Those Killer Mask Mandates: Health Harms Caused by Government Authoritarianism

In my January 21 article “Those Killer Mask Mandates: How CDC ‘Science’ Follows Policy”, I discussed how the claimed benefits of mandatory mask use by the general public in the community setting never manifested in the data. Moreover, beyond studies finding no effect of masks on COVID‑19-related outcomes, some studies have found mask use to be associated with net harms.

A study published in the Southern Medical Journal in September 2021 assessed the effects of a mask order in Bexar County, Texas, and found that intensive care unit (ICU) utilization and mortality increased after the order went into place.

A study published in Medicine in February 2022 assessed the effect on case fatality rates between groups with and without mask mandates in Kansas and found mandatory mask use to be associated with increased mortality. The author hypothesized that this might be due to retention and re-inhalation of virus particles.

While I wasn’t yet aware of it when I published that article, on January 20, 2023, an updated systematic review and meta-analysis was published in the Cochrane Database of Systematic Reviews that assessed the evidence on “non-pharmaceutical interventions” (NPIs), including mask use, from randomized controlled trials, including six conducted during the COVID‑19 pandemic.

The review found that, compared to not wearing masks, the use of masks in the community setting “probably makes little or no difference” to the outcomes of influenza-like illness (ILI), laboratory-confirmed influenza, COVID‑19-like illness, or laboratory-confirmed SARS‑CoV‑2 infection.

Another study I was unaware of at the time I wrote my earlier article was published in Cureus in April 2022 and examined the correlation between mask compliance and COVID‑19 outcomes in Europe. It found that mask usage was associated with either no effect or increased morbidity and mortality. The correlation between mask usage and increased deaths was statistically significant.

As the author concluded (emphasis added):

The findings presented in this short communication suggest that countries with high levels of mask compliance did not perform better than those with low mask usage in the six-month period that encompassed the second European wave of COVID‑19. . . .

While no cause-effect conclusions could be inferred from this observational analysis, the lack of negative correlations between mask usage and COVID‑19 cases and deaths suggest that the widespread use of masks at a time when an effective intervention was most needed, i.e., during the strong 2020-2021 autumn-winter peak, was not able to reduce COVID‑19 transmission. Moreover, the moderate positive correlation between mask usage and deaths in Western Europe also suggests that the universal use of masks may have had harmful unintended consequences.

A more recently published study provides insights into the findings that mask mandates might result in overall net harms. Published in Frontiers in Public Health on April 5, 2023, it is titled “Physio-metabolic and clinical consequences of wearing face masks—Systematic review with meta-analysis and comprehensive evaluation”.

The review included both observational studies and randomized controlled trials. As the authors reported, “Overall, our systematic review found mask related symptoms that can be classified under the previously described Mask-Induced Exhaustion Syndrome (MIES), with typical changes and symptoms that are often observed in combination.”

Among these symptoms were increased breathing resistance, increased blood carbon dioxide, decreased blood oxygen saturation, increased heart rate, shortness of breath, headache, dizziness, decreased ability to concentrate, and overall perceived fatigue and exhaustion.

The decreased blood oxygen saturation was significant for general mask use. In another analysis distinguishing between N95 and surgical masks, the finding was significant for the former but not the latter.

The increased blood carbon dioxide content was significantly elevated for general mask use, and in the subanalysis, the finding was also significant for both N95 and surgical masks.

The most frequently reported symptom was headache, with a prevalence of 62% for general mask use and up to 70% for N95 masks.

The authors noted that by impeding natural breathing, mask use affects “a wide range of physio-metabolic processes within various organ systems and/or at cellular levels”, with a wide range of possible harmful consequences.

“Restricting breathing through face masks”, the authors remarked, “has turned out to be a fundamental, incisive intervention with possible negative effects on public health.”

In a discussion of the consequences of transient hypoxemia, or deficient oxygenation of the blood, they noted:

Studies have shown that oxidative stress (under hypoxic conditions) can inhibit cell-mediated immune response . . . to fight viral infections, which may gradually lead to immune suppression. . . . This may set the stage for contracting any infection, including SARS‑CoV‑2 and making the consequences of that infection much more severe. In essence, masks may put wearers at an increased risk of infection and severity.

Referencing the study in Cureus, they added, “The findings of Spira from European data show that mask use correlates with increased morbidity and mortality, which could be due to the above-discussed possible processes.”

In a discussion of transient hypercarbia, or an excess of carbon dioxide in the blood, they noted that this condition can result in inflammation, vasoconstriction, vascular damage, and oxidative stress.

Other adverse effects of mask wearing include increased humidity and skin temperature. As the authors explained:

Increased humidity and temperature can increase droplet and aerosol generation, which facilitate liquid penetration through the mask mesh. This not only increases the chance of microorganism (fungal and bacterial pathogens) growth on and in masks causing increased risk for accumulation of fungal and bacterial pathogens including mucormycosis, but also leading to re-breathing of viruses that may be trapped and enriched within the moisturized mask meshwork. Therefore, these conditions within masks are favorable for pathogenic growth and are unfavorable for good/systemic microbiota i.e., individual specific.

Referencing the study in Medicine, the authors added:

The findings of Fögen using data from the USA which shows that mask use correlates with an increased mortality (case fatality rate of COVID‑19) could be due to these processes. This phenomenon could also explain the similar figures found by Spira in the EU.

Another point the authors raise is that many of the symptoms of mask use overlap with symptoms of “Long Covid”, raising the possibility of misdiagnosis:

Regarding the numerous mask symptoms an important question arises: Can masks be responsible for a misinterpreted long-COVID‑19-syndrome after an effectively treated COVID‑19 infection? Nearly 40% of main long-COVID‑19 symptoms overlap with mask related complaints and symptoms described by Kisielinksi as MIES like fatigue, dyspnea, confusion, anxiety, depression, tachycardia, dizziness, and headache, which we also detected in the qualitative and quantitative analysis of face mask effects in our systematic review. It is possible that some symptoms attributed to long-COVID‑19 are predominantly mask-related. Further research on this phenomenon needs to be conducted.

Mask mandates, the authors concluded, are not conducive to the ostensible policy goal of health maintenance:

All of these mask-related symptoms contradict a state of wellbeing and health as defined by the WHO [World Health Organization]. According to the WHO; “health is a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity”. Based on our findings, the use of face mask in the hope of maintaining health is unfortunately contradicting the WHO’s definition of health. Regarding all the possible side effects of mask and their still unproven efficacy against viral transmission within the general population, health seems not to be substantially preserved by wearing face masks. . . .

Seeing the overall weak evidence for efficacy of masks against viral transmission within the general population, face masks have to be evaluated appropriately in the sense of the Hippocratic Oath and as per the Primum nihil nocere (above all do not harm). To avoid at all costs that the damage caused by preventive or therapeutic measures becomes greater than that caused by the disease itself, should be the credo of all those involved in the containment of the crisis, including politicians and the so-called experts. Medical decisions can only be made on the basis of comprehensive knowledge on a patient’s overall condition, individualized case history, considering all previous illnesses and interventions, physical and mental predispositions, and his/her socio-economic state, etc.

Masks might also result in increased aerosolization of SARS‑CoV‑2 and other viruses, thus potentially increasing the risk of so-called “airborne” transmission (which is distinguished from transmission via larger respiratory droplets):

Given the fact, that medical masks (surgical and N95) increase particle exhalation in the smallest size range of 0.3–0.5 μm [micrometers], shifting the geometric mean diameter toward smaller sizes (longer in air) compared to no mask conditions doubts arise. Such scientific facts are pointing toward the nebulization effect of masks, which could be an add-on for their weakness against viral transmission in general.

While the debate about the utility of masks will go on, one thing is absolutely clear: the proclaimed benefits of mandatory mask use never manifested in the data, and given the known potential harms of prolonged mask use, we must take steps to ensure that the government will never again be able to implement such authoritarian policies as mask mandates and the disastrously harmful lockdown measures.