza like illness (covid19 falls in the ILI category).

https://pubmed.ncbi.nlm.nih.gov/28039289/

(13) The rates of CRI, ILI and laboratory-confirmed virus infections were lowest in the medical mask arm, followed by the control arm, and highest in the cloth mask arm. (In a nushell cloth masks were WORSE)

https://bmjopen.bmj.com/content/5/4/e006577

(14) The primary finding was that regular hand hygiene was significantly protective in protecting from pandemic influenza infection, while facemask use was not significantly protective.

https://www.sciencedirect.com/science/article/pii/S1755436516300858

(15) Contaminated masks and masks holding moisture and pathogen retention can increase the risk of infection.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420971/#__ffn_sectitle

(16) None of the studies reviewed showed a benefit from wearing a mask, in either HCW or community members in households (H). See summary Tables 1 and 2 therein.

Cowling, B. et al. (2010) “Face masks to prevent transmission of influenza virus: A systematic review,” Epidemiology and Infection, 138(4), 449-456. https://www.cambridge.org/core/journals/epidemiology-and-infection/article/face-masks-to-prevent-transmission-of-influenza-virus-a-systematic- review/64D368496EBDE0AFCC6639CCC9D8BC05

(17) Reported that cloth masks are only marginally beneficial in protecting individuals from particles less than 2.5 micrometers. As referenced in the New England Journal of Medicine, the size of Coronavirus particles varied between 0.06 micrometers and 0.14 micrometers.

https://www.nature.com/articles/jes201642

(18) Wearing a mask for seven hours straight may not be safe. Carbon dioxide (CO2) rebreathing has been recognized as a concern in the Ergonomics Journal. The CDC has also admitted that the CO2 slowly builds up in the mask over time. This build-up can cause a condition called Hypercapnia. Essentially, CO2 poisoning – can cause mild symptoms of drowsiness or a headache. More severe symptoms can cause shortness of breath and even death.

https://pubmed.ncbi.nlm.nih.gov/23514282/

(19) On May 6th, 2020, the New York Post reported the death of two boys dying within a week of each other while wearing a face mask during gym class.

http://nypost.com/2020/05/06/two-boys-drop-dead-in-china-while-wearing-masks-during-gym-class/

(20) “There were 17 eligible studies. … None of the studies established a conclusive relationship between mask/respirator use and protection against influenza infection.” 

bin-Reza et al. (2012) “The use of masks and respirators to prevent transmission of influenza: a systematic review of the scientific evidence,” Influenza and Other Respiratory Viruses 6(4), 257–267. https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1750-2659.2011.00307.x

(21) “Breathing through N95 mask materials have been shown to impede gaseous exchange and impose an additional workload on the metabolic system of pregnant healthcare workers. The benefits of using an N95 mask to prevent serious emerging infectious diseases should be weighed against potential respiratory consequences associated with extended N95 respirator usage.

https://aricjournal.biomedcentral.com/articles/10.1186/s13756-015-0086-z

(22) “We identified six clinical studies … . In the meta-analysis of the clinical studies, we found no significant difference between N95 respirators and surgical masks in associated risk of (a) laboratory-confirmed respiratory infection, (b) influenza-like illness, or (c) reported work-place absenteeism.” 

Smith, J.D. et al. (2016) “Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis,” CMAJ Mar 2016 https://www.cmaj.ca/content/188/8/567

(23) “Self-reported assessment of clinical outcomes was prone to bias. Evidence of a protective effect of masks or respirators against verified respiratory infection (VRI) was not statistically significant”

Radonovich, L.J. et al. (2019) “N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical Trial,” JAMA. 2019; 322(9): 824–833. https://jamanetwork.com/journals/jama/fullarticle/2749214

(24) “Among 2862 randomized participants, 2371 completed the study and accounted for 5180 HCW-seasons. … Among outpatient health care personnel, N95 respirators vs medical masks as worn by participants in this trial resulted in no significant difference in the incidence of laboratory-confirmed influenza.”

Radonovich, L.J. et al. (2019) “N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical Trial,” JAMA. 2019; 322(9): 824–833. https://jamanetwork.com/journals/jama/fullarticle/2749214

(25) “A total of six RCTs involving 9,171 participants were included. There were no statistically significant differences in preventing laboratory-confirmed influenza, laboratory-confirmed respiratory viral infections, laboratory-confirmed respiratory infection, and influenza-like illness using N95 respirators and surgical masks. Meta-analysis indicated a protective effect of N95 respirators against laboratory-confirmed bacterial colonization (RR = 0.58, 95% CI 0.43-0.78). The use of N95 respirators compared with surgical masks is not associated with a lower risk of laboratory-confirmed influenza.”

Long, Y. et al. (2020) “Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis,” J Evid Based Med. 2020;
1-9. https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.12381

(26) “Medical staff are at increased risk of getting ‘Severe acute respiratory syndrome’ (SARS), and wearing N95 masks is highly recommended by experts worldwide. However, dizziness, headache, and short of breath are commonly experienced by the medical staff wearing N95 masks. The ability to make correct decision may be hampered, too.

https://clinicaltrials.gov/ct2/show/NCT00173017

(27) Per OSHA masks dont work – “Surgical masks are not designed or certified to prevent the inhalation of small airborne contaminants.”

https://www.osha.gov/Publications/OSHA3219.pdf

(28) After 1,537 operations performed with face masks, 73 (4.7%) wound infections were recorded and, after 1,551 operations performed without face masks, 55 (3.5%) infections occurred. This difference was not statistically significant (p> 0.05) and the bacterial species cultured from the wound infections did not differ in any way… These results indicate that the use of face masks might be reconsidered.

https://link.springer.com/article/10.1007/BF01658736

(29) The wearing of a surgical face mask had no effect upon the overall operating room environmental contamination and probably work only to redirect the projectile effect of talking and breathing.

https://journals.lww.com/clinorthop/Citation/1975/09000/The_Operating_Room_Environment_as_Affected_by.20.aspx

Additional References

Categories
Community

9 Reasons why we need to open NOW!

In a nutshell we should open up NOW and stay open, unless something changes dramatically. The Covid19 risk is within the same risk level as historical influenza outbreaks that did NOT result in economic shutdown. The number of studies that debunk the 3.5% and 7% death rates are overwhelming.
Last updated: 5/22/2020

Blue “sick person sampling” vs “Random Sampling” vs 100% sampling

One other key thing. Infection testing is less important that anti-body testing. If you have the anti-bodies you cant be seriously infected with the same virus strain again.

Reason 1: The Death Rate is a LOT lower than reported.

The number reported is correct except no one understands that it is knowingly wrong because of sample error. The blue columns are what are regularly reported on TV. The real numbers are 5 to 20x lower

The ACTUAL random samples (below) are in grey and orange. The random or 100% sampling death rates are between 0.39% and 1.47% not the 3.5% or 7% being reported. The German study was the lowest of all and had 100% sampling.

The difference between the John’s Hopkins numbers and these studies is purely sampling bias or “error”. The blue represents a sampling of tested sick people. The orange and grey represent a sampling of an entire group of people (those sick and those who don’t appear to be sick).

Recently the “death rate” fell from 7% to 6.01% – that is highly unlikely, and indicates wider testing not decreased lethality.

What is Sampling Bias?

Nearly all the currently reported data is misleading. A simple example of sampling bias: Only sample the fish in a grocery store. You measure size and type. The sample shows all the fish are fairly large, uniform and of limited number of species. If I go out and randomly catch fish in rivers, lakes and oceans, the size and types of fish vary widely. (sample bias vs random sampling)

What is Omission Bias?

Omission bias is reporting a fact but skipping related facts. Example: News headlines say “infection rates spiking!” but they fail to report real data like hospitalization utilization compared to normal hospitalization rates and death rates compared to NORMAL death rates. Infections alone don’t really mean anything.

Another omission is that the widely reported information is ONLY for those sampled (it is not random sampling). We rarely here about random sampling statistics.

Read more about sampling bias

Reason 2: Most Hospitals are Not Overloaded

We were told we were trying to flatten the curve. Remember this graph?

In this example above, we all get Covid19 but we get it slow enough that we didn’t overwhelm healthcare. We didn’t overwhelm the system. We flattened it completely. In fact we have created a situation where it is TOO flat. As an example in Wisconsin the ICU load was less than 10% NORMAL utilization and 7.6% of max utilization.

With this very low utilization, the hospitals will go bankrupt quickly, so unless the goal was to bankrupt hospitals – we need to change our behavior. Source: https://www.wha.org/COVID19Update

The blue line (bottom) is even misleading. The “max” for that line is 1442 without the military hospitals. See link above for current data.

Another way to look at the numbers


Image: Wisconsin ICU Bed Utilization
** does not include temporary military hospitals which are EMPTY.

Wisconsin regularly reported increases in hospitalization. But the fact is that hospitals in Wisconsin were regularly below 20% utilization from April through May 2020. Nationwide over 256 hospitals had to lay off staff. There was not a huge spike nationwide, there were spikes in specific locations (just like a bad flu season). https://www.beckershospitalreview.com/finance/49-hospitals-furloughing-workers-in-response-to-covid-19.html.

Reason 3: Only 15% or less of us are at risk

We were told, we are ALL at risk! We are in this together. A half truth. Yes, everyone is at risk. We are at risk of dying from pretty much everything and there is a 100% chance we will all die. The facts are that the risk is high for elderly and people with pre-existing conditions, and very low for everyone else (see graphs)

Remember, even these numbers are biased because they are not random sampling of the population. This is ONLY those who were infected or suspected of being infected.

Image: Age distribution – from information is beautiful

We should be focusing our limited resources on the 15% of the population that is at risk, not the 85% of us that are at low or very low risk.

Reason 4: Yes people are dying, but not a lot more than normal

Cold hard math, unpleasant, uncomfortable thoughts. The numbers of people dying are not significantly higher than normal. It feels like this cant be true. The news says its unprecedented but the numbers don’t lie.

Here is a graph from CDC of normal (orange line) and actual deaths blue. Note only two spikes in 2018 and one in 2020 – and note not hugely different. For historical comparison we had influeza spikes that were equal or higher per 100k and we didn’t put 22 mil into unemployment and bankrupt 4% to 12% of small businesses.

Image: CDC Normal Death Rates see spikes in 2018 and 2020

If the .39% death rate is true that is 2.7 times as dangerous as normal flu (like the 1998 flu season).

Image: CDC Normal Death Rates
https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm. https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm

Reason 5: Big Events haven’t resulted in increased death

Big events such as: elections, rallies and reopening entire states have had no impact on death rates. Georgia re-opened April 24th.

May 13th Report – the curve to the right shows decreases. Even though they opened up. Source: https://dph.georgia.gov/covid-19-daily-status-report

On May 22nd the predicted 1000s of Georgia deaths didn’t materialize. The graph below confirms the graph above. At minimum, there is no increase in deaths, even with the state being “open”. 28 days later there is a downward trend in deaths (or at least no significant increase).

May 22nd report

On April 7th Wisconsin had an in person election with 300,000+ people participating. Wisconsin had a rally with 3000+ people (mostly without masks) on April 24th, and 28 days later there is no big spike in deaths. The predicted 1000s of deaths in Wisconsin didn’t materialize.

Wisconsin Covid Death Graph Source

The following are other examples of decreasing or stable trends after reopening. See CNN link for updated data

Alaska opened April 24 – no spike: https://www.cnn.com/interactive/2020/us/states-reopen-coronavirus-trnd/
Opened May 4th: https://www.cnn.com/interactive/2020/us/states-reopen-coronavirus-trnd/

Reason 6: Staying inside will not stop the virus.

The idea that staying inside will “stop the virus” is purely wishful thinking. WHO, CDC and all other agencies all expected us to get the virus. The only goal was to reduce the number of people infected at one time. If we stay inside more all we do is SLOW the spread, we dont STOP the spread.

You may have seen a graph on social media called “flattening the curve.” That graph shows a tall, narrow curve and a short, wide curve. Through the graph is a line that shows how many sick people U.S. hospitals can treat. The tall curve goes above the line. That means too many people are sick at one time: We won’t have enough hospital beds for all the people who will need treatment. The flatter curve shows what happens if the spread of the virus slows down. The same number of people may get sick, but the infections happen over a longer span of time, so hospitals can treat everyone.

https://www.webmd.com/lung/qa/what-is-flattening-the-curve

The CDC, WHO and other medical agencies never said staying home would “stop the virus”. Staying home only delays things – it will not stop Covid19.

Also, we need real herd immunity so we can protect those at most risk. Thinking that hiding and still going out only to Walmart or Costco will somehow “protect us” is not realistic.

Reason 7: Staying locked down hurts and kills people

We have 22million+ people already unemployed. In a good year we have 45,000 suicides – the economic crash is NOT going to help that number, and increases in suicides are reported widely. Decreases in GDP will result in decreased govt revenue which will result in decreased govt support for those in need of help. LOST REVENUE WILL RISK LIVES.

Related articles

The UN is noting that worldwide famine is likely because of Covid. https://www.nbcnews.com/news/world/u-n-warns-hunger-pandemic-amid-threats-coronavirus-economic-downturn-n1189326

We are hiding at home from a virus that we will get sooner or later. We are trading higher suicides, higher poverty, loss of freedom, reduced revenue for critical services, and directly leading to famine overseas to simply put off the inevitable?

At some point we NEED to get infected. If we stick our head in the sand, this fall 2020 and winter 2021 version of Covid19 will be even worse (read about the Spanish flu if you haven’t). We need to build up immunity

Reason 8: The Vaccine won’t solve it

Even if we get a vaccine (which I hope is safe and effective). It is likely to be at most 20% effective. So we are going to see people get infected and some will die. That is a fact, that unfortunately cannot be avoided. Once we reopen (even with a vaccine) we will see increased infections and death. Likely to exceed a 100 million infections nationwide and 300,000 deaths when it is all done.

Delaying the infection is all we can do, and the WAY we are delaying now destroys our econmony which destroys our ability to help those most in need.

Reason 9: Return Choice to the People

This is our constitutional right, and the government is overstepping by taking it away. I talked with my parents who are 77 and 81. They would trade their lives to protect their children and grandchildren in a minute. I don’t want to make that trade, but I cannot lock them away either. And WE don’t have the right to take away other peoples children’s futures.

This is a serious, real dilemma. But we have been and I hope we continue to be focused on freedom, shared risk and personal responsibility. Recommending behavior and allowing the PEOPLE to decide is the only way we are going to succeed in the long run.

Why Masks Should Not Be Mandatory

It is ok to recommend masks, but mandating the use of masks is not supported by studies. Quite the contrary, there are numerous studies and reports that indicated low value and some limited risks with ongoing use of face mask.

https://pubmed.ncbi.nlm.nih.gov/32027586/

Further, non-medical, home made or “cloth” masks are even less effective. Also, reuse of masks introduces other bacterial and viral risks, which have limited studies, some of which indicate secondary bacterial and secondary transmission risks.

References

First Published May 15th 2020.