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Masks

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“Our lives begin to end the day we become silent about important things!”

Dr. Martin Luther King (1929 – 1968)

We make every effort to provide reputable and neutral source information as far as we are able. Our post on mandatory masks is primarily about medical face masks and community masks.1

Expressis Verbis

Since April 20, 2020, the mouth-nose protection (mask) is mandatory in Luxembourg indoors. The exception were seated customers in a restaurant/café. The regulation of restaurants and cafés differs from the current state of affairs (October 1,2020)

The mask is to protect the people around us, if the distance of 2 meters can not be maintained.

In order to do this, the hygiene regulations for wearing the mask must be strictly adhered to.

The Luxembourg Ministry of Health explains: 2

  • Before putting on the mask, you must wash your hands with soap or disinfect them!
  • The mask must fit in such a way that no opening is visible anywhere!
  • If you touch the mask with your hands, please wash (or disinfect!) them immediately
  • Before removing the mask, please wash or disinfect your hands again!
  • When removing the mask, please touch only the rubber bands and dispose of them immediately in case of everyday masks!
  • Wash fabric masks at 60 degrees!

Now let’s be honest…

Is it really possible for us to comply with these hygiene regulations in our everyday lives?

If you can answer YES to this question, then you have something in common with the surgeons of this world.

They, too, have learned how to use a mask properly during their training.

Dr. Jim Meehan is such a surgeon and has already performed over 10,000! operations with surgical mask!

Since many people think that wearing the mask protects against viruses and wouldn’t be so bad because, after all, surgeons wear them all day long, Dr. Meehan has written a public letter about the issue. 3

Among other things, it states:

“Surgeons and OR staff are well trained, experienced and careful to maintain sterility. We wear only fresh sterile masks. We put on the mask in a sterile manner. We wear the mask for a short period of time and change it at the first sign of excessive moisture accumulation, which we know compromises the effectiveness of the mask and increases its negative effects.”

Dr. Jim Meehan

Unlike the general public, who are known to wear their masks in everyday life, both indoors and outdoors, surgeons work in sterile operating rooms equipped with high-performance air exchange systems that maintain positive pressure, exchange and filter room air at a very high level, and increase the oxygen content of room air.

These conditions limit the negative effects of masks on the surgeon and OR staff.

The so-called Lancet study on social distance and mouth and nose protection (June 2020) 4, on which our government relies for its recommendation, does NOT make it clear whether community masks or commercially available surgical masks (Level 1 masks according to ASTM standard) protect.

In this regard, the following parliamentary question, N° 2981 of October 13, 2020 on the part of Mr. Jeff Engelen MP:

Mr. Minister,

I have the honor to send you in annex the joint answer of the Minister of Family and Integration, the Minister of Labor, Employment and Social Economy and the undersigned to the parliamentary question No. 2981 of October 13, 2020 of Mr. Jeff Engelen, Member of Parliament, concerning the “Wearing of the Mask”.

Please accept, Mr. Minister, the assurance of my highest consideration.

The response from the Luxembourg government was:

“The Luxembourg government does not impose a general mask obligation, but a selective mask obligation when the distance of 2 meters is not respected (e.g. in stores or in public transport). Meanwhile, there is clear scientific evidence that wearing masks and distance rules effectively avoids COVID-19“ (References: Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. D.K Chu et al. Lancet 2020, June27, 395(10242): 1973-87, and Strong impact of closing schools, closing bars and wearing masks during the Covid-19 pandemic: results from a simple and revealing analysis. P. Matzinger & J. Skinner)

It should be noted that the Lancet-study is a Meta-Analyse 5.

This means that only observational studies, non-controlled random studies (randomized studies 6) or comparative studies were used.

However, these are not the best studies. At least one should have done controlled randomized studies.

The study also claims that no randomized studies were found (but a randomized one is presented later)

“We planned to use the Cochrane Risk of Bias tool 2.0 for randomised trials, but our search did not identify any eligible randomised trials.”

Here is a summary:

There is a higher level of protection for hospital staff (70% protection) than for untrained staff (44% protection).

“With stronger associations in health-care settings (RR 0 · 30, 95% CI 0 · 22 to 0 · 41) compared with non-health-care settings (RR 0 · 56, 95% CI 0 · 40 to 0 · 79 )

The provisions of the masks apply to everyone.

The Lancet study also included old studies, including studies on masks related to SARS and MERS.

At the ECDC (European Center for Disease Prevention and Control) you can read the following:

“It should be noted that all relevant evidence comes from studies on influenza and other coronaviruses and may not be directly applicable to Covid-19” 7

So if you only take the studies on Covid-19, you can see the following:

The total number of study participants with Covid-19 amounts to 5.929 people.

The largest study was done in April 2020 in Hubei Province, China; “Epidemiological characteristics of COVID-19 in medical staff members of neurosurgery departments in Hubei province: A multicentre descriptive study” 8

Apparently only 1 out of 1.286 people wearing masks are said to have been infected there. With 4.036 people without a mask, it should have been 119.

But if you look at the original article, the following comes out:

Of the 119 infected individuals, 25 did not have a mask on. 94 of them had a surgical mask on and 1 person had a level 2 mask on.

So about 80% of those infected had surgical masks, 20% did not. One can NOT draw the conclusion that masks help. One can NOT draw the conclusion that masks help. When you get right down to it, you might even advise against wearing masks that are not Level 2 standard or FFP2 masks (see later) at all. And the question arises, who wears the masks in reality as compliant with the rules as in the hospital? Did the author purposely slant these facts? Is the phenomenon of the “virus slinger” at play here, as the German Chancellor put it at the beginning of the pandemic?

The second major study, “Association between 2019-nCoV transmission and N95 respirator use” (March 2020) in the Lancet study consisted of 493 people. The result was that N95 (FFP2) masks helped. It was concluded that because FFP2 AND surgical masks help with influenza, that might well be the case with Covid-19. However, this is not very scientific. 9

That leaves 2 Covid-19 studies with a total of 114 participants, but they are not conclusive, because the number of participants is too small.

Another note in the Lancet study is that policies and regulations of interventions should also be kept under review and based on carefully collected evidence.

The ECDC also points out that there is no complete evidence on the effectiveness of non-medical face masks (community masks) with respect to SARS-Cov2.

“There is no evidence that non-medical face masks or other face coverings are an effective means of respiratory protection for the wearer of the mask. Overall, various non-medical face masks have been shown to have very low filtration efficiency (2-38%).” 10

It can also be read at the WHO that the mask is only seen as an additional measure because it does not provide adequate protection on its own.

“The World Health Organization (WHO) advises the use of masks as part of a comprehensive package of prevention and control measures to limit the spread of SARS-CoV-2, the virus that causes COVID-19. A mask alone, even when it is used correctly, is insufficient to provide adequate protection or source control.” 11

In addition, the WHO also points out, among other things, potential disadvantages of mouth-to-nose coverage, such as headaches and/or breathing problems depending on the type of mask, development of skin lesions or irritation, aggravation of acne with frequent use over time, litter problems when masks are improperly disposed of in public spaces, and difficulties for people with hearing disorders because they rely on lip reading. 12

A randomized controlled trial from Denmark “Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers” 13 (April/ May 2020) shows about 15% effectiveness when measured between 2 groups with mask + distance versus distance only.

Under results you can read there:

“A total of 3030 participants were randomly assigned to the recommendation to wear masks, and 2994 were assigned to control; 4862 completed the study. Infection with SARS-CoV-2 occurred in 42 participants recommended masks (1.8%) and 53 control participants (2.1%).The between-group difference was 0,3 percentage point (95% CI, 􀀀 1.2 to 0.4 percentage point; P= 0.38) (odds ratio, 0.82 [CI, 0.54 to 1.23]; P= 0.33).”

And further:

“Multiple imputation accounting for loss to follow-up yielded similar results. Although the difference observed was not statistically significant, the 95% CIs are compatible with a 46% reduction to a 23% increase in infection.”

It would have been interesting to see how the group would have done with just mask-without distance, because in buses and some stores you can’t keep a 2 meter distance.

Lancet Studie: https://www.expressis-verbis.lu/wp-content/uploads/2020/12/Lancet-gouvernement-masques.pdf

Dänische Studie: https://www.expressis-verbis.lu/wp-content/uploads/2020/12/Masken-daenische-Studie.pdf


References:

1 Community masks are all non-medical mouth and nose covers.

2 https://covid19.public.lu/de/toolbox/masken.html

3 https://www.meehanmd.com/blog/post/173679/an-evidence-based-scientific-analysis-of-why-masks-are-ineffective-unnecessary-and-harmful

4 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142-9/fulltext

5 “A meta-analysis is a summary of primary studies on metadata that works with quantitative and statistical means. It tries to summarize and present earlier research work quantitatively or statistically. The difference to the systematic review article (also called “review”) is that a review critically evaluates the earlier research data and publications, while the meta-analysis only includes the quantitative and statistical processing of the earlier results.https://de.wikipedia.org/wiki/Metaanalyse

6 “The randomized controlled trial (RCT) is proven to be the best study design in medical research in order to obtain a clear statement on a clear question and to prove causality.https://de.wikipedia.org/wiki/Randomisierte_kontrollierte_Studie

7 https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-use-face-masks-community.pdf

8 https://www.medrxiv.org/content/10.1101/2020.04.20.20064899v1

9 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7134426/

10 Using face masks in the community (8. April 2020). https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-use-face-masks-community.pdf

11 + 12 https://www.who.int/publications-detail/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak

13 https://www.acpjournals.org/doi/10.7326/M20-6817

The original language of this article is German. The English and French versions are translations.