The Mask Bully is back, here to instill fear in the hearts of the general public share information demonstrating that masks are not harmful to most people.
As I mentioned in my post from this morning, we can see the benefits of wearing a mask. The question is if those benefits outweigh the risks.
One of the women in the thread claimed there was plenty of reputable evidence for the lack of efficacy of masks and that they are harmful.
There are plenty of peer-reviewed studies pre rona showing masks don’t work, but do make things worse however one now has to dig to find them.
I tried to find peer-reviewed articles on this subject. I also looked at what other experts have said that may make people question the safety of masks, and even looked into some more questionable claims.
We can see the benefits of wearing a mask. The question is if those benefits outweigh the risks. Click To TweetMask-wearing is safe for the vast majority of people when the masks are worn correctly.
There are, of course, people who have legitimate medical reasons for not wearing one. For example, children under the age of 2 and people who cannot remove a mask without assistance shouldn’t wear one. People with breathing difficulties should consult their doctor. People who have sensory issues or severe anxiety or PTSD related to masks should speak to their medical providers who may be able to recommend another solution.
Those exceptions should not prevent the vast majority of the population who can mask (with very limited risk to their own health) from doing so.
General Overview of Mask Safety
Friendly Neighbor Epidemiologist wrote two excellent posts with loads of resources about masks not being harmful.
The BBC ranges from center to a little left-leaning, so you may want to confirm the information they report if you prefer right-leaning sources, but their reality check on masks is really good (and the information is consistent with other sources I’ve read).
Reuters also has a great fact check post.
Stanford Medicine wrote a piece that addressed the question of “how do you respond to people who feel that wearing a mask can be harmful?” and other common questions about masks.
A Toronto physician and medical researcher fact-checked several claims via CTV News.
CNET has an article about eight myths related to masks.
One of the women commenting in the Facebook thread was particularly concerned about the potential harm to her children from wearing masks. Dr. Kimberly M. Dickinson and Dr. Theresa W. Guilbert wrote a helpful FAQ.
Frequent Claims
The biggest concern I see people express regarding mask use is breathing difficulties due to lack of oxygen and/or too much carbon dioxide. For healthy individuals, this is not a problem.
It may feel like it is harder to breathe, but both oxygen and carbon dioxide levels stay in safe ranges while wearing masks.
Keep in mind that a number of these studies monitor masks like N95 and surgical masks which are not recommended for general public use. If these problems are not observed with those masks, it is even less likely to be a problem for those wearing cloth masks. 1, 2, 3, 4, 5, 6, 7, 8, 9
There is no evidence supporting the claim that masks harm the immune system. 1
Some sources suggest that cloth masks may increase risk of infection, but they might be related to how the masks are used, and results may or may not be applicable to the general public.. 1, 2
It may feel like it is harder to breathe, but both oxygen and carbon dioxide levels stay in safe ranges while wearing masks. Click To TweetOther Evidence-Based Concerns
Skin reactions (redness, indentation, itch, pain, burning, acne, pore-volume, etc.) may occur. 1, 2, 3
Mask fatigue may occur, but there are ways to prevent it. 1
Prolonged mask-wearing by healthcare workers might cause headaches. The studies did not exclude other factors that could contribute to headaches (sleep deprivation, stress, poor nutrition, etc.). 1, 2
There are studies showing some potential adverse effects from N95s and surgical masks in health care workers. 1, 2, 3 (focused specifically on pregnant healthcare workers), 4
Improper Mask Use Concerns
There are some legitimate, evidence-based concerns about wearing masks comes from improper use of masks rather than dangers from the masks themselves.
The Conversation posted this article with a few links, but it seems that the concerns were more along the lines of possibilities based on other evidence-based situations rather than warnings based on currently available data.
Of course, these things are still worth considering, but we’d need to see more data on these scenarios in the context of the pandemic.
Precautionary Principle
The BMJ, a highly-respected medical journal, published an article in April 2020. They said “This raises an ethical question: should policy makers apply the precautionary principle now and encourage people to wear face masks on the grounds that we have little to lose and potentially something to gain from this measure? We believe they should.” However, there were some responses that differ in the conclusion. Though these are not journal articles themselves, they do come from people with strong credentials and most include sources.
It’s worth noting that most responses encouraged the use of masks. Even most of the criticisms (which I mention below) recognized some benefit to mask-wearing.
It’s also important to remember that most of the responses came shortly after the article was first published (last spring) so we have a lot more data to fill gaps where commenters were formerly concerned about the lack of evidence.
Sheung-Tak Cheng said “Recommendations should take into consideration people’s actual behavior in everyday life and compliance with good practice, even if wearing mask itself works.” They also brought up mask fatigue. The conclusions in both responses still encouraged mask-wearing.
Kerry Wilbur expressed concern about how masks can obscure non-verbal cues to health care professionals, but argued that it was important to enhance training (rather than stop masking).
Philippe Courtet shared concerns about how masks could impact psychiatric care, but ultimately proposed some adjustments.
Miguel Á Royo-Bordonada believed that the original article took the precautionary principle too far, focusing specifically on outdoor situations in Spain. He still acknowledged some benefit to wearing mask.
Vasiliy Vlassov said “It is necessary to add more caution to the application of the precautionary principle in the case of face masks…The costs of the face masks is not dangerous, but other dangers are possible.” They didn’t expand much on where the line was.
Lingzhong Meng described cultural considerations for mask-wearing, but still encouraged the use.
Dominic Cochran said “wearing masks has the potential to increase the transmission of infection,” but offers no explanation for the mechanism of spread this way, nor does he provide any sources to substantiate his claim.
Frances M King argued that the social factors outweighed the unknown benefits of mask-wearing. However, the response was based mostly on anecdotes. Though it certainly is still valuable to consider, they do not include evidence beyond that to support their stance. Additionally, much more data on the benefits of wearing masks has been released.
James A Morris called for additional research on bacterial flora in those wearing masks.
Graham P. Martin disagreed with the original article, but now (almost one year later) there is data to address several of his concerns where data was previously lacking.
Antonio I Lazzarino disagreed with the article citing several concerns. Some were related to improper wearing of masks. He brings up concerns for people who have pre-existing breathing difficulties and possible increased viral load to infected individuals. However, it seems that his concern lies with the recommendation for the widespread use of surgical masks.
Giles Morgan said “At the moment there is little evidence based medicine to support the use of face masks by the general public as a protection against Coronavirus. Until there is more substantial evidence to support the use of face masks, or not, that is all we can reasonably say. So, why not just say it?”, but there is now much more evidence than at his time of writing (April 17, 2020).
Nick Flatt’s 4/16/2020 response starts with what borders on a strawman argument against the authors of the original article. He goes on to describe lack of understanding about the severity of COVID (we now have data on the severity) and social concerns (no sources listed). He makes other harsh assumptions about supporters of wearing masks.
Syed S M Raza’s criticisms focused on lack of understanding of efficacy (for which we now have data) and a shortage for healthcare workers.
Ian B Johnston’s criticism was primarily focused on how the use of masks could encourage more risk-taking and if it was done at the expense of other mitigation efforts.
John D Shaw’s response was more questions than criticisms, but he raised some important considerations
Emilio Polo Ledesma encouraged evaluating “the other side of the coin of the devastating problem that is the CoViD pandemic generating around the world. It has to do with the dynamics of the normal functioning of the human organism.”
Michael R Robling cautioned against health inequalities but still encouraged masking.
Gawril Markov brought up concerns based on Japanese influenza rates but admits there aren’t comparison studies.
Neil Raitt says that “the population is currently struggling to comply with existing evidence based advice. The sensible precautionary principle in the current situation would be to endorse only those policies which are known to be effective.”
Note: you can read a rebuttal from one of the original article’s authors here.
Public Health Officials
Some public health officials said masks were unsafe when worn incorrectly and advised the general public against them. Their statements did not stand the test of time (see my post on developments in science).
Dr. Jenny Harries expressed concerns about facemasks.
What tends to happen is people will have one mask. They won’t wear it all the time, they will take it off when they get home, they will put it down on a surface they haven’t cleaned.
She also cited concerns about improper mask use like touching ones face or not washing hands.
However, the article describing these concerns was written in March 2020. There is additional information available, and they have since released an updated guide to masks.
Former US Surgeon General Dr. Jerome Adams advised against masks in March 2020.
He revised his stance after additional information of the novel coronavirus emerged.
I imagine there are other public health officials who may have shared similar statements during March and April 2020. I think it’s important to consider why they may have advised against masks initially and all the information we now have available one year later.
Social Risks
Black men are already disproportionately profiled by police officers and are viewed as suspicious for performing ordinary tasks. Wearing a mask could put their lives in immediate danger if someone were to unfairly view them as a threat.
The solution to that challenge is well-beyond my understanding, but I would be remiss to not acknowledge that there are some social risks with masks as well.
The New York Times wrote an excellent article on this subject, as did TIME.
Though there a number of evidence-based and peer-reviewed sources that discuss racial profiling in general, I couldn’t find something specific to what role DIY masks play.
Pseudoscience
As I explained to women in the thread, if someone could provide me with reputable information that demonstrated the dangers of wearing a mask, I would change my mind.
Since I couldn’t find anything in the numerous peer-reviewed articles I read (and all the evidence-based articles), I decided to go down the rabbit hole a little more.
There are a number of internet rumors, pseudoscientific claims, and conspiracy theories floating around. They are easily disproven.
Lung Cancer
The one source that was shared with me in that entire Facebook thread was an article on a website called Science.News. I will not be linking to the article because it is absolute trash. The website itself has no credibility, and the contents of the article are almost immediately disproven.
The claim that they made was that using masks long-term “breeds microbes” which “contributed to advanced stage lung cancer.” The title itself is misleading because the content of the article goes on to claim that lung cancer progresses, but people easily misread it thinking it means that mask-wearing causes cancer.
What is particularly sneaky about this article is they use some legitimate science and use quotes from the study. The reality, however, is that the study had nothing to do with masks. Science.News is making unsubstantiated claims and misrepresenting the contents of the study.
I know I’m lacking charity here, but this article is a prime example of fake news. I don’t blame the woman who shared it with me because the website does add enough stuff to make it seem somewhat legitimate and uses a modification of the name of a reputable source of news for scientific subjects.
But the author (Lance D Johnson) and Science.News should be absolutely ashamed of themselves for their lack of integrity.
You can find a fact check on this article which includes quotes from the original study authors here.
Pleurisy
One story being shared is that a healthy 19-year-old grocery store worker developed pleurisy from wearing a mask for eight hours a day.
Other pictures are being shared, cautioning that children can develop pleurisy from consistent mask use.
These claims have been thoroughly debunked. 1, 2, 3
The Key Take-aways
(The following is for educational purposes only. It is not medical advice. Please consult public health officials for the most up-to-date recommendations regarding masks and other NPIs).
- Most people are not at risk when wearing masks if they wear them properly.
- Only using disposable masks once reduces your risk.
- Washing cloth masks between uses reduces your risk.
- Masking is most effective if combined with other protective measures (washing hands, social distancing, cough hygiene, etc.).
- Talk to your doctor if you have a medical condition that makes you think you shouldn’t wear a mask.
