If We Remain Ignorant, We Will Lose

If we have a hot civil war in the future, our side will win. If we have a biological civil war, our side will lose. This is my opinion. I know many will disagree.

I continue to receive emails concerning the use of masks and how they are ineffective. People continue to argue for their ignorance. Here are some examples:

The use of mask and respirators to prevent transmission of influenza: A systematic review of the scientific evidence

A former neurosurgeon wrote an op-ed published Thursday warning that face masks are not only ineffective against the novel coronavirus that causes COVID-19, but they can be potentially dangerous in some circumstances.

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This article had no linked scientific studies within the article so I went to the first reference: 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.:

Here is part of the Abstract:

Eight of nine retrospective observational studies found that mask and/or respirator use was independently associated with a reduced risk of severe acute respiratory syndrome (SARS). Findings, however, may not be applicable to influenza and many studies were suboptimal. None of the studies established a conclusive relationship between mask/respirator use and protection against influenza infection. Some evidence suggests that mask use is best undertaken as part of a package of personal protection especially hand hygiene. The effectiveness of masks and respirators is likely linked to early, consistent and correct usage.

There were no conclusions to this reference and as noted above the studies were observational. No controls. No testing parameters. No p-value. But this was used as a reference to support a false statement concerning masks.

Here is another emailed article:

Masks: Are There Benefits or Just a Comfort Prop? Let the Facts Speak, by Jennifer Giustra-Kozek

In  Epidemics 2017, a meta-analysis concluded that masks had a non-significant protective effect. In the Annuals of Internal Medicine, April 2020, “neither surgical nor cotton masks effectively filtered SARS-CoV-2 during coughs by affected people.”

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.

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Let’s link at the above links:

Epidemics 2017 article:

However, PPMs such as respiratory etiquette, hand hygiene and the use of facemasks are inexpensive and easy to implement, and are commonly recommended and undertaken during influenza outbreaks (Aledort et al., 2007, Aiello et al., 2010a, van der Weerd et al., 2011).

One reported that the incidence and proportion of school absence associated with pandemic influenza decreased in schools where a hand sanitizer intervention was implemented (Azor-Martinez et al., 2014), while the other found that hand hygiene in conjunction with facemask use reduced risk of secondary influenza infection (OR = 0.26; 95% confidence interval (CI) 0.07–0.93) (Suess et al., 2012). 

3.4. Facemask use:

If the randomized control trial and cohort study were pooled with the case–control studies, heterogeneity decreased and a significant protective effect was found.

4. Discussion

Analyses of hand hygiene found significant protective effects associated with frequent hand-washing and hand-washing after contact with an index patient or a contaminated surface. These results compare favourably to the results of a systematic review of RCTs evaluating hand hygiene effectiveness during seasonal influenza epidemics, which found a significant protective effect associated with a combination of hand hygiene and facemask use, but no significant effect of hand hygiene alone in preventing influenza infection (Wong et al., 2014). 

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Given the questionable effectiveness of respiratory etiquette, mask use and hand hygiene should form the foundation of protective behavior. 

From the Annals of Internal Medicine link in the article:

Effectiveness of Surgical and Cotton Masks in Blocking SARS–CoV-2: A Controlled Comparison in 4 Patients

Background: 

However, the SARS–CoV-2 pandemic has contributed to shortages of both N95 and surgical masks, and cotton masks have gained interest as a substitute.

A previous study reported that surgical masks and N95 masks were equally effective in preventing the dissemination of influenza virus, so surgical masks might help prevent transmission of severe acute respiratory syndrome–coronavirus 2 (SARS–CoV-2). However, the SARS–CoV-2 pandemic has contributed to shortages of both N95 and surgical masks, and cotton masks have gained interest as a substitute.

Objective: To evaluate the effectiveness of surgical and cotton masks in filtering SARS–CoV-2.

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This study is only concerned with cotton masks, not N95 (or higher) or even surgical masks. Let me repeat this statement from the above article: A previous study reported that surgical masks and N95 masks were equally effective in preventing the dissemination of influenza virus, so surgical masks might help prevent transmission of severe acute respiratory syndrome–coronavirus 2 (SARS–CoV-2).

If you actually read the links, you will see that there is a difference between the influenza virus and the SAR-CoV-2 virus for transmission BUT masks are effective in the contraction and dissemination of HB-19.

University of New South Wales link:

Cloth masks—dangerous to your health?

Professor Raina MacIntyre, lead study author and head of UNSW’s School of Public Health and Community Medicine, said the results of the study caution against the use of cloth masks.

“Masks are worn to protect from infection during pandemics and outbreaks, especially when there are no drugs or vaccines available for protection,” Professor MacIntyre said.

“Masks are especially important for frontline doctors and nurses, as their protection from infection is key to maintaining the ability to tackle a pandemic effectively.

“Cloth masks should not be used by workers in any healthcare setting, but particularly high-risk situations such as emergency departments, intensive care, paediatric or respiratory wards.”

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Again, the authors use misdirection by not specifying the type of mask. I would not wear a cotton mask. I would not wear an N95 mask unless it was a low risk environment, a method to get infected with a low inoculum or it was the only available option.

David DeGerolamo