As Time Goes By …

After wearing, fit testing for, teaching about and working with masks for infectious diseases over about twenty years, last year I had to forget all that I knew about masks because suddenly they were alleged to have completely different functionality than I had spent years understanding. This was according to World Health Organisation and Centers for Disease Control, so who was I to argue, even though they provided zero new evidence to support their rapidly updated recommendations? Whilst other parts of the pandemic story had caused confusion, the mask debacle was really when I became aware that something serious was amiss. When a breakfast television host announced to Australia that we should all be buying and wearing masks, I turned off the television and have avoided mainstream media as much as possible ever since.

In 2014, six years before masks became a political tool, a group of Russian virology researchers published Influenza virus aerosols in the air and their infectiousness. To summarise, 99% of Influenza virus particles are found in the “aerosol fraction”. This means that when someone with Influenza in their respiratory tract exhales, coughs or sneezes, large droplets (bigger than 50 microns) settle on the ground almost immediately; intermediate sized droplets (10-50 microns) settle within several minutes; and (this part is the aerosol fraction), the smallest particles (<10 microns) can remain airborne for hours and are easily inhaled into the deep respiratory tract. Influenza RNA was detected in the exhaled breath of patients, and more than 99% of particles were <5 microns in diameter.

Air exhaled by healthy people may also contain virus particles as viruses and micro-organisms of all types are circulating in our environment, being inhaled and exhaled by us constantly. This interplay between the human body and micro-organisms is an important part of human health, exposing our immune system to challenges, keeping it fit and functional. When we inhale an infectious dose of a potentially harmful organism such as SARS-CoV-2, those of us with some immunity will probably mount a strong response and either not become ill, or be less ill than we otherwise might. Those of us who only inhale tiny doses of infectious particles are also less likely to become unwell as an infectious “loading dose” is more likely to result in sickness, but even harmless exposure helps us to build immunity. This is partly why PCR test results on their own are not useful information, unless performed following strict protocols, as detecting viral genetic material in a respiratory sample says nothing about the health status or infectiousness of the person being tested.

To reiterate, Christian Drosten, who created the SARS-CoV-2 PCR test and is famous for his creation of other PCR tests, and those in the World Health Organisation who announced that we should “test, test, test”, clearly know this information.

The apertures between the threads in masks – without which mask wearers cannot breathe – are bigger than the aerosols constantly floating in our environment. Masks are used in hospital environments for two main purposes. The main use of surgical masks is to prevent contact of heavy droplets (blood and body fluids) between surgeons and patients; or to reduce the droplets released from infectious respiratory patients into their environment. High filtration masks such as N95s are more tightly woven than ordinary surgical masks, or other materials, hence their special purpose, although smaller aerosols can still pass through this fabric. The main use of these masks is for staff or others in close contact with infectious patients to receive some protection from high dose infectious aerosols suspended in the immediate environment of an unwell patient (eg Tuberculosis, Measles, Influenza, Covid-19). They are usually used in conjunction with other measures such as specialised or open air ventilation of the patient’s environment.

Health care staff receive regular training in when, where and how to put on, safely wear, remove and dispose of masks and other personal protective equipment; how to teach their patients these skills; and in the case of high filtration masks, staff are “fit tested” to ensure they are wearing the best fitting mask for their face size and shape. Without an adequate fit they will not serve their purpose. Masks are not considered fully protective and we are always aware, when caring for infectious patients, that there is a risk of exposure. We are also aware that fresh air and specialised ventilation (such as that on commercial aircraft) dilutes infectious aerosols and is always healthier than breathing through a potentially contaminated mask. That masks, as the general public in random settings are now being told to wear them, provide protection against nano-particles, is implausible and certainly not supported by the growing body of evidence.

The below two charts show 1) the pattern of “cases” in the USA as it coincides with reported mask use; and 2) difference in case rates between four states with different mask wearing laws. Cases are not a metric for anything other than PCR positive tests. This data has limited public health use without additional information but we can see that the pattern of viral transmission appears unrelated to mask use. Why are Centers for Disease Control – ostensibly a public health agency – making pronouncements based on PCR testing? They have the expertise to understand this is not useful data, yet they choose to use dishonest language. They also continue to promote mask use and make claims about mask effectiveness in controlling the pandemic. It is difficult to comprehend their motives.

How often in history have “conspiracists” turned out to be speaking truth to power? As time goes by, explanations to mysterious and confusing events begin to reveal themselves.

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