If One Mask Doesn’t Work, Try Two, or Three, or Four…

Once upon a time, my primary specialty of anesthesiology was the most scientific of all the medical specialties that actually touch patients. Then I saw that Dr. Scott Segal, chair of Anesthesiology at Wake Forest Baptist Health in Winston-Salem, North Carolina told NBC news that we should consider wearing four -- count ‘em -- four face masks at once. I had thought that the insanity would stop at double masking. Welcome to the new normal. Panic porn has taken over even the medical community that should know better.

Albert Einstein is credited with the maxim that “Doing something a second time and expecting a different result is insanity.” So the first step in “Will more masks help?” is to ask, “Do masks help at all?” Lots of people have done a lot of good work on the mechanics of masks. Jose-Luis Jiminez at the University of Colorado and Linsey Marr at Virginia Tech are two excellent scientists who study the mechanics of the aerosols that transmit COVID-19. Both have demonstrated that masks will markedly reduce droplets. Numerous YouTube videos have also demonstrated that quite dramatically. Masks may even slightly reduce -- not eliminate -- aerosols.

The problem with all this work is that it starts from two primary assumptions. First is the questionable idea that droplets are responsible for spreading the bug. The second is that if we stop droplets, we will necessarily stop the virus. When the epidemic started, we were told to worry about droplets from speaking, singing, and sneezing. But while those can travel many feet, they follow a spitball’s path to the floor, where they cause no further problems. Unless someone sneezes directly in your face from close range as you are inhaling, they can’t get inside your lungs to make you sick.

The mechanistic (fancy word for how something works) answer to the first question is that it is not reasonable to expect masks used by the general public to be useful in preventing disease transmission. But as scientists, we must check out whether this is actually true. RationalGround.com has put together a lot of the data. Notice that Southern California put in a bunch of mask mandates, and the rate of COVID-19 cases skyrocketed. The simplistic answer would be that masks caused infections. A comparison of the fifty states would suggest the same.

Of course, infections went down later without a change in the mask requirements. Any rational scientist would suggest that this means that masks were irrelevant. RationalGround.com has many other charts that make the same point. Put simply, the mechanistic studies examine something that isn’t important in the transmission of COVID-19, because the bug isn’t spread by that way, and stopping droplets won’t matter.

But what about aerosols? These are the smaller particles that can stay suspended in the air for hours and are probably responsible for most infections. We’re all familiar with them.  If you wear a mask and can smell the sample odor, it’s not fitting properly. That’s why I had to be fitted for the alternate N-95 brand at my hospital. Incidentally, there is data that properly fitted and worn N-95s do reduce infections among health-care workers in high-risk environments. But that’s not the issue. We’re asking about the general public.

Some time ago I demonstrated with a vape that aerosols simply evade most masks. Studies suggesting that redirecting them is a benefit forget that sending them sideways only deal with one breath. As you continue to breathe, the aerosol accumulates like the classic smoke-filled room. But even with a 20% reduction in aerosol, the CDC’s “close proximity” allowance of ten minutes only increases to twelve and a half. Perhaps we should invest in stopwatches?

There are studies on both sides of the argument. I find this summary most useful (banned by FB “fact-checkers”).

Of key interest, in one CDC study, 85% of COVID victims report nearly always wearing face masks. One study claiming benefits had to be withdrawn after its conclusions were contradicted by continuing experience. Others have major confounding variables. Mask advocates ignore significant downsides such as reduced personal performance, severe psychosocial consequences, and difficulty breathing. And the Danish Mask Study, a “gold standard” randomized, controlled study, showed no benefit to mask wearing in the general population.

Difficulty breathing is something I didn’t quite appreciate during the thirty-six years I wore a mask on a daily basis in the operating room. After all, masks were a part of life. But I always dropped my mask the moment I left the OR, and almost every other OR staff member did the same. It’s really simple. Masks increase your work of breathing. If you’re wearing a properly fitted N-95, all your air has to come in and out through that filter material. That’s work. And it makes you short of breath.

Do a simple experiment. Fold a bath towel a couple of times and try to breathe through it. Make sure you aren’t breathing around it. The filtration from the fabric creates resistance to air flow. Now do it for several minutes. That’s what breathing through an effective mask feels like. You’ll get short of breath, and as soon as you can, you’ll take it off. What you felt was increased work of breathing. And that’s why the movies often show someone being strangled with a pillow.

Most Americans intuitively recognize that masks don’t reduce infections. But they go along with the virtue signaling to be good citizens. And, to make their own life a bit better, they use a single thickness gaiter over their mouth and nose like a train robber. Or they use a face shield that does nothing at all other than “covering” their mouth and nose without restricting air flow. Often you see them with a mask over their mouth but not their nose. And of course, President Biden doesn’t wear one in the Oval Office.

Returning to Einstein, since a single mask doesn’t help in the general populace, why should anyone think that double masking might help? Or quadruple, as Dr. Segal suggests. Such suggestions fall under the logical designation of “magical thinking.” Or as Albert Einstein is reputed to have said, insanity.

Images: Ted Noel, https://www.nursetogether.com