Do masks work?/Is it a violation of my constitutional rights?
Many stores and other businesses are requiring either employees or patrons or both, to wear masks.
Many states or local governments are requiring or encouraging people to wear masks when around others in public places or private businesses. Why? I have compiled some legal info (based on my personal knowledge as an attorney) and some scientific info that I researched. I hope this is of benefit.
LEGAL INFORMATION:
First, is it a violation of my rights to force me to wear a mask?
Just as there are laws that require people to wear clothes in public, or to wear seat belts in cars, helmets when on a motorcycle, etc., laws can be passed, even at the local level, especially during an emergency crisis, if the benefit to public health, safety and welfare, outweighs the liberty being denied.
However, store policies aren’t law. So shouldn’t we have the right to choose to wear a mask or not?
No. Private entities can create their own policies, like no shirt, no shoes, no service, or no pets, or even requiring people to keep their kids from roaming, etc., as long as those policies aren’t discriminatory. So they have the right to kick you out and refuse you service if you don’t abide by the policy.
But isn’t it discrimination to force me to wear a mask?
No. Unless they are only forcing a certain “protected class” to wear a mask, it is legal for them to require it.
What’s a protected class?
Gender, sex, age, race, ethnicity, religion, disability.
But I have a condition that makes wearing a mask hard or impossible for me. So aren’t they violating the ADA by requiring me to wear one?
Only if they’re not providing you with a reasonable accommodation like a personal shopper or online shopping.
If they ask me for a note to prove I have a condition that makes wearing a mask dangerous or impossible for me, isn’t that a violation of HIPAA?
No. The same way you have to show proof of disability at Disneyland to get certain accommodations, or to get a “handicapped” placard, it is not a violation of HIPAA to require proof of disability in this instance.
SCIENTIFIC INFORMATION:
But what the heck, the CDC changed it’s time about masks. So aren’t we “sheeple” for wearing them? Where is the proof that they work and why if they work did the CDC day they weren’t effective and we should not wear them?
Need to Preserve Certain Masks for Health Care Workers:
At the beginning of this we had a run on N-95’s and surgical masks leaving front line health care workers without enough PPE’s. A case in point is a 61 year old nurse working with COVID patients who died after having contracted COVID from a patient because she rushed to give him emergency care (chest compressions) with only a surgical mask. She died 14 days after treating him, trying to save his life:
Hollywood nurse died 14 days after rushing into room to save COVID-19 patient — without an N95 mask
So initially, the CDC wanted to preserve masks for those who need them more than others.
Efficacy Depends on Type and Circumstance:
But wait, doesn’t that prove that masks are ineffective if she got COVID awhile wearing a surgical mask?
No. Transmission of COVID19 depends on exposure to a certain amount of viral load, apparently. Surgical masks offer some protection but if a person is forcefully exhaling or spewing aerosol droplets right in your face, it might not be enough.
Study Showing No One Wearing Masks Was Infected by COVID:
In an investigative study in China by epidemiologists investigating an outbreak among bus passengers, tracing showed that one person infected 13 people after a four hour bus ride.
The bus was enclosed. No open windows. The person who spread the virus was feeling sick, however it was on 1-22-20, before the Chinese government had declared the virus a national emergency. The sick person was not wearing a mask.
At least one of the passengers who contracted the virus got it within 30 minutes of boarding AFTER the infected person GOT OFF the bus. That led the researchers to determine that, based on various factors, the aerosol droplets can linger for up to 30 minutes in an enclosed space.
The epidemiologists were able to determine exactly who infected whom and how far apart they were because all buses in China carry cameras and they watched everything on video and had traced the infected patients to the bus.
Importantly, people in China often wear surgical masks in public. And some did on the bus as well.
NOT ONE PERSON WEARING A MASK ON THE BUS BECAME INFECTED.
So for normal exhalations in an enclosed area, or even more forceful ones, a surgical mask may help people around the infected person.
Study Comparing N-95's and Surgical Masks During SARS:
And of course we all have seen doctors and dentists or other medical staff wearing masks during procedures and surgeries. We’ve also seen cancer patients wearing masks and people in the hospital visiting the patient wearing masks as well. Why is that?
A 2007 study during the SARS outbreak provides some of the answers:
[In a ]study comparing the
in vivo protective performance of surgical masks and N95 respirators [1] [the] authors found that N95 respirators filtered out 97% of a test aerosol while surgical masks did almost as well, filtering out 95% of the aerosol.
Methods
The authors used a KCl-fluorescein solution aerosol as a viral simulant. KCl is the test challenge aerosol recommended by the National Institute for Occupational Safety and Health (NIOSH), and fluorescein was added as a visual marker to gauge the degree of KCl penetration. Each of 10 subjects (half men and half women) was tested wearing each kind of mask. The masks were fitted properly, and the subjects were tested at rest and while walking on a treadmill up to 6.4 km/hr (4 miles/hour). The KCl solution was sprayed on the mask twice every 10 minutes, for a total of 14 times, from a distance of 1 meter away using an atomizer.
The degree of filtration of the challenge aerosol was measured in two ways. First, the concentration of KCl in the 4 layers of the exposed N95 and the 3 layers of the exposed surgical mask was determined. Second, the degree of fluorescein staining on the portion of a subject’s face covered by the mask was quantified.
Results
The estimated size of the most penetrating aerosol particles reaching the mask was 0.1-0.3µm. By each method, the N95 performed significantly better than the surgical mask, but the difference was small (2%).
Droplet vs. Aerosol
Surgical masks have long been the recommended respiratory protection for diseases transmitted by large droplets (>5µ) such as plague or meningococcal meningitis. For diseases such as TB that are transmitted by small droplet aerosols, an N95 (or better) respirator or powered air purifying respirators (PAPRs) with high efficiency particulate absorbing (HEPA) filter is recommended. It has been generally assumed that a surgical mask provided little protection from aerosols. With SARS and influenza, both droplet and aerosol transmission may occur, although the relative importance of each is debated.
During the SARS epidemic,
in most circumstances, surgical masks were effective in protecting healthcare workers (HCW) from infection. In a case-control study of five hospitals in Hong Kong affected by SARS, W. H. Seto and colleagues found that
consistent use of surgical masks was associated with a significant reduction in risk of infection. In fact, of 51 HCW with documented SARS exposure while wearing a surgical mask, none became infected. In contrast, 13 of 198 exposed HCWs (6.5%) who did not wear a surgical mask or N95 were infected. [2]
Similar results were found in Toronto during the SARS outbreak, where consistent use of surgical masks reduced the risk of infection by 50% among 32 critical care nurses who entered the room of a SARS patient. Consistent use of an N95 resulted in an 80% risk reduction. [3]
The experience with the SARS epidemic clearly demonstrated a relationship between the risk of infection to HCWs and certain aerosol-generating medical procedures.
The highest risk was associated with endotracheal intubation, airway suctioning, and non-invasive positive pressure ventilation[4]. In these settings, the highest degree of respiratory protection possible is warranted.
02-15-2007: Surgical Masks May Provide Significant Aerosol Protection
Emphasized by me.
This shows that when attending to a patient and walking in a room with not only droplets, but viral aerosols, a surgical masks offers the wearer protection. However when doing more invasive procedures like chest compressions, where there are forceful exhalations in the worker’s face, a surgical mask would not necessarily be enough protection.
Study of Homemade vs. Surgical Masks
Here’s a study of cloth masks and surgical masks from 2012 which studied the efficacy of reduction in transmission of influenza from those who were wearing masks. It found that while cloth masks weren’t as effective at preventing microorganisms from spreading, both did contain a significant amount and that cloth masks were better than nothing in preventing infection BY the wearer:
“The median-fit factor of the homemade masks was one-half that of the surgical masks. Both masks significantly reduced the number of microorganisms expelled by volunteers, although the surgical mask was 3 times more effective in blocking transmission than the homemade mask.”
Testing the Efficacy of Homemade Masks: Would They Protect in an Influenza Pandemic? - PubMed
Note also that the homemade masks in the study did not have any filters or other barriers in them.
But I’ve heard that COVID 19 particles are maybe smaller than other viruses or more contagious and in studies, can penetrate masks and thus masks are no use? Is that true?
Study of 4 COVID Patients and Masks
There was a recent study of four (4) COVID19 patients that showed that the coronavirus was found on the OUTSIDE of both surgical and cloth masks when people were told to cough forcefully into the mask. This led to an indication that masks are ineffective.
New study questions the effectiveness of masks against SARS-CoV-2
However, the presence of the virus on the outside of the masks doesn’t indicate that it spread throughout the room in either droplet or aerosol form and thus that the masks do nothing to prevent transmission.
Tests of the air, or distance tests were not done. And this indication is contrary to actual tests involving spread in the room and contagion by others (on a bus or healthcare workers wearing various masks).
We don’t know the exact size but in my inexpert opinion it seems it’s unlikely to be smaller than the coronavirus that caused SARS. We do know that apparently, higher viral load is what matters.
Whether Airborne or Aerosol - Conditions Seem to Matter
There is no indication thus far that this virus is airborne in the true sense of the word. It spreads mainly by droplets. But there is evidence that aerosolized droplets can be spread by close talking or singing. The chances increase in small or poorly ventilated areas and thus higher exposure to “minimal infectious load”:
Studies of Aerosol Spread/Mask Efficacy
Another paper, recently published in the
New England Journal of Medicine, showed that infectious SARS-CoV-2 virus can remain in aerosols for at least three hours—and for several days on various surfaces—in a laboratory setting.
But the amount of viable virus diminished significantly during that time. Scientists do not know the infectious dose of SARS-CoV-2. (For influenza, studies have shown that just three virus particles are enough to make someone sick.)
Overall, most of the evidence that SARS-CoV-2 can become airborne comes from clinical settings—which tend to have a lot of sick people and may host invasive procedures, such as intubations, that can cause patients to cough, generating aerosols. It is not clear how representative of everyday environments these areas are. “There is not much convincing evidence that aerosol spread is a major part of transmission” of COVID-19, Perlman says.
Cowling hypothesizes that many respiratory viruses can be spread through the airborne route—but that the degree of contagiousness is low. For seasonal flu, the basic reproduction number, or R0—a technical designation for the average number of a people a sick person infects—is about 1.3. For COVID-19, it is estimated to be somewhere between two and three (though possibly as high as 5.7). Compared with measles, which has an R0 in the range of 12 to 18, these values suggest most people with the disease caused by SARS-CoV-2 are not extremely contagious.
But there are seeming exceptions, such as the choir practice in Washington State, Cowling says.
[The article goes on the explain that ventilation, exposure by a “super spreader”, size of the room and forcefulness/type of the exhalations can impact the contagion risk].
Cowling co-authored a study, published in early April in
Nature Medicine, of patients with respiratory infections at an outpatient clinic in Hong Kong between 2013 and 2016. This research detected RNA from seasonal coronaviruses—the kind that cause colds, not COVID-19—as well as seasonal influenza viruses and rhinoviruses, in both droplets and aerosols in the patients’ exhaled breath.
The paper, led by Nancy Leung, an assistant professor at the University of Hong Kong’s school of public health, found that wearing surgical masks reduced the amounts of influenza RNA in droplets and of seasonal coronavirus RNA in aerosols.
Although the study did not look at COVID-19 specifically, the findings support mask wearing as an effective way to limit transmission of the virus from an infected person—known in medical parlance as source control. There is not much evidence that masks convey protection to healthy people, although it is possible (and may depend on the type of mask). Given the prevalence of asymptomatic infection with COVID-19, however, there is some justification for universal mask wearing to prevent those who do not know they are sick from infecting others. In Hong Kong, which has kept its outbreak relatively under control, masks are worn by the vast majority of the population, Cowling says.”
How Coronavirus Spreads through the Air: What We Know So Far
CDC Did Not Know That Asymptomatic Carriers Spread COVID. Now We Know
Evidence that COVID19 can be contracted by asymptomatic coronavirus carriers was not known when the CDC issued its statement that masks were not required. Once it was determined that asymptomatic carriers can infect others and cause them to develop COVID19, the advice changed, in regard to homemade masks.
CONCLUSION
Being required to wear a mask is not a violation of our constitutional rights.
And it appears that doing so lowers the risk of spread to the wearer and to others.
In the final analysis it appears that a cloth mask is is better than nothing in protecting the wearer from some amount of viral load. Surgical masks are three times more effective but a cloth mask does offer some protection. I thinks it’s not unreasonable to suggest that wearing a filter in the mask might protect the wearer even more.
But while surgical masks are much more effective than cloth, they don’t provide the protection of an N95 and can allow a health care provider to become infected when exposed to forceful exhalations from a sick person who is inches from their face, or maybe by being in a small space for a lengthy period in which a sick person or persons has or have been coughing, sneezing or undergoing procedures. (I have also seen that amount of time exposed also has a bearing on transmission).
N95’s provide the wearer with the most protection but as health care workers desperately need them, no one is recommending that the rest of us wear them.
Importantly, it also appears that homemade masks
can protect others from being infected by the wearer. Yes, if someone forcefully coughs, virus microorganisms will be present on the front of the mask. That’s even true for surgical masks. But it seems even cloth masks can prevent the aerosolized droplets from spreading in the air around the person. It is a barrier that can protect others.
And while most won’t become sick from COVID and fewer will become seriously ill or die, this is a small inconvenience to protect some of our most vulnerable and to prevent the impact on our health care system and economy of so many people getting sick at around the same time. Those numbers add up and have devastated nations. And it will enable others to feel more confident going back out into the world of everyone does their part and follows some basic guidelines. So wearing a mask when possible, in close proximity to others, in my opinion, is both wise and ethical. It's a responsibility we should all have in a civilized society. And it just might help our economy get back on track as it will make more people comfortable venturing out if this becomes the norm for the present.
