Does a Mask Protect the Wearer from the Coronavirus? (Three-Pronged Path to Ending this Crisis) Part One

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Does a Mask Protect the Wearer from the Coronavirus?

(Three-Pronged Path to Ending this Crisis)

Part One

By Gary F. Zeolla

“I’m not going to comment directly about the president. But I am going to comment, as the CDC director, that face masks, these face masks, are the most important, powerful public health tool we have. And I will continue to appeal for all Americans, all individuals in our country, to embrace these face coverings. I’ve said it: If we did it for six, eight, 10, 12 weeks, we’d bring this pandemic under control. We have clear scientific evidence. They work, and they are our best defense.

I might even go so far as to say that this face mask is more guaranteed to protect me against Covid than when I take a Covid vaccine, because the immunogenicity may be 70 percent. And if I don’t get an immune response, the vaccine is not going to protect me. This face mask will. So I do want to keep asking the American public to take the responsibility, particularly the 18-to-25 year olds, where we’re seeing the outbreak in America continue to go like this [straight up] because we haven’t got the acceptance, the personal responsibility that we need for all Americans to embrace this face mask. (Director of the Centers for Disease Control and Prevention Dr. Robert Redfield; bolding and italics added, as it is in all quotes in this article, unless otherwise indicated).

Controversial Comments

Dr. Redfield made these controversial comments on Wednesday, September 16, 2020 before a Senate committee. They were controversial because they seemed to go against the President’s emphasis on a vaccine and his downplaying of the need for masks. They are also controversial because they contradicted the hordes of anti-maskers. But most of all, they were controversial because he was saying a mask protects the person wearing the mask, but all along we have been told wearing masks is not to protect the wearer but to protect others in case the wearer has a Coronavirus (CV) infection (also called COVID-19).

But does in fact a mask protect the person wearing it from the CV? And why did Dr. Redfield compare wearing a mask to a vaccine? This three-part article will consider these questions. But it does get a bit complicated, so please bear with me. I will try to explain it a simply as I can and will provide documented evidence from health authorities. I have included numerous references at the end of each part of this three-part article for further details and documentation.

Not Trusting the Health Authorities

But first, if you are one who does not trust health authorities, then this article might not mean much to you. You will just believe what you want to believe, despite the evidence otherwise. I understand why some people have a distrust of the authorities. I detail possible reasons why in my article Coronavirus Surges Across the South (The Authorities Have Lost All Credibility).

On the topic of mask-wearing, the authorities did seem to contradict themselves when back in March (2020) they were telling us to not wear masks, but now we are being told we should wear them. But there is a reason for this apparent contradiction that I will explain later.

Moreover, it does bother me when people with no medical background seem to think they know more than those with medical degrees and experience in dealing with viruses, like the CDC director. It is hard to say where such people are getting their ideas from. I guess from Facebook memes.

As for myself, I do not have a medical background, but I do have a degree in Nutrition Science. That gives me some background in physiology, microbiology, and the like. But most of all, it gives me experience in looking at health research studies and evaluating comments by health experts. That can be seen in my books God-given Foods Eating Plan and Creationist Diet: Second Edition. Both are filled with research studies demonstrating my Bible-based recommendation on diet are scientifically based.

I apply that experience to my extensive writings about the CV, being sure to base what I say on the scientific evidence and comments by those who do have the relevant background, all documented extensively. As such, I am not appealing to my authority, but to those with the appropriate credentials to do research and to make comments on this matter.

The Research

The research Dr. Redfield cited included a recently published study suggesting that universal use of surgical masks helped reduce rates of confirmed coronavirus infections among health-care workers at the Mass General Brigham health-care system in Massachusetts….

Dr. Verma and one of his co-authors, Manhar Dhanak, said they are also in the process of putting a laboratory apparatus together to test how much protection various masks might offer to the person wearing them. They plan to study protection against various-sized droplets and particles, as researchers home in on evidence that in addition to large respiratory droplets coronavirus can also be transmitted through aerosol particles that linger in the air.

Exposure is also a focus of researchers now. The amount of virus exposure might influence degree of sickness, according to a review of viral literature and coronavirus epidemiology by Monica Gandhi, a professor of medicine at the University of California, San Francisco. She and her co-authors posit in the research, published in July in the Journal of General Internal Medicine, that masks provide an important barrier and could lead to a milder infection or even prevent one altogether. While cloth and surgical masks can widely vary, she believes some masks can likely filter out a majority of large viral droplets (WSJ).

This article in the Wall Street Journal was written on July 20, 2020. To explain what is being said here, the first point is that in a hospital setting, the masks the health care workers were wearing were shown to protect them from being infected with the CV. That is clear evidence that masks do in fact protectthe wearer of the mask from the CV.

The second point is that the CV can linger in the air. That means, when a person without a mask walks through an area with the CV aerosolized, he or she could inhale those particles and be infected. The question to be studied is if wearing a mask will make it less likely that the CV particles would be inhaled.

The third point is the most important. It is that how many CV particles a person is infected with can determine the seriousness of that person’s CV infection, If the person only inhales a small number of particles, his or her infection will be less severe than someone who inhales a large number of particles.

The fourth point is the variability of masks. It is not just the type of mask but also how they are worn.

At the time of this article, the research was tentative. But then on September 8, 2020, the New England Journal of Medicine published further research:

As SARS-CoV-2 continues its global spread, it’s possible that one of the pillars of Covid-19 pandemic control — universal facial masking — might help reduce the severity of disease and ensure that a greater proportion of new infections are asymptomatic. If this hypothesis is borne out, universal masking could become a form of “variolation” that would generate immunity and thereby slow the spread of the virus in the United States and elsewhere, as we await a vaccine….

Past evidence related to other respiratory viruses indicates that facial masking can also protect the wearer from becoming infected, by blocking viral particles from entering the nose and mouth. Epidemiologic investigations conducted around the world — especially in Asian countries that became accustomed to population-wide masking during the 2003 SARS pandemic — have suggested that there is a strong relationship between public masking and pandemic control. Recent data from Boston demonstrate that SARS-CoV-2 infections decreased among health care workers after universal masking was implemented in municipal hospitals in late March…

Recent virologic, epidemiologic, and ecologic data have led to the hypothesis that facial masking may also reduce the severity of disease among people who do become infected. This possibility is consistent with a long-standing theory of viral pathogenesis, which holds that the severity of disease is proportionate to the viral inoculum received (NEJM).

Some of this quote repeats what was just said, but the new information is the population studies. Where there is universal mask wearing, there are lower rates of infection. That is due to the mask-wearer being protected from infection. And again, there is the point that the less virus someone is infected with, the less severe his or her infection will be.

Next is the following from the Anchorage Daily News:

But the latest research on masks suggests that covering one’s face actually does protect the wearer as well as those they come into contact with, said Joe McLaughlin, the state’s chief epidemiologist, said during a call on Thursday.

That’s because wearing a mask lessens the amount of virus that is able to enter the mouth or nose, he explained.

“There’s good evidence to suggest that if you’re exposed to less of the virus, you have a decreased risk for getting a more serious infection, because it’s a lot easier for your body to fight off a small amount of the virus,” he said, citing two peer-reviewed studies published in September and late July.

This report repeats what was said before, but it bears repeating. Yes, wearing a mask protects the wearer by reducing the viral load the mask-wearer is infected with. That reduces the severity of that person’s infection.

Comparison to a Vaccine

Now for the real exciting stuff. First from ABC News reporting about Dr. Redfield’s comments quoted at the beginning of this article.

“I agree with Dr. Redfield. At best, a vaccine will be about 75% effective against moderate to severe disease,” Dr. Paul Offit, a professor of pediatrics at Children’s Hospital of Philadelphia and a co-inventor of the rotavirus vaccine, told ABC News. “A mask, on the other hand, if used correctly and combined with social distancing, will be far more effective than that.”…

“The first-generation COVID vaccines are not expected to render all vaccines impervious to infection -- as they won’t be like the current measles vaccine -- but to modify illness so that severity and need for hospitalization is lower. So, even among the vaccinated, there will still be infections that occur, they will just be less frequent and less severe,” he said.

“The bottom line is we don’t know what is more effective without data about the Phase 3 of the vaccine trials” (italics in original).

The 75% figure cited here for the effectiveness of a vaccine is optimistic. More often, I heard a vaccine will more likely only be 50-70% effective. But most of all, note that a vaccine does not always prevent an illness. It more often only reduces the severity of illness.

That is true for the flu vaccine. It is generally only 50% effective at preventing an infection, but those who are infected who have been vaccinated generally have a less severe illness. That reduction in severity is vital. It could literally mean the difference between life and death for both the flu and the CV, or at least, the difference between an infected person being bedridden for two weeks or even hospitalized versus just a couple of days of not feeling well.

But note, that is the same effect a mask has. It reduces the amount of viral load a person is infected with, lessening the severity of the illness.

Now, medical experts are saying that your face mask actually does protect you from COVID-19, too, decreasing the risk of infection for anyone wearing one by 65 percent.

During an interview on July 2 about the effectiveness of coronavirus prevention methods, Dean Blumberg, MD, chief of pediatric infectious diseases at UC Davis Children’s Hospital, and William Ristenpart, a professor of chemical engineering at UC Davis, said research shows that the virus is spread by two primary methods: aerosol particles and droplets. And, according to their findings, someone wearing a mask is more protected against the barely visible droplets that are expelled when someone talks than someone who isn’t. “Wearing masks decreases the risk by 65 percent,” Blumberg said (Best Life).

Note that percentage, 65%. That is in the 50-70% range I just cited for a vaccine. Note also, this research is based on someone talking. The person expels particles that linger in the air. The person being talked to will then inhale those particles if that person is not wearing a mask, but someone wearing a mask will be protected 65%. That reduction in viral load will reduce the severity of the illness of the newly infected person, just like with a vaccine.

Now for some more detailed research from the Journal of General Internal Medicine. Quoting from the Abstract:

Although the benefit of population-level public facial masking to protect others during the COVID-19 pandemic has received a great deal of attention, we discuss for one of the first times the hypothesis that universal masking reduces the “inoculum” or dose of the virus for the mask-wearer, leading to more mild and asymptomatic infection manifestations. Masks, depending on type, filter out the majority of viral particles, but not all. We first discuss the near-century-old literature around the viral inoculum and severity of disease (conceptualized as the LD50 or lethal dose of the virus). We include examples of rising rates of asymptomatic infection with population-level masking, including in closed settings (e.g., cruise ships) with and without universal masking. Asymptomatic infections may be harmful for spread but could actually be beneficial if they lead to higher rates of exposure. Exposing society to SARS-CoV-2 without the unacceptable consequences of severe illness with public masking could lead to greater community-level immunity and slower spread as we await a vaccine.

The rest of this study then demonstrates each of these points are true. Masks do indeed reduce the viral load, and the amount of viral load does indeed determine the degree of seriousness of symptoms. But the new piece of information is that this lower level of viral load still leads to immunity. It is tantamount to a vaccine. You get infected with just enough virus to elicit an immune response, but not enough that it makes you sick, at least not significantly so.

What this means is, Dr. Redfield was absolutely correct in comparing mask wearing to a vaccine. A mask protects the mask-wearer just as much as a potential vaccine. It reduces the degree of symptoms, just like a vaccine, and it can lead to immunity, just like a vaccine.

To repeat from the preceding study, “Exposing society to SARS-CoV-2 without the unacceptable consequences of severe illness could lead to greater community-level immunity and slow down spread as we await a vaccine.”

What this means is, universal mask wearing now, then widespread vaccination later will lead to herd immunity. Hopefully, those who will not wear a mask will get the vaccine, and those who will not get a vaccine will wear a mask. Together, that will end this CV crisis.

The only question is if a mask or a vaccine offers greater protection. In that regard, the CDC director might have exaggerated just a bit in saying a mask offers greater protection than a potential vaccine. He may have exaggerated so as to make his point, that masks work. He later clarified that in no way was he downplaying the importance of a vaccine.

But in fact, they are probably about equally effective. But then, that depends on the efficacy rate of a vaccine, which, since we do not have one yet, we can only speculate about. It also depends on the type of mask and if it is correctly worn. I will address those points about masks in Part Two. But here, it would be good to sum things up in an easy to understand manner.

An Illustration

Previously, the CDC page said that Covid-19 was thought to spread mainly between people in close contact -- about 6 feet -- and “through respiratory droplets produced when an infected person coughs, sneezes or talks.”

The page, updated Friday (9/18/20), still says Covid-19 most commonly spreads between people who are in close contact with one another, and now says the virus is known to spread “through respiratory droplets or small particles, such as those in aerosols, produced when an infected person coughs, sneezes, sings, talks or breathes.”

These particles can cause infection when “inhaled into the nose, mouth, airways, and lungs,” it says. “This is thought to be the main way the virus spreads” (CNN).

Note the reference to “talks or breathes.” That is all it takes for an infected person to infect someone else, to talk or breath near them. That is, if both are not wearing a mask. But it is a totally different picture if one or both are wearing a mask.

To illustrate, let’s say two men are talking, both sitting in chairs, about 2-3 feet apart. Luke is on the left, and Robert is on the right. Robert is infected with the CV, but does not know it, because he is asymptomatic. Luke is not infected. Neither are wearing a mask.

As Roberts breaths and speaks, CV particles are released from his nose and mouth. The force of his breath forces the particles towards Luke. As those particles reach Luke’s face, he inhales them through his nose and his open mouth when he is speaking. The longer they sit and talk, the more CV particles that are inhaled by Luke.

After about 30 minutes, Luke has received a large load of the CV and is thoroughly infected. How serious his infection will be depend on his age and if he has any comorbidities (preexisting health conditions). But even if he is young and healthy, that large load of the CV could cause him to have severe symptoms, though that is far more likely is he is older and/ or has one or more comorbidities.

But let’s say Luke was wearing a mask. When those CV particles reached his face, they would hit his mask rather than easily traveling into his nose and mouth. Now, depending on the mask material, some of those particles might penetrate the material, but by no means all of them. And some of the particles might get around his mask through gaps at the top and bottom of it, but again, by no means all of them.

What that means is, Luke will receive just a small load of CV particles. As a result, even if he is older and has comorbidities, he is likely to not have a severe infection. He will probably only have minor symptoms. If he is younger and without comorbidities, he will probably be asymptomatic, not even knowing he has been infected, just like with Robert. The possibility of a asymptomatic infection is somewhat dangerous, as it means Luke, like his friend Robert, could spread the CV to his friends that the talks to in the same way he was infected.

However, if Robert wore a mask, that would block most of the CV particles coming out of his nose and mouth. Only a few of them will get past the mask, most likely through gaps in the top and bottom. Those particles could still travel to Luke, but there would be les air pressure behind them pushing them, with the mask blocking Robert’s exhales. If Luke is also wearing a mask, he will receive a tiny load of the CV and most likely will only have very mild if any symptoms.

Then if Luke continues to wear a mask when he talks to others, then the same scenario will occur over and over again. Those he talks to will only get a low load of the CV, even lower if they are also wearing a mask. However, if everyone is this scenario are not wearing masks, then a large flare-up of the CV with many serious infections could result in this group of friends.

In sum, if everyone involved in this scenario are wearing masks, you will have a group of people who got infected, do not have serious consequence to the point of maybe not even knowing they are infected, but they are now immune. They can no longer be infected, and their immunity contributes to herd immunity, bringing us closer to an end to this crisis.

However, if none of them are wearing masks, you could end up with a major flare-up, with several hospitalizations and deaths, all because they were not wearing masks.

A Meta-Analysis of 216 Studies

Given the preceding, it is clear, masks can make a huge difference by both protecting the mask-wearer from the CV and by the wearer protecting others if the wearer is infected with the CV. This conclusion is verified by a meta-analysis from The Lancet. The following is from the abstract.

Our search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25 697 patients). Transmission of viruses was lower with physical distancing of 1 m [3 feet] or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds ratio [aOR] 0·18, 95% CI 0·09 to 0·38; risk difference [RD] −10·2%, 95% CI −11·5 to −7·5; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2·02 per m; pinteraction=0·041; moderate certainty).

Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD −14·3%, −15·9 to −10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12–16-layer cotton masks; pinteraction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD −10·6%, 95% CI −12·5 to −7·7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings.

In regard to the difference between N95 masks, surgical masks, and cloth masks, the body of this meta-study states:

    Medical or surgical face masks might result in a large reduction in virus infection; N95 respirators might be associated with a larger reduction in risk compared with surgical or similar masks.

    ... the use of both N95 or similar respirators or face masks (eg, disposable surgical masks or similar reusable 12–16-layer cotton masks) by those exposed to infected individuals was associated with a large reduction in risk of infection.

    ... both N95 and surgical masks also had a stronger association with protection versus single-layer masks.

Thus, N95s are best, surgical masks are next best, while cloth masks are the least effective. But all three are still effective at protecting the wearer from being infected. These differences between these three types of masks, along with eye protection, will be addressed in Part Two.

Late-Breaking News/
Conclusion to Part One

Following are tweets by President Donald J. Trump:

Hope Hicks, who has been working so hard without even taking a small break, has just tested positive for Covid 19. Terrible! The First Lady and I are waiting for our test results. In the meantime, we will begin our quarantine process! 10:44 PM · Oct 1, 2020

Tonight, @FLOTUS and I tested positive for COVID-19. We will begin our quarantine and recovery process immediately. We will get through this TOGETHER! 12:54 AM · Oct 2, 2020

Our elegant First Lady added shortly afterwards:

As too many Americans have done this year, @potus & I are quarantining at home after testing positive for COVID-19. We are feeling good & I have postponed all upcoming engagements. Please be sure you are staying safe & we will all get through this together. 1:27 AM · Oct 2, 2020

Immediately, the media and Twitterverse began blaming the infections of the President, his lovely wife, and his close advisor on Trump “downplaying” this pandemic, especially his downplaying of the importance of the wearing of masks. However, the White House pushed back, saying everyone on Air Force One were wearing masks, including Hope when she was on board. Also, at the first presidential debate on September 29, when the moderator Chris Wallace asked Trump about mask-wearing, Trump pulled a mask out of his shirt pocket and said, “I put a mask on when I think I need it.”

It is almost impossible to know for sure where a particular CV infection occurred. But the very detailed and numerous scientific research presented in this Part One of this three-part article has demonstrated that masks do indeed work at both protecting the mask-wearer from the CV and at protecting others from the masker-wearing if he or she is infected. Thus, if the Trumps and Hope had been more conscientious about the wearing of masks, maybe none of them would have gotten infected.

However, if their claims about mask-wearing are true, it could mean the Trumps and Hope received a low dose of CV infection, making a good prognosis more likely for each of them. In fact, at 10:45 am on October 2, Trump’s Chief of Staff Mark Meadows reported Trump was “showing mild symptoms” but was in good spirits. Melania tweeted the same about herself shortly afterwards, “Thank you for the love you are sending our way. I have mild symptoms but overall feeling good. I am looking forward to a speedy recovery.”

On the other hand, President Trump’s age and borderline obesity put him at increased risk of serious CV consequences. But he does not have other comorbidities that are even more risking producing, like diabetes, hypertension, and lung or heart disease. But still, later that day, he was transferred to Walter Reed Medical Center. It was not clear if that was because his condition had worsened or not. It was just said to be “as a precautionary measure.”

Walter Reed has a suite just for the President, so he can keep working while he is being treated. I will update Trump’s condition in Part Two of this article. But for now, see my article President Trump’s First Annual Physical for details on Trump’s general health situation.

The prognosis is better for Melania and Hope, as both are much younger, of normal weight, and without other comorbidities, as far as I know. And of course, all of them will received the best medical care possible. I discuss all of these issues in my extensive CV writings.

But the risk is still there of serious consequences for anyone who gets infected, though much less so for those who are younger and those without comorbidities. But still, that risk might have been avoided or result in less severe symptoms due to a lower CV infection load if the Trumps and those around them were more conscientious about mask-wearing.

In addition to the Trumps and Hope Hicks, several other governmental officials in Washington DC have tested positive for the CV. Contact tracing seems to indicate all of these cases originated at the nomination ceremony for Amy Comey Barrett, Trump’s pick to fill Justice Ginsburg’s seat on the Supreme Court, though Judge Barrett herself tested negative. That is because she already had the CV and recovered this past summer. The importance of all of this will be discussed in Part Two.

Part Two of this three-part article will discusses correct versus incorrect mask-wearing, different types of masks, and addresses arguments against the effectiveness of masks.

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