Long Mask: A new meta-analysis quantifies mask harms
In 2021, Kisielinski et al. published a long scoping review called “Is a Mask That Covers the Mouth and Nose Free from Undesirable Side Effects in Everyday Use and Free of Potential Hazards?” [TL:DR Hell no!] In it, they coined the term Mask-Induced Exhaustion Syndrome (MIES) to collectively describe the numerous and varied adverse effects of masks found in the scientific literature up to that point.
Last week, Kisielinski et al. validated their concept of MIES in a new paper in Frontiers in Public Health titled “Physio-metabolic and clinical consequences of wearing face masks—Systematic review with meta-analysis and comprehensive evaluation.”
A systematic review of 2,168 studies on adverse medical mask effects yielded 54 publications for synthesis and 37 studies for meta-analysis (on n = 8,641, m = 2,482, f = 6,159, age = 34.8 ± 12.5).
The 54-study qualitative analysis confirmed the MIES symptoms shown in the figure above and also some new ones. But the main value of the new paper is the 37-study meta-analysis, which quantified the physio-metabolic burden of mask-wearing.
Meta-analysis results: Take a deep breath.
The results showed that masks (particularly N95 masks) significantly restricted oxygen (O2) uptake, hindered carbon dioxide (CO2) release, and led to increased humidity and temperature under the mask.
One potential consequence of reduced O2 uptake is transient hypoxemia (lower than normal oxygen levels in blood), which ironically could lead to worse infection outcomes.
Studies have shown that oxidative stress (under hypoxic conditions) can inhibit cell-mediated immune response (e.g., T-lymphocytes, TCR CD4 complex, etc.) to fight viral infections, which may gradually lead to immune suppression (106, 107). Arterial hypoxemia increases the level of the hypoxia inducible factor-1α (HIF-1α), which further inhibits T-cells and stimulates regulatory T-cells (107). This may set the stage for contracting any infection, including SARS-CoV-2 and making the consequences of that infection much more severe.
So is there any evidence to back up this hypothesis? Yep.
The findings of Spira (16) from European data show that mask use correlates with increased morbidity and mortality, which could be due to the above-discussed possible processes.
Next, Kisielinski et al. discuss how hindered CO2 release may lead to transient hypercarbia (increase in carbon dioxide in the bloodstream). Again, there’s not much positive to report here.
kidney and organ calcification were frequently seen in animal studies on low-level CO2 exposure(122, 123)… Even slightly elevated CO2 induces higher levels of pro-inflammatory Interleukin-1β, a protein involved in regulating immune responses, which causes inflammation, vasoconstriction and vascular damage (128).
The effects of increased humidity and temperature under the mask aren’t much better.
Increased humidity and temperature can increase droplet and aerosol generation, which facilitate liquid penetration through the mask mesh. This not only increases the chance of microorganism (fungal and bacterial pathogens) growth on and in masks (134–136) causing increased risk for accumulation of fungal and bacterial pathogens (134, 136) including mucormycosis (137), but also leading to re-breathing of viruses that may be trapped and enriched within the moisturized mask meshwork…Additionally, the high concentration of microbiome in masks can be a potential source of infection for the population.
In other words, like hypoxemia, increased humidity and temperature under the masks may make infections worse. Oh, and there’s evidence to back this hypothesis up too.
The findings of Fögen (11) using data from the USA which shows that mask use correlates with an increased mortality (case fatality rate of COVID-19) could be due to these processes.
Kisielinski et al. also quantified the compensatory physiological mechanisms that result from mask-wearing. Results show significant decreases in ventilation (breathing volume) and tidal volume (the amount of air that moves in or out of the lungs with each respiratory cycle) and a significant increase in systolic blood pressure (the pressure in arteries when a heart beats).
From the above results, they hypothesise about the effects of long-term masking, especially for the elderly and sick.
Thus, prolonged masks use may lead to hypercapnic hypoxia like conditions. While short and acute hypercapnic hypoxia like conditions in healthy individuals can promote positive effects (sport, training, etc.) (143–145), a chronic/prolonged hypercapnic hypoxia (as also known from sleep apnea) is toxic for the renal (146), nervous (147), and cardiovascular system (148) in the long run—causing metabolic syndrome (14) as well as additional effects on cognitive functions (149).
This is just a hypothesis currently. But if it’s true, countries full of long-term maskers may be expected to report excess cardiovascular-related deaths. Like Japan just so happened to do in 2022, for example.
MIES as long-mask
Kisielinski et al. also meta-analysed the prevalence of various symptoms people suffer from mask-wearing. Just reading/hearing the word “mask” gives me headaches at this point.
From these results and others, Kisielinski et al. ask an interesting question: Are some alleged symptoms of long-Covid actually symptoms of long-mask?
Nearly 40% of main long-COVID-19 symptoms (171) overlap with mask related complaints and symptoms described by Kisielinski et al. as MIES (14) like fatigue, dyspnea [shortness of breath], confusion, anxiety, depression, tachycardia [a heart rate over 100 beats a minute], dizziness, and headache, which we also detected in the qualitative and quantitative analysis of face mask effects in our systematic review. It is possible that some symptoms attributed to long-COVID-19 are predominantly mask-related. Further research on this phenomenon needs to be conducted.
Don’t expect any of that further research to be conducted in Japan though. The danger of long-Covid is pointed to by Japanese media as a reason to wear masks!
Unsafe and ineffective
No Covid-era study on masks would be complete without mentioning their effectiveness, or lack of, against viral transmission. Mask advocates have regularly claimed that universal masking kept Covid infections low in East Asia. Kisielinski et al. are no more impressed by this post-hoc reasoning than I am.
there is evidence that COVID-19 rates have been able to expand swiftly when omicron hit (178) even in societies where mask use was assiduously followed—as in Korea, Taiwan, Hong Kong, and Singapore (179).
There’s one other East Asian nation I would’ve mentioned. But since I started this blog as an antidote to the fawning coverage the western media gave to the mask obsession in this part of the world, it’s nice to finally read a peer-reviewed article pointing to East Asia as evidence that masks don’t work.
To end the paper, Kisielinski et al. make a point that essentially reflects my position since early 2020: forced masking is unethical.
From the above facts, we conclude that a mask requirement must be reconsidered in a strictly scientific way without any political interference as well as from a humanitarian and ethical point of view. There is an urgent need to balance adverse mask effects with their anticipated efficacy against viral transmission. In the absence of strong empirical evidence of mask effectiveness, mask wearing should not be mandated let alone enforced by law.
And as anyone who’s ever read my long (and recently updated) article on mask effectiveness will know, “strong empirical evidence” for mask effectiveness is absent and always will be.
Thank you for this. I have not run across this elsewhere.
What has bothered me the most and the longest is that these findings are not new. Far from it. Industrial Hygienists and those whose work falls under their preview have known all this for decades. I have known all this my certification in respirators. There are reasons why filters need to be changed often. But those of us who know have from early on been silenced. This knowledge is forbidden.
One point I will use this opportunity to emphasize is that children have been denied the ability to learn how to communicate as a human being. My oldest child is 9 and they can no longer clearly understand the spoken word. How could it not be otherwise? A full 1/3 of their life to this point they have been denied the unruffled sound of the spoken word as it has been only spoken through at least a mask. This too was warned about at the very beginning but ignored. All who read this, please ask every mad masker Japanese why they hate the Japanese language so much? Why do they hate it so much that they have guaranteed that their own children and grandchild can not correctly hear it?
Update on panicked covid mitigation measures. Children and my 9 year old’s school are no longer required to wear masks. This fact was communicated via email the day before the first day of the new school year but not at school. Most students still believe that masks are required and harass my kids and the couple of others that are no longer wearing masks. The teachers, according to my kids are sometimes wearing masks and sometimes not. The school is still enforcing mokushoku.
I like turtles!