On Monday, August the 24th, I checked my mailbox to find a small advertisement from HugsOverMasks.
When I first saw the card, I gave it a good look over. It looks very well done- a colourful, laminated page about your hand's size, with straightforward claims anyone can read and understand. On it are six claims as to why masks are unsafe and that wearing one is detrimental to your health and that Provincial and Municipal legislation does not require patrons to provide any exemptions. Everything you have heard to be true is wrong, according to HugsOverMasks.
On the bottom of the back page are references to support 3 of their six claims.
As soon as I read the words "wearing a face mask is detrimental to my health" written in bold on the front of the card, I knew it was time to dig into the science. Why? Because it goes against everything we know about the safety and efficacy of wearing masks, and something like this could harm people.
Who Is HugsOverMasks?
HugsOverMasks is a group of people whose goal is "restoring our liberties, democracy, and way of life."
In regards to Covid-19: "Our governments have mandated measures that are not supported by the latest scientific data on COVID-19. We are dedicated to removing the lockdown measures that are unnecessarily harming Canadians & People around the world. We must reopen our countries so everyone can return to normal life, have a voice in their Legislature, and resume earning their livelihoods, for themselves and their families."
Although they don't specify what they do, they protest at busy locations in both the US and Canada. They put up protesting photos of adults and children without face protection on their social media pages, who, of course, are not following distancing guidelines.
The takeaway: the HugsOverMasks ideology goes against most of the safety precautions set out by the government, world health organizations, and the medical community.
I'm not here to tell you what ideology is right or wrong, but I want to question the research that backs their claims. I want to see if this is simply a narrative created by someone's opinions or any truth to the statements made, and ultimately their call to arms as an opposition to mainstream health recommendations. So let's dive in.
PS. I am not a virologist, nor am I claiming to be an expert at anything to do with COVID-19.
Claim 1. Masks increase respiratory infections.
"Wearing a cloth masks significantly increases the risk of flu-like-illness. Masks absorb moisture and can become reservoires of bacteria and viral particles."
This claim is based on one study, which can be found here.
The study compared trials involving cloth masks, medical masks, and control (which was deemed 'usual practice' of wearing a mask). In short, 1607 healthcare workers from multiple hospitals were instructed to wear either of the 2 masks, cloth or medical, or maintain usual practices in the hope of determining which of the safety measures reduced the likelihood of getting sick. The end result was those who wore the medical masks got sick less than those wearing cloth masks (which we expect).
A couple of things.
-First, these trials were conducted in Vietnam. Vietnam and Canada are two very different places, with two different standards of care. Does a trial in another country with a different standard of care and practice yield the same safety and results?
-Healthcare workers were given instructions on washing their masks but were not appropriately monitored to wash and clean those masks. Hand washing was not observed during the study, as well.
-This study is about health care workers. The criteria to enter the study were doctors or nurses working 8 hours a day wearing the masks 70% of the time during working hours with a sick population (totalling a minimum of 5.6 hours). The average person is not a healthcare worker who is exposed to the same hazards.
-Those who are working with a sick population are advised to wear medical masks. It is very well known that cloth masks do not compare to N95's or medicals masks in these settings. So really, this is no surprise that the cloth mask group got sick more. If anything, even though the medical mask group did better than the cloth mask group in this study, it still demonstrated that cloth masks work to some degree.
-Furthermore, a systematic review from April 2020 (which is a conglomeration of all the available evidence at that time) concluded that "Universal face mask use is likely to have the most impact on epidemic growth in the community, given the high risk of asymptomatic and pre-symptomatic transmission"
This is only 1 study comparing the use of different masks for efficacy against various viruses and bacteria. The government of Ontario has deemed that "homemade and/or cloth masks is the recommended mask type for use in non-healthcare settings"
The World Health Organization recommends "cloth masks as intended for community use and public settings where there are COVID-19 cases and where physical distancing cannot be maintained".
The University of Maryland Medical System says that "cloth face masks are effective. They create a barrier between your mouth and nose and those around you. This makes it more difficult for the droplets that spread coronavirus through coughs, sneezes and talking to reach other people"
HealthLinkBC states, "A cloth mask can help prevent respiratory droplets of an unknowingly infected person from coming into contact with others outside the home. A non-medical mask or face covering may be used for periods of time when you cannot keep a safe distance from others, such as on public transit."
It should be mentioned that mask use alone is not as effective as mask use + handwashing + not touching your face. Although surgical masks are much more useful than cloth masks for healthcare workers working within the sick community, a blanket term of "masks are bad" does not reflect the scope of evidence concerning the average person heading into Home Depot or the grocery store. This claim is an excellent example of cherry-picking the evidence without considering all the available data.
Claim 2. Mental Health Impacts Overlooked
"Those with exemptions for mental health often face discrimination or disbelief of their condition. Masks can cause stress and anxiety, aggravating pre-existing symptoms before, during, and after use."
Before I dive into this claim, I don't want to devalue how prominent mental health issues are in our society. They are real, I think they exist in more people than we think, and we need more support for those who suffer from mental illnesses.
However, sources? Anything?
The sentence comes in 2 claims.
The first is that those with mental health issues face discrimination or disbelief in their condition. Sure, there may be people with exemptions who are judged for not wearing a mask without knowing who they are and what they suffer from. This is possible—people judge.
The second, masks can cause stress and anxiety, aggravating pre-existing symptoms before, during, and after use. I searched Google Scholar for "cloth masks anxiety" & "cloth mask stress" and found limited information. However, when I put in "cloth mask mental health" a WHO PDF popped up. Through the article it offers a practical approach for people in this situation:
3. "Alternatives to non-medical masks for the general public. In the context of non-medical mask shortage, face shields may be considered as an alternative noting that they are inferior to mask with respect to prevention of droplet transmission. If face shields are to be used, ensure proper design to cover the sides of the face and below the chin. In addition, they may be easier to wear for individuals with limited compliance with medical masks (such as those with mental health disorders, developmental disabilities, deaf and hard of hearing community and children)."
My next question is, how do we conclude that anxiety and stress come from wearing a mask? How do we know that heightened stress and anxiety aren't coming from being amid a pandemic? Job loss? Financial troubles? Being away from family and friends?
We have alternatives for those with mental health issues and others with face mask exemptions. And although face shields don't appear to work as well as cloth masks, they are absolutely better than nothing. Again, this appears as a limited view from HugsOverMasks.
Claim 3. Bullying and Shaming
"Those who are unable to wear a mask will be confronted multiple times a day regarding a mask. Children who are unable to wear masks face bullying from other children and even their parents."
Bullying is awful. It is an unfortunate reality that kids and adults both face, and I'm certain it is not going away anytime soon, especially as our school's change to accommodate COVID-19.
However, the issue I have with this claim is that it promotes fear-mongering. It reads as though your child WILL face bullying from other kids if they don't wear a mask or have a substitute. This is called fear-mongering.
Often people will use fear-mongering for claims like this to amp up their point. We can't quantify who will get bullied and who will not, so we really can't prove this to right or wrong.
Timmy might go to school with a face shield and get made fun of, while Daniel goes to another school with a face shield and is entirely accepted. Kim might go to school this year and be made fun of wearing a unicorn mask while Sally goes to another school with a unicorn mask, and her friends think it's cool. We also see some schools opening up anonymous hotlines to report bullying associated with COVID-19 and mask use.
We really can't tell.
Claim 4. Impairs Social Development
"Children rely on the nose and lips to identify their parents. Masks muffle sound, hide facial expressions, and prevent lip reading. Communication relies heavily on lip movement, especially for hearing impaired."
The claim here is that masks muffle sound, hide facial expressions, and prevent lip-reading, which may be detrimental for the hearing impaired. Well, yes, they are masks. We wear masks to prevent the spread of infectious diseases. However, this is a genuine concern. Masks do remove the ability to discern lip movement and facial features. Non-verbal communication, aka the not-talking portion of how we communicate, may make up 90% of how we communicate with people.
The study linked is titled Eye movements during emotion recognition in faces, which reinforces their claim that we use facial cues to communicate, which we already know.
Similar to claim 2, people are smart, and HugsoOverMasks left out transparent masks. Recently, a woman in Belgium who works in a special needs school with many deaf students began creating transparent masks approved by Belgian virologists to be worn by students and the public alike. There is also the Clear Mask, Safe'N'Clear, and face shields as alternatives.
Claim 5. Poses Public Safety Risks
"Masks compromise safety and enable anonymous crime. Being able to identify people and children in distress is paramount for safety; this is especially important for identifying missing children."
It seems that with the new recommendations of wearing masks it may make anonymous crime easier for criminals. However, before COVID-19, criminals have worn bandanas and other facial coverings while committing crimes. So this is not new.
This point does make sense. In the event of an amber alert or a missing person's report, trying to identify them may become more difficult since their face is being mostly covered. Criminals robbing a store would be difficult to identify with a face mask.
With this being said, local police aren't just sitting back accepting the new world. For example, the Vancouver Police Department is taking preventative action by analyzing crime trends and data to reduce crime.
Claim 6. Causes Headaches And Dizziness.
"Masks impair breathing, can cause shortness of breath and have other negative side effects. Masks increase carbon dioxide and reduce oxygen concentrations inside the mask."
There are many claims here.
The study they provided for this claim is about headaches, which I take as 'other negative side effects' since they don't list it in their statement. The study mainly looked at the N95 face mask (not cloth masks) and headaches' prevalence and impact. The study goes like this:
212 healthcare workers participated in the study. Out of 212 people:
79 people (only 37.3%) reported face-mask associated headaches
26 (32.9%) of those people reported having headaches more than 6 times per month
6 (7.6%) reported taking sick leave
47 (59.5%) of people reported taking pain relieves or pain killers for those headaches.
Furthermore:
The following limitations were provided by the authors:
"Factors other than use of the N95 face‐mask, such as psychological stress and sleep disturbances, which could have influenced the development of headaches, were not included in this study"
According to the WHO, 1 in 2 people gets a headache nearly every day, and they are more common in women occurring in 1/3 of men and 1/2 of women). The study group was almost 2/3rd women (77.8%).
So, of the study group, around 1/3 reported headaches. One-third of that 1/3 had 6+ headaches per month...and we have a whole host of other factors that could have influenced headaches. Also, knowing what we know about headaches, the study results don't surprise me any further.
I really don't see this as a good argument to say that masks=headaches. It really says that people get headaches...and that masks may contribute to them. For the remainder of the study group, odds are people working in the healthcare community will probably take sick leave, and yes, if you have a headache, there are painkillers for that. The evidence doesn't seem conclusive. At all.
Next, masks increase carbon dioxide and reduce oxygen concentrations.
As per the American Lung Association, they conclude: "Do Masks Cause Low Oxygen Levels? Absolutely not. We wear masks all day long in the hospital. The masks are designed to be breathed through and there is no evidence that low oxygen levels occur prolonged use of N-95 masks in patients with pre-existing lung disease could cause some build-up of carbon dioxide levels in the body. People with pre-existing lung problems should discuss mask wearing concerns with their health care providers."
On the WHO myth-busting page, they state: "FACT: The prolonged use of medical masks* when properly worn, DOES NOT cause CO2 intoxication nor oxygen deficiency."
A pulmonologist from the Ohio State University Wexner Medical Centre writes about the oxygen/co2 myth and concludes, "In a word: no."
I suppose I could have kept searching for sources, but I feel like the point is obvious. The idea that masks reduce oxygen concentrations in the body is false, nor does wearing a mask mean you're going to get a headache. Although a mask can be uncomfortable, the above claims are weak-sauce compared to the level of evidence supporting the safe wear of masks.
In conclusion
Having looked at the statements made by HugsOverMasks, I believe they cherry-pick the evidence to support their ideology. You can clearly see that the opposing body of evidence is quite robust and publicly available.
I would urge HugsOverMasks to review the research concerning masks and mask use. I believe their current position to be absolutely dangerous to the general public, primarily due to case numbers rising in specific locations and the available evidence to support safe mask use.
PS. I am open to different perspectives on mask-wearing and safety. If you think I've made a mistake here, feel free to let me know!
