Updated: Feb 23, 2022
And once again... masks are starting to resurface.
Quite honestly. If you WANT to wear one, have at it.
But don't ENFORCE/MANDATE/REQUIRE it.
It's NOT supported by SCIENCE.
Let alone, logical thought and basic understanding of physiology, virology, and immunology.
References and Resources
Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients
Masks Are Neither Effective Nor Safe: A Summary Of The Science
^^^ A great start to many of your questions and assumptions.
All you Need
Masks are Tools for Discrimination
Masks are Ineffective and Risky, So Stop Calling Us Selfish
In Epidemics 2017, a meta-analysis concluded that masks had a non-significant protective effect. There is a lack of real scientific evidence that cloth and surgical masks are too effective in reducing the risk of SARS-CoV2 transmission.
According to a University of New South Wales, the widespread use of masks by healthcare workers may put them at increased risk of respiratory illness and viral infections, and their global use should be discouraged.
In the British Medical Journal 2015, “Over three times, the risk of contracting influenza-like illness if a cloth mask is used versus no mask at all.” Contaminated masks and masks holding moisture and pathogen retention can increase the risk of infection.
A 2016 study in the Journal of Exposure Science & Environmental Epidemiology found 97% of particles penetrated cloth masks, and 44% of particles penetrated medical masks. They 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.
Cloth and surgical masks do not have a fit test. When worn, gaps around the edges allow small particles to enter the respiratory system. Also, according to the May 2010 edition of PLoS One, lack of eye protection was a primary risk factor of SARS-CoV transmission.
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. 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.
In February, the CDC said they don’t recommend people use face masks. The World Health Organization also advised people to wear a mask only if they are displaying symptoms of Coronavirus or “taking care of a person with a suspected 2019-nCoV infection.”
There is zero scientific evidence that wearing a mask, especially for more extended periods, protects us. However, several studies found significant problems with wearing one. Side-effects range from headaches to increased airway resistance, carbon dioxide accumulation, hypoxia, to more severe complications.
In the Head and Neck Pain Journal, most healthcare workers develop de novo PPE‐associated headaches or exacerbation of their pre‐existing headache disorders.
When a person is infected with a respiratory virus, they will expel some of the virus with each breath. Wearing a mask creates a situation in which the individual continually breathes back in their viruses—breathing viruses back in raises the concentration of the virus in the lungs and nasal passages. It has been studied that those with a higher number of viral particles can develop a more severe illness. A recent study out of China published in the Lancet Journal reported a strong association between Covid19 disease severity and the amount of virus present in the nose.
The Antimicrobial Resistance & Infection Control Journal demonstrated, “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.
Wearing a mask could put you at a greater risk of getting Covid19. Regular cloth or surgical masks, irritate the user, causing the user to touch their face with dirty hands more often. Also, the Coronavirus spreads in droplets, which most masks do not block. These masks can actually trap droplets inside, increasing risk instead of reducing it.
Masks also hamper oxygen intake; the body and the immune system require optimal levels of oxygen to feed cells and fight off illness, including Covid19. When studied, surgeons who wore surgical masks had a decrease in blood O2 saturation and an increase in pulse rates of the surgeons after the operations due to surgical mask usage.
According to the Journal of Biomedicines, our oxygen concentration is closely associated with cell survival and immune functioning, making one more susceptible to illness.
Masks can cause difficulty and labored breathing – even in a healthy individual. Blocking air even partially puts excess stress on thoracic muscles and the diaphragm, causing a person to feel out of breath. Wearing a mask can also make a person feel anxiety and panic. Claustrophobia and a feeling of suffocation must be acknowledged, especially among individuals who have Post-Traumatic Stress Disorder and other mental health issues.
So, in summary, mask-wearing can be dangerous and is shown over and over again to be ineffective. It appears masks are more effective in helping to spread illness, by providing a surface for viruses to collect on, like carrying a petri dish in front of your face. According to the Americans with Disabilities Act, if wearing a mask poses a mental or physical risk, there are exemptions. So please don’t mandate them to attend school, and please don’t teach the masses to hate and shame those that do not comply. This conditioning leads people to be more willing to follow irrational orders and do things without questioning authority, or logic, in the future. When there is a risk, there should always be a choice.
Facemasks in the COVID-19 era: A health hypothesis
Baruch Vainshelboim * Cardiology Division, Veterans Affairs Palo Alto Health Care System/Stanford University, Palo Alto, CA, United States
Efficacy of cloth face mask in prevention of novel coronavirus infection transmission: A systematic review and meta-analysis
RESULTS: Cloth face masks show minimum efficacy in source control than the medical grade mask. The efficacy of cloth face masks filtration varies and depends on the type of material used, number of layers, and degree of moisture in mask and fitting of mask on face.
CONCLUSION: Cloth face masks have limited efficacy in combating viral infection transmission. However, it may be used in closed, crowded indoor, and outdoor public spaces involving physical proximity to prevent spread of SARS-CoV-2 infection.
Is a Mask That Covers the Mouth and Nose Free from Undesirable Side Effects in Everyday Use and Free of Potential Hazards?
"For a quantitative evaluation, 44 mostly experimental studies were referenced, and for a substantive evaluation, 65 publications were found. The literature revealed relevant adverse effects of masks in numerous disciplines. In this paper, we refer to the psychological and physical deterioration as well as multiple symptoms described because of their consistent, recurrent and uniform presentation from different disciplines as a Mask-Induced Exhaustion Syndrome (MIES). We objectified evaluation evidenced changes in respiratory physiology of mask wearers with significant correlation of O2 drop and fatigue (p < 0.05), a clustered co-occurrence of respiratory impairment and O2 drop (67%), N95 mask and CO2 rise (82%), N95 mask and O2 drop (72%), N95 mask and headache (60%), respiratory impairment and temperature rise (88%), but also temperature rise and moisture (100%) under the masks. Extended mask-wearing by the general population could lead to relevant effects and consequences in many medical fields."
Masks Are Neither Effective Nor Safe: A Summary Of The Science
New Study Highlights Face Mask Problems with Safety and Efficacy
Compilation of 35+ studies
Masks Don't Work: A Review of Science Relevant to COVID-19 Social Policy
Boat load of noteworthy research:
An overview of the current evidence regarding the effectiveness of face masks. 1. Studies on the effectiveness of face masks So far, most studies found little to no evidence for the effectiveness of cloth face masks in the general population, neither as personal protective equipment nor as a source control.
A May 2020 meta-study on pandemic influenza published by the US CDC found that face masks had no effect, neither as personal protective equipment nor as a source control. (Source)
A Danish randomized controlled trial with 6000 participants, published in the Annals of Internal Medicine in November 2020, found no statistically significant effect of high-quality medical face masks against SARS-CoV-2 infection in a community setting. (Source)
A large randomized controlled trial with close to 8000 participants, published in October 2020 in PLOS One, found that face masks “did not seem to be effective against laboratory-confirmed viral respiratory infections nor against clinical respiratory infection.” (Source)
A February 2021 review by the European CDC found no significant evidence supporting the effectiveness of non-medical and medical face masks in the community. Furthermore, the European CDC advised against the use of FFP2/N95 respirators by the general public. (Source)
A July 2020 review by the Oxford Centre for Evidence-Based Medicine found that there is no evidence for the effectiveness of cloth masks against virus infection or transmission. (Source)
A November 2020 Cochrane review found that face masks did not reduce influenza-like illness (ILI) cases, neither in the general population nor in health care workers. (Source)
An April 2020 review by two US professors in respiratory and infectious disease from the University of Illinois concluded that face masks have no effect in everyday life, neither as self-protection nor to protect third parties (so-called source control). (Source)
An article in the New England Journal of Medicine from May 2020 came to the conclusion that cloth face masks offer little to no protection in everyday life. (Source)
A 2015 study in the British Medical Journal BMJ Open found that cloth masks were penetrated by 97% of particles and may increase infection risk by retaining moisture or repeated use. (Source)
An August 2020 review by a German professor in virology, epidemiology and hygiene found that there is no evidence for the effectiveness of cloth face masks and that the improper daily use of masks by the public may in fact lead to an increase in infections. (Source)
A meta-study in the journal Lancet, commissioned by the WHO, claimed that masks “could” lead to a reduction in the risk of infection, but the studies considered mainly N95 respirators in a hospital setting, not cloth masks in a community setting, the strength of the evidence was reported as “low”, and experts found numerous flaws in the study. Professor Peter Jueni, epidemiologist at the University of Toronto, called the WHO study “essentially useless”.
A study in the journal PNAS claimed that masks had led to a decrease in infections in three global hotspots (including New York City), but the study did not take into account the natural decrease in infections and other simultaneous measures. The study was so flawed that over 40 scientists recommended that the study be withdrawn.
A US study claimed that US counties with mask mandates had lower Covid infection and hospitalization rates, but the authors had to withdraw their study as infections and hospitalizations increased in many of these counties shortly after the study was published.
A German study claimed that the introduction of mandatory face masks in German cities had led to a decrease in infections. But the data does not support this claim: in some cities there was no change, in others a decrease, in others an increase in infections (see graph below). The city of Jena was an ‘exception’ only because it simultaneously introduced the strictest quarantine rules in Germany, but the study did not mention this.
A Canadian study claimed that countries with mandatory masks had fewer deaths than countries without mandatory masks. But the study compared African, Latin American, Asian and Eastern European countries with very different infection rates and population structures.
A review by the University of Oxford claimed that face masks are effective, but it was based on studies about SARS-1 and in health care settings, not in community settings.
A review by members of the lobby group ‘Masks for All’, published in the journal PNAS, claimed that masks are effective as a source control against aerosol transmission in the community, but the review provided no real-world evidence supporting this proposition.
A few more studies to investigate:::
1. bin-Reza F et al. The use of mask and respirators to prevent transmission of influenza: A systematic review of the scientific evidence. Resp Viruses 2012;6(4):257-67. 2. Zhu JH et al. Effects of long-duration wearing of N95 respirator and surgical facemask: a pilot study. J Lung Pulm Resp Res 2014:4:97-100. 3. Ong JJY et al. Headaches associated with personal protective equipment- A cross-sectional study among frontline healthcare workers during COVID-19. Headache 2020;60(5):864-877. 4. Bader A et al. Preliminary report on surgical mask induced deoxygenation during major surgery. Neurocirugia 2008;19:12-126. 5. Shehade H et al. Cutting edge: Hypoxia-Inducible Factor-1 negatively regulates Th1 function. J Immunol 2015;195:1372-1376. 6. Westendorf AM et al. Hypoxia enhances immunosuppression by inhibiting CD4+ effector T cell function and promoting Treg activity. Cell Physiol Biochem 2017;41:1271-84. 7. Sceneay J et al. Hypoxia-driven immunosuppression contributes to the pre-metastatic niche. Oncoimmunology 2013;2:1 e22355. 8. Blaylock RL. Immunoexcitatory mechanisms in glioma proliferation, invasion and occasional metastasis. Surg Neurol Inter 2013;4:15.
(Thanks Dr. David Jockers)
Do facemasks protect against COVID‐19? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7323223/?fbclid=IwAR1jt_JzRdoAht0ra1hxp3sQxgDfV1gfhmCHKF0BCeYGotlJ0s4ecMozr3s "A meta‐analysis of randomised controlled trials of pre‐COVID‐19 showed that surgical masks or N95 respirators reduced clinical respiratory illness in health‐care workers by 41% and influenza‐like illness by 66%: they work but are far from perfect. 1 N95 masks were not statistically better than surgical masks in preventing proven influenza, 2 nor in preventing COVID‐19, although the latter is based on weak data. 3 N95 masks are more efficient filters of small particles, but these findings suggest it is reasonable to recommend that health‐care workers use surgical masks when there is risk of droplet spread and reserve precious N95 masks for health‐care workers performing aerosol‐generating procedures." "The public might wear masks to avoid infection or to protect others. During the 2009 pandemic of H1N1 influenza (swine flu), encouraging the public to wash their hands reduced the incidence of infection significantly whereas wearing facemasks did not. 5There is no good evidence that facemasks protect the public against infection with respiratory viruses, including COVID‐19. 6" "During the pandemics caused by swine flu and by the coronaviruses which caused SARS and MERS, many people in Asia and elsewhere walked around wearing surgical or homemade cotton masks to protect themselves. One danger of doing this is the illusion of protection. Surgical facemasks are designed to be discarded after single use. As they become moist they become porous and no longer protect. Indeed, experiments have shown that surgical and cotton masks do not trap the SARS‐CoV‐2 (COVID‐19) virus, which can be detected on the outer surface of the masks for up to 7 days. 7 , 8 Thus, a pre‐symptomatic or mildly infected person wearing a facemask for hours without changing it and without washing hands every time they touched the mask could paradoxically increase the risk of infecting others. Because the USA is in a desperate situation, their Centers for Disease Control has recommended the public wear homemade cloth masks. This was essentially done in an effort to try and reduce community transmission, especially from people who may not perceive themselves to be symptomatic, rather than to protect the wearer, although the evidence for this is scant. In contrast, the World Health Organization currently recommends against the public routinely wearing facemasks.In Australia and New Zealand currently, the questionable benefits arguably do not justify health‐care staff wearing surgical masks when treating low‐risk patients and may impede the normal caring relationship between patients, parents and staff. We counsel against such practice, at least at present."
Volume 26, Number 5—May 2020 Policy Review Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Personal Protective and Environmental Measures https://wwwnc.cdc.gov/eid/article/26/5/19-0994_article?fbclid=IwAR03mZyGlNZfZeXDQu0ZaETxnK-h4e01I1U_IZMn5ekqocm1e6dQfUpla7I " 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. We identified several major knowledge gaps requiring further research, most fundamentally an improved characterization of the modes of person-to-person transmission." Most of these studies are aimed towards the influenza virus (80-120um), which is LARGER (or similar sized) than the Coronavirus (60-140um). ** Note, masks are NOT selective on the virus, only the size of particles, which is what most of these studies analyze. Cover your cough, wash your hands, and think before touch commonly touched areas! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420971/ https://pubmed.ncbi.nlm.nih.gov/18500410/ https://pubmed.ncbi.nlm.nih.gov/15340662/ https://clinicaltrials.gov/ct2/show/NCT00173017 https://pubmed.ncbi.nlm.nih.gov/18331781/ https://www.nature.com/articles/s41598-018-35797-3 https://pubmed.ncbi.nlm.nih.gov/31479137/ https://bmjopen.bmj.com/content/5/4/e006577#T1 https://pubmed.ncbi.nlm.nih.gov/21477136/ https://pubmed.ncbi.nlm.nih.gov/28039289/ https://bmjopen.bmj.com/content/5/4/e006577.long https://pubmed.ncbi.nlm.nih.gov/20584862/ https://pubmed.ncbi.nlm.nih.gov/22188875/ https://pubmed.ncbi.nlm.nih.gov/31479137/ https://pubmed.ncbi.nlm.nih.gov/27531371/ https://pubmed.ncbi.nlm.nih.gov/29855107/ https://pubmed.ncbi.nlm.nih.gov/29678452/ https://pubmed.ncbi.nlm.nih.gov/25806411/ https://pubmed.ncbi.nlm.nih.gov/23108786/ https://pubmed.ncbi.nlm.nih.gov/25858901/ https://pubmed.ncbi.nlm.nih.gov/5333967/ https://journals.plos.org/plosone/article… https://academic.oup.com/annweh/article/54/7/789/202744 https://pubmed.ncbi.nlm.nih.gov/27531371/ https://www.nature.com/articles/s41591-020-0843-2 https://vimeo.com/424254660 https://www.facebook.com/watch/live/?v=276231940292992&ref=watch_permalink https://www.youtube.com/watch?v=D0t84p6H4XA https://pubmed.ncbi.nlm.nih.gov/19216002/ https://www.cambridge.org/…/64D368496EBDE0AFCC6639CCC9D8BC05 https://onlinelibrary.wiley.com/…/…/j.1750-2659.2011.00307.x https://www.cmaj.ca/content/188/8/567 https://academic.oup.com/cid/article/65/11/1934/4068747 https://jamanetwork.com/journals/jama/fullarticle/2749214 https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.12381 https://citeseerx.ist.psu.edu/viewdoc/download… https://www.cambridge.org/…/0921A05A69A9419C862FA2F35F819D55 https://academic.oup.com/cid/article/11/3/494/397025 https://royalsocietypublishing.org/d…/10.1098/rsif.2011.0537 https://journals.plos.org/plosone/article… https://bmcpublichealth.biomedcentral.com/…/1471-2458-12-106 https://royalsocietypublishing.org/d…/10.1098/rsif.2010.0686 https://link.springer.com/article/10.1007/s12560-011-9056-7 Here are key anchor points to the extensive scientific literature that establishes that wearing surgical masks and respirators (e.g., "N95") does not reduce the risk of contracting a verified illness: • 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. N95-masked health-care workers (HCW) were significantly more likely to experience headaches. Face mask use in HCW was not demonstrated to provide benefit in terms of cold symptoms or getting colds. • Cowling, B. et al. (2010) "Face masks to prevent transmission of influenza virus: A systematic review," Epidemiology and Infection, 138(4), 449-456. DOI:10.1017/S0950268809991658 None of the studies reviewed showed the benefit of wearing a mask in either HCW or community members in households (H). See summary Tables 1 and 2 therein. • 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. “There were 17 eligible studies. [...] None of the studies established a conclusive relationship between mask/respirator use and protection against inﬂuenza infection." • 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, cmaj.150835; DOI: 10.1503/cmaj.15083 "We identified 6 clinical studies ... In the meta-analysis of the clinical studies, we found no significant difference between N95 respirators and surgical masks in the associated risk of (a) laboratory-confirmed respiratory infection, (b) influenza-like illness, or (c) reported work-place absenteeism." • Offeddu, V. et al. (2017) "Effectiveness of Masks and Respirators Against Respiratory Infections in Healthcare Workers: A Systematic Review and Meta-Analysis," Clinical Infectious Diseases, Volume 65, Issue 11, 1 December 2017, Pages 1934-1942, https://doi.org/10.1093/cid/cix681 • 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. DOI:10.1001/jama.2019.11645 "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.” • 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://doi.org/10.1111/jebm.12381 No study with verified outcome shows a benefit for HCW or community members in households to wearing a mask or respirator. There is no such study. There are no exceptions. Likewise, no study exists that shows a benefit from a broad policy to wear masks in public. Furthermore, if there were any benefit to wearing a mask, because of the blocking power against droplets and aerosol particles, then there should be more benefit from wearing a respirator (N95) compared to a surgical mask, yet several large meta-analyses, and all the RCT, prove that there is no such relative benefit. Masks and respirators do not work. Many potential harms may arise from broad public policies to wear masks, and the following unanswered questions arise: • Do used and loaded masks become sources of enhanced transmission, for the wearer and others? • Do masks become collectors and retainers of pathogens that the mask wearer would otherwise avoid when breathing without a mask? • Are large droplets captured by a mask atomized or aerosolized into breathable components? Can virions escape an evaporating droplet stuck to a mask fiber? • What are the dangers of bacterial growth on a used and loaded mask? • How do pathogen-laden droplets interact with environmental dust and aerosols captured on the mask? • What are long-term health effects on HCW, such as headaches, arising from impeded breathing? • Are there negative social consequences to a masked society? • Are there negative psychological consequences of wearing a mask, as a fear-based behavioral modification? • What are the environmental consequences of mask manufacturing and disposal? • Do the masks shed fibers or substances that are harmful when inhaled? God bless y’all Dr. Serge
Thinking a mask will save you is like thinking a 'filter' on a cigarette will prevent lung cancer.
Volume 26, Number 5—May 2020
Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Personal Protective and Environmental Measures
"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 (RR 0.78, 95% CI 0.51–1.20; I2 = 30%, p = 0.25) (Figure 2)"
Emerg Infect Dis
. 2020 May;26(5):961-966. doi: 10.3201/eid2605.190993. Epub 2020 May 17. Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings-International Travel-Related Measures
Now that we have a randomized controlled trial (RCT) about masks, will it change what you do? https://aapsonline.org/now-that-we-have-a-randomized-controlled-trial-rct-about-masks-will-it-change-what-you-do/
Association of American Physicians and Surgeons
Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—International Travel-Related Measures Sukhyun Ryu, Huizhi Gao, [...], and Benjamin J. Cowling https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7181936/ From the CDC::: Community and Close Contact Exposures Associated with COVID-19 Among Symptomatic Adults ≥18 Years in 11 Outpatient Health Care Facilities — United States, July 2020 https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6936a5-H.pdf?fbclid=IwAR2oybbWzTy8HckcGsZRidy4N1ylf7Tp5hP2MyapiLO8dMu1Y_cYkhLqrcg "Exercise with facemask; Are we handling a devil's sword?" - A physiological hypothesis
"In the view of anticipated effects on immune system and prevention against influenza and Covid-19, globally moderate to vigorous exercises are advocated wearing protective equipment such as facemasks. Though WHO supports facemasks only for Covid-19 patients, healthy "social exercisers" too exercise strenuously with customized facemasks or N95 which hypothesized to pose more significant health risks and tax various physiological systems especially pulmonary, circulatory and immune systems. Exercising with facemasks may reduce available Oxygen and increase air trapping preventing substantial carbon dioxide exchange. The hypercapnic hypoxia may potentially increase acidic environment, cardiac overload, anaerobic metabolism and renal overload, which may substantially aggravate the underlying pathology of established chronic diseases. Further contrary to the earlier thought, no evidence exists to claim the facemasks during exercise offer additional protection from the droplet transfer of the virus. Hence, we recommend social distancing is better than facemasks during exercise and optimal utilization rather than exploitation of facemasks during exercise."
doi: 10.1016/j.mehy.2020.110002.Epub 2020 Jun 22
Mask Facts https://aapsonline.org/mask-facts/?fbclid=IwAR1Pl-aVBH6O1qo_XwRPXSSQHUeBW0J6xtBaMOjiykPIL5_om95v4vc2Pcs curated by Marilyn M. Singleton, M.D., J.D. Transmission of SARS-CoV-2 Note: A COVID-19 (SARS-CoV-2) particle is 0.125 micrometers (μm); influenza virus size is 0.08 – 0.12 μm; a human hair is about 150 μm. *1 nm = 0.001 micron; 1000 nm = 1 micron; Micrometer (μm) is the preferred name for micron (an older term) 1 meter is = 1,000,000,000 nm or 1,000,000 microns Droplets
Virus is transmitted through respiratory droplets produced when an infected person coughs, sneezes or talks. Larger respiratory droplets (>5 μm) remain in the air for only a short time and travel only short distances, generally <1 meter. They fall to the ground quickly. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30245-9/fulltext
This idea guides the CDC’s advice to maintain at least a 6-foot distance.
Virus-laden small (<5 μm) aerosolized droplets can remain in the air for at least 3 hours and travel long distances. https://www.nejm.org/doi/pdf/10.1056/NEJMc2004973?articleTools=true
In air conditioned environment these large droplets may travel farther.
However, ventilation — even the opening of an entrance door and a small window can dilute the number of small droplets to one half after 30 seconds. (This study looked at droplets from uninfected persons). This is clinically relevant because poorly ventilated and populated spaces, like public transport and nursing homes, have high SARS-CoV-2 disease transmission despite physical distancing. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30245-9/fulltext
Objects and surfaces
Person to person touching
The CDC’s most recent statement regarding contracting COVID-19 from touching surfaces: “Based on data from lab studies on Covid-19 and what we know about similar respiratory diseases, it may be possible that a person can get Covid-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose or possibly their eyes,” the agency wrote. “But this isn’t thought to be the main way the virus spreads. https://www.cdc.gov/media/releases/2020/s0522-cdc-updates-covid-transmission.html.
Chinese study with data taken from swabs on surfaces around the hospital https://wwwnc.cdc.gov/eid/article/26/7/20-0885_article?deliveryName=USCDC_333-DM25707
The surfaces where tested with the PCR (polymerase chain reaction) test, which greatly amplifies the viral genetic material if it is present. That material is detectable when a person is actively infected. This is thought to be the most reliable test.
Computer mouse (ICU 6/8, 75%; General ward (GW) 1/5, 20%)
Trash cans (ICU 3/5, 60%; GW 0/8)
Sickbed handrails (ICU 6/14, 42.9%; GW 0/12)
Doorknobs (GW 1/12, 8.3%)
81.3% of the miscellaneous personal items were positive:
Medical equipment (spirometer, pulse oximeter, nasal cannula)
PC and iPads
Cellular phones (83.3% positive for viral RNA)
Remote controls for in-room TVs (64.7% percent positive)
Toilets (81.0% positive)
Room surfaces (80.4% of all sampled)
Bedside tables and bed rails (75.0%)
Window ledges (81.8%)
Plastic: up to 2-3 days
Stainless Steel: up to 2-3 days
Cardboard: up to 1 day
Copper: up to 4 hours
Floor – gravity causes droplets to fall to the floor. Half of ICU workers all had virus on the bottoms of their shoes
Filter Efficiency and Fit *Data from a University of Illinois at Chicago review https://www.cidrap.umn.edu/news-perspective/2020/04/commentary-masks-all-covid-19-not-based-sound-data
HEPA (high efficiency particulate air) filters – 99.97 – 100% efficient. HEPA filters are tested with particles that are 0.125 μm.
Masks and respirators work by collecting particles through several physical mechanisms, including diffusion (small particles) and interception and impaction (large particles)
N95 filtering facepiece respirators (FFRs) are constructed from electret (a dielectric material that has a quasi-permanent electric charge. An electret generates internal and external electric fields so the filter material has electrostatic attraction for additional collection of all particle sizes. As flow increases, particles will be collected less efficiently.
N95 – A properly fitted N95 will block 95% of tiny air particles down to 0.3 μm from reaching the wearer’s face. https://www.honeywell.com/en-us/newsroom/news/2020/03/n95-masks-explained.
But even these have problems: many have exhalation valve for easier breathing and less moisture inside the mask.
Surgical masks are designed to protect patients from a surgeon’s respiratory droplets, aren’t effective at blocking particles smaller than 100 μm. https://webcache.googleusercontent.com/search?q=cache:VLXWeZBll7YJ:https://multimedia.3m.com/mws/media/957730O/respirators-and-surgical-masks-contrast-technical-bulletin.pdf+&cd=13&hl=en&ct=clnk&gl=us
Filter efficiency was measured across a wide range of small particle sizes (0.02 to 1 µm) at 33 and 99 L/min.
N95 respirators had efficiencies greater than 95% (as expected).
T-shirts had 10% efficiency,
Scarves 10% to 20%,
Cloth masks 10% to 30%,
Sweatshirts 20% to 40%, and
All of the cloth masks and materials had near zero efficiency at 0.3 µm, a particle size that easily penetrates into the lungs.
Another study evaluated 44 masks, respirators, and other materials with similar methods and small aerosols (0.08 and 0.22 µm).
N95 FFR filter efficiency was greater than 95%.
Medical masks – 55% efficiency
General masks – 38% and
Handkerchiefs – 2% (one layer) to 13% (four layers) efficiency.
Conclusion: Wearing masks will not reduce SARS-CoV-2.
N95 masks protect health care workers, but are not recommended for source control transmission.
Surgical masks are better than cloth but not very efficient at preventing emissions from infected patients.
Cloth masks will be ineffective at preventing SARS-CoV-2 transmission, whether worn as source control or as personal protective equipment (PPE).
“Masks may confuse that message and give people a false sense of security. If masks had been the solution in Asia, shouldn’t they have stopped the pandemic before it spread elsewhere?” *The first randomized controlled trial of cloth masks. https://bmjopen.bmj.com/content/5/4/e006577
Penetration of cloth masks by particles was 97% and medical masks 44%, 3M Vflex 9105 N95 (0.1%), 3M 9320 N95 (<0.01%).
Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection.
The virus may survive on the surface of the face- masks
Self-contamination through repeated use and improper doffing is possible. A contaminated cloth mask may transfer pathogen from the mask to the bare hands of the wearer.
Cloth masks should not be recommended for health care workers, particularly in high-risk situations, and guidelines need to be updated.
*A study of 4 patients in South Korea https://www.acpjournals.org/doi/10.7326/M20-1342 Known patients infected with SARS-CoV-2 wore masks and coughed into a Petrie dish. “Both surgical and cotton masks seem to be ineffective in preventing the dissemination of SARS–CoV-2 from the coughs of patients with COVID-19 to the environment and external mask surface.” *Singapore Study – Few people used mask correctly https://www.medpagetoday.com/infectiousdisease/publichealth/86601 Overall, data were collected from 714 men and women. About half the sample were women and all adult ages were represented. Only 90 participants (12.6%, 95% CI 10.3%-15.3%) passed the visual mask fit test. About three-quarters performed strap placement incorrectly, 61% left a “visible gap between the mask and skin,” and about 60% didn’t tighten the nose-clip. *A 2011 randomized Australian clinical trial of standard medical/surgical masks https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1750-2659.2011.00198.x?fbclid=IwAR3kRYVYDKb0aR-su9_me9_vY6a8KVR4HZ17J2A_80f_fXUABRQdhQlc8Wo Medical masks offered no protection at all from influenza. Conclusions from Organizations The World Health Organization (WHO): https://apps.who.int/iris/bitstream/handle/10665/331693/WHO-2019-nCov-IPC_Masks-2020.3-eng.pdf?sequence=1&isAllowed=y “Advice to decision makers on the use of masks for healthy people in community settings As described above, the wide use of masks by healthy people in the community setting is not supported by current evidence and carries uncertainties and critical risks.” “Medical masks should be reserved for health care workers. The use of medical masks in the community may create a false sense of security, with neglect of other essential measures, such as hand hygiene practices and physical distancing, and may lead to touching the face under the masks and under the eyes, result in unnecessary costs, and take masks away from those in health care who need them most, especially when masks are in short supply.” “Masks are effective only when used in combination with frequent hand-cleaning with alcohol-based hand rub or soap and water.” WHO acknowledges that most people do not use masks properly. Dr. Nancy Messonnier, director of the Center for the National Center for Immunization and Respiratory Diseases: https://www.cdc.gov/media/releases/2020/t0131-2019-novel-coronavirus.html “We don’t routinely recommend the use of face masks by the public to prevent respiratory illness,” said on January 31. “And we certainly are not recommending that at this time for this new virus.” The Centers for Disease Control and Prevention (CDC) https://www.cdc.gov/flu/professionals/infectioncontrol/maskguidance.htm In March 5, 2019 regarding the flu: “Masks are not usually recommended in non-healthcare settings; however, this guidance provides other strategies for limiting the spread of influenza viruses in the community:
cover their nose and mouth when coughing or sneezing,
use tissues to contain respiratory secretions and, after use, to dispose of them in the nearest waste receptacle, and
perform hand hygiene (e.g., handwashing with non-antimicrobial soap and water, and alcohol-based hand rub if soap and water are not available) after having contact with respiratory secretions and contaminated objects/materials.
From the New England Journal of Medicine https://www.nejm.org/doi/full/10.1056/NEJMp2006372 “We know that wearing a mask outside health care facilities offers little, if any, protection from infection. Public health authorities define a significant exposure to Covid-19 as face-to-face contact within 6 feet with a patient with symptomatic Covid-19 that is sustained for at least a few minutes (and some say more than 10 minutes or even 30 minutes). The chance of catching Covid-19 from a passing interaction in a public space is therefore minimal. In many cases, the desire for widespread masking is a reflexive reaction to anxiety over the pandemic.” Final Thoughts
Surgical masks – loose fitting. They are designed to protect the patient from the doctors’ respiratory droplets. The wearer is not protected from others airborne particles
People do not wear masks properly. Most people have the mask under the nose. The wearer does not have glasses on and the eyes are a portal of entry.
The designer masks and scarves offer minimal protection – they give a false sense of security to both the wearer and those around the wearer. **Not to mention they add a perverse lightheartedness to the situation.
If you are walking alone, no mask – avoid folks – that is common sense.
Remember – children under 2 should not wear masks – accidental suffocation and difficulty breathing in some
If wearing a mask makes people go out and get Vitamin D – go for it. In the 1918 flu pandemic people who went outside did better. Early reports are showing people with COVID-19 with low Vitamin D do worse than those with normal levels. Perhaps that is why shut-ins do so poorly. https://www.medrxiv.org/content/10.1101/2020.04.08.20058578v4
Sums things up nicely Ben Swann https://www.facebook.com/BenSwannRealityCheck/videos/705845830268772/ Evidence Not FEAR https://evidencenotfear.com/tag/face-masks/ The truth about face masks and the coronavirus: Wearing masks in crowded places may help reduce the spread, but it isn't a perfect solution https://www.businessinsider.com/coronavirus-face-masks-how-effective-are-they-evidence-so-far-2020-3?fbclid=IwAR3NtYKtRq7pF7UG1GniE7vI8jd_f3DR9z_97r5z0Wl3nmTD_dkRnZGG5do The truth is that gold-standard scientific studies about face masks — randomized controlled trials — are in short supply. The Use of Masks and Respirators to Prevent Transmission of Influenza: A Systematic Review of the Scientific Evidence https://pubmed.ncbi.nlm.nih.gov/22188875/ J Evid Based Med. 2020 Mar 13. doi: 10.1111/jebm.12381. [Epub ahead of print] Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis https://www.ncbi.nlm.nih.gov/pubmed/32167245 CONCLUSION: "The use of N95 respirators compared with surgical masks is not associated with a lower risk of laboratory-confirmed influenza. It suggests that N95 respirators should not be recommended for general public and nonhigh-risk medical staff those are not in close contact with influenza patients or suspected patients." WHO says there is no need for healthy people to wear face masks, days after the CDC told all Americans to cover their faces https://www.businessinsider.com/who-no-need-for-healthy-people-to-wear-face-masks-2020-4?fbclid=IwAR3v70JhSxjPVPQql3CoUQ-R92ZYScfc9LygSwnOqyEQTff8QF2RD_PKxnI https://thehill.com/changing-america/well-being/prevention-cures/491725-who-no-evidence-wearing-a-mask-can-protect?fbclid=IwAR0PM-GfbmZMm_-Rjyklqno8uj61EdQncwRh2tTxo89oAuBvVIm9S-w9-cs Effectiveness of Surgical and Cotton Masks in Blocking SARS–CoV-2: A Controlled Comparison in 4 Patients https://annals.org/aim/fullarticle/2764367/effectiveness-surgical-cotton-masks-blocking-sars-cov-2-controlled-comparison?fbclid=IwAR0AyiuonCUL62Rm0KEIvKyyzww0UlfM9HxFJ0iywr8my0637WQ_otA41jE Identifying airborne transmission as the dominant route for the spread of COVID-19 https://www.pnas.org/content/early/2020/06/10/2009637117 The Science of Masking Kids at School Remains Uncertain
By David Zweig A cluster randomised trial of cloth masks compared with medical masks in healthcare workers https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420971/?fbclid=IwAR1tFbGNBMtPfUxvn8JeksGq3eQbX6seGFNwhLF0WIBSYkVMAIgrSV9hG7U Conclusions This study is the first RCT of cloth masks, and the results caution against the use of cloth masks. This is an important finding to inform occupational health and safety. 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. "The use of cloth masks is widespread around the world, particularly in countries at high-risk for emerging infections, but there have been no efficacy studies to underpin their use." Sequential CQ / HCQ Research Papers and Reports January to April 20, 2020 Executive Summary Interpretation of the Data In This Report The HCQ-AZ combination, when started immediately after diagnosis, appears to be a safe and efficient treatment for COVID-19, with a mortality rate of 0.5%, in elderly patients. It avoids worsening and clears virus persistence and contagious infectivity in most cases. https://docs.google.com/document/d/1545C_dJWMIAgqeLEsfo2U8Kq5WprDuARXrJl6N1aDjY/preview?pru=AAABcewU92A*mzspQchbZCUjDKYsWjU6Kw Necessary for Kids?
The Science of Masking Kids at School Remains Uncertain
By David Zweig
Impact of the COVID-19 Pandemic on Early Child Cognitive Development: Initial Findings in a Longitudinal Observational Study of Child Health
"Leveraging a large on-going longitudinal study of child neurodevelopment, we examined general childhood cognitive scores in 2020 and 2021 vs. the preceding decade, 2011-2019. We find that children born during the pandemic have significantly reduced verbal, motor, and overall cognitive performance compared to children born pre-pandemic. Moreover, we find that males and children in lower socioeconomic families have been most affected. Results highlight that even in the absence of direct SARS-CoV-2 infection and COVID-19 illness, the environmental changes associated COVID-19 pandemic is significantly and negatively affecting infant and child development."
Mask Hysteria: Are We Going Too Far? — Kevin Campbell believes media and politicians use masking as a way to fear monger by Kevin Campbell MD June 17, 2020 https://www.medpagetoday.com/infectiousdisease/covid19/87120?fbclid=IwAR3Dg4WHfY6KoKR0UUBHQ6HbNpfslGr1iew6ydt3Pje5v_rhjvurFqVbr_A Sweden’s disease expert says just wearing face masks could be ‘very dangerous’+ https://nypost.com/2020/08/19/swedens-tegnell-wearing-face-masks-may-be-very-dangerous/amp/?fbclid=IwAR1WTJRwSqrJapBUIKAGO2250ht35QpkZ4TcOjcYcQBv2e2LMs7Cx8SlEGw Here are 12 FACTS that we KNOW…
No studies have been done to demonstrate that either a cloth mask or the N95 mask has any effect on transmission of COVID-19. As a matter of fact, research published in the Annals of Internal Medicine at the first of April indicated that “both surgical and cotton masks seem to be ineffective in preventing the dissemination of SARS–CoV-2 from the coughs of patients with COVID-19.” (Reference)
In a February 2020 meta-analysis of six randomized controlled trials involving 9,171 patients, there were no statistically significant differences in preventing influenza or viral infections using N95 respirators and surgical masks. (Reference)
A May 2020 study involving 159 healthcare workers aged 21 to 35 years of age found that 81% developed headaches from wearing a face mask. (Reference)
In a 2008 study of surgical masks worn by 53 surgeons, researchers found that the mask reduced the blood oxygen levels significantly, creating a condition known as “hypoxia.” (Reference)
A 2015 study indicated that hypoxia inhibits T-lymphocytes (the main immune cells used to fight viral infections) by increasing the level of a compound called hypoxia inducible factor-1 (HIF-1). (Reference) In other words, wearing a mask, which has been shown to cause hypoxia, may actually set the stage for contracting COVID-19 and make the consequences much worse.
Hypoxia promotes inflammation which can promote the growth, invasion and spread of cancers. (Reference) Hypoxia is also a significant factor in atherosclerosis, thus it increases the risk of stroke and heart attack. (Reference)
The WARNING on the box of surgical masks states clearly “THIS PRODUCT WILL NOT PROVIDE ANY PROTECTION AGAINST COVID-19 (CORONAVIRUS) OR OTHER VIRUSES OR CONTAMINANTS.”
Those who wear masks are constantly rebreathing the viruses, raising the concentration of the virus in the lungs and the nasal passages. By wearing a mask, the exhaled viruses will not be able to escape and will concentrate in the nasal passages, enter the olfactory nerves and can travel into the brain. (Reference, Reference, Reference)
Anthony Fauci, head of the director of the National Institute of Allergy and Infectious Diseases (NIAID), did an interview on 60 Minutes where he said, “People shouldn’t be walking around wearing masks.”
The World Health Organization says that there is no need for healthy people to wear face masks. (Reference) They recommend that healthy people only wear masks when taking care of someone infected with COVID-19. (Reference)
Surgeon General Jerome Adams advised against the general public wearing face masks, saying they were “not proven to be effective” in preventing people from contracting COVID-19. (Reference)
Although the CDC recommends wearing masks, they admitted that they do not have data to confirm that wearing a mask reduces the risk of contracting or spreading COVID-19. (Reference)
Blaylock: Face Masks Pose Serious Risks To The Healthy https://www.technocracy.news/blaylock-face-masks-pose-serious-risks-to-the-healthy/ Masks, false safety and real dangers, Part 1: Friable mask particulate and lung vulnerability https://childrenshealthdefense.org/wp-content/uploads/Masks-false-safety-and-real-dangers-Part-1-Friable-mask-particulate-and-lung-vulnerability.pdf Roman Bystrianik for his COVID-19 fact sheet COVID-19 Face Masks 05.pdf
https://www.docdroid.net/hIVGIrz/covid-19-face-masks-05-pdf Effects of wearing a cloth face mask on performance, physiological and perceptual responses during a graded treadmill running exercise test
"Cloth face masks led to a 14% reduction in exercise time and 29% decrease in VO2max, attributed to perceived discomfort associated with mask-wearing. Compared with no mask, participants reported feeling increasingly short of breath and claustrophobic at higher exercise intensities while wearing a cloth face mask. Coaches, trainers and athletes should consider modifying the frequency, intensity, time and type of exercise when wearing a cloth face mask."
Effects of surgical face masks on cardiopulmonary parameters during steady state exercise https://pubmed.ncbi.nlm.nih.gov/33349641/
Effects of surgical and FFP2/N95 face masks on cardiopulmonary exercise capacity https://pubmed.ncbi.nlm.nih.gov/32632523/
"Conclusion: Ventilation, cardiopulmonary exercise capacity and comfort are reduced by surgical masks and highly impaired by FFP2/N95 face masks in healthy individuals. These data are important for recommendations on wearing face masks at work or during physical exercise." Shelby Co. Health Dept. stops distribution of face masks over health concerns https://www.wmcactionnews5.com/2020/06/01/shelby-co-health-dept-stops-distribution-face-masks/?fbclid=IwAR3_PWnJe6xEhM4x_Vtd6smOj7EFxRy5k8Py7_VVLBdpx_YzJtocsWWEFGk March 4, 2020 Medical Masks https://jamanetwork.com/journals/jama/fullarticle/2762694?fbclid=IwAR0rrNSBgrvPJ3h9X5coPUOMSKhaZUvpI33e-ADmWjSMq1NlOrcMRjF65HM When Should a Mask Be Used? Face masks should be used only by individuals who have symptoms of respiratory infection such as coughing, sneezing, or, in some cases, fever. Face masks should also be worn by health care workers, by individuals who are taking care of or are in close contact with people who have respiratory infections, or otherwise as directed by a doctor. Face masks should not be worn by healthy individuals to protect themselves from acquiring respiratory infection because there is no evidence to suggest that face masks worn by healthy individuals are effective in preventing people from becoming ill. Face masks should be reserved for those who need them because masks can be in short supply during periods of widespread respiratory infection. Because N95 respirators require special fit testing, they are not recommended for use by the general public. Compilation of Research From Dr. Brett Jones https://docs.google.com/document/d/1DCEjDgnEqW4GMBYUshXWgR_lO6H583iOYYFJjyCaytU/edit?fbclid=IwAR3NaYtn1NF5oJ0OomBDkO4Tj_9hM5T5eN1vvLxirRNO-S27aju7jKcONgc Eric L. Zielinski. ￼Ever wonder why no one has given a clear, concise explanation to why masks (specifically cloth “face coverings”) are now recommended and even required in many places like Costco starting Monday?!? Because there is NO science and logical explanation to justify it! 😳 In fact, studies like this one in Vietnam, published in the journal BMJ in 2015, found that for medical professionals treating the flu in Hanoi hospitals, cloth masks appeared to lead to more infections than medical masks. The cloth holds on to moisture, is often reused, and filters poorly compared to medical masks.” 😳 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420971/… Hence, the ridiculously weak, nebulous and almost cryptic explanations from the most revered health organizations in the world... 🤦♂️ According to the World Health Organization, “Masks are effective ONLY when used in combination with frequent hand-cleaning with alcohol-based hand rub or soap and water.” 🤦♂️ https://www.who.int/…/advice-for-…/when-and-how-to-use-masks 🤦♂️ In the words of Mayo Clinic, “Can face masks help prevent the spread of coronavirus disease 2019 (COVID-19)? Yes, face masks COMBINED WITH other preventive measures, such as frequent hand-washing and social distancing, help slow the spread of the disease.” 🤦♂️ https://www.mayoclinic.org/coronavirus-mask/art-20485449 (Just let this sink in for a moment... if something in-and-of-itself were effective at stopping the spread of COVID, it would not require something else to enhance its efficacy) ⚠️ The fact remains that, “There is little information on the efficacy of face masks in filtering respiratory viruses and reducing viral release from an individual with respiratory infections, and most research has focused on influenza.” ⚠️ https://www.nature.com/articles/s41591-020-0843-2 https://www.google.com/…/busi…/costco-mask-policy/index.html The US Surgeon General once warned against wearing face masks for the coronavirus but the CDC now recommends it https://www.businessinsider.com/americans-dont-need-masks-pence-says-as-demand-increases-2020-2?fbclid=IwAR3L5kYm-YI9OuPumpyTJPxkDVCscHZeaK-bnklG3O3TUo-w1LxOEhszfGw https://standforhealthfreedom.com/action/act-now-mandatory-masks-endanger-your-health/ References 1 T Jefferson, M Jones, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. MedRxiv. 2020 Apr 7. https://www.medrxiv.org/content/10.1101/2020.03.30.20047217v2 2 J Xiao, E Shiu, et al. Nonpharmaceutical measures for pandemic influenza in non-healthcare settings – personal protective and environmental measures. Centers for Disease Control. 26(5); 2020 May. https://wwwnc.cdc.gov/eid/article/26/5/19-0994_article 3 J Brainard, N Jones, et al. Facemasks and similar barriers to prevent respiratory illness such as COVID19: A rapid systematic review. MedRxiv. 2020 Apr 1. https://www.medrxiv.org/content/10.1101/2020.04.01.20049528v1.full.pdf 4 L Radonovich M Simberkoff, et al. N95 respirators vs medical masks for preventing influenza among health care personnel: a randomized clinic trial. JAMA. 2019 Sep 3. 322(9): 824-833. https://jamanetwork.com/journals/jama/fullarticle/2749214 5 J Smith, C MacDougall. 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