Masks have become an unwelcome staple of American life with no end in sight. Mask recommendations change faster and more frequently than the weather. How did we get here?

In the medical world, particularly in operating rooms, masks protect patients undergoing surgery from bacteria passing from the mouths and noses of surgeons, nurses, and anesthesiologists, to an open surgical wound.

The Rolls Royce of masks is the N95 mask, used by healthcare workers when caring for COVID infected individuals. Assuming the mask is properly fitted and worn, a given for healthcare workers (but much less likely for a shopper in the grocery store), they are generally effective.

I say generally because the COVID virus is about 0.125 microns in size while the N95 mask pores are larger, at 0.3 microns. But the N95 mask is not simply a miniature chain link fence but uses fibers and electrostatic charges to capture viral particles.

Most individuals, however, are wearing loosely fitting cloth masks, cheap surgical masks, or bandanas to cover their face and nose. These masks easily allow breath to escape through or around the mask, as this video from Dr Ted Noel illustrates.

Negative mask consequences range from the annoying, like headaches and bad breath, to the potentially harmful, as in impaired oxygenation and gum disease. Then there are the psychosocial and developmental aspects, especially for children.

As we have never been told to wear masks, or socially distance, during past flu seasons, masks for COVID are a new phenomenon. Is the actual virus that much different from the seasonal flu virus in terms of size or transmissibility such that we need new rules? What have the medical experts said about masks in the past?

Last March, the World Health Organization did not recommend mask use for individuals, “unless they are sick with COVID or caring for someone who is sick.”

"There is no specific evidence to suggest that the wearing of masks by the mass population has any potential benefit. In fact, there's some evidence to suggest the opposite in the misuse of wearing a mask properly or fitting it properly," Dr. Mike Ryan, executive director of the WHO health emergencies program, said at a media briefing in Geneva, Switzerland.

In April 2000 guidance, the WHO was against routine public mask use.

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.

Infectious disease expert Dr Anthony Fauci last March said,

There’s no reason to be walking around with a mask. When you’re in the middle of an outbreak, wearing a mask might make people feel a little bit better and it might even block a droplet, but it’s not providing the perfect protection that people think that it is. And, often, there are unintended consequences — people keep fiddling with the mask and they keep touching their face.

Former Surgeon General Dr Jerome Adams agreed,

"Seriously people- STOP BUYING MASKS!" Adams purportedly tweeted on Feb. 29, 2020.

They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can't get them to care for sick patients, it puts them and our communities at risk!

Yet masks became a staple of life, not only in America, but also in many parts of the world. Was it logical? Did it “follow the science”?

The Danish mask study provided some science to follow via a randomized controlled trial published in the Annals of Internal Medicine. 

The recommendation to wear surgical masks to supplement other public health measures did not reduce the SARS-CoV-2 infection rate among wearers by more than 50% in a community with modest infection rates, some degree of social distancing, and uncommon general mask use.

They did not conclude that there was NO protection, only not a significant degree of protection for the community. Are there any comparable studies demonstrating a significant benefit to mask wearing? Why haven’t those studies been performed to “follow the science”?

Dr Fauci doubled down last month, advocating for two masks, “So if you have a physical covering with one layer, you put another layer on, it just makes common sense that it likely would be more effective.

Then why not 3 or 4 masks, or 10, as each layer adds more protection? Where does such logic turn into absurdity?

YouTube screen grab

He quickly clarified days later, saying about double masking, “There’s no data that indicates that that is going to make a difference,” acknowledging that the CDC will follow the science, “And that’s the reason why the CDC has not changed their recommendation.”

A South Carolina chair of anesthesiology doubled down on Dr Fauci’s initial comments, "If you put three or four masks on, it's going to filter better because it's more layers of cloth."

Is there science to follow on that, or simply the logic of, “If one is good, two must be better”? How does that work out in other areas of medicine, particularly for medications? One Prozac improved my mood so imagine how much better I’ll feel if I take three or four pills instead of just one.

There is another aspect of masks receiving scant attention, concern over the environmental impact of abandoned face masks. If masks are actually capturing COVID virus, are the masks being disposed of as medical waste or simply dropped in the trash or in parking lots?

COVID can persist on inanimate surfaces for up to 9 days, yet infected masks are being discarded anywhere and everywhere like cigarette butts. The UK alone will generate, in one year, mask waste equivalent to over five Eiffel Towers. Add in the rest of the world and it could be an Eiffel Tower of masks every few days.

Masks take 450 years to biodegrade. How many will end up in oceans and landfills, contaminating water and food chains with micro-plastics? Will sea animals become entangled in elastic mask straps as they are with plastic six-pack rings?

Where are the environmentalists? While AOC and the Green New Deal harpies are busy defending frozen windmills in Texas’s cold dark winter last week, they show no concern over the environmental effects of gazillions of discarded masks.

So here we are, not following the science on whether masks provide a clinically significant benefit based on mask type and circumstances of use, how many are necessary, or when multiple masks morph from virtue signaling to suffocation. And ignoring the environmental science as well.

The carbon footprint of a backyard grill is of concern to NPR but not the effects of discarded masks. The so-called experts can’t seem to make up their minds on all of this.

Which raises the age-old question about COVID: Was it ever about the virus?

Brian C Joondeph, MD, is a physician and writer. He is on sabbatical from social media.