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The best evidence for masks was commissioned by the WHO and published in the Lancet in June 2020. The title, “Physical Distancing, Face Masks, and Eye Protection to Prevent Person-to-Person Transmission of SARS-CoV-2 and COVID-19: A Systematic Review and Meta-Analysis,” sounds like high-level scientific evidence. After all, systemic reviews and meta-analyses are typically considered the epitome of evidence based medicine. However, don’t be deceived by the authors’ deceptive attempts to elevate the relevancy of this study. This systemic review/meta-analysis was entirely comprised of low-level observational studies. No high-level randomized controlled trials were included.
No matter how much the authors attempt to deceive or embellish the study’s relevance with its “dressed up” title, the fact remains, this study still amounts to nothing more than a steaming pile of weak evidence. No matter how much the authors and the WHO want this study to represent high-level evidence for masking world populations, it simply cannot be considered to be more than the sum of its low level parts.
Furthermore, the study is seriously flawed with serious misrepresentations and misinterpretations of the data. The flaws, errors, and mistakes in this analysis of 29 observational studies should lead to its retraction from the Lancet. The flaws are buried in the data tables, therefore, it is missed by those that do little more than read titles and conclusions. Which is exactly why studies like this should be subjected to thorough and independent peer-review before publication.
Scientists all over the world are raising concerns and speaking against the study and demanding its retraction. For example, University of Toronto epidemiology professor Peter Jueni called the WHO study “methodologically flawed” and “essentially useless”.
Summary: the WHO-commissioned meta-study on the effectiveness of facemasks and social distancing, published in The Lancet, is seriously flawed and should be retracted.
This study is nothing more than a seriously flawed meta-analysis of 29 weak observational studies. None of the trials were randomized controlled trials. No matter how thoroughly you sift through the weak, low-level of evidence, observational studies, in the end, all you end up with is weak, easily biased, and essentially unusable evidence.
For a more comprehensive analysis of the flaws and a thorough debunking of the relevance of this study, read this: WHO Mask Study Seriously Flawed, Swiss Policy Research (Sept. 9, 2020), copied here:
Update: A US analyst has reviewed all 29 studies and found numerous additional mistakes.
As mentioned above, several studies have been misinterpreted by the authors of the meta-study. All of the misinterpretations resulted in falsely claiming or exaggerating a benefit of facemasks. In the following, only the four studies relating to SARS-CoV-2 are reviewed. (HCW: health care worker)
Non-Covid studies were also misinterpreted or misrepresented by the Lancet meta-study authors. For instance, in the case of the non-Covid study with the allegedly biggest impact of masks (Kim et al. [49] about N95 respirators in a hospital with MERS patients), the meta-study authors incorrectly mixed serological and PCR results, again exaggerating the benefit of (N95) masks. The actual results of the Kim et al. study were not statistically significant (p=0.159).
In an additional section, the WHO meta-study evaluated studies on the benefit of “social distancing” measures. However, several independent experts have shown that this section is seriously flawed. The authors again misinterpreted several studies and made several statistical errors.
As with the studies on facemasks, all of these mistakes resulted in falsely claiming or exaggerating a benefit of “social distancing” measures.
For more information on this section, see PubPeer (and links therein) and the CEBM review.
As shown in this analysis, the WHO-commissioned meta-study on the effectiveness of facemasks and social distancing, published in The Lancet, is seriously flawed and should be retracted. Health authorities may want to reconsider their Covid-19 policy guidelines.
https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00818
Does not measure face cover use in the community or any measure of compliance.
Did not control for other community-wide and hospital-specific interventions that may have contributed to or confounded their observations, including:
Public health officials and the media have been warning us that coronavirus kills not just old or immunocompromised people but young people too. While this is true, it remains extremely rare.
Table 1. Parameter Values that vary among the five COVID-19 Pandemic Planning Scenarios.
The study by the University hospital in Dresden analysed blood samples from almost 1,500 children and 500 teachers from 13 schools in Saxony, Germany suggests schools may not play as big a role in spreading the virus as some had feared.
“Of the almost 2,000 samples, only 12 had antibodies,” said Reinhard Berner, a professor of paediatrics at the hospital. In other words, in Saxony’s open and unmasked schools 0.6% of school children demonstrated SARS-CoV-2 antibodies.
All cases were asymptomatic. There were no fatalities.
“Children may even act as a brake on infection,” Berner told a news conference, saying “infections in schools had not led to an outbreak, while the spread of the virus within households was also less dynamic than previously thought.”
“For other states with low infection rates, the study suggests schools could be reopened without fear of causing widespread outbreaks of the virus,” Berner said.
Sweden kept schools open and unmasked during the pandemic, yet their decision to adhere to the science and do what has always been done before, did not lead to a higher rate of infection among their children compared to neighboring Finland, where schools were closed temporarily.
Based on Covid-19 case data collected from each country during the time period, Feb. 24 to June 14, the percentage of children between the ages of 1-19 infected by Covid-19 was the same:
Separate studies by Sweden’s Karolinska Institutet (KI), an independent medical research institute, and the European Network of Ombudspersons for Children and Unicef, showed that Swedish children fared better than children in other countries during the pandemic, both in terms of education and mental health.
The Lancet Child & Adolescent Health: Effective testing and contact tracing is essential for schools to safely open during COVID-19 pandemic, two studies show. The Lancet; August 3, 2020. https://www.eurekalert.org/pub_releases/2020-08/tl-pss080320.php
Real world data from schools where masks were not required or worn demonstrates a remarkably low rate of transmission of SARS-CoV-2. Analysis of COVID-19 case data from 3103 schools and approximately 4600 nurseries in New South Wales demonstrate that schools and nurseries do not pose a high risk for COVID-19 transmission.
Subset analysis found that only 27 children or teachers went to school while they were infectious, with an additional 18 people later becoming infected. Out of 1448 contacts in total, the rate of secondary transmission was found to be 1.2%.
A subset analysis of 7 schools and nurseries that underwent additional investigations including antibody testing, symptom surveys, and extra RT-PCR testing for the virus showed that the transmission rates among children and staff were extremely low:
The researchers noted that this finding suggests that children are less likely to transmit the virus than adults.
While coronavirus is obviously concerning and a very real threat to some people (namely, the elderly and immunocompromised), these data also show that the risk for the rest of the population is extraordinarily low.
As a physician and former medical journal editor, I've carefully read the scientific literature regarding the use of face masks to mitigate viral transmission. I believe the public health experts have community wearing of masks all wrong. Here are a few of the mechanisms by which medical masks can be harmful to their wearers and community wearing of face masks is a very bad idea:
Wearing masks for extended periods increased incidences of headaches and negatively affected work performance.
See Jonathan J.Y. Ong, et al., Headaches Associated With Personal Protective Equipment – A Cross‐Sectional Study Among Frontline Healthcare Workers During COVID‐19, Headache, the Journal of Head and Face Pain (May 2020). https://headachejournal.onlinelibrary.wiley.com/doi/full/10.1111/head.13811
Medical masks lower blood oxygen and raise carbon dioxide such that respiratory rate and depth of breaths are increased.[R]
Wearing a mask for more than a few minutes causes a significant reduction in a person’s blood oxygen level.
Beder, A., U. Büyükkoçak, H. Sabuncuoğlu, Z. A. Keskil, and S. Keskil. 2008. “Preliminary Report on Surgical Mask Induced Deoxygenation during Major Surgery.” Neurocirugia 19 (2): 121–26. DOI: 10.1016/s1130-1473(08)70235-5
Here are two cases of the tragic consequences of forcing children to wear masks: Two Chinese boys drop dead while wearing face masks during physical exercise classes.[R][R]
Two boys from two Chinese cities died of sudden cardiac arrest within a week. The first boy, 15, collapsed after jogging in PE class while wearing a face mask on April 24. The other boy, 14, reportedly died during a running exam while wearing a mask.
Why would healthy boys drop dead while wearing masks and running in gym class?! To answer this question, we must consider how mask induced deoxygenation and increased oxygen demands of heart muscle during exercise could have precipitated heart attacks in otherwise healthy teenagers:
Studies of masked individuals have shown that mask wear decreases arterial oxygen. For example, the effects of surgical masks worn by surgeons in the operating room (an environment in which the oxygen blocking effects of masks are minimized by the high air flow, increased oxygen levels, and cool temperature of the operating suite) during major surgery showed a significant decrease in arterial oxygen.[R]
The lesson here is that medical masks should not be worn during intense exercise. As described above and shown in the study of surgeons wearing surgical masks, medical masks block oxygen intake. Depriving the heart of oxygen while exercising, especially intense exercise, could precipitate an acute heart attack.
Any questions? Wait...there’s more...
Jogger's lung collapses after he ran for 2.5 miles while wearing a face mask [R]
Mr Zhang's left lung was punctured due to high pressure caused by running. The 26-year-old became breathless whiling jogging with a mask on in China. Doctors said his punctured lung was caused by jogging with a face covering. He is now in stable condition after undergoing an operation, the hospital said.
Although the body has robust mechanisms for mitigating transient and minor elevations of CO2 in the air we breathe, these mechanisms can easily be overwhelmed by chronic exposure to significant elevations in CO2, such as occurs with prolonged wearing of a medical mask.
The science clearly demonstrates that face masks cause carbon dioxide rebreathing and hypercapnia [R]
Objective evidence demonstrating how masks increase blood carbon dioxide levels and negatively impact health and function.
Medical masks force the wearer to inspire (re-breathe) air that is a mix of air from the local environment and the respiratory waste products from the mask wearer’s previous exhalations.
Neurosurgeon, Russell Blaylock, MD, raises additional concerns:
“By wearing a mask, the exhaled viruses will not be able to escape and will concentrate in the nasal passages, enter the lungs, olfactory nerves, and travel into the brain.”[R]
Asymptomatic or mild cases of CoVID-19 become more severe when the infected is masked, oxygen lowers, viral load increases from particle re-breathing, and the disease overwhelms the innate immune system.
So, the question we should all be asking is how did the genetic sequence that codes for this serious gain of function that increases the potential for the virus to successfully infiltrate the host find its way into SARS-CoV-2?
That’s the trillion dollar question; it demands a real and honest answer.
See MacIntyre CR, Seale H, Dung TC, et al., A cluster randomised trial of cloth masks compared with medical masks in healthcare workers, BMJ Open 2015; 5: e006577, US National Library of Medicine, National Institutes of Health, doi: 10.1136/bmjopen-2014-006577, April 22, 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420971/pdf/bmjopen-2014-006577.pdf
To fully appreciate the danger of improper wear and handling of face masks, all you have to do is observe how the public is managing them. Take a trip to Walmart or your local school and observe how mask wearers pull masks from their pocket or purse, drop the masks on the floor, cough and sneeze in them, move them below the nose, on their heads, or under their chin. I see it every day. I also see their soiled and stained surgical face masks and know that these people are dangerously reusing a mask that should never be reused.
You don’t need a clinical trial to determine that even when mask-wearers manage to don a fresh, sterile mask properly, keep them on for more than a few minutes at a time, they very quickly contaminate the mask, their environment, and increase their risk of infection as the mask induces them to compulsively touch their faces and their masks.
In other words, masks worn imperfectly are dangerous.
People can infect themselves if they use contaminated hands to adjust a mask or repeatedly take it on or off,” explained WHO Director-General, Dr Tedros Adhanom Ghebreyesus. "I cannot say this clearly enough. Masks alone will not protect you from COVID-19."
Failing to follow strict medical standards for wearing protective equipment and specification of sterilizing and cleaning often leads to “skin and mucous membrane injury, which may cause acute and chronic dermatitis, secondary infection and aggravation of underlying skin diseases.”
The Truth Never Suffers from Honest Examination!