Summary of research into the lack of efficacy and harms of wearing face masks
Matt Irwin M.D., M.S.W.
First published June, 2021, Updated May 2022
Below is a review of research studies on lack of efficacy and harms from face masks. Face masks are not the primary focus of my research, but when the low mortality from covid-19 and the lack of efficacy of masks are combined, they are at least seen as annoying and unnecessary.
At the end I have included a link to an article I wrote about a mortality rate in college students of less than 1 in 100,000, a more recent study in Germany also with mortality rates less than 1 in 100,000, and a link to the CDC ‘s own web page showing a mortality rate for people under age 20 of 1 in 33,000. Note that all these studies showing extremely low risk in young people used early data, starting in Wuhan China, with viral strains thought to be much more severe than newer strains such as Omicron. This low mortality is the area I have researched in most detail, and makes the mask issue somewhat irrelevant.
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Fifteen randomized trials found masks not effective in preventing respiratory virus infections of all types, including covid-19. The low mortality rate for covid-19 also argues against the use of masks, and three review articles detail the negative effects of wearing masks, causing both physiological and psychological harm.
The first article reviewed below was taken down shortly after being published in January 2021 (Vainshelboim, 2021). It was written by a professor and researcher specializing in exercise physiology and was a thorough review of research studies showing that masks are not effective at preventing respiratory illnesses. Because the research he reviewed showed how misguided the widespread mask mandates and recommendations were, his paper came under heavy criticism. However, two other excellent summaries of the research documenting harms of face coverings were published with very similar conclusions, and I review both of them, as well. One was published in a peer-reviewed medical journal, and the other in a non peer reviewed open format (Kisielinski et al, 2021, Rancourt et al, 2021). I provide direct quotes from all three articles, and I can provide a pdf of the article by Vainshelboim that was retracted if desired.
I also review a large randomized trial in Denmark which showed lack of efficacy of masks published in the summer of 2020. They randomly assigned 6000 people to "mask or no-mask” groups, and found no statistically significant effect in reducing covid-19 rates (Bundgaard et al, 2020).
Two thorough reviews of randomized studies, Rancourt (2020) and Xiao et al (2020) found that masks were ineffective in every randomized study they could find. Rancourt (2020) also focused on studies of N95 masks which are considered to be higher quality than surgical masks. However, research consistently found that they had no better effect than other masks which are considered lower quality. Rancourt’s second review (2021) focused on the many harms of masks, similar to Kisielinski et al (2021) and Vainshelboim (2021). Finally, a review article from April 2022 found increased mortality from masks, and no effect on reducing covid-19 cases (Spira, 2022).
I then provide a critique of a review published by Howard et al (2021) which claimed that masks were effective. However, they routinely cited studies with no statistically significant results as if they were positive studies, and I discuss several examples. A worse example is a very poor quality study from Bangladesh which was widely quoted as showing evidence of protection from facemasks, and even this study found no result from cloth face coverings. One of many problems with the Bangladesh study is the measurement of outcomes: they could not test every subject in the trial for covid-19. Instead they used self reported symptoms to decide who to test, and only tested a small minority of subjects, about 3%, or one of every 33 subjects. This introduces an obvious bias because people wearing masks would likely consider themselves at lower risk, and under-report their symptoms, resulting in increased testing in the non-mask group. In contrast, the Danish study, with 6000 participants, showed no decrease in covid-19 and they attempted to test every participant for both antibodies and RNA. The Danish study succeeded in testing almost 5000 of them, about 83% of subjects (Abaluck et al, 2021, Bundgaard et al, 2021).
Finally, links to two articles on the extremely low mortality from covid-19 are provided, showing that the lack of efficacy of masks should cause no alarm, because when people get normal, high quality care, the mortality is lower than influenza. - Update February 2022: two major research efforts show that in young people covid-19 has similar or lower risk than chickenpox (Irwin, 2022 German study, Irwin 2021 US college student data).
No single randomized trial is perfect, but when you combine multiple trials and reviews published in peer reviewed journals, they become quite convincing. The author of the retracted review article in Medical Hypotheses is a Ph.D. researcher and professor of exercise physiology whose specialty is helping people who already have impaired heart and lung function. His experience with people who are especially vulnerable to harm from mask wearing may have motivated him to write such a blunt and harsh review.
My main effort has been to expose that the virus is weak, with an extraordinarily low mortality, especially when people receive normal high quality care instead of solitary confinement and quarantine. Because the mortality is so low, one could simply say about whether masks work, “Who cares?”. The same is true of “social distance” which also causes significant harm. Unless the low mortality is addressed, when people learn that masks are ineffective and harmful they may be even more frightened and place more restrictions. Such a person could argue for a 15 foot social distance, triple masks with special carbon dioxide release filters, and certainly never, ever consider giving anyone a hug unless they have been vaccinated and also tested negative for covid in the previous 3 days. I hope you can see my sense of humor here.
One of my other main purposes these days is to accept the world as it is, with all its inconsistencies. Changing something is easier when you accept it first, however paradoxical that may seem :-).
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1: This study was taken down due to its negative conclusions, which were quite stated clearly, but also well explained and referenced. Those who advocate for social isolation, viral containment, and solitary confinement policies may have a defensive reaction, regardless of the research reviewed. The second study below by Kisielinsky et al, reviewed much of the same research, with very similar conclusions.
Vainshelboim B. (2021). Facemasks in the COVID-19 era: A health hypothesis. Medical hypotheses, 146, 110411. Received 10/4/2020; Revised 10/28/2020; Accepted 11/19/2020. https://doi.org/10.1016/j.mehy.2020.110411. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680614/
Quote from the conclusion section:
“The data suggest that both medical and non-medical facemasks are ineffective to block human-to-human transmission of viral and infectious diseases such as SARS-CoV-2 and COVID-19, supporting against the usage of facemasks. Wearing facemasks has been demonstrated to have substantial adverse physiological and psychological effects. These include hypoxia, hypercapnia, shortness of breath, increased acidity and toxicity, activation of fear and stress response, rise in stress hormones, immunosuppression, fatigue, headaches, decline in cognitive performance, predisposition for viral and infectious illnesses, chronic stress, anxiety and depression. Long-term consequences of wearing facemask can cause health deterioration, developing and progression of chronic diseases and premature death.”
2: Kisielinski K, Giboni P, Prescher A, Klosterhalfen B, Graessel D, Funken S, Kempski O, Hirsch O. (2021, April). Is a Mask That Covers the Mouth and Nose Free from Undesirable Side Effects in Everyday Use and Free of Potential Hazards? International Journal of Environmental Research and Public Health. 18(8):4344. https://doi.org/10.3390/ijerph18084344 https://www.mdpi.com/1660-4601/18/8/4344/htm
This extremely thorough review of the harms of facemasks has multiple sections, each for a different area of research. Below is a quote from their section on psychological harms.
“According to a questionnaire survey, masks also frequently cause anxiety and psycho-vegetative stress reactions in children—as well as in adults—with an increase in psychosomatic and stress-related illnesses and depressive self-experience, reduced participation, social withdrawal and lowered health-related self-care [74]. Over 50% of the mask wearers studied had at least mild depressive feelings [74]. Additional fear-inducing and often exaggerated media coverage can further intensify this. A recent retrospective analysis of the general media in the context of the 2014 Ebola epidemic showed a scientific truth content of only 38% of all publicly published information [75]… In addition, 72% of the media content aimed to stir up health-related negative feelings. The feeling of fear, combined with insecurity and the primal human need to belong, causes a social dynamic that seems partly unfounded from a medical and scientific point of view.
The mask, which originally served purely hygienic purpose, has been transformed into a symbol of conformity and pseudo-solidarity. The WHO, for example, lists the advantages of the use of masks by healthy people in public to include a potentially reduced stigmatization of mask wearers, a sense of contribution to preventing the spread of the virus and a reminder to comply with other measures [2].”
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3: Danish randomized trial of 6000 people showing no statistically significant effect of masks in reducing covid-19.
Bundgaard et al (2021) 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. Annals of Internal Medicine, 2021 March; 174(3):335-343, ePub Nov 18, 2020. https://doi.org/10.7326/M20-6817
https://www.acpjournals.org/doi/10.7326/M20-6817
From their Discussion section:
“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. We designed the study to detect a reduction in infection rate from 2% to 1%.”
This study from Denmark, in which they attempted to test every participant for covid-19, is much higher quality than a study in Bangladesh by Abaluck et al (2021) which is often cited because it protects people's ego defenses. The Bangladesh study showed a very small reduction in covid-19 cases from surgical masks, but no reduction from cloth masks. However, the Bangladesh study suffered from numerous issues including only testing a small minority of participants, based on "self reported symptoms", which biases towards excess testing in the non-mask group.
Abaluck et al, (2021). The impact of community masking on covid-19: a cluster randomized trial. https://www.poverty-action.org/sites/default/files/publications/Mask_RCT____Symptomatic_Seropositivity_083121.pdf
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4: This review article found 14 randomized trials, none of which showed reduction in influenza like illness by non-drug measures like wearing masks and hand hygiene. Ten of the studies were of masks, and none of them showed a reduction, nor did their pooled data "meta-analysis".
Xiao J, Shiu E, Gao H, Wong JY, Fong MW, Ryu S, et al. Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Personal Protective and Environmental Measures. Emerg Infect Dis. 2020;26(5):967-975. https://dx.doi.org/10.3201/eid2605.190994
https://wwwnc.cdc.gov/eid/article/26/5/19-0994_article#tnF2
Quote from their abstract:
“Local, national, and international health authorities regularly update their plans for mitigating the next influenza pandemic in light of the latest available evidence on the effectiveness of various control measures in reducing transmission. Here, we review the evidence... Although mechanistic studies support the potential effect of hand hygiene or face masks, 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.”
A second quote specifically on facemasks which describes all ten failed studies:
“In our systematic review, we identified 10 RCTs that reported estimates of the effectiveness of face masks in reducing laboratory-confirmed influenza virus infections in the community from literature published during 1946–July 27, 2018. In pooled analysis, we found no significant reduction in influenza transmission with the use of face masks… One study evaluated the use of masks among pilgrims from Australia during the Hajj pilgrimage and reported no major difference in the risk for laboratory-confirmed influenza virus infection in the control or mask group. Two studies in university settings assessed the effectiveness of face masks for primary protection by monitoring the incidence of laboratory-confirmed influenza among student hall residents for 5 months. The overall reduction in ILI or laboratory-confirmed influenza cases in the face mask group was not significant in either study. Study designs in the 7 household studies were slightly different… None of the household studies reported a significant reduction in secondary laboratory-confirmed influenza virus infections in the face mask group.”
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The two literature reviews by Rancourt cited below are extremely thorough. The first reviews randomized studies about lack of efficacy, with a focus on the failure of N95 respirators, which are considered to be very high quality, to offer any improvement over other masks which are considered low quality. The second review focuses on many harms such as headaches and rashes, impaired lung and heart function, significantly reduced communication ability, and psychological harms of anxiety and social withdrawal. Many of these adverse effects occur in a majority of people wearing face coverings, and are not at all rare or isolated events.
5: Rancourt (April 2020) Masks do not work: A review of science relevant to covid-19 social policy. https://pashev.me/files/rancourt-2020.pdf
“There have been extensive randomized controlled trial (RCT) studies, and meta-analysis reviews of RCT studies, which all show that masks and respirators do not work to prevent respiratory influenza-like illnesses, or respiratory illnesses believed to be transmitted by droplets and aerosol particles. Furthermore, the relevant known physics and biology, which I review, are such that masks and respirators should not work. It would be a paradox if masks and respirators worked.”
6: Rancourt (February 2021) Review of scientific reports of harms caused by face masks, up to February 2021. https://childrenshealthdefense.org/wp-content/uploads/5thsciencereview-masksharm-1.pdf
“There have been no less than 15 policy-grade RCTs with verified outcome… All 15 studies find that no reduction in risk of being infected can be detected with statistical significance… claims that masks work are disingenuous propaganda improperly relying on substandard and irrelevant studies.”
He also cites many studies of harms in health care workers with well over 50% having headaches, rashes, and other adverse effects which they often report impairs their work performance. One group of surgeons stated in their conclusions: “The safety of PPE use against COVID-19 for surgeons should be investigated…. The PPE-associated discomfort and side effects during surgery may increase surgeons' anxiety and fatigue while performing difficult operations.”
7: Spira B. (April 19, 2022). Correlation between mask compliance and covid-19 outcomes in Europe.
file:///C:/Users/MIrwin/Downloads/Mask%20compliance%20vs%20COVID%20(1).pdf
Beny Spira is a professor in the department of microbiology at the University of São Paulo, Brazil. His review article, published on April 19 2022, covers data from the 2020-2021 winter in Europe, a time period when respiratory illnesses commonly surge. He found no association with reduced covid-19 cases and mask compliance, but did find a correlation with mask compliance and higher deaths. He discusses how smaller short-term studies gave biased results in favor of mask mandates.
Although it is only an observation study, and there can be many confounding factors, he accounts for these well in his discussion section. Also, many previous randomized trials showed that masks do not reduce the transmission of respiratory illnesses, including covid-19, so the lack of an effect is actually an expected finding and matches this higher quality data.
In his abstract he gives brief statement on their lack of effectiveness, "These findings indicate that countries with high levels of mask compliance did not perform better than those with low mask usage."
Later, in the discussion section, he describes how biased reporting of short-term population studies created an illusion of mask effectiveness because the mask mandates were instituted as the number of cases were already declining. Some countries kept mask mandates, but surges in cases happened equally in these countries compared to those who dropped them or never used them: "Masks became mandatory in all of Germany's federal states between the 20th and 29th of April, at a time when the propagation of covid-19 was already declining. Furthermore, the mask mandate was still in place in the subsequent autumn-winter wave of 2020-2021, but it did not help preventing the outburst of cases and deaths in Germany that was several-fold more severe than in the first wave."
At the very end, in the Conclusions section, he comments on the increased mortality from masks: "Moreover, the moderate positive correlation between mask usage and deaths in Western Europe also suggests that the universal use of masks may have had harmful unintended consequences."
One thing not mentioned is that surges in cases came due to surges in testing, creating a false, or at least exaggerated, appearance of increased spread. When a surge in testing occurs, of course there will be surges in positive cases. Contact tracing protocols were widely adopted, creating a domino-like cascade of testing, and intense media attention caused people to join voluntarily in the testing waves. Another commonly forgotten cause of skewed data is that false positive PCR tests are more likely when someone's immune system is activated including by viral illnesses of all types. This includes illnesses caused by the many other coronaviruses which are known historically for causing the common cold, as well as more significant inflammatory states like influenza-like illness, autoimmune reactions, and multisystem inflammatory syndromes like Kawasaki disease.
The risk of mortality, especially in vulnerable populations, can easily be increased by masks. This can be due to increased risk of falls, car accidents, and surgical errors. However, the main harms of masks are interpersonal. In my office I routinely offer that people can take off their masks, "So I can see if you are smiling or frowning at me."
8: Howard J., Huang A., Li Z. et al. (2021, January). An evidence review of face masks against COVID-19. Proceedings of the National Academy of Sciences 118 (4) e2014564118; DOI: 10.1073/pnas.2014564118
Cowling BJ, Chan KH, Fang VJ, et al.. (2009, October). Facemasks and hand hygiene to prevent influenza transmission in households: a cluster randomized trial. Ann Intern Med. 2009 Oct 6;151(7):437-46. doi: 10.7326/0003-4819-151-7-200910060-00142. Epub 2009 Aug 3. PMID: 19652172.
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This review by Howard et al claimed that masks were effective, but they relied on studies with no statistically significant results, reporting them as if they were positive, just as Rancourt points out in his review. A more appropriate conclusion when statistical significance is not reached is to simply say, “The study did not show better results that random chance.” Several studies did not have positive results in their primary outcome, but by finding a positive result in one of many subgroup analyses, the authors claimed that their results “suggested” a positive effect. Analyzing subgroups is prone to bias and is not intended to be used to make recommendations. At best, subgroup analysis can suggest possible future research.
One example of this is a study by Seuss et al, which they state “suggests that household transmission of influenza can be reduced by the use of nonpharmaceutical interventions, namely the use of face masks and intensified hand hygiene.” (Howard et al, 2021). However, when one looks at the actual study by Seuss et al, they did not have statistical significance in their main outcomes, and only achieved significance in one of several subgroup analyses. Furthermore, the positive result was in a subgroup with fewer nonpharmacological interventions, which goes against what would be expected.
Similarly, a study by Aiello et al found reduction in a subgroup analysis for a brief period of “4-6 weeks”, but their overall conclusion was that “Neither face mask use and hand hygiene nor face mask use alone was associated with a significant reduction in the rate of ILI cumulatively.” Another study cited by Howard et al is one which again only found a result in a single subgroup: people who started the measures within a certain time of illness onset (Cowling et al 2009). However, Cowling et al state in their conclusions: “Hand hygiene with or without facemasks seemed to reduce influenza transmission, but the differences compared with the control group were not statistically significant.”
9: Two articles by Matt Irwin on the extraordinarily low risk for young people and people without underlying illnesses. The first paper focuses on US Colleges, with mortality rates of less than 1 in 100,000 as of January 2021. This article also describes Swedish government data on their schools which were never closed, with no social distancing or mask wearing, and exactly zero children died as of August 2020. A more formal study on mortality in young people was published in November 2021, and it showed very similar risk of less than 1 in 100,000 in young people, using data from the entire country of Germany. Below is a link to the more comprehensive paper on US Colleges and Swedish schools, as well as a link to a shorter summary of the study from Germany.
www.drmattirwin/college
www.drmattirwin.com/german
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10: Below is a link to the CDC website and results table from September 2020 which lists mortality for people under 20 at 1 in 33,000. This is cited as a fatality ratio of 0.00003 under the “current best estimate” column. The fatality ratio for people between 20 and 50 is listed as 1 in 5000 (0.0002). Combining these two age groups, the death rate for people under 50 would be about 1 in 10,000, which is five times lower than what was reported by the CDC in May 2020. At that time their table said the death rate for people under 50 was about 1 in 2000, which was already extremely low compared what was predicted in February and March when the first alarms were broadcast around the world, resulting in worldwide school and business closures and massively harmful social isolation policies. Without these policies, and if normal care was given instead of solitary confinement and quarantine for covid-19 positive people, more than half of the excess deaths in 2020 would have been avoided.
Table with summary: CDC Table with 1 in 33,000 mortality rate in young people.
CDC Web Page with detailed description of their mortality data: https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios-archive/planning-ccenarios-2021-03-19.pdf
Matt Irwin M.D., M.S.W.
First published June, 2021, Updated May 2022
Below is a review of research studies on lack of efficacy and harms from face masks. Face masks are not the primary focus of my research, but when the low mortality from covid-19 and the lack of efficacy of masks are combined, they are at least seen as annoying and unnecessary.
At the end I have included a link to an article I wrote about a mortality rate in college students of less than 1 in 100,000, a more recent study in Germany also with mortality rates less than 1 in 100,000, and a link to the CDC ‘s own web page showing a mortality rate for people under age 20 of 1 in 33,000. Note that all these studies showing extremely low risk in young people used early data, starting in Wuhan China, with viral strains thought to be much more severe than newer strains such as Omicron. This low mortality is the area I have researched in most detail, and makes the mask issue somewhat irrelevant.
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Fifteen randomized trials found masks not effective in preventing respiratory virus infections of all types, including covid-19. The low mortality rate for covid-19 also argues against the use of masks, and three review articles detail the negative effects of wearing masks, causing both physiological and psychological harm.
The first article reviewed below was taken down shortly after being published in January 2021 (Vainshelboim, 2021). It was written by a professor and researcher specializing in exercise physiology and was a thorough review of research studies showing that masks are not effective at preventing respiratory illnesses. Because the research he reviewed showed how misguided the widespread mask mandates and recommendations were, his paper came under heavy criticism. However, two other excellent summaries of the research documenting harms of face coverings were published with very similar conclusions, and I review both of them, as well. One was published in a peer-reviewed medical journal, and the other in a non peer reviewed open format (Kisielinski et al, 2021, Rancourt et al, 2021). I provide direct quotes from all three articles, and I can provide a pdf of the article by Vainshelboim that was retracted if desired.
I also review a large randomized trial in Denmark which showed lack of efficacy of masks published in the summer of 2020. They randomly assigned 6000 people to "mask or no-mask” groups, and found no statistically significant effect in reducing covid-19 rates (Bundgaard et al, 2020).
Two thorough reviews of randomized studies, Rancourt (2020) and Xiao et al (2020) found that masks were ineffective in every randomized study they could find. Rancourt (2020) also focused on studies of N95 masks which are considered to be higher quality than surgical masks. However, research consistently found that they had no better effect than other masks which are considered lower quality. Rancourt’s second review (2021) focused on the many harms of masks, similar to Kisielinski et al (2021) and Vainshelboim (2021). Finally, a review article from April 2022 found increased mortality from masks, and no effect on reducing covid-19 cases (Spira, 2022).
I then provide a critique of a review published by Howard et al (2021) which claimed that masks were effective. However, they routinely cited studies with no statistically significant results as if they were positive studies, and I discuss several examples. A worse example is a very poor quality study from Bangladesh which was widely quoted as showing evidence of protection from facemasks, and even this study found no result from cloth face coverings. One of many problems with the Bangladesh study is the measurement of outcomes: they could not test every subject in the trial for covid-19. Instead they used self reported symptoms to decide who to test, and only tested a small minority of subjects, about 3%, or one of every 33 subjects. This introduces an obvious bias because people wearing masks would likely consider themselves at lower risk, and under-report their symptoms, resulting in increased testing in the non-mask group. In contrast, the Danish study, with 6000 participants, showed no decrease in covid-19 and they attempted to test every participant for both antibodies and RNA. The Danish study succeeded in testing almost 5000 of them, about 83% of subjects (Abaluck et al, 2021, Bundgaard et al, 2021).
Finally, links to two articles on the extremely low mortality from covid-19 are provided, showing that the lack of efficacy of masks should cause no alarm, because when people get normal, high quality care, the mortality is lower than influenza. - Update February 2022: two major research efforts show that in young people covid-19 has similar or lower risk than chickenpox (Irwin, 2022 German study, Irwin 2021 US college student data).
No single randomized trial is perfect, but when you combine multiple trials and reviews published in peer reviewed journals, they become quite convincing. The author of the retracted review article in Medical Hypotheses is a Ph.D. researcher and professor of exercise physiology whose specialty is helping people who already have impaired heart and lung function. His experience with people who are especially vulnerable to harm from mask wearing may have motivated him to write such a blunt and harsh review.
My main effort has been to expose that the virus is weak, with an extraordinarily low mortality, especially when people receive normal high quality care instead of solitary confinement and quarantine. Because the mortality is so low, one could simply say about whether masks work, “Who cares?”. The same is true of “social distance” which also causes significant harm. Unless the low mortality is addressed, when people learn that masks are ineffective and harmful they may be even more frightened and place more restrictions. Such a person could argue for a 15 foot social distance, triple masks with special carbon dioxide release filters, and certainly never, ever consider giving anyone a hug unless they have been vaccinated and also tested negative for covid in the previous 3 days. I hope you can see my sense of humor here.
One of my other main purposes these days is to accept the world as it is, with all its inconsistencies. Changing something is easier when you accept it first, however paradoxical that may seem :-).
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1: This study was taken down due to its negative conclusions, which were quite stated clearly, but also well explained and referenced. Those who advocate for social isolation, viral containment, and solitary confinement policies may have a defensive reaction, regardless of the research reviewed. The second study below by Kisielinsky et al, reviewed much of the same research, with very similar conclusions.
Vainshelboim B. (2021). Facemasks in the COVID-19 era: A health hypothesis. Medical hypotheses, 146, 110411. Received 10/4/2020; Revised 10/28/2020; Accepted 11/19/2020. https://doi.org/10.1016/j.mehy.2020.110411. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680614/
Quote from the conclusion section:
“The data suggest that both medical and non-medical facemasks are ineffective to block human-to-human transmission of viral and infectious diseases such as SARS-CoV-2 and COVID-19, supporting against the usage of facemasks. Wearing facemasks has been demonstrated to have substantial adverse physiological and psychological effects. These include hypoxia, hypercapnia, shortness of breath, increased acidity and toxicity, activation of fear and stress response, rise in stress hormones, immunosuppression, fatigue, headaches, decline in cognitive performance, predisposition for viral and infectious illnesses, chronic stress, anxiety and depression. Long-term consequences of wearing facemask can cause health deterioration, developing and progression of chronic diseases and premature death.”
2: Kisielinski K, Giboni P, Prescher A, Klosterhalfen B, Graessel D, Funken S, Kempski O, Hirsch O. (2021, April). Is a Mask That Covers the Mouth and Nose Free from Undesirable Side Effects in Everyday Use and Free of Potential Hazards? International Journal of Environmental Research and Public Health. 18(8):4344. https://doi.org/10.3390/ijerph18084344 https://www.mdpi.com/1660-4601/18/8/4344/htm
This extremely thorough review of the harms of facemasks has multiple sections, each for a different area of research. Below is a quote from their section on psychological harms.
“According to a questionnaire survey, masks also frequently cause anxiety and psycho-vegetative stress reactions in children—as well as in adults—with an increase in psychosomatic and stress-related illnesses and depressive self-experience, reduced participation, social withdrawal and lowered health-related self-care [74]. Over 50% of the mask wearers studied had at least mild depressive feelings [74]. Additional fear-inducing and often exaggerated media coverage can further intensify this. A recent retrospective analysis of the general media in the context of the 2014 Ebola epidemic showed a scientific truth content of only 38% of all publicly published information [75]… In addition, 72% of the media content aimed to stir up health-related negative feelings. The feeling of fear, combined with insecurity and the primal human need to belong, causes a social dynamic that seems partly unfounded from a medical and scientific point of view.
The mask, which originally served purely hygienic purpose, has been transformed into a symbol of conformity and pseudo-solidarity. The WHO, for example, lists the advantages of the use of masks by healthy people in public to include a potentially reduced stigmatization of mask wearers, a sense of contribution to preventing the spread of the virus and a reminder to comply with other measures [2].”
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3: Danish randomized trial of 6000 people showing no statistically significant effect of masks in reducing covid-19.
Bundgaard et al (2021) 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. Annals of Internal Medicine, 2021 March; 174(3):335-343, ePub Nov 18, 2020. https://doi.org/10.7326/M20-6817
https://www.acpjournals.org/doi/10.7326/M20-6817
From their Discussion section:
“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. We designed the study to detect a reduction in infection rate from 2% to 1%.”
This study from Denmark, in which they attempted to test every participant for covid-19, is much higher quality than a study in Bangladesh by Abaluck et al (2021) which is often cited because it protects people's ego defenses. The Bangladesh study showed a very small reduction in covid-19 cases from surgical masks, but no reduction from cloth masks. However, the Bangladesh study suffered from numerous issues including only testing a small minority of participants, based on "self reported symptoms", which biases towards excess testing in the non-mask group.
Abaluck et al, (2021). The impact of community masking on covid-19: a cluster randomized trial. https://www.poverty-action.org/sites/default/files/publications/Mask_RCT____Symptomatic_Seropositivity_083121.pdf
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4: This review article found 14 randomized trials, none of which showed reduction in influenza like illness by non-drug measures like wearing masks and hand hygiene. Ten of the studies were of masks, and none of them showed a reduction, nor did their pooled data "meta-analysis".
Xiao J, Shiu E, Gao H, Wong JY, Fong MW, Ryu S, et al. Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Personal Protective and Environmental Measures. Emerg Infect Dis. 2020;26(5):967-975. https://dx.doi.org/10.3201/eid2605.190994
https://wwwnc.cdc.gov/eid/article/26/5/19-0994_article#tnF2
Quote from their abstract:
“Local, national, and international health authorities regularly update their plans for mitigating the next influenza pandemic in light of the latest available evidence on the effectiveness of various control measures in reducing transmission. Here, we review the evidence... Although mechanistic studies support the potential effect of hand hygiene or face masks, 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.”
A second quote specifically on facemasks which describes all ten failed studies:
“In our systematic review, we identified 10 RCTs that reported estimates of the effectiveness of face masks in reducing laboratory-confirmed influenza virus infections in the community from literature published during 1946–July 27, 2018. In pooled analysis, we found no significant reduction in influenza transmission with the use of face masks… One study evaluated the use of masks among pilgrims from Australia during the Hajj pilgrimage and reported no major difference in the risk for laboratory-confirmed influenza virus infection in the control or mask group. Two studies in university settings assessed the effectiveness of face masks for primary protection by monitoring the incidence of laboratory-confirmed influenza among student hall residents for 5 months. The overall reduction in ILI or laboratory-confirmed influenza cases in the face mask group was not significant in either study. Study designs in the 7 household studies were slightly different… None of the household studies reported a significant reduction in secondary laboratory-confirmed influenza virus infections in the face mask group.”
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The two literature reviews by Rancourt cited below are extremely thorough. The first reviews randomized studies about lack of efficacy, with a focus on the failure of N95 respirators, which are considered to be very high quality, to offer any improvement over other masks which are considered low quality. The second review focuses on many harms such as headaches and rashes, impaired lung and heart function, significantly reduced communication ability, and psychological harms of anxiety and social withdrawal. Many of these adverse effects occur in a majority of people wearing face coverings, and are not at all rare or isolated events.
5: Rancourt (April 2020) Masks do not work: A review of science relevant to covid-19 social policy. https://pashev.me/files/rancourt-2020.pdf
“There have been extensive randomized controlled trial (RCT) studies, and meta-analysis reviews of RCT studies, which all show that masks and respirators do not work to prevent respiratory influenza-like illnesses, or respiratory illnesses believed to be transmitted by droplets and aerosol particles. Furthermore, the relevant known physics and biology, which I review, are such that masks and respirators should not work. It would be a paradox if masks and respirators worked.”
6: Rancourt (February 2021) Review of scientific reports of harms caused by face masks, up to February 2021. https://childrenshealthdefense.org/wp-content/uploads/5thsciencereview-masksharm-1.pdf
“There have been no less than 15 policy-grade RCTs with verified outcome… All 15 studies find that no reduction in risk of being infected can be detected with statistical significance… claims that masks work are disingenuous propaganda improperly relying on substandard and irrelevant studies.”
He also cites many studies of harms in health care workers with well over 50% having headaches, rashes, and other adverse effects which they often report impairs their work performance. One group of surgeons stated in their conclusions: “The safety of PPE use against COVID-19 for surgeons should be investigated…. The PPE-associated discomfort and side effects during surgery may increase surgeons' anxiety and fatigue while performing difficult operations.”
7: Spira B. (April 19, 2022). Correlation between mask compliance and covid-19 outcomes in Europe.
file:///C:/Users/MIrwin/Downloads/Mask%20compliance%20vs%20COVID%20(1).pdf
Beny Spira is a professor in the department of microbiology at the University of São Paulo, Brazil. His review article, published on April 19 2022, covers data from the 2020-2021 winter in Europe, a time period when respiratory illnesses commonly surge. He found no association with reduced covid-19 cases and mask compliance, but did find a correlation with mask compliance and higher deaths. He discusses how smaller short-term studies gave biased results in favor of mask mandates.
Although it is only an observation study, and there can be many confounding factors, he accounts for these well in his discussion section. Also, many previous randomized trials showed that masks do not reduce the transmission of respiratory illnesses, including covid-19, so the lack of an effect is actually an expected finding and matches this higher quality data.
In his abstract he gives brief statement on their lack of effectiveness, "These findings indicate that countries with high levels of mask compliance did not perform better than those with low mask usage."
Later, in the discussion section, he describes how biased reporting of short-term population studies created an illusion of mask effectiveness because the mask mandates were instituted as the number of cases were already declining. Some countries kept mask mandates, but surges in cases happened equally in these countries compared to those who dropped them or never used them: "Masks became mandatory in all of Germany's federal states between the 20th and 29th of April, at a time when the propagation of covid-19 was already declining. Furthermore, the mask mandate was still in place in the subsequent autumn-winter wave of 2020-2021, but it did not help preventing the outburst of cases and deaths in Germany that was several-fold more severe than in the first wave."
At the very end, in the Conclusions section, he comments on the increased mortality from masks: "Moreover, the moderate positive correlation between mask usage and deaths in Western Europe also suggests that the universal use of masks may have had harmful unintended consequences."
One thing not mentioned is that surges in cases came due to surges in testing, creating a false, or at least exaggerated, appearance of increased spread. When a surge in testing occurs, of course there will be surges in positive cases. Contact tracing protocols were widely adopted, creating a domino-like cascade of testing, and intense media attention caused people to join voluntarily in the testing waves. Another commonly forgotten cause of skewed data is that false positive PCR tests are more likely when someone's immune system is activated including by viral illnesses of all types. This includes illnesses caused by the many other coronaviruses which are known historically for causing the common cold, as well as more significant inflammatory states like influenza-like illness, autoimmune reactions, and multisystem inflammatory syndromes like Kawasaki disease.
The risk of mortality, especially in vulnerable populations, can easily be increased by masks. This can be due to increased risk of falls, car accidents, and surgical errors. However, the main harms of masks are interpersonal. In my office I routinely offer that people can take off their masks, "So I can see if you are smiling or frowning at me."
8: Howard J., Huang A., Li Z. et al. (2021, January). An evidence review of face masks against COVID-19. Proceedings of the National Academy of Sciences 118 (4) e2014564118; DOI: 10.1073/pnas.2014564118
Cowling BJ, Chan KH, Fang VJ, et al.. (2009, October). Facemasks and hand hygiene to prevent influenza transmission in households: a cluster randomized trial. Ann Intern Med. 2009 Oct 6;151(7):437-46. doi: 10.7326/0003-4819-151-7-200910060-00142. Epub 2009 Aug 3. PMID: 19652172.
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This review by Howard et al claimed that masks were effective, but they relied on studies with no statistically significant results, reporting them as if they were positive, just as Rancourt points out in his review. A more appropriate conclusion when statistical significance is not reached is to simply say, “The study did not show better results that random chance.” Several studies did not have positive results in their primary outcome, but by finding a positive result in one of many subgroup analyses, the authors claimed that their results “suggested” a positive effect. Analyzing subgroups is prone to bias and is not intended to be used to make recommendations. At best, subgroup analysis can suggest possible future research.
One example of this is a study by Seuss et al, which they state “suggests that household transmission of influenza can be reduced by the use of nonpharmaceutical interventions, namely the use of face masks and intensified hand hygiene.” (Howard et al, 2021). However, when one looks at the actual study by Seuss et al, they did not have statistical significance in their main outcomes, and only achieved significance in one of several subgroup analyses. Furthermore, the positive result was in a subgroup with fewer nonpharmacological interventions, which goes against what would be expected.
Similarly, a study by Aiello et al found reduction in a subgroup analysis for a brief period of “4-6 weeks”, but their overall conclusion was that “Neither face mask use and hand hygiene nor face mask use alone was associated with a significant reduction in the rate of ILI cumulatively.” Another study cited by Howard et al is one which again only found a result in a single subgroup: people who started the measures within a certain time of illness onset (Cowling et al 2009). However, Cowling et al state in their conclusions: “Hand hygiene with or without facemasks seemed to reduce influenza transmission, but the differences compared with the control group were not statistically significant.”
9: Two articles by Matt Irwin on the extraordinarily low risk for young people and people without underlying illnesses. The first paper focuses on US Colleges, with mortality rates of less than 1 in 100,000 as of January 2021. This article also describes Swedish government data on their schools which were never closed, with no social distancing or mask wearing, and exactly zero children died as of August 2020. A more formal study on mortality in young people was published in November 2021, and it showed very similar risk of less than 1 in 100,000 in young people, using data from the entire country of Germany. Below is a link to the more comprehensive paper on US Colleges and Swedish schools, as well as a link to a shorter summary of the study from Germany.
www.drmattirwin/college
www.drmattirwin.com/german
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10: Below is a link to the CDC website and results table from September 2020 which lists mortality for people under 20 at 1 in 33,000. This is cited as a fatality ratio of 0.00003 under the “current best estimate” column. The fatality ratio for people between 20 and 50 is listed as 1 in 5000 (0.0002). Combining these two age groups, the death rate for people under 50 would be about 1 in 10,000, which is five times lower than what was reported by the CDC in May 2020. At that time their table said the death rate for people under 50 was about 1 in 2000, which was already extremely low compared what was predicted in February and March when the first alarms were broadcast around the world, resulting in worldwide school and business closures and massively harmful social isolation policies. Without these policies, and if normal care was given instead of solitary confinement and quarantine for covid-19 positive people, more than half of the excess deaths in 2020 would have been avoided.
Table with summary: CDC Table with 1 in 33,000 mortality rate in young people.
CDC Web Page with detailed description of their mortality data: https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios-archive/planning-ccenarios-2021-03-19.pdf