UPDATE March 30: this link sent to me form Dr S just showed up today. Emphasis added. Be sure to read the whole 2-page article (not just the first page).
UPDATE April 7: see this short video at Petapixel: This Old Photo Technique Shows How Masks Help Prevent the Spread of COVID-19. The short video shows how effective a mask against coughing.
Layman translation for the public: the CDC, WHO, etc are in effect INFECTING and KILLING PEOPLE with their idiotic anti-scientific guidelines. I predict that we will see a reversal of the mask guidelines, well after thousands of people have met their demise, needlessly—it’s a statistical certainty.
Huge kudos to this doctor for speaking out. The medical establishment, licensing boards, insurance companies, etc can exert enormous pressures on doctors who do not toe the line on official guidelines—it is far removed from a free market of ideas.
'Stealth Transmission' of COVID-19 Demands Widespread Mask Usage, by Barbara Einav, MD and cardiologist and clinical assistant professor at SUNY Upstate Medical University.
I was concerned to see that most healthcare workers (HCWs) and patients are still roaming the hospital floors and the emergency department without wearing masks. Hospitals are citing guidelines from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) restricting mask use mostly to close encounters with symptomatic individuals or confirmed cases with COVID-19.
I decided to research the evidence and justification behind official prevention guidelines. My findings were rather striking.
It is widely agreed that face masks (even surgical masks and non-fit-tested respirators) are an effective barrier against COVID-19, as its primary mode of transmission is through respiratory droplets. Contrary to common belief, however, respiratory droplets are released not only when sneezing or coughing, but also when talking.
... Still, the CDC strongly discourages mask use in the community or by healthcare workers when not directly exposed to a symptomatic individual. The message from authorities is clear: Among asymptomatic individuals, masks are not effective against the spread of COVID-19. In fact, facing a nationwide shortage of masks, the surgeon general tweeted, "STOP BUYING MASKS!"
To be clear, mask use is one of the most effective physical interventions to prevent the spread of respiratory viruses. A comprehensive Cochrane review examined multiple physical preventive measures (eg, screening at entry ports, isolation, quarantine, social distancing, barriers, personal protection, hand hygiene) and found that masks were the most consistent and comprehensive measure.
... As the weight of evidence shifts toward supporting a major role for asymptomatic transmission, the use of personal facemasks, especially in crowded areas, becomes instrumental in preventing community spread of the virus. We can no longer rely on symptoms or screening to tell us whether mask protection is needed.
... Asymptomatic transmission was also estimated in multiple modeling studies of the outbreak. A study published in the journal Science shows that "nondocumented infections were the infection source for 79% of documented cases." Jeffrey Shaman, the lead author, stated that this "stealth transmission" is flying under the radar and becoming a major driver of the epidemic.
... In the meantime, homemade cloth masks could be used in the community, similar to CDC advice to HCWs "when no facemasks are available." Limited data suggest that cloth masks protect against droplet transmission better than no barrier.
...
The idea that masks or facial coverings don’t limit the spread of disease is absurd. That the WHO and CDC advised going without is criminal negligence.
My original post, below, March 29 2020
Ask yourself why a surgeon wears a surgical mask, even though s/he is not sick.
There are only two realistic and common ways the COVID-19 virus can be transmitted:
- Airborne particles containing virions—infection by inhalation. An N95 or N100 mask addresses that risk for those who have them. This is why health care workers are up in arms about the shortage.
- Contact with contaminated surfaces e.g., hands that pick up virus then go to mouth/nose/etc.
We can safely ignore sex, fecal contamination, etc as extremely unlikely to be more than footnotes in transmission of COVID-19.
My assertion is that coughing and sneezing into open air that other people might inhale is a likely mode of transmission, perhaps even the primary mode (no one knows yet). That includes directly breathing that air as well as the surfaces upon which droplets land.
If that is so, a facial covering should be the #1 means of reducing virus transmission. If that is not true, then why do we need social distancing at all? Surely one cough with thousands of virus-infected tiny droplets spewed out violently en masse is 1000 times more infectious than just breathing air from normal exhalation.
A facial covering will block most all such particles from getting into the air. We all know this and if you need reminding, pick up a napkin and cough into it. Or cough without one onto your kitchen table. Why public health officials don’t 'get' this is baffling. The professionals are getting infected with full protective gear, public health officials are telling the public that masks are useless.
Nationwide Public-Policy Proposal
PURPOSE: stop the dispersal of virions by coughing/sneezing/forceful exhalations, and thus reduce both airborne and surface contamination, and thereby reduce hand-to-face transmission as well.
POLICY
- All people in all spaces frequented by others should wear a facial covering over mouth and nose in order to protect others in the event of coughing or sneezing.
- All people entering any space frequented by others should wear fresh disposable gloves, removing them upon exiting that space and changing them frequently. Hand washing is highly encouraged also, but not a substitute for keeping contamination off hands in the first place.
If such a policy reduces transmission by 50% or even 20%, that’s a HUGE win. Even 5% is a huge win. It’s a certainty that it will have some effect, so why is it not public policy?
Perfect? Of course not. We are talking about reducing the risk, not eliminating it!
Do we need an MD to tell us this makes basic hygienic sense? Don’t be ridiculous—officials are telling us to take the risk without any data at all. Fact is, coughing/sneezing could be the primary mode of transmission and this has not been proven or disproven. Meanwhile, doctors and nurses are up in arms from lack of protective gear, particularly masks.
LIES to the public
From today’s WSJ:
“I got infected even wearing all of my protective equipment,” said Shelley Urquhart, a pulmonary and critical-care nurse practitioner at Norton Audubon Hospital in Louisville, Ky., who tested positive for the virus last week.
The WHO, CDC, surgeon general, etc have ALL promulgated and continue to promulgate the grotesque lie that the public does not need to wear masks. Statistically speaking, the failure to wear masks has surely cost lives and will continue to do so. The intent presumably was to preserve mask supply for health care workers, but the perverse consequences of escalating infections and death are surely the result.
Count me out on ever trusting these organizations again for any advice on personal protection.
Whoever is stupid enough to not understand the concept of “friction” (reducing any problem with retarding mechanisms)—MD or not—is a total moron. Why the FUCK are public health officials LYING to us about masks? You DO NOT fuck around with stuff like this. You DO NOT lie to the public and endanger them based on ZERO data. This thing is deadly and spreading, and these assholes are putting everyone at risk. And that is too-gentle language when people are dying in droves. Assholes who are traitors to humanity.
- The fact is that when someone coughs or sneezes, this is a virion-dispersal mechanism. Imagine yourself within 10 feet of an infected person who coughs in your direction or where the air moves towards you after the cough: what do you think your odds are of being infected? Twice as high? Ten times as high? I’d guess 100 times higher than if that cough had been blocked by a facial covering, thus blocking thousands of tiny wet droplets containing virus.
- No one knows the primary mode of transmission of COVID-19... direct person-to-person, droplets in the air from coughing or just breathing, touching surfaces contaminated (how contaminated?), etc. Yet the “experts” claim that masks are useless for the public. It is highly plausible that a single cough can contaminate at least 1000 cubic feet of air and nearby surfaces. So blocking droplets from a cough should be given very serious thought.
- The public is getting infected by the public and none of the experts can say it’s not through the air via coughing and sneezing (or just breathing). Yet the experts recommend that the public should not wear masks. Where is that hard data showing that masks are useless and unnecessary? Why do doctors and nurses need them?!
- The 6-foot rule is absurd; I have seen my own snot fly 20 feet, and there are often air currents, even indoors, that can quickly move small droplets 20 or 30 feet. Put 10 people in even a moderately large room with any kind of HVAC and pretty soon one cough or sneeze is in the entire room. Within minutes, everyone is breathing in that air. But what if that person had worn a face covering? Most or all of the infectious droplets are still in the fabric of that covering after a cough! Any covering.
- The fact is that when someone touches their face, infectious agents transfer from fingers/hands to nose/mouth/eyes and the fact is that if ANY facial covering is worn, from a surgical mask to a handkerchief to a full N100 mask, the ability to easily touch one’s nose or mouth is STOPPED. This alone makes ANY kind of facial covering worthwhile to avoid self transmission (hands to mouth/nose). Eyes are still a possibility but nothing is perfect.
Reader comments
Eeraj
Q writes:
Saw your notes on COVID-19 / masks. Passing along this link in case you want to share on your site: https://smartairfilters.com/en/blog/best-materials-make-diy-face-mask-virus/
DIGLLOYD: looks plausible. I am sticking with my position that at the least, blocking coughs and sneezes and reducing facial contact by hands is WAY better than no mask at all.
Tor writes:
"Thanks to you, and to your early alerts, my family was able to acquire the small amount of N95 and N100 masks we needed, just in time."
Yes, same message and thank you from me - you were right, and I am glad I trusted your early warning.
DIGLLOYD: in spite of the warning, I was not smart enough to get a supply for my family; we have one or two per person and fortunately can all self isolate and so the masks remain adequate due to little need.
If we all wore masks, there would be less for the doctors and the nurses to do. This in response to people SHOUTING AT ME online for suggesting to my blog folks (7600 or so) that we should all have masks, if only for the sake of not contaminating others. As for me, a surgical mask prevents that (a bit), but I would rather wear a N95 or P100 mask, although they are hard (for me) to breath through.
DIGLLOYD: agreed, but I will say “any facial covering”—if only to block thousands of tiny infectious droplets from entering the nearby air when coughing/sneezing/etc. These droplets that can land directly on faces or hands, or be inhaled, or land on surfaces. You can feel them if someone coughs towards you!
Per K writes:
Regarding face masks, For the public not using a mask is better:
- An efficient face mask requires proper handling (tight, take on/off handling the wrong way can be a disaster) by pro's
- A mask can give you a false security - very dangerous. Looking at people that wear mask many are useless to begin with and people take them on/off al the time.
- There is a huge global demand for masks at the moment
- let's prioritize those who work with the patients and those who take care of our elderly.
- Social distancing IS effective
DIGLLOYD: these views are IMO quite dangerous.
For starters, the first item is not even on topic—my key point in this post is blocking transmission of infectious particles due to coughing. This post was NOT about filtering out 100% of the virus in air breathed in. The point is to drastically reduce infectious particles in the air to begin with!
If I am right about this even to the extent of only a 10% risk reduction, then the public policy of no-mask-use will kill thousands of people. I very much wish to be wrong on this. But the fact is that aerosolizing the virus into droplets when coughing must be assumed to be very dangerous to those nearby (far more than 6 feet / 2 meters), and no expert can refute that with any data whatsoever.
There is no proof or study of any kind supporting the idea that NOT using a mask is as good as using one. And it directly contradicts itself by saying that we should save them for professionals. What would be the point of that if they don’t do anything useful? Mask supply will increase rapidly, and mask sterilization is close at hand as well. So if we see a reversal of public policy once supply is adequate, then the lie should be fully exposed, and we will know that our experts have caused thousands of deaths, needlessly.
Have you ever had anyone cough towards you and felt the droplets on your face? I have, many times—it’s gross. I can feel the droplets landing on my face. But even if you cannot feel them, they are there, and it takes only one near a nostril or mouth and the infection is transmitted. So block those droplets with a facial covering.
I have clearly stated that “any facial covering” is worthwhile in order to protect others by blocking thousands of tiny infectious droplets when coughing/sneezing/etc, droplets that can land directly on faces or hands, or be inhaled, or land on surfaces.
I have used the term “facial covering” in my post above, any facial covering. Because any facial covering blocks thousands of infectious droplets from entering the air space when coughing. It doesn’t matter if a few percent get through. It’s all about risk reduction. Which is what ALL medicine is about—nothing is 100% safe and effective.
If infected persons all wore masks, the risk of transmission to those very same professionals would be lessened. Ditto for transmission to the rest of the public. Therefore, everyone should wear a facial covering whenever in a space used by others, since we don’t know who is infected and it is exponentially increasing.
In no way have I suggested that social distancing should be lessened. Indeed, maintaining and increasing social distancing is implicit in my example of 10 people in a room—it’s dangerous to be near other people who may be infected, and we can count on airborne transmission as a likely culprit. Until science rules that out (highly improbable!) it must be assumed as a key vector.
The one thing I agree on above is that *if* wearing a mask decreases social distancing or similar, then the benefit of a mask will be offset by some unknown amount. But the mask will still block a cough and will still capture some amount of infectious particles. Thus I deem that statement highly speculative and without supporting evidence of any kind. Moreover, there are situations where close proximity cannot be avoided.
Michael R writes:
Definitely in agreement with you Lloyd. During the H1N1 outbreak I purchased a box of 24 n100 masks, it just seemed prudent. They came in handy during the Norcal fires and while doing drywall repairs during a renovation. They are well beyond their expiration date, but appear perfectly good inside their sealed individual packaging.
I felt the guidance against mask usage was patently ridiculous, and hid the real motivation… saving masks for healthcare works given a lack of preparation and supplies.Equipping healthcare workers is obviously a critical priority but arguing there is no utility for the public is completely disingenuous. Every virus micro-droplet blocked at source or at a recipient has a positive outcome value.
I gave three last week to front-line workers at my grocery store… I hope they are wearing them now. As soon as supplies are plentiful again, I’ll be purchasing another supply of the best possible masks for the next wave of COVID-19 or whatever comes next.
We have earthquake kits in CA, masks and their use should be part of everyone’s personal healthcare protection. Thanks for helping puncture this disinformation. Undoubtedly it will be clear the mask prohibition was wrong.
DIGLLOYD: well done!
Reader Staale A writes with a link to OurWorldInData.org, which among other things does a great job of explaining the CFR (Case Fatality Rate) and IFR (Infection Fatality Rate), the latter being a total unknown. It is by far the best discussion I have seen of COVID-19 infection and mortality—excellent analysis and logic.
That page should be required reading for every member of the media, which is wrongly characterizing so many things, including COVID-19. And for those so inclined to read and understand the article, you will acquire a critical skill in understanding just how bad the media is at explaining what is going on.
OurWorldInData.org: What do we know about the risk of dying from COVID-19?
The various graphs are the best I’ve seen in coverage:
OurWorldInData.org graphs by age, country, etc
For those who are still saying “it’s just the flu”: infection rates are escalating (this thing is just getting started) and the Case Fatality Rate (CFR) is so far 12 times higher for all ages. The graph below should make anyone in a higher-risk group concerned enough to take every possible precaution.
COVID-19 Case Fatality Rate as of March 29
Actual fatality rate per infected person (IFR) is guaranteed to be much lower, because no one knows how many are/were actually infected
Excerpts.
The key point is that the “case fatality rate”, the most commonly discussed measure of the risk of dying, is not the answer to the question, for two reasons. One, it relies on the number of confirmed cases, and many cases are not confirmed; and two, it relies on the total number of deaths, and with COVID-19, some people who are sick and will die soon have not yet died. These two facts mean that it is extremely difficult to make accurate estimates of the true risk of death.
...
What we want to know isn’t the case fatality rate: it’s the infection fatality rate
Remember the question we asked at the beginning: if someone is infected with COVID-19, how likely is it that they will die? The answer to that question is captured by the infection fatality rate, or IFR.
However, the total number of cases of COVID-19 is not known. That’s partly because not everyone with COVID-19 is tested..... and despite what some media reports imply, the CFR is not the same as – or, probably, even similar to – the IFR. Next, we’ll discuss why.
...
The case fatality rate isn’t constant: it changes with the context
Sometimes journalists talk about the CFR as if it’s a single, steady number, an unchanging fact about the disease. This is a particularly bad example from the New York Times in the early days of the COVID-19 outbreak. But it’s not a biological constant; instead, it reflects the severity of the disease in a particular context, at a particular time, in a particular population...
...
Importantly, this means that the number of tests carried out affects the CFR – you can only confirm a case by testing a patient. So when we compare the CFR between different countries, the differences do not only reflect rates of mortality, but also differences in the scale of testing efforts.
...
What we do know if that the mortality risk is higher for older populations and those with underlying health conditions such as cardiovascular disease, diabetes and respiratory disease – we look at some preliminary evidence for this in our full coverage of the COVID-19 pandemic here.
COVID-19 Case Fatality Rate as of March 29
Actual fatality rate per infected person (IFR) is guaranteed to be much lower, because no one knows how many are/were actually infected
