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Masks-for-all for COVID-19 not based on sound data

Lisa M Brosseau, ScD, and Margaret Sietsema, PhD

  | 

Apr 01, 2020

Dr. Brosseau is a national expert on respiratory protection and infectious diseases and professor (retired), University of Illinois at Chicago.Dr. Sietsema is also an expert on respiratory protection and an assistant professor at the University of Illinois at Chicago.

In response to the stream of misinformation and misunderstanding about the nature and role of masks and respirators as source control or personal protective equipment (PPE), we critically review the topic to inform ongoing COVID-19 decision-making that relies on science-based data and professional expertise.

As noted in a previous commentary, the limited data we have for COVID-19 strongly support the possibility that SARS-CoV-2—the virus that causes COVID-19—is transmitted by inhalation of both droplets and aerosols near the source. It is also likely that people who are pre-symptomatic or asymptomatic throughout the duration of their infection are spreading the disease in this way.

Data lacking to recommend broad mask use

We do not recommend requiring the general public who do not have symptoms of COVID-19-like illness to routinely wear cloth or surgical masks because:

• There is no scientific evidence they are effective in reducing the risk of SARS-CoV-2 transmission
• Their use may result in those wearing the masks to relax other distancing efforts because they have a sense of protection
• We need to preserve the supply of surgical masks for at-risk healthcare workers.

Sweeping mask recommendations—as many have proposed—will not reduce SARS-CoV-2 transmission, as evidenced by the widespread practice of wearing such masks in Hubei province, China, before and during its mass COVID-19 transmission experience earlier this year. Our review of relevant studies indicates that cloth masks will be ineffective at preventing SARS-CoV-2 transmission, whether worn as source control or as PPE. 

Surgical masks likely have some utility as source control (meaning the wearer limits virus dispersal to another person) from a symptomatic patient in a healthcare setting to stop the spread of large cough particles and limit the lateral dispersion of cough particles. They may also have very limited utility as source control or PPE in households.

Respirators, though, are the only option that can ensure protection for frontline workers dealing with COVID-19 cases, once all of the strategies for optimizing respirator supply have been implemented.

We do not know whether respirators are an effective intervention as source control for the public. A non-fit-tested respirator may not offer any better protection than a surgical mask. Respirators work as PPE only when they are the right size and have been fit-tested to demonstrate they achieve an adequate protection factor. In a time when respirator supplies are limited, we should be saving them for frontline workers to prevent infection and remain in their jobs.

These recommendations are based on a review of available literature and informed by professional expertise and consultation. We outline our review criteria, summarize the literature that best addresses these criteria, and describe some activities the public can do to help "flatten the curve" and to protect frontline workers and the general public.

We realize that the public yearns to help protect medical professionals by contributing homemade masks, but there are better ways to help.

Filter efficiency and fit are key for masks, respirators

The best evidence of mask and respirator performance starts with testing filter efficiency and then evaluating fit (facepiece leakage). Filter efficiency must be measured first. If the filter is inefficient, then fit will be a measure of filter efficiency only and not what is being leaked around the facepiece.

Filter efficiency

Masks and respirators work by collecting particles through several physical mechanisms, including diffusion (small particles) and interception and impaction (large particles).¹ N95 filtering facepiece respirators (FFRs) are constructed from electret filter material, with electrostatic attraction for additional collection of all particle sizes.²

Every filter has a particle size range that it collects inefficiently. Above and below this range, particles will be collected with greater efficiency. For fibrous non-electret filters, this size is about 0.3 micrometers (µm); for electret filters, it ranges from 0.06 to 0.1 µm. When testing, we care most about the point of inefficiency. As flow increases, particles in this range will be collected less efficiently.

The best filter tests use worst-case conditions: high flow rates (80 to 90 liters per minute [L/min]) with particle sizes in the least efficiency range. This guarantees that filter efficiency will be high at typical, lower flow rates for all particle sizes. Respirator filter certification tests use 84 L/min, well above the typical 10 to 30 L/min breathing rates. The N95 designation means the filter exhibits at least 95% efficiency in the least efficient particle size range.

Studies should also use well-characterized inert particles (not biological, anthropogenic, or naturogenic ones) and instruments that quantify concentrations in narrow size categories, and they should include an N95 FFR or similar respirator as a positive control.

Fit

Fit should be a measure of how well the mask or respirator prevents leakage around the facepiece, as noted earlier. Panels of representative human subjects reveal more about fit than tests on a few individuals or mannequins.

Quantitative fit tests that measure concentrations inside and outside of the facepiece are more discriminating than qualitative ones that rely on taste or odor.

Mask, N95 respirator filtering performance

Following a recommendation that cloth masks be explored for use in healthcare settings during the next influenza pandemic,³ The National Institute for Occupational Safety and Health (NIOSH) conducted a study of the filter performance on clothing materials and articles, including commercial cloth masks marketed for air pollution and allergens, sweatshirts, t-shirts, and scarfs.⁴

Filter efficiency was measured across a wide range of small particle sizes (0.02 to 1 µm) at 33 and 99 L/min. N95 respirators had efficiencies greater than 95% (as expected). For the entire range of particles tested, t-shirts had 10% efficiency, scarves 10% to 20%, cloth masks 10% to 30%, sweatshirts 20% to 40%, and towels 40%. All of the cloth masks and materials had near zero efficiency at 0.3 µm, a particle size that easily penetrates into the lungs.⁴

Another study evaluated 44 masks, respirators, and other materials with similar methods and small aerosols (0.08 and 0.22 µm).⁵ N95 FFR filter efficiency was greater than 95%. Medical masks exhibited 55% efficiency, general masks 38% and handkerchiefs 2% (one layer) to 13% (four layers).

These studies demonstrate that cloth or homemade masks will have very low filter efficiency (2% to 38%). Medical masks are made from a wide range of materials, and studies have found a wide range of filter efficiency (2% to 98%), with most exhibiting 30% to 50% efficiency.^6-12

We reviewed other filter efficiency studies of makeshift cloth masks made with various materials. Limitations included challenge aerosols that were poorly characterized¹³ or too large^14-16 or flow rates that were too low.¹⁷

Mask and respirator fit

Regulators have not developed guidelines for cloth or surgical mask fit. N95 FFRs must achieve a fit factor (outside divided by inside concentration) of at least 100, which means that the facepiece must lower the outside concentration by 99%, according to the OSHA respiratory protection standard. When fit is measured on a mask with inefficient filters, it is really a measure of the collection of particles by the filter plus how well the mask prevents particles from leaking around the facepiece.

Several studies have measured the fit of masks made of cloth and other homemade materials.^13,18,19 We have not used their results to evaluate mask performance, because none measured filter efficiency or included respirators as positive controls.

One study of surgical masks showing relatively high efficiencies of 70% to 95% using NIOSH test methods measured total mask efficiencies (filter plus facepiece) of 67% to 90%.⁷ These results illustrate that surgical masks, even with relatively efficient filters, do not fit well against the face.

In sum, cloth masks exhibit very low filter efficiency. Thus, even masks that fit well against the face will not prevent inhalation of small particles by the wearer or emission of small particles from the wearer.

One study of surgical mask fit described above suggests that poor fit can be somewhat offset by good filter collection, but will not approach the level of protection offered by a respirator. The problem is, however, that many surgical masks have very poor filter performance. Surgical masks are not evaluated using worst-case filter tests, so there is no way to know which ones offer better filter efficiency.

Studies of performance in real-world settings

Before recommending them, it's important to understand how masks and respirators perform in households, healthcare, and other settings.

Cloth masks as source control

A historical overview of cloth masks notes their use in US healthcare settings starting in the late 1800s, first as source control on patients and nurses and later as PPE by nurses.²⁰

Kellogg,²¹ seeking a reason for the failure of cloth masks required for the public in stopping the 1918 influenza pandemic, found that the number of cloth layers needed to achieve acceptable efficiency made them difficult to breathe through and caused leakage around the mask. We found no well-designed studies of cloth masks as source control in household or healthcare settings.

In sum, given the paucity of information about their performance as source control in real-world settings, along with the extremely low efficiency of cloth masks as filters and their poor fit, there is no evidence to support their use by the public or healthcare workers to control the emission of particles from the wearer.

Surgical masks as source control

Household studies find very limited effectiveness of surgical masks at reducing respiratory illness in other household members.^22-25

Clinical trials in the surgery theater have found no difference in wound infection rates with and without surgical masks.^26-29 Despite these findings, it has been difficult for surgeons to give up a long-standing practice.³⁰

There is evidence from laboratory studies with coughing infectious subjects that surgical masks are effective at preventing emission of large particles^31-34 and minimizing lateral dispersion of cough particles, but with simultaneous displacement of aerosol emission upward and downward from the mask.³⁵

There is some evidence that surgical masks can be effective at reducing overall particle emission from patients who have multidrug-resistant tuberculosis,³⁶ cystic fibrosis,³⁴ and influenza.³³ The latter found surgical masks decreased emission of large particles (larger than 5 µm) by 25-fold and small particles by threefold from flu-infected patients.³³ Sung³⁷ found a 43% reduction in respiratory viral infections in stem-cell patients when everyone, including patients, visitors, and healthcare workers, wore surgical masks.

In sum, wearing surgical masks in households appears to have very little impact on transmission of respiratory disease. One possible reason may be that masks are not likely worn continuously in households. These data suggest that surgical masks worn by the public will have no or very low impact on disease transmission during a pandemic.

There is no evidence that surgical masks worn by healthcare workers are effective at limiting the emission of small particles or in preventing contamination of wounds during surgery.

There is moderate evidence that surgical masks worn by patients in healthcare settings can lower the emission of large particles generated during coughing and limited evidence that small particle emission may also be reduced.

N95 FFRs as source control

Respirator use by the public was reviewed by NIOSH: (1) untrained users will not wear respirators correctly, (2) non-fit tested respirators are not likely to fit, and (3) improvised cloth masks do not provide the level of protection of a fit-tested respirator.

There are few studies examining the effectiveness of respirators on patients. An N95 FFR on coughing human subjects showed greater effectiveness at limiting lateral particle dispersion than surgical masks (15 cm and 30 cm dispersion, respectively) in comparison to no mask (68 cm). ³⁵ Cystic fibrosis patients reported that surgical masks were tolerable for short periods, but N95 FFRs were not.³⁴

In summary, N95 FFRs on patients will not be effective and may not be appropriate, particularly if they have respiratory illness or other underlying health conditions. Given the current extreme shortages of respirators needed in healthcare, we do not recommend the use of N95 FFRs in public or household settings.

Cloth masks as PPE

A randomized trial comparing the effect of medical and cloth masks on healthcare worker illness found that those wearing cloth masks were 13 times more likely to experience influenza-like illness than those wearing medical masks.³⁸

In sum, very poor filter and fit performance of cloth masks described earlier and very low effectiveness for cloth masks in healthcare settings lead us conclude that cloth masks offer no protection for healthcare workers inhaling infectious particles near an infected or confirmed patient.

Surgical masks as PPE

Several randomized trials have not found any statistical difference in the efficacy of surgical masks versus N95 FFRs at lowering infectious respiratory disease outcomes for healthcare workers.^39-43

Most reviews have failed to find any advantage of one intervention over the other.^23,44-48 Recent meta-analyses found that N95 FFRs offered higher protection against clinical respiratory illness^49,50 and lab-confirmed bacterial infections,⁴⁹ but not viral infections or influenza-like illness.⁴⁹

A recent pooled analysis of two earlier trials comparing medical masks and N95 filtering facepiece respirators with controls (no protection) found that healthcare workers continuously wearing N95 FFRs were 54% less likely to experience respiratory viral infections than controls (P = 0.03), while those wearing medical masks were only 12% less likely than controls (P = 0.48; result is not significantly different from zero).⁵¹

While the data supporting the use of surgical masks as PPE in real-world settings are limited, the two meta-analyses and the most recent randomized controlled study⁵¹ combined with evidence of moderate filter efficiency and complete lack of facepiece fit lead us to conclude that surgical masks offer very low levels of protection for the wearer from aerosol inhalation. There may be some protection from droplets and liquids propelled directly onto the mask, but a faceshield would be a better choice if this is a concern.

N95 FFRs as PPE

A retrospective cohort study found that nurses' risk of SARS (severe acute respiratory syndrome, also caused by a coronavirus) was lower with consistent use of N95 FFRs than with consistent use of a surgical mask.⁵²

In sum, this study, the meta-analyses, randomized controlled trial described above,^49,51 and laboratory data showing high filter efficiency and high achievable fit factors lead us to conclude that N95 FFRs offer superior protection from inhalable infectious aerosols likely to be encountered when caring for suspected or confirmed COVID-19 patients.

The precautionary principle supports higher levels of respiratory protection, such as powered air-purifying respirators, for aerosol-generating procedures such as intubation, bronchoscopy, and acquiring respiratory specimens.

Conclusions

While this is not an exhaustive review of masks and respirators as source control and PPE, we made our best effort to locate and review the most relevant studies of laboratory and real-world performance to inform our recommendations. Results from laboratory studies of filter and fit performance inform and support the findings in real-world settings.

Cloth masks are ineffective as source control and PPE, surgical masks have some role to play in preventing emissions from infected patients, and respirators are the best choice for protecting healthcare and other frontline workers, but not recommended for source control. These recommendations apply to pandemic and non-pandemic situations.

Leaving aside the fact that they are ineffective, telling the public to wear cloth or surgical masks could be interpreted by some to mean that people are safe to stop isolating at home. It's too late now for anything but stopping as much person-to-person interaction as possible.

Masks may confuse that message and give people a false sense of security. If masks had been the solution in Asia, shouldn't they have stopped the pandemic before it spread elsewhere?

Ways to best protect health workers

We recommend that healthcare organizations follow US Centers for Disease Control and Prevention (CDC) guidance by moving first through conventional, then contingency, and finally crisis scenarios to optimize the supply of respirators. We recommend using the CDC's burn rate calculator to help identify areas to reduce N95 consumption and working down the CDC checklist for a strategic approach to extend N95 supply.

For readers who are disappointed in our recommendations to stop making cloth masks for themselves or healthcare workers, we recommend instead pitching in to locate N95 FFRs and other types of respirators for healthcare organizations. Encourage your local or state government to organize and reach out to industries to locate respirators not currently being used in the non-healthcare sector and coordinate donation efforts to frontline health workers.

References

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2. Martin SB Jr, Moyer ES. Electrostatic respirator filter media: filter efficiency and most penetrating particle size effects. Appl Occup Environ Hyg 2000 Nov 30;15(8):609-17
3. Reusability of facemasks during an influenza pandemic.News conference, Apr 27, 2006
4. Rengasamy S, Eimer B, Shaffer RE. Simple respiratory protection—evaluation of the filtration performance of cloth masks and common fabric materials against 20-1000 nm size particles.Ann Occup Hyg 2010 Jun 28;54(7):789-98
5. Jung H, Kim J, Lee S, et al. Comparison of filtration efficiency and pressure drop in anti-yellow sand masks, quarantine masks, medical masks, general masks, and handkerchiefs.Aerosol Air Qual Res 2014;14(14):991-1002.
6. Grinshpun SA, Haruta H, Eninger RM, et al. Performance of an N95 filtering facepiece particulate respirator and a surgical mask during human breathing: two pathways for particle penetration. J Occup Environ Hyg 2009 Jul 22;6(10):593-603
7. Oberg T, Brosseau LM. Surgical mask filter and fit performance. Am J Infect Control 2008 May;36(4):276-82
8. Willeke K, Qian Y, Donnelly J, et al. Penetration of airborne microorganisms through a surgical mask and a dust/mist respirator. Am Ind Hyg Assoc J 1996;57(4):348-55
9. Brosseau LM, McCullough NV, Vesley D. Mycobacterial aerosol collection efficiency of respirator and surgical mask filters under varying conditions of flow and humidity. Appl Occup Environ Hyg 1997;12(6):435-45
10. Chen CC, Willeke K. Aerosol penetration through surgical masks. Am J Infect Control 1992 Aug;20(4):177-84
11. McCullough NV, Brosseau LM, Vesley D. Collection of three bacterial aerosols by respirator and surgical mask filters under varying conditions of flow and relative humidity. Ann Occup Hyg 1997 Dec;41(6):677-90
12. Rengasamy S, Eimer B, Szalajda J. A quantitative assessment of the total inward leakage of NaCl aerosol representing submicron-size bioaerosol through N95 filtering facepiece respirators and surgical masks. J Occup Environ Hyg 2014 11(6):388-96
13. Davies A, Thompson KA, Giri K, et al. Testing the efficacy of homemade masks: would they protect in an influenza pandemic?Disaster Med Public Health Prep 2013 Aug;7(4):413-8
14. Cherrie JW, Apsley A, Cowie H, et al. Effectiveness of face masks used to protect Beijing residents against particulate air pollution.Occup Environ Med 2018 Jun;75(6):446-52
15. Mueller W, Horwell CJ, Apsley A, et al. The effectiveness of respiratory protection worn by communities to protect from volcanic ash inhalation. Part I: filtration efficiency tests.Int J Hyg Environ Health 2018 July;221(6):967-76
16. Bowen LE. Does that face mask really protect you?Appl Biosaf 2010 Jun 1;15(2):67-71
17. Shakya KM, Noyes A, Kallin R, et al. Evaluating the efficacy of cloth facemasks in reducing particulate matter exposure.J Expo Sci Environ Epidemiol 2017 May;27(3):352-7
18. van der Sande M., Teunis P, Sabel R. Professional and home-made face masks reduce exposure to respiratory infections among the general population. PLOS One 2008 Jul 9;3(7):0002618
19. Derrick JL, Gomersall CD. Protecting healthcare staff from severe acute respiratory syndrome: filtration capacity of multiple surgical masks. J Hosp Infect 2005 Apr;59(4):365-8
20. Chughtai AA, Seale H, MacIntyre CR. Use of cloth masks in the practice of infection control—evidence and policy gaps. Int J Infect Control 2013 Jun;9(3)
21. Kellogg WH, MacMillan G. An experimental study of the efficacy of gauze face masks.Am J Public Health 1920;10(1):34-42
22. Saunders-Hastings P, Crispo JA, Sikora L, et al. Effectiveness of personal protective measures in reducing pandemic influenza transmission: A systematic review and meta-analysis.Epidemics 2017 Sep;20:1-20
23. Cowling B J, Zhou Y, Ip DKM, et al. Face masks to prevent transmission of influenza virus: a systematic review. Epidemiol Infect 2010 Jan 22;138(4):449-56
24. bin‐Reza F, Chavarrias VL, Nicoll A, et al. The use of masks and respirators to prevent transmission of influenza: a systematic review of the scientific evidence. Influenza Other Respir Viruses 2011 Dec 11;6(4):257-67
25. MacIntyre CR, Zhang Y, Chughtai AA, et al. Cluster randomised controlled trial to examine medical mask use as source control for people with respiratory illness.BMJ Open 2016 Dec 30;6(12):e012330
26. Meleny FL. Infection in clean operative wounds: a nine year study. Surg Gynecol Obstet 1935;60:264-75
27. Orr NWM. Is a mask necessary in the operating theater? Ann R Coll Surg Engl 1981;63:390-2
28. Mitchell NJ, Hunt S. Surgical face masks in modern operating rooms—a costly and unnecessary ritual? J Hosp Infect 1991;18(3):239-42
29. Tunevall TG. Postoperative wound infections and surgical face masks: a controlled study. World J Surg 1991 May-Jun;15(3):383-7
30. Belkin NL. Masks, barriers, laundering, and gloving: Where is the evidence?AORN J 2006 Oct 25;84(4):655-63
31. Johnson DF, Druce JD, Birch C, et al. A quantitative assessment of the efficacy of surgical and N95 masks to filter influenza virus in patients with acute influenza infection.Clin Infect Dis 2009 Jul 15;49(2):275-7
32. Driessche KV, Hens N, Tilley P, et al. Surgical masks reduce airborne spread of Pseudomonas aeruginosa in colonized patients with cystic fibrosis.Am J Respir Crit Care Med 2015 Oct 1;192(7):897-9
33. Milton DK, Fabian MP, Cowling BJ, et al. Influenza virus aerosols in human exhaled breath: particle size, culturability, and effect of surgical masks.PLoS Pathog 2013 Mar;9(3):e1003205
34. Stockwell RE, Wood ME, He C, et al. Face masks reduce the release of Pseudomonas aeruginosa cough aerosols when worn for clinically relevant periods.Am J Respir Crit Care Med 2018 Nov 15;198(10):1339-42
35. Hui DS, Chow BK, Chu L, et al. Exhaled air dispersion during coughing with and without wearing a surgical or N95 mask.PloS One 2012;7(12)e50845
36. Dharmadhikari AS, Mphahlele M, Stoltz A, et al. Surgical face masks worn by patients with multidrug-resistant tuberculosis: impact on infectivity of air on a hospital ward.Am J Respir Crit Care Med 2012 May 15;185(10):1104-9
37. Sung AD, Sung JA, Thomas S, et al. Universal mask usage for reduction of respiratory viral infections after stem cell transplant: a prospective trial.Clin Infect Dis 2016 Oct 15;63(8):999-1006
38. MacIntyre CR, Seale H, Dung TC, et al. A cluster randomised trial of cloth masks compared with medical masks in healthcare workers.BMJ Open 2015 Apr 22;5(4):e006577
39. Loeb M, Dafoe N, Mahony J, et al. Surgical mask vs N95 respirator for preventing influenza among healthcare workers: a randomized trial. JAMA 2009 Nov 4;302(17):1865-71
40. MacIntyre CR, Wang Q, Cauchemez S, et al. A cluster randomized clinical trial comparing fit‐tested and non‐fit‐tested N95 respirators to medical masks to prevent respiratory virus infection in health care workers. Influenza Other Respir Viruses 2011;5(3):170-9
41. MacIntyre CR, Wang Q, Rahman B, et al. Efficacy of face masks and respirators in preventing upper respiratory tract bacterial colonization and co-infection in hospital healthcare workers—authors' reply. Prev Med 2014 Aug;65:154
42. MacIntyre CR, Wang Q, Seale H, et al. A randomized clinical trial of three options for N95 respirators and medical masks in health workers. Am J Resp Crit Care Med 2013;187(9):960-6
43. Radonovich LJ, Simberkoff MS, Bessesen MT, et al. N95 respirators vs medical masks for preventing influenza among health care personnel: a randomized clinical trial. JAMA 2019 Sep 3;322(9):824-33
44. Gralton J, and McLaws ML. Protecting healthcare workers from pandemic influenza: N95 or surgical masks?. Crit Care Med 2010 Feb;38(2):657-67
45. bin Reza 2012 (we have Bin-Reza 2011)
46. Bunyan D, Ritchie L, Jenkins D, et al. Respiratory and facial protection: a critical review of recent literature. J Hosp Infect 2013 Nov;85(3):165-9
47. Smith JD, MacDougall CC, Johnstone J, et al. Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis. CMAJ 2016 May 17;188(8):567-74
48. Jefferson T, Jones M, Ansari LAA, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Part 1 - Face masks, eye protection and person distancing: systematic review and meta-analysis. medRxiv 2020 Mar 30
49. Offeddu V, Yung CF, Low MSF, et al. Effectiveness of masks and respirators against respiratory infections in healthcare workers: a systematic review and meta-analysis. Clin Infect Dis 2017 Aug 7;65(11):1934-42
50. Long Y, Hu T, Liu L, et al. Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta‐analysis. J Evid Based Med 2020 (published online Mar 13)
51. MacIntyre CR, Chughtai AA, Rahman B, et al. The efficacy of medical masks and respirators against respiratory infection in healthcare workers. Influenza Other Respir Viruses 2017;11(6):511-7
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Cloth Masks Are Useless Against COVID-19

April 25, 2020

Frank Diamond

Lisa Brosseau, ScD: "What we’re seeing is a lot of magical thinking. A lot of wishful thinking. Cloth masks are wishful thinking."

Lisa Brosseau, ScD, is a nationally recognized expert on infectious diseases. Brousseau taught for many years at the University of Illinois at Chicago. She may be retired from the university, but she’s not retired from teaching. She recently cowrote an opinion piecethat drew a lot of notice: In it Brousseau argues that cloth masks offer no protection from COVID-19. As one might imagine, it drew a lot of attention and caused a fair amount of controversy. She recently sat down with Infection Control Today®to talk about her strong feelings about cloth masks and that data she used to reach her conclusions.

Infection Control Today®: What made you decide to write the piece?

Lisa Brosseau: The article started out with the goal of trying to look at the literature related to cloth masks in healthcare. And then it got expanded way beyond that to cloth masks and surgical masks and respirators for healthcare and for the community. It was much more comprehensive than I expected it to be. Took me a little longer to write but at the end of the day, I was looking at cloth masks and surgical masks and respirators from several points of view. First of all, for healthcare and community, but also do they work as source control? Or do they work as personal protective equipment? Or both? And at the end of the day, cloth masks in my opinion don’t work in any form. They aren’t very good at source control, except for maybe very large particles. And they should not be used in healthcare settings for a number of reasons. Surgical masks, I decided, based on the literature, might have a role as source control for people who have symptoms. Say if they’re staying home and they have some symptoms. They shouldn’t be something you’d wear if you have symptoms going out into the public because you shouldn’t be going out into the public service. But it’s a good option for patients to wear in healthcare settings where they-especially for those who are experiencing symptoms-to what I would call diminish the viral load. Basically, decrease the amount of particles, infectious particles in the air in a healthcare setting. So, at the end of the day, the only thing that provides personal protection for the person wearing the mask is a respirator. And that is the thing that healthcare workers should be wearing. Particularly if we’re worried about the small aerosols, small particles that people will generate when they’re infectious. And in fact, people generate particles, whether they’re infectious or not. But particularly when they’re infected and infectious, that will be present in the vicinity of a patient. The best protection in that case is for the healthcare worker to wear a respirator. And I’ve got asked a little bit to think about respirators for the community. You know, if we had a lot of respirators, that might be a good idea, but we don’t have very many of them. And so, for the purposes of saving those respirators for the people who really need them, I recommended that the public not be wearing respirators and not be buying respirators. And if they had them, please donate them even to healthcare workers. That’s a good summary.

ICT®: You did a deep dive into the literature. I saw you had many, many references. So, the mystery to me is why did the CDC say to people go out and wear cloth masks if you want to? 

Brosseau: What’s interesting to me is if you look at the references that were listed on under their recommendation, none of them have anything to do with masks or the performance of masks or the performance of their filters or any of that. They’re all references related to pre-symptomatic or asymptomatic transmission. I didn’t get the message there entirely, but I was glad to see is that they recognized that asymptomatic and pre-symptomatic transmission are happening. My message would have been if those were the references I was looking at, is maybe we should actually be encouraging people to stay home more. My biggest problem with telling people they can wear masks is it gives you this false sense of security. And it might even encourage you to think that now you’re protected and you’re protecting people around you. My husband and I try to take a walk every afternoon, just to get out, get a little bit of fresh air and exercise. And I’m seeing more and more people now wearing cloth masks on the streets. And I don’t go to stores anymore, but my understanding is they’re wearing them there as well. I don’t have a problem with people wearing them. I just want them to understand that they aren’t very much more protective than if they weren’t wearing them. And they’re really not doing a whole lot of good for the people around them. So, we should continue to do social distancing as much as we possibly can. I have places that are saying that you actually have to wear them. New York where you’re supposed to wear them anytime you’re in contact with people. I don’t know. I just think it’s not recognizing that the mode of transmission for this organism is likely small aerosols and close range and wearing a cloth mask shouldn’t give you any feeling of safety for being close to people. It shouldn’t make you feel that you’re not generating small particles because you still are. And since we none of us know if we’re infected or infectious, many of us probably are and aren’t going to have symptoms because we know that that’s the case for at least some fraction of the population that we’re putting everyone around us at risk. And especially the people I most care about are the workers. Our essential workers are really key to our success in flattening the curve. And they’re the ones who make it possible for us to stay home and be isolated those of us who are privileged enough to have that opportunity. But we go out and think that we are doing something good for the public and the workers, and we’re actually not. I think we put them at more risk. So, I don’t understand the CDC’s recommendations for this. My guess is that there’s a lot of political pressure. And no government agency is entirely immune from political pressure. There’s pressure to open, right? There’s pressure to restart the economy. I understand that entirely. And so I think the feeling was, probably if we give everybody a mask, we can just reopen and everything’s going to be fine. I think we’re going to be shocked to find that that’s not going to work. And I mean, I won’t be shocked, but there will be lots of people who will be shocked. And in fact, I read an article recently about a funeral. A number of people who attended the funeral. They were all wearing masks. They were taking photos next to each other. They were talking and a number of people got infected. So, it’s very clear these things do no good.

ICT®: Have you gotten much feedback from healthcare workers or healthcare experts themselves? 

Brosseau: Oh, yeah. There are a number who don’t agree, but there are a lot of people who didn’t agree with my first article about aerosol transmission either. I’m sort of used to it. The important thing is to say, here’s what the science tells us. My conversations with people these days, I often point out that what we’re seeing is a lot of magical thinking. A lot of wishful thinking. Cloth masks are wishful thinking. And people saying, well, they worked in Asia. There’s no evidence that they worked in Asia. In fact, it’s very clear that the healthcare workers in China, they may have been wearing cloth masks to start with, but when you look at pictures of what they were wearing later, they were wearing respirators. They were wearing full face gear and body gear and gloves. It was clear that even surgical masks weren’t working in healthcare settings or controlling COVID-19. I don’t understand it. The Asian countries wear masks for societal and cultural reasons, not because they actually think they’re protecting. I’m not an expert in epidemiology. So, I will leave the modeling to the to those who know more about how this is going to work, but I do know my history. And if you read about the 1918 influenza and the pandemic, it took almost two years for that to be completely done with. They did a lot of similar things. They closed down. They opened again. Then they had to close down and then they had to open again. Now, granted, they didn’t have a lot of what we have today. But in some ways, we’re not all that different from 1918. We don’t have any testing. We don’t have any contact tracing. They didn’t either. They didn’t even really know about that. They didn’t know much about viruses. So, we have huge amounts of scientific information. But we have almost no infrastructure anymore in public health. Without our infrastructure in public health and our resources to do contact tracing and testing…. And testing, I mean with tests that really work that are both highly specific and highly sensitive. And we don’t have any of those yet. In many ways we’re being forced to make many of the same decisions that were made during the 1918 influenza pandemic. And the results are going to be similar. We are trying to decide when to open it back up. No one really knows the perfect answer to that. The models, they’re not perfect, right? I know infection preventionists are often pulled in two directions. One is they have to worry about patients. The other is they have to worry about workers. And sometimes the things you do for patients don’t work for workers and sometimes the other way around. That’s why I recommend including your health and safety people, industrial hygienists, and others, because they can give you that perspective about workers that will help you make good decisions for both. And really, it should be a hand-in-hand decision making that goes on.

ICT®: Any final words about cloth masks?

Brosseau: I would really strongly encourage hospitals to stop asking people to send them cloth masks and instead asked for respirators. I don’t necessarily discourage the public from wearing them if it makes them feel comfortable, but I hope they don’t think that they’re protecting themselves.

This interview has been edited for clarity and length.

There are two versions of the law

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Google tries to censor content it disagrees with

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From the comments on this video:

Just Google “European people history” “Pregnant white women” “American inventors” “White couple” And then look up anything else and tell me they aren’t blackwashing everything

I tried this and was amazed with the results.

Enough.....Seriously ENOUGH

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Rebels

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It would not surprise me that YouTube will take these videos down, due to their record of censoring speech.

Anarchy will rule in every major city

Daniel Horowitz · June 9, 2020  

Call it reverse broken windows policing. Police are treated as criminals and criminals are exalted as oppressed and entitled to riot with no consequences for assaults and property damage. The result? Record shootings and homicides in some major cities. This is only the beginning.

The societal and cultural response to the killing of George Floyd is closely paralleling the response to coronavirus. Just as with the virus, the lockdown killed more people than the ailment itself, the rioting in response to George Floyd’s death will lead to thousands more deaths in the long run and is already directly and indirectly responsible for exponentially more murders – primarily of black citizens.

On Sunday, a record 18 people were killed in Chicago in the worst single day of violence in 60 years, since the University of Chicago’s crime lab began keeping records in 1961. In total, over the weekend, 92 were shot and 27 succumbed to their wounds. All of the pictures of the known victims indicate they were African-Americans. And unlike with coronavirus, nearly all the victims were very young with much more life to live. Who is going to kneel on the ground for them? Who is going to pass legislation deterring repeat violent offenders, ending bail and parole for career criminals, and prescribing tougher sentences on gun felons? Well, certainly not the people using George Floyd’s death to promote the exact opposite.

The reality is that at least 17 people have been killed so far during the riots. However, as we see from Chicago and other cities, an unknown number – possibly totaling in the hundreds – have died likely as the result of police taking a hands-off approach to their work. The results of the riots and the war on cops are more deadly for African-Americans than anything imaginable.

Here is an eyewitness account of downtown Chicago by anti-gun violence activist Rev. Michael Pfleger:

“On Saturday and particularly Sunday, I heard people saying all over, ‘Hey, there’s no police anywhere, police ain’t doing nothing,’” Pfleger said.

“I sat and watched a store looted for over an hour,” he added. “No police came. I got in my car and drove around to some other places getting looted [and] didn’t see police anywhere.”

Chicago is not even the most vivid example. In some ways, they have been experiencing a relative increase in violence for several years. New York is really where we are seeing the stark contrast. Thanks to the more aggressive policing first begun by Mayor Rudy Giuliani, New York City enjoyed a massive decline in violent crime for over two decades.

Now that is all being wiped out overnight by new jailbreak laws and the war on the NYPD. Last week, the city reported 13 murders, up from just five over the same week last year. Shootings have nearly doubled and property crime is up. On Monday night, seven people were shot in Brooklyn over a 10-minute period.

Why? Because police are getting beaten and can’t defend themselves lest they face prosecution. Over 300 NYPD officers have been injured in the riots. Few will see justice. In Los Angeles, the prosecutor announced that few rioters will face charges and all those who violated curfew will be free from criminal charges. In Chicago alone, in just nine days, 2,665 arrests have been made for civil unrest and disorderly, 788 arrests for looting, and 525 guns recovered. Watch for the same people who claim to abhor guns in the hands of law-abiding citizens to suddenly ignore these gun crimes.

What is the point of being a cop in America today? According to the FBI, in 2018, there were 58,866 assaults against law enforcement officers, resulting in 18,005 injuries. You almost never heard about them. God knows how many are taking place today. The resignations and retirements will continue while new recruitment will be nonexistent. The ones who don’t resign will be fired unless they kneel to the mob, like one police chief in Michigan who was forced out after voicing support for people engaging in open carry to protect their families from the politically untouchable rioters.

By far, according to the FBI, the most common circumstance leading to a cop injury is a disturbance call. Police are responding to help and protect other citizens. Now they will just take a hands-off approach and come to do the paperwork.

The question President Trump and Republicans must start asking is what level of killings, injuries, and property damage is acceptable before they begin pushing an active pro-enforcement agenda with as much passion and energy as the Left is pushing anarchy?

Overcoming ALL the Big Lies!

Kevin McCullough

Posted: Jun 07, 2020 10:40 AM

 

 

America has had enough.

The amount of dishonesty being peddled from Congressional representatives to CNN is suffocating the average citizen. Half of them believing every word of it and feeling helpless to do anything about it. The other half knowing it’s nearly all false and also feeling helpless to be able to do anything about it.

Stirred outrage that’s uninformed but highly volatile and mixed with misguided ideas and a powder keg has been lit. Combined with utterly incompetent mayors, governors, and other public officials and we see disasters one never imagined in America have become reality.
It’s time to stop.

To pull the plug on the incendiary.

To quell the violence, end the murder, correct the record.

To call out the biggest lies...

We were never divided.

As the horrific death of George Floyd played out on viral video captured publicly from what seemed like endless angles, NO ONE defended the actions. The president, the mayor, the African American vice-chair of the Minneapolis City Council who grew up in the inflammatory teaching of Jeremiah Wright, the white Bible-teaching pastors of the suburbs, civil rights organizations and thousands of police unions ALL condemned the killing that took place not even two weeks ago. From the homogeneous to the multi-cultural, north to south, from Hollywood to the White House, the nation was outraged, angry, and determined to seek justice.

 

All Black Lives have not mattered.

Oddly after such unity—violence broke out inexplicably. Even though the president green-lit a federal investigation into the Floyd death as a homicide, it took days for the mayor to fire, then have arrested, first just the one offender and many more days to follow for the three accomplices. The initially peaceful protests were aimed at demanding the city act as swiftly and as thoroughly as the feds. The actions finally took place but the slight hiccup in time allowed for Antifa, some black extremist groups, and ne’er-do-wells to infiltrate, terrorize, loot, and kill. Sadly, the criminal element of the protests have already (in 12 days) killed roughly the same number of unarmed black people (14) as all police departments did for the entire year of 2019 (15) (according to  a Washington Post crime report). The media has ignored the lives of these murdered black citizens, proving ultimately—they simply do not matter—for the sake of the narrative.


The media is and has become more so the enemy of the people. 

 

Such negligence has proven that most of our nation’s media is heavily invested in manipulating an outcome through their “influence” rather than giving the facts and allowing the people to draw their own conclusions about their meaning. Through the obfuscation of the deadly toll of the riots, and the omission of important information in some cases one could argue media malfeasance. But the whole-cloth invention of facts and twisting outcomes is another level of malevolent disrespect for their viewers. For instance, it’s one thing to refuse to report on the impact to black-owned businesses, violence (serious but non-lethal) to black people, and to most certainly ignore the hundreds of hospitalizations of police officers. It’s another thing entirely to report that the president used weapons of war against the American people for a photo-op, with reckless disregard for any of the facts of the report. Most precisely that the president never ordered it, no such weapons were used, and the photo was taken in front of a historic church that terrorists had attempted to burn down the night before. Through all of it the media acts as though they are above any accountability for their actions.

 

“Bad cops” are the problem, not “police.” 

One of the untold stories the media has yet to even demonstrate curiosity about is just how bad the “policing” issue is across the country. Unilaterally the activists associate police departments with being a “white on black” matter. But increasingly in cities across the nation, police chiefs are POC (people of color.) On some of the largest police forces, the departments themselves are POC majority. So many of the minutes of footage from even the riots show black officers being screamed at in the face by a white protestor. Police departments have been undergoing reforms for the past couple of decades. Diversity in management, adjustment of policies regarding techniques used, and other criteria have consistently been re-examined. The murderer of George Floyd had not been reformed.

Through the protection of a big union, operating in a heavily unionized blue city, and an increasingly less blue state this bad apple had not been held accountable for 18 different complaints of excessive force with nearly all of them being made by POC. A simple review at the 2019 Uniform Crime Report would have again shed light on the overall trend. Out of a nation of 328,000,000 citizens, a total of 56 shootings of unarmed individuals occurred from all of the millions of police officers across the nation. 25 of those were against white individuals, and only 15 against black ones. Nevertheless, the newest demand by the extremists and their accomplices in the media is to eliminate police departments by defunding the police.

 

 

More engagement with police is necessary—not their elimination.

At the very moment when (perhaps ever) the nation cried out as a united voice to correct an injustice, those who would hijack that progress are seeking to destroy the nation as a whole. The idea that the answer to a society that has struggled as mightily for the last 90 days as ours has is to remove the only restraint against evil that we lawfully trust is just insane. Speak to civil rights leaders—real ones who have been through the fight, not the woke snowflake wannabes like Alexandria Ocasio-Cortez—and they will tell you what low income and crime-ridden neighborhoods need is greater engagement with police. And on a couple of levels, more POC who look like the people in their neighborhood, and come from their neighborhood develops a level of trust. But even when they don’t look like or come from where they live it is a detriment to the welfare of society to not have police engaging with citizens. This week my heart was touched when a viral video of a white Houston PD officer put his arm around a five-year-old black girl and assured her he was there for her protection, that he was there to keep her and her parents safe. Why did he need to assure her? Because the little girl had asked him if he was there to shoot her or her parents. Whoever planted that thought in her little heart was evil. But her interaction with a police officer—even one who looked nothing like her—broke down the barrier.

Breaking down barriers is what our nation desperately needs.

We came together to seek justice for Floyd. It’s time to overcome these lies and seek the best for all of our fellow Americans from this point forward.

We long for that more perfect union!

But there are those invested in preventing it from occurring. And it is to those evil elements we reply...

We will overcome!