"It would be nice if there was better data regarding masks. Honesty and open discussion is always the best.Masks reduce droplet and aerosol transmission. No discussion or controversy about that. Droplets and aerosols are the principal mode of transmission. Masks also remind people that there is a problem and times are not normal to take precautions."
So, the point is that masks have been studied with influenza and NOT worked.
Surgical masks do not reduce aerosolized particles, even if the exhaled breath goes through them, since the pores are too large.
N95 masks are designed to catch and block aerosolized particles. Surgical masks were not designed for this purpose. They were designed to catch a surgeon's spit or sneeze, hence the name.
Most people don't even breath through a surgical mask.
The vast majority of the exhaled breath goes around a surgical mask and, therefore, re-directs the droplets or fomites, but does not reduce them.
Regardless, clinical data are the most important thing, by far.
And the clinical data that do exist do not support the use of surgical masks to prevent the spread of respiratory viruses.
As mentioned in the post, the fact that putting on surgical mask after your household member developed symptoms didn't protect you means that masks don't work.
That's pretty damning evidence and that is with this virus during this pandemic.
Yes, people can spread before symptoms develop, but they have the highest viral load in the first few days of symptomatic illness and are most contagious during this period.
"Masks are part of the solution not the entire solution. There has been no demonstrated risk to using masks (unlike hydroxychloroquine)."
First, no one has studied the safety of surgical masks in the community.
How many car accidents have occurred because someone was distracted by mask-related activities?
Similarly, how many headaches or other symptoms have developed?
How many people have had anxiety attacks from the claustrophobia caused by wearing a surgical mask?
How many acts of violence have occurred because one stranger told another to put on a mask?
Just because it hasn't been studied, doesn't mean it's a safe practice.
Every intervention causes some issue or problem.
The law of unintended consequences guarantees that.
By the way, the HCQ prophylaxis study from India proves HCQ prevents Covid-19.
The study has controls, was on pre-exposure prophylaxis and tested people in this study. The study by David Boulware in NEJM tested very few subjects and was post-exposure prophylaxis, meaning after a HCW was exposed to someone with possible Covid-19.
In this study on Indian HCWs, the HCQ protection was only seen after 5 doses. This makes a lot sense. The researchers used a very small weekly dose of HCQ, but, since HCQ's 1/2 life is very long, the HCQ level built up with each successive dose. So, these data fit and say you need to take about 2,800 mg of HCQ before you seen an effect.
This isn't a lot of HCQ by the way.
Lupus pts take 400 mg or more per day for life.
HCQ levels increase each day for over 7 months, until steady state is finally reached.
In other words, lupus pts have much higher levels of HCQ than the Indian HCWs in this study.
I don't know how anyone argues with these data.
The US press hasn't argued or criticized them, they have simply ignored them.
"There has been no demonstrated risk to using masks (unlike hydroxychloroquine)."
What risk has HCQ been demonstrated to cause? I have treated over 200 Covid-19 pts with HCQ. I know of no AE's (adverse effects) in these pts. Two pts stayed on HCQ after they recovered from Covid, because it helped their arthritis, an unintended consequence for sure.
The US press, some of it at least, has simply lied about HCQ's safety profile.
If you don't believe me, go to www.ClinicalTrials.Gov and search for all of the FDA approved HCQ trials. The FDA has approved several hundred studies of HCQ over the decades. More recently, they have approved 120 HCQ studies on things other than Covid-19 and 59 Covid-19, HCQ studies. All of the non-Covid-19 HCQ studies use more cumulative HCQ than any Covid-19 pt gets. None of the studies require monitoring of ECGs.
What is the demonstrated risk of HCQ?
Why hasn't the FDA immediately halted the 179 HCQ studies to evaluate safety?
Why hasn't the FDA demanded that each of these 179 studies include ECG monitoring?
So, let's debate, openly and honestly.
Stephen M. Smith, M.D.
Thank you for your response to my post!
I am glad you feel the report regarding family members is not useful. I agree and brought it up only I response to your claiming that it contained “damming evidence” in your post of Sept 3 “Masks - Covid-19 - HCQ - Let's Debate”.
Regarding references 1 and 2. I agree, they are merely reporting regarding the flu. They were cited because in my post as I noted the decrease in reported flu cases in the Southern Hemisphere. Some of your readers may not have been aware of that info so I cited it. My discussion pointed out that the decrease is felt to be due to a combination of factors implemented after COVID became an issue; distancing, hand washing, masks. Commentary in references 1,2,3 supported my point, and is why they were referenced.
Your story about how the flu decreased in NJ is interesting. Perhaps it should be investigated further and offered as more evidence to show masks don’t work. My point was that masks are a low or no risk standard infection control method. Trying to tease out the incremental benefits of the various components is important, but dismissing one of the major components of population health efforts in the midst of a pandemic is, in my opinion, not helpful.
Reference 4 was a commentary by the author of the original study, there are numerous references contained in it regarding importance of inoculum and how masks reduce inoculum. Reference 5 is indeed a lay article that discusses the original study. I included it because it contains interviews with other experts, supporting the statements that masks and reducing inoculum are both important.
We agree that there is no great study saying masks work. My contention is that even when they do not “catch” the virus, they disperse and diffuse it, thereby reducing the inoculum. Up until your reply to my post, I thought that was a pretty standard goal of treating infectious disease (several citations in #4).
If you have information that size of inoculum is not important please let us know.
Finally, I may have missed it, but I’m wondering if you support the CDC recommendations regarding masks?:
“CDC recommends that people wear masks in public settings and when around people who don’t live in your household, especially when other social distancing measures are difficult to maintain.”
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html#evidence-effectiveness
"Dr Steve question, your studies seems to discuss the aquireing of a virus but i don't see anything about the transmission of the virus. I understand in a closed environment of long periods of time and activities that concentration levels and opportunities are more prevalent. I thought mask wearing in public was to protect not mask wearer but others. I thought that in a open environment or larger enclosed environment without the long hours of virus infested air that mask wearing will help the projection of the virus to others? I feel your study is misleading that mask wearing is not useful? I would think even at 5% effectiveness that could be 100 000 lives or 300,000 less infections? Let's be clear only time i wear a mask is around the dog walking crew."
Well, the CDC is unclear on what they think about surgical mask protection from Covid-19 as they cite stories about both using masks to reduce transmission to and from a person.
There are no data on putting masks on Covid+ people. There is the story about the hair stylists in Missouri who wore masks and were infected. But two things, just an anecdotal story, and, second, everyone in salon wore masks.
As for protecting others, in lieu of clinical data, I point out that most exhaled air or breath goes around the surgical mask and not through it. Obviously, when you exhale, the air goes the path of least resistance. So, unless you tape your mask to your face, most of your exhaled air goes around the mask. As stated before, this just means that the droplets are re-routed, not filtered out. And as stated, airborne particles are too small and even if the air or breath goes through the surgical mask, aerosolized particles are not filtered out. Hence, N95 masks were developed for that purpose.
And please remember the name, they are called surgical masks for a reason, because Hawk-Eye and Trapper John wore similar masks to protect their pts from getting saliva or mucous into the open wounds.
Finally, if you want to wear masks, go ahead, but don't fool yourself into thinking that surgical masks confer significant protection. And that's one of the dangers of doing things rotely. But in any case, the idea is or, at least, was that the surgical masks be thrown out because they would be covered with infectious droplets.