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One of the more depressing aspects of the COVID-19 pandemic has been the way that it has revealed just how politicized public health has become, including fights over relatively benign requirements such as wearing a mask in public buildings. The politicization of public health mandates is not new (nothing involving public policy can escape some degree of politics), but what is unprecedented is the level of politicization we are seeing now. Indeed, I first noted this a few years back when it became apparent that school vaccine mandates were becoming increasingly politicized as a result of antivaxxers’ successful messaging to the right wing by portraying school vaccine mandates as government overreach and an assault on “parental rights” and “health freedom”. Indeed, by 2015 and the second Republican Presidential Debate, several GOP candidates were blatantly pandering to the antivaccine movement by expressing support for “parental rights” and support for widely applied “personal belief exemptions” to school vaccine mandates. It wasn’t long before several powerful right wing antivaccine groups, such as Texans for Vaccine Choice and Michigan for Vaccine Choice were wielding considerable influence in Republican Primaries at the local level in some states, which saw a significant number of antivaccine legislators elected and working to block any attempt to eliminate nonmedical exemptions to school vaccine mandates.

I suppose that I shouldn’t be surprised, then (although I am a little bit) that the same politicization has infected the response to COVID-19, in particular, the discussion over whether mandates requiring mask wearing as a strategy to slow the spread of coronavirus. I will also admit that my knowledge of history was a little lacking, as I did not know that during the 1918 influenza pandemic there was resistance to mask wearing and that there was even an Anti-Mask League (also dubbed the “Sanitary Spartacans“) formed in 1919 in San Francisco. History repeats, only more intensely than 100 years ago.

Sadly, facemasks have become yet one more flashpoint, one more symbol, in the culture wars, and it doesn’t help that President Trump himself recently explicitly said that some Americans wear facemasks not as a means of preventing the spread of COVID-19 but rather “to signal disapproval” of him and that so many are portraying wearing masks as somehow unmanly, leading one columnist to lament that it’s “worrisome that, in order for us to survive as a species, spouses and daughters or sons must scour Etsy for Venom-themed masks so that their 52-year-old packaging-engineer husbands and fathers can feel gender-secure when they pop out to Safeway for some milk.” Indeed, over on his own blog, our fearless leader discussed the facemask war that has erupted around the country. Seemingly every day, I come across videos of people ranting and spewing misinformation against masks while they refuse to wear one:

You’ll find ugly (and sometimes racist) memes implying that mask wearing is cowardly:

Or that mask wearing is a sign of emasculation or submission:

Or that mask wearing is about control, not public health:

Mandates to wear masks to slow the spread of COVID-19 have even been likened to the masks that slaves were sometimes forced to wear:

Given that I’ve recently discussed the evidence in favor of wearing facemasks in order to slow the spread of coronavirus and that Steve updated that evidence last week, I’m more interested in looking at the myths that those opposing masks have cited in order to claim that, not only do masks not stop transmission of COVID-19, but that they cause harm. The evidence is now pretty strong and getting stronger that the use of facemasks decreases the risk of transmitting COVID-19, including a recent study suggesting that countries that mandated facemask use early have done better in the pandemic. There will never be a randomized controlled clinical trial of this (indeed, given what we know, it’s likely that such a trial would now be ethical, given the lack of clinical equipoise), but observational evidence has become more convincing. And, yes, it is true that public health officials shot themselves in the foot, messaging-wise, with mixed messages, starting out discouraging facemask use, only to do an about-face and support the use of masks. Indeed, as I discussed last time, anti-mask advocates recently weaponized the World Health Organization’s initial recommendation not to wear a mask unless you’re sick or around sick people. I’ll discuss some of these problems at the end, as well as a rather unexpected advocate of masks who’s made his presence known.

Myth #1: The Americans with Disabilities Act says you don’t have to wear a mask

You might have noticed that the woman ranting in Trader Joes in the first Tweet above claims that she has a “medical condition” that makes it impossible for her to wear a facemask. This is a common claim, so common that you might have seen this card that mask refusers have been spreading around social media and that some of them have been using to try to trick shop and restaurant owners into believing that they have a legitimate medical condition that precludes mask use. (Of course, I couldn’t help but note that the Trader Joe’s woman didn’t have any noticeable respiratory issues, given how loud and long she could yell.)

Here is the card:

Mask exemption

Superficially it appears official, but in reality it’s the sort of thing anyone with a color printer and a laminating machine could produce. Moreover, the “Freedom to Breath Agency” is most definitely not a government agency. As this news story notes:

The card looks semi-legitimate, especially if the person showing the card has a laminating machine – but it’s absolutely unofficial an unenforceable in any legal capacity. As noted by the Department of Justice, the card may include a message suggesting that exemption from face mask rules is allowed because of the Americans with Disabilities Act (ADA) – but it’s all a sham.

It turns out that the person who originated this card is someone named Lenka Koloma, who publishes claims like this about COVID-19:

Virus is created in each and every living organism at any given time. Virus is a way how [sic] your cells cleanse themselves of toxic material that has been absorbed from an external environment. This a wonderful, natural process of your body’s intelligence for self-preserving functions.

Virus is produced when your body is exposed to any unfavorable conditions that create stress on your system. Such stressors are:

1/ Environmental toxins – smoking, alcohol, processed food, industrial chemicals (BPA, PCB, fluoride, parabens, aluminum, lead, mercury and the remaining 80,000+ chemicals in our world)
2/ Medications
3/ Emotional Stress (such as fear of disease and/or death)
4/ Physical Injury
5/ Ionized Radiation
6/ Electromagnetic Radiation ( such as 5G)

Longtime readers will likely find the claim that the body produces viruses in response to various stressors to be a familiar one. It’s the sort of thing that Robert O. Young, a cancer quack and germ theory denialist, used to claim all the time. You might recall that he was finally arrested and convicted after many years of selling snake oil to desperate cancer patients and that he lost a $105 million lawsuit by a woman whose breast cancer progressed under his treatment. Indeed, Young used to like to claim that viruses were “molecular acids“:

The point being that viruses are molecular liquids or gases (venom) that can be created by chemical imbalances in humans, plants and animals (by malnutrition or toxic acidic food and/or drink consumption), also created in humans, plants and animal glands, sometimes used in defense (snake venom) or emergency (overactive adrenals), also can be crystallized in laboratories, rarely, if ever crystallized in vivo, and foolish to call viruses contagious when viruses are nothing more than acidic liquids or gases from biological transformation or rotting matter.

It’s funny how germ theory denialism of this sort permeates so much of alternative medicine. That’s why it’s not surprising that germ theory denial is coupled with denial of the efficacy of masks. In any event, the US Attorney’s Office for the Middle District of North Carolina issued a denial:

The Department of Justice also warned people:

The Department of Justice has been made aware of postings or flyers on the internet regarding the Americans with Disabilities Act (ADA) and the use of face masks due to the COVID-19 pandemic, many of which include the Department of Justice’s seal.

These postings were not issued by the Department and are not endorsed by the Department.

The Department urges the public not to rely on the information contained in these postings and to visit ADA.gov for ADA information issued by the Department.

Nor was the above card the only example of such fraudulent “medical exemption” cards:

This incident goes to show how far anti-mask activists will go to try to misuse and abuse a law for their own purpose. Before I move on to other myths, let me just point out that the ADA does not mean that business owners must allow maskless people into their buildings:

If a person with a disability is not able to wear a face mask, state and local government agencies and private businesses must consider reasonable modifications to a face mask policy so that the person with the disability can participate in, or benefit from, the programs offered or goods and services that are provided. A reasonable modification means changing policies, practices, and procedures, if needed, to provide goods, services, facilities, privileges, advantages, or accommodations to an individual with a disability. The requirement to modify a policy, practice, or procedure does not include individuals without disabilities, as they are not protected under the ADA.

Examples of reasonable modifications to a face mask policy

  • Allow a person to wear a scarf, loose face covering, or full face shield instead of a face mask;
  • Allow customers to order online with curbside pick-up or no contact delivery in a timely manner;
  • Allow customers to order by phone with curb-side pick-up or no contact delivery in a timely manner;
  • Allow a person to wait in a car for an appointment and enter the building when called or texted; or
  • Offer appointments by telephone or video calls.

The same source also notes that there are three conditions when an agency or business does not have to provide a reasonable modification to the facemask policy:

  • Fundamental Alteration: The modification would change the nature of the service, program, activity, goods, services, or facilities. A fundamental alteration is a change to such a degree that the original program, service, or activity is no longer the same.
  • Undue Burden: A state and local government agency or private business is not required to take any action that it can demonstrate would result in an undue financial or administrative burden. An undue burden is a significant difficulty or expense.
  • Direct Threat: The individual with a disability poses a direct threat to the health or safety of others. A direct threat is a significant risk to the health or safety of others that cannot be eliminated by a modification of policies, practices, or procedures, or by the provision of auxiliary aids or services.

During a pandemic, it’s not too hard to see how that last one could apply to those refusing to wear a mask. As for legitimate medical reasons not to wear a mask, contrary to what the anti-mask brigade will claim, the list is quite short:

  • People with severe (not mild) respiratory ailments, such as asthma, chronic obstructive pulmonary disease (COPD), or cystic fibrosis.
  • People with post-traumatic stress disorder, severe anxiety, or claustrophobia, for whom masks can cause severe anxiety or even fear.
  • Some people with autism, who are sensitive to touch and texture and for whom covering the nose and mouth with fabric can cause sensory overload, feelings of panic, and extreme anxiety.
  • Persons who have extreme difficulty putting on and removing a mask without assistance.

That’s really about it, and even many of these people can learn to function with a mask. This brings us to Myth #2.

Myth #2: Masks impair gas exchange, leading to low oxygen levels and/or CO2 retention

I must admit that it came as quite a surprise to me as a surgeon, as someone who’s been wearing medical masks many hours a day since he was in his early 20s, that there were people out there claiming that masks can make one hypoxic (low oxygen levels in the blood) or hypercapnic (high CO2 levels in the blood). If that were the case, I’ve apparently been hypoxic and/or hypercapnic several hours a day for at least a couple of days a week nearly my entire adult life! More recently, surgeons at my institution have been wearing N95 masks in the operating room. These are masks that will stop 95% of bacteria or virus particles; unsurprisingly, their pore sizes are much smaller than standard paper medical masks or cloth masks. I haven’t been hypoxic, and, when this silly myth started making the rounds, I put a pulse oximeter on myself and checked, out of curiosity and for the sake of science. I will admit that I don’t really like wearing an N95 mask to operate with because it doesn’t take long to get hot, it tends to leave red marks on the bridge of my nose and under my chin, and only one pair of my glasses “plays well” with an N95 mask while the my others tend not to fit. Those are, however, a small price to pay for safety.

In any event, if you hang out on social media, it won’t take you long to find memes like this:

There are even videos out there of people using a pulse oximeter (the finger clip that measures the oxygen saturation in your blood using an LED) to measure their oxygen saturation with and without a mask, purportedly showing that their saturation levels drop when they’re wearing a mask. Of course, one can cause one’s saturation level to fall a bit by not breathing as deeply, for instance; so any test where someone knows his oxygen saturation is being monitored is suspect, particularly when it’s clearly been done for propaganda purposes.

Let’s just say that I like this video better, in which a nurse not only measures his oxygen saturation with a pulse oximeter but monitors his end-tidal CO2 level as well while putting on more and more masks. (Spoiler alert: Three masks don’t affect either value.) End-tidal CO2 measures the CO2 content in the breath at the end of exhalation, when the concentration of CO2 is at its highest, and serves as a measure of ventilation (gas exchange), while O2 saturation serves as a measure of adequacy of oxygenation (how much oxygen is dissolved in the blood).

Check it out:

And here’s a doctor demonstrating the same principle, this time with a surgical mask and an N95 mask:

The bottom line: Masks do not lead to CO2 retention or decrease oxygenation of the blood.

Of course, the hilarious thing is that Myth #2 and Myth #3 are often both accepted, even though they are mutually exclusive.

Myth #3: Masks don’t stop viruses because the pore sizes are too small

The silliness of this myth is obvious when you realize that people who claim that masks are impairing gas exchange and oxygenation also claim that masks can’t stop virus particles because they’re so small. I think that the pseudonymous physician Doc Bastard put it best:

Although I like this explanation too:

Or, as Dr. Cohen put it:

So SARS-CoV-2, the coronavirus that causes COVID-19, is a fairly large virus, measuring approximately 120 nm (0.12 micron) in diameter. N95 masks filter out at least 95% of very small (0.3 micron) particles, while surgical facemasks and cloth facemasks obviously filter out only much larger particles. Here’s the thing, though. A mask doesn’t have to filter individual virus particles to be effective because SARS-CoV-2 doesn’t float around free in the air as individual virus particles. It floats in the air in respiratory droplets, and aerosols, whose particles are much larger than individual virus particles. I’ve discussed aerosols and respiratory droplets in great detail before in the context of whether Ebola could be spread by respiratory droplets. The bottom line is that aerosol and droplet particles range from a few microns in diameter to as large as 100 microns, many, many times larger than even the large SARS-CoV-2 virus. Most of these droplets are too heavy to remain suspended in the air and settle, landing on nearby floors and surfaces. These can be stopped by simple facemasks.

Again, evidence is accumulating that wearing facemasks is an effective means of preventing COVID-19 transmission, so none of this should be surprising. Is it perfect? Of course not. No medical intervention is, but being even just 50% effective could save a lot of lives.

Myth #4: Masks concentrate the virus (if you have it) and make you sicker

This is a myth that appears to have been popularized (if not originated) by neurosurgeon turned quack Dr. Russell Blaylock and was prevalent on social media about a month ago. (Sadly, it still hasn’t gone away.) Here’s an example:

And here’s the money quote that’s been showing up all over Twitter and Facebook:

And still is, as of yesterday:

From the article:

There is another danger to wearing these masks on a daily basis, especially if worn for several hours. When a person is infected with a respiratory virus, they will expel some of the virus with each breath. If they are wearing a mask, especially an N95 mask or other tightly fitting mask, they will be constantly rebreathing the viruses, raising the concentration of the virus in the lungs and the nasal passages. We know that people who have the worst reactions to the coronavirus have the highest concentrations of the virus early on. And this leads to the deadly cytokine storm in a selected number.

It gets even more frightening. Newer evidence suggests that in some cases the virus can enter the brain.11,12 In most instances it enters the brain by way of the olfactory nerves (smell nerves), which connect directly with the area of the brain dealing with recent memory and memory consolidation. By wearing a mask, the exhaled viruses will not be able to escape and will concentrate in the nasal passages, enter the olfactory nerves and travel into the brain.13

This is, to put it mildly, nonsense, utter poppycock. There is no evidence that wearing a facemask increases the risk of SARS-CoV-2 entering the brain or that it makes it more likely that you will suffer severe COVID-19 disease if you are infected. For one thing, you’re not going to be rebreathing the virus particles. They’re in respiratory droplets that will lodge in the mask.

As Sarah Stanley, associate professor of infectious diseases and vaccinology at the University of California, Berkeley School of Public Health, notes:

Stanley also noted that when infected with COVID-19, the tissues in the nose already harbor the virus. “Breathing out the virus is not going to appreciably change the amount that is there,” she said in an email. “Therefore, there should be no reason why wearing a mask would increase your chance of infection in the brain.”

Also, it’s Russell Blaylock. He’s antivaccine and there is literally no form of quackery that I haven’t seen associated with him at one time or another. As the Encyclopedia of American Loons puts it:

Russell Blaylock is one of the big legends in the most radical quackery and denialist movements, and one of the most influential peddlers of, shall we say, nonconformistic medical advice in the US (indeed, you can hardly enter any quack-related or denialist discussion, regardless of the particular topic, without encountering a reference to Blaylock – he is absolutely everywhere). Blaylock is a trained neurosurgeon, though he has retired as such in order to, instead, take up his roles as a perceived expert on nutrition and toxins in food, teeth, and vaccines. He claims that vaccines (in particular the H1N1 vaccine) are dangerous, that dental amalgams and fluoridated water are harmful to our health; and that aluminum cookware, aspartame (also here) and MSG are toxic substances causing brain damage. It is probably unnecessary to point out that science, research, and reality fail to agree with him on these points.

Basically, Dr. Blaylock was putting the “q” in “quack” long before I took an interest in refuting medical misinformation.

Quackfight

Those are the main myths about how facemasks supposedly cause harm; others exist but are mostly variations on one of the three main themes in Myths #2-4 ± claims that masks don’t work to slow the spread of COVID-19. I wish to conclude, however, with a rather surprising observation I made last week. It actually made my jaw drop. This isn’t a myth, but rather something I would never have expected to come from one of the biggest quacks out there in the form of a headline I saw on Friday, FACT CHECK: Natural News remains the most outspoken pro-mask independent news publisher, even as InfoWars and others have become strongly anti-mask:

With all the misinformation and lies from mainstream media circulating around, it’s worth pointing out that Natural News remains nearly the only pro-mask independent news publisher in existence, where most of the other indy media publishers (at least those who are right-leaning) have become “anti-mask” in their editorial coverage.

The dishonest mainstream media, of course, lies about all this and claims that both myself and Natural News are telling people that masks don’t work. Quite the opposite is true. No independent media publisher has been more strongly pro-mask than Natural News, even when that position has gone against most of the indy media.

And:

InfoWars is not only 100% anti-mask, they have been claiming since March — when I parted ways with them — that the coronavirus is a “hoax” and that all the deaths were being faked. The Gateway Pundit and other conservative indy media outlets have long claimed the coronavirus was “no worse than the flu,” and they tend to run stories that claim masks are bad or that masks don’t work.

I think that both InfoWars and The Gateway Pundit are wrong in their conclusions about masks. While I disagree with their assessment on masks and the severity of the virus, I strongly defend their right to speak, by the way. I’m not contributing to InfoWars any longer, and Alex and I strongly disagree on this topic of masks, but his voice is still very important, especially given the extreme assaults against humanity and human freedom that are now under way by the left-wing media, rioters and communist sympathizers.

This podcast is rather revealing:

Here’s part of Adams’ rationale:

So the rest of the world is now looking at American and saying: What’s wrong with these Americans? They won’t wear masks! And they think that it’s a statement of freedom, of rebellion or something, to not wear a mask. Well, I’m here to try to help correct everyone on that. The way to defeat globalists who released this thing is to wear a mask and defeat it. By stopping the spread, stopping the epidemic, you are defeating the globalists, and the way to stop the spread is to wear a mask. In fact, wearing a mask is a sign of resistance to globalism! That’s what people need to understand. Not wearing a mask means you are an obedient sheeple slave to the globalists, because you will likely get infected and then you will be part of the coronavirus death count or hospitalization crowd or you’re going to be microchipped and have your antibodies tested and all that. If you don’t wear a mask, then you’re going to be treated like a slave.

Wearing a mask helps preserve your freedom because it stops the spread—or it helps stop the spread…it doesn’t stop it entirely. But along with other things that I’ve also promoted here, such as zinc and vitamin D3 and, you know, testing asymptomatic carriers and things like that, we can stop the spread of this. We can stop it long before there’s a vaccine available. That’s the other point. Not wearing a mask means that you support vaccines, because if you don’t wear a mask vaccines are the only way we’re going to get it stopped, and that’s only if the vaccine even works, which is highly unlikely. But if you don’t wear a mask you are continuing the spread of this and making the case of the vaccine industry that says a vaccine is the only thing that’s going to stop this. So the way to beat the vaccine industry is to stop this pandemic before a vaccine is available, so that on the day they finally have a vaccine available nobody needs it because we’ve already beat it.

That’s why wearing a mask is the true act of resistance or rebellion or freedom or liberty or patriotism, whatever you want to call it. Wearing a mask is how you preserve your freedom and stop this pandemic. So for those people out there saying, “Well I’m not wearing a mask, I’m a free American,” OK, be free—in your grave! Because you’re going to be dead. How free are you when you’re dead? Not that free! You’re locked in a little coffin box. That’s pretty small. If you thought locking down yourself in your apartment or house was bad, wait till you’re locked down in a coffin, dead, because you refused to wear a mask. It just makes no sense. Everybody should wear a mask.

You know, if Adams wants to beat the globalists by getting people to wear masks, this one time I say to him: “Knock yourself out!” (At least as long as people are wearing masks.) And how bad do InfoWars and Gateway Pundit have to be to have an arch-quack like Mike Adams lecture them thusly:

InfoWars has gone so deep into the anti-mask slant on all this that they now run scary-sounding anti-mask headlines like this: “SadoMASKism – The love of fear and pain.” You have to chuckle at the word play.

The conclusion among InfoWars hosts like David Knight and Alex Jones is that masks kill people and deprive the body of oxygen. Such claims have no basis in medical reality, but they make for very entertaining coverage.

Says the man who’s been producing cartoons, videos, and songs promoting quackery and antivaccine views for at least 15 years. Don’t worry, though. Although Adams has flipped the usual conspiracy theories about COVID-19 to justify wearing a mask as a sign of rebellion against the “globalists” who (in his mind) started the pandemic, he’s still the same old Mike Adams:

Finally, we wonder why the mask-pushing hysteria of the corporate-run media completely ignores the role of nutrition (zinc, vitamin D, vitamin C, elderberry, etc.) Because the bigger truth in all this is that the mainstream media is anti-nutrition. And that’s far more dangerous than being anti-mask.

So if you’re looking for news publishers to blame in all this, blame the lying left-wing media for blacklisting any mention of nutrition, for attacking hydroxychloroquine and for pushing weaponized lockdowns and vaccine mandates that will probably end up killing more people than the pandemic itself.

Of course, when it comes to Mike Adams, it’s also always about the grift. I notice that he sells something called the “Bioscarf” on his website for $44.99 apiece, which, according to the blurb, has “been lab-verified at one of the FDA’s premier testing facilities to filter out an average of 99.75% of all airborne particulates size 0.1 microns and larger.” He also sells something called the ReadiMask, a disposable mask with eye shield costing $11.99 apiece(!):

I note that you can get exactly the same mask from the manufacturer for $8.99, because of course you can.

Myths never die

Sadly, as I’ve described before, the COVID-19 pandemic has been a magnet for medical conspiracy theories, and, part and parcel with those conspiracy theories, are myths about coronavirus and any recommended public health interventions. Unfortunately, the misinformation and disinformation tend to flow faster than medical authorities can keep up with it. I’m guessing that the myths about masks will continue and will mutate, taking forms that even I can’t predict, but I also predict that the myths I discussed above will never go away. Why should they? Antivaccine myths always keep popping back up, no matter how often they’re refuted, and COVID-19 myths won’t be any different.

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Posted by David Gorski

Dr. Gorski's full information can be found here, along with information for patients. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here.