Does Wearing a Mask During a Pandemic Make a Difference: A Counterpoint
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In the March 11 e-Letter, I editorialized that based on the extensive Cochrane study1 mask wearing appeared to offer limited protection, if at all, from the virus both for the individual and the community. The lead author of the review, Tom Jefferson, MD, said, “there is just no evidence that they make any difference.” Further, as to the quality of the masks, N95 versus cloth masks, he said that it “makes no difference—none of it.”
A column in the NY Times dated March 10 by Zeynep Tufekci titled “Here’s Why the Science is Clear that Masks Work,” not only begged to differ but asserted an opposite conclusion. (Tufekci is a Columbia University sociology professor and author of Twitter and Tear Gas: The Power and Fragility of Networked Protest.)
The Editor-in-Chief of the Cochrane Library, Karla Soares-Weiser, disagreed entirely with Jefferson’s conclusion: “The review examined whether interventions to promote mask wearing help to slow the spread of respiratory virus…Given the limitations in the primary evidence, the review is not able to address the question of whether mask wearing itself reduces people’s risk of contracting or spreading respiratory viruses…This wording was open to misinterpretation, for which we apologize.” Cochrane intends to amend the summary of the study to include this conclusion. Soars-Weiser acknowledged that Jefferson’s “statement is not an accurate representation of what the review found.”
It is a curious observation in medicine and science that data in a study may be interpreted one way by the authors and an entirely different way by others. What may be viewed as supporting a hypothesis can be interpreted as disputing such thinking. Of course, this assumes that the analysis of the data is addressed truthfully without willful misinterpretation. It does not appear that Jefferson’s assessment is entirely faulty but deserves to be tempered. Tufekci asserts that that he has ignored those studies examined in the Cochrane review that have demonstrated effectiveness of mask wearing.
There were problems with the studies analyzed: too small study groups, inadequate mask wearing, and limited time when masks were worn. The majority of the studies were from before the Covid-19 pandemic. Tufekci noted that only one study prior to Covid-19 had high adherence to mask wearing. The study done in 2009 during an outbreak of H1N1 in Germany found that when masks were worn consistently viral spread was reduced; however, this study did have a small sample size. She commented on another small Danish study during a pandemic: those wearing a mask had a 1.8% infection rate while those who did not had a higher 2.1% rate.
Tufekci discussed an observational study done in 2020 at Massachusetts General-Brigham Hospital comparing infection before masking was required to after it had been mandated. Among health care workers prior to the mandate, infection rate “doubled every 3.6 days and rose to 21.3%. After universal masking was required, the rate stopped increasing, and then quickly declined to 11.4%.” She also cited a German study that also took place early in 2020 before and after masks were mandated: “face masks reduced the daily growth rate of reported infections by around 47%, with the effect more pronounced in large cities and among older people.”
Other commentators had similar concerns about the Cochrane study and the backlash against masks. Kelsey Piper, who authors the Future Perfect newsletter, expressed her concerns in a Feb. 10 Vox writing titled “The Covid mask wars have left us unprepared for the next pandemic.” She thinks that the takeaway that mask mandates are ineffective is wrong. Piper poses the question when we do have the next pandemic will wearing a mask be effective public health policy?
Piper interviewed Yale behavioral economist, Jason Abaluck, who was a co-author of a masking study in Bangladesh. Indeed, this was the largest randomized mask study done during the Covid-19 pandemic. In those villages that encouraged masking there was a significant reduction in cases compared to those villages that were not given masking recommendations. Abaluck commented that the mask question is not a simple question of whether wearing a mask is effective. There are at least eight questions to consider as a public health authority about mask wearing: 1. Is it less likely that the individual wearing a mask will get sick? 2. If the individual is sick and wears a mask, is it less likely that others will get sick? 3. If others are less likely to get sick because the individual is wearing a mask, does this directly benefit others or are we simply delaying an eventual infection? 4. Does wearing a mask change the overall outcome of the pandemic? 5. If you tell an individual to wear a mask, will that person regularly wear the mask correctly? 6. If you mandate an individual to wear a mask, will that person regularly wear the mask correctly? 7. What “costs” are there to the individual by mandating mask wearing? 8. What adverse effects are there to an individual wearing a mask?
Tufekci opines that “consistently wearing a mask, preferably a high-quality, well-fitting one, provides protection against the coronavirus.” Unfortunately, the Cochrane study was not able to establish that mask wearing is effective, concluding that larger randomized trials would be necessary.
Tufekci thinks that public health authorities and medical leaders will continue to call for mask wearing whenever there is a respiratory viral outbreak. She concludes that while the evidence for wearing a mask is weak, there is sufficient observational evidence that mask wearing plays an important role in curbing viral spread.
Piper agrees but thinks that we do need much more research to answer the aforementioned questions about mask wearing. In particular, the question as to whether routine mask wearing will significantly reduce disease transmission needs to be answered. Piper thinks that we have done little to improve mask quality and that the technology could be greatly improved. There should be more effective and comfortable masking options.
Treatment of Arterial Ulcer with EDTA Chelation Therapy by Efrain Olszewer, MD
The Townsend Letter has been privileged over many years to publish Dr. Efrain Olszewer’s medical reviews. Olszewer is well recognized internationally in orthomolecular and chelation medicine. He currently practices in Sao Paulo, Brazil, with a specialty practice in internal medicine and cardiology. Olszewer is an exuberant speaker presenting at medical conventions and symposia in the US, throughout South America, as well as in Europe and in Asia. At his clinic he has overseen treatment of 60,000 patients.
In the chelation community he is renowned for studies he has reported on chelation. In 1989 he published a study with James Carter examining 2870 patients over a 28-month period of time.2 The retrospective study was conducted in Sao Paulo. The patients were treated with intravenous disodium EDTA chelation primarily for atherosclerotic disorders. Among patients treated for ischemic heart disease, 76.9% demonstrated marked improvement and 17% had good improvement. Patients diagnosed with cerebrovascular disease showed 91% improvement. Olszewer’s and Carter’s chelation study was part of the evidence submitted substantiating chelation’s effectiveness that prompted the NIH to initiate the TACT trial in the early 2000s.
In this issue Olszewer reports on a 72-year-old hypertensive woman who sustained an ankle arterial ulcer. Conventional care for three months did not yield any improvement in the ulcer. Photos of the ulceration changes over the course of chelation therapy revealed remarkable improvement and resolution of the ulcer. Olszewer emphasizes that arterial ulcers compared to venous ulcers obligate treatment with an aggressive therapy such as EDTA chelation.
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References
1. Jefferson T, Dooley L, Ferroni E, Al-Ansary LA, van Driel ML, Bawazeer GA, Jones MA, Hoffmann TC, Clark J, Beller EM, Glasziou PP, Conly JM. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database of Systematic Reviews 2023, Issue 1. Art. No.: CD006207. DOI: 10.1002/14651858.CD006207.pub6.
2. Olszewer, E, Carter, J. EDTA chelation therapy: a retrospective study of 2870 patients. IN: A Textbook of EDTA Chelation, edited by Elmer Cranton. 1989.
Published March 25, 2023