On September 24, a group from the University of California, Davis, published a paper in Nature that claims “wearing of surgical masks or KN95 respirators, even without fit-testing, substantially reduce the number of particles emitted from breathing, talking, and coughing.” In other words, put those masks on! Down in the fine print they admitted that some masks were notably better than others, but… “Wear a mask!”
It would seem that this should settle the issue, but not so fast. If you re-read that first paragraph, you’ll see that this is a “mechanistic” paper. That is, it examines mechanisms – the physical way things happen. The CDC published a review of fourteen – count ‘em – fourteen studies of this kind, and found no evidence that masks had any effect on transmission of airborne diseases, in particular H1N1 flu, which is spread the same way that SARS-CoV-2 is spread. Even when they lumped the fourteen studies together in a “meta-analysis,” they still struck out. This should immediately raise our antennae, since we already know that the measured data do not translate into the clinical recommendation they make.
At this point, it’s tempting to note that this group is likely to add that mask reco since they are based in the Peoples’ Republic of California, and Governor Gruesome signs their paychecks. But they published in Nature, a well-regarded family of international journals. Hmmm…. Maybe the devil IS in the details.
The prime contact for the study is William D. Ristenpart, PhD. He states that,
“My research is in complex transport phenomena, with an emphasis on using advanced experimental techniques to extract quantitative measurements from complicated phenomena. My group strives to answer fundamental scientific questions about a variety of systems where the transport behavior is paramount.”
He ought to know what he’s doing. Exhaled particles from breathing, speaking, and coughing are definitely transported when they leave your mouth. Credibility oozes from every pore.
Next we check out the “materials and methods.” This is where we find out how Professor Ristenpart did his measurements. In that section he talks about surgical masks, KN95s, t-shirt masks of various kinds, and so on. So far, so good. Enquiring minds want to know.
A most curious picture appears.
There are several parts to this. The box is a “laminar flow hood,” which takes ultra-filtered air and blows it gently through the top into the box. The purpose is to keep anything inside the box from being contaminated by anything outside the box. These hoods are common in pharmacies and clinical laboratories so that sterile conditions can be maintained inside the box. The key feature here is that the air is flowing out into the room.
Next we see an experimental subject with a mask. The subject’s face is within one centimeter (about 3/8 of an inch) of a funnel attached to a suction that draws air in through an analyzer. Think about this for a moment. The only air that will enter the funnel comes directly forward from the test subject.
This is of extreme importance. If I breathe out without a mask, this vape is what it looks like. (I used the vape to make my breath visible.) In the setup for the experiment, most of what I breathe out will be sucked up by the funnel. So far, so good. The problem comes when I use a surgical mask.
If I look at where my breath goes, a little bit does go through the mask material. This matches Ristenpart’s data, where masks block large portions of the particles. Duh. We already knew that. One YouTube presenter did a set of experiments with an ether spray can and propane torch. Even as close as three inches, a surgical mask blocks the direct spray of ether droplets. That’s actually not a big surprise. He’s trying to spray through layers of filter material.
In a brief discussion with aerosol scientist Jose-Luis Jiminez, (@jljcolorado) we agreed that masks block a lot of aerosols traveling through the mask. The problem arises with aerosols around the mask. He admits that aerosols can follow the pattern demonstrated in the second photograph. Those around the side simply diffuse into the room, unaffected by the mask. But all of us in operating rooms have known this for decades. You don’t breathe through surgical masks, you breathe around them. And what goes out around, also comes in around. As the California Air Resources Board notes, masks “do not provide protection against smoke particles,” which, coincidentally, are similar in size to a lot of human breath aerosols.
This brings us back to experimental design. If you look at the second photograph again, you’ll see that most of my breath goes out in places where the funnel in the analyzer can’t capture them. You read that right. Most of my breath aerosol will escape, completely undetected in Ristenpart’s experiment. As it escapes through the sides of my mask, the air flowing from the laminar flow hood blows it into the room. It isn’t permitted to get anywhere near the sampling funnel.
This brings us to a key question in science. What is the question we’re trying to answer? In this case it’s, “Do masks reduce the emission of aerosols into the room?” The secondary question is, “Do masks protect against the spread of COVID-19?”
Notice that we have to answer the first question before we can even think about the second one. If masks don’t reduce aerosols into the room, then there’s no way they can reduce transmission of COVID-19. So let’s go back to that first question. Does the study measure the release of aerosols into the room? The answer must be a resounding NO! It only measures the aerosols that penetrate the mask. All those aerosols that escape out the sides of the mask are blown away from the test apparatus. Since most of the breath doesn’t go through the mask, Ristenpart’s experiment doesn’t measure room aerosols. Because it doesn’t measure room aerosols, it can’t legitimately answer the second question, even though Ristenpart gives an answer to it.
Let’s get this straight. The experiment was well designed to measure the effect of masks on breath that passes through them. It’s terribly designed if it intends to evaluate total aerosol into the room. It simply cannot support the conclusion its authors give, because it did not test that question.
This is a classic demonstration of why we have to be very careful with “authorities” and “scientific studies.” Bad studies are common. Worse editorial comments in the conclusion section of those bad studies is even more prevalent. We should look at the CDC’s own publication in May again. After looking at fourteen peer-reviewed studies, they could not find evidence that masks will reduce the spread of disease. That’s the right question, and a robust answer. We must not accept badly flawed information just because it’s in a “scientific” journal.
Masks remain virtue signaling. There is no data to support their use by the general public.
Ted Noel MD blogs on various social media platforms as DoctorTed or @vidzette.
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