For the fourth day of mask mess, we got these:

Matuschek et al.

Face masks: benefits and risks during the COVID-19 crisis. Eur J Med Res. 2020 Aug 12;25(1):32.

Received on May 18, 2020, this study finds “only weak evidence for wearing a face mask as an efficient hygienic tool to prevent the spread of a viral infection.” Matuschek et al. do find “relevant protection” from the use of medical masks “during close contact scenarios by limiting pathogen-containing aerosol and liquid droplet dissemination.”

“Masks for everyday use (temporary masks made from fabric, etc.),” they find, “grant no protection for the user,” and what “limited self-protection for its wearer” a simple mask offers is only when the mask is “worn properly.” Matuschek et al. consider it “safe to assume there is a small risk reduction for droplet transmission” from everyday cloth masks such that they are “commonly recommended for walking, shopping, or using public transportation.” They acknowledge “there is no reliable data concerning the amount of virus particles that can be spread by an asymptomatic person, when keeping at a minimum safe distance.”

Matuschek et al. find greater protection from surgical masks, filtering face pieces (masks used for work among non-toxic dust), and N95 respirators. But those masks also included a greater risk of airflow obstruction or feeling of strained breathing, “especially during physical exertion.” Matuschek et al. write that “Depending on the design, masks can increase the lung’s dead space. In extreme cases, carbon dioxide retention (hypercapnia) can occur with side effects.” They note that “Only few investigations are available and addressing this medical problem.”

Matuschek et al. echo the World Health Organization in warning against improper use of masks, by which their protective effect could be “severely reduced”:

Improper donning or doffing, insufficient maintenance, long or repeated use of disposable masks, no dry cleaning of fabric masks, or using masks made of non-protective material.

Going further, they stress that the “mask must fit airtight to the skin” and that taking off the mask must be done carefully since that “the outside of the mask should not be touched.” Furthermore, “Breathing dampens the mask” and with “excessive moisture, the masks become airtight,” causing air to flow unfiltered along the edges, “losing the protective effect to both the wearer and the environment.” Not exchanging or washing masks regularly means “pathogens can accumulate in the mask,” not just COVID-19 — and that the risk of spreading those pathogens “might be critically increased.”

Does this study support Cooper’s extreme exercise of power?

No.

Findings of “only weak evidence” of “limited” to “no protection” cannot be enough for extreme emergency orders.

Furthermore, Matuschek et al. specifically caution against some aspects of mask-wearing inherent in the extents of Cooper’s order. For example, Cooper’s requirement that restaurants, etc. “have all Guests wear Face Coverings (including at their table) when they are not actively drinking or eating” would necessarily require the very kind of improper donning and doffing and touching of masks leading to pathogenic accumulation they warn against. Cooper’s requirement that people at gyms, fitness centers, etc. wear masks even while “strenuously exercising” would also lead to excessive moisture dampening the masks losing their protective effect and leading to pathogenic accumulation. Cooper’s orders affecting workplaces all across the state also would tend to workers’ “long or repeated use” of masks.

Stutt et al.

A modelling framework to assess the likely effectiveness of facemasks in combination with ‘lock-down’ in managing the COVID-19 pandemic. Proc. R. Soc.

Received on April 30, 2020, this study relies on mathematical modeling to estimate the “likely effectiveness of facemasks,” which include homemade masks. Rather than provide another “complex” model that “encounter challenges of analysis and interpretation in all but the most expert hands,” Stutt et al. offer “a simple modeling framework to examine the probable effectiveness of facemask wearing in combination with lock-down periods on the dynamics of COVID-19 epidemics.” They propose that their work “provides an objective and logical approach to examining the key question of whether, or not, the public should be advised to wear facemasks in the current COVID-19 pandemic.”

These models make numerous simplifying assumptions and rely on numerous variables given values “arbitrarily defined” or “arbitrarily set in the absence of detailed data.” Stutt et al. assume multiple lockdown periods will be necessary along with mask wearing on an “18-month time scale.” A key assumption in their model is 100 percent probability of infection without wearing a mask.

Stutt et al. cite Hong Kong as a superior example of mask wearing. On the other hand, they say, a “human factor that may reduce facemask adoption in the West is cultural, because the use of facemasks is not common in public, and there is an implication that the facemask wearer considers others as a threat.” They write that “it is necessary to change this view” in the West,

which could be achieved if the message is conveyed by a facemask was “my facemask protects you, your facemask protects me.” Indeed, it is probable that making facemasks into fashion items may be another route to changing the culture surrounding facemask use in public. A further positive effect from this cultural changewould be to reinforce the message that it is necessary to keep to a safe distance from one another. This educational message could be conveyed easily by the government and the popular press.

Does this study support Cooper’s extreme exercise of power?

No.

Results from a simplified mathematical model with “arbitrarily set” and “arbitrarily defined” variables cannot be the basis for extreme emergency orders. Nor can questionable assumptions built into the model.

Furthermore, this model’s assumption of four-plus lockdown orders in conjunction with mask-wearing over 18 months is simply untenable for an extreme emergency order and counter to other research put forward by the Cooper administration (see Gandhi et al., Brainard et al., Chu et al., MacIntyre et al., and Matuschek et al. above).

Changing the culture is no business of extreme emergency orders. It is clear from the Cooper administration’s messaging, however, that they have adopted this study’s perspective about messaging (“my facemask protects you, your facemask protects me”) in order to change the culture.

Click for more of the Twelve Days of Mask Mess series.