Professor Roger Seheult, MD explains the important role Vitamin D may have in the prevention and treatment of COVID-19. Dr. Seheult illustrates how Vitamin D works, summarizes the best available data and clinical trials on vitamin D, and discusses vitamin D dosage recommendations. Roger Seheult, MD is the co-founder and lead professor at https://www.medcram.com He is an Associate Professor at the University of California, Riverside School of Medicine and Assistant Prof. at Loma Linda University School of Medicine Dr. Seheult is Quadruple Board Certified: Internal Medicine, Pulmonary Disease, Critical Care, and Sleep Medicine Interviewer: Kyle Allred, Producer and Co-Founder of MedCram.com
A private practice is your best bet for receiving the highest quality of care at the lowest cost.
By Nicholas Grosso, M.D., Contributor
It's true that private physician practices are not as common as they once were. But don't write them off just yet: A private practice is still your best bet for receiving the highest quality of care at the lowest cost. And although the number of private practices has declined significantly in recent years, they are poised for a comeback under a new business model.
Here's what that means for consumers – and why you shouldn't give up on private practices:
Independence leads to the best care. Under the private practice model, physicians have full autonomy to make the decisions that will lead to the best outcome for the patient. The trusted doctor-patient relationship is comprised of just two parties: the physician and the patient.
A third party is often introduced to this relationship when physicians work for large hospitals or health systems. These health systems, primarily led by executives with no clinical training, have a surprising amount of influence in the medical decisions a physician is allowed to make. The organization might dictate what tests to perform, which brand of implants to use in orthopaedic surgery and even push for more surgeries regardless of whether they are truly required by the patient. As an orthopaedic surgeon who has spent much of my career serving patients at my own private practice, I have always valued the autonomy I have to make referrals to the best specialists, prioritize non-invasive treatment options and squeeze patients into my schedule for emergency visits. With this model, I have the latitude to make sure that every single treatment decision is based on evidence, best practices and the patient's health history.
Additionally, independent practices are much more nimble than large health systems or hospitals – which means that we can adopt new technology and techniques more quickly.
[See: HIPAA: Protecting Your Health Information.]
Private practice treatment can drive down expenses. Hospital treatment will always be the most expensive option for a variety of reasons, including site of service fees and reimbursement structures. Whenever possible, private practitioners can perform surgeries for low-risk patients in outpatient centers – which dramatically lowers costs while typically improving the patient experience.
A recent study published in Orthopaedic Reviews found that orthopaedic surgeries cost an average of $3,225 more when performed in a hospital setting compared to an outpatient clinic. And that's just the average – the research found that cost savings ranged from 17.6 percent to 57.6 percent. Another study found that ACL reconstruction surgery cost an average of $9,220 at an inpatient hospital facility and just $3,905 in an outpatient clinic. But the quality is not poorer because of the lower cost: Additional research has shown that outpatient care is simply more efficient, allowing patients to spend 25 percent less time in the ambulatory surgical center than they would in a hospital setting, while realizing the same clinical outcomes.
[See: 14 Things You Didn't Know About Nurses.]
The private practice model is evolving – not dying. The independent "super group" is a new business model that is rapidly gaining traction because it combines the best of both worlds. When individual practices join together, they can maintain the autonomy and standard of patient care that is unique to private practices – while also benefiting from shared financial resources, economies of scale and a broader network of services. My group, The Centers for Advanced Orthopaedics, was among the first to pilot this model, and today we are the largest private provider of orthopaedic care in the country and have more than 30 individual practices on board.
Our commitment to quality, the patient experience and efficient, low-cost services remains the same. But with the backing of a larger group, we can offer patients convenient access to local specialists, plus ancillary services like physical therapy. We also have the industry recognition to move forward with value-based care payment models, such as bundled payments.
Super groups are becoming an increasingly compelling and viable option for private practitioners of every specialty, from primary care to urology. If a super group doesn't already exist in your area, you will likely have one soon.
[See: 10 Questions Doctors Wish Their Patients Would Ask.]
So the next time you need to search for a medical professional, don't skip past the private practices and assume they won't be in business much longer. Instead, think about the independent care and cost savings they can provide, and make the decision based on your own circumstances. The private practice model, although it has certainly struggled in recent years, is here to stay.
Dr. Nicholas Grosso is president of The Centers for Advanced Orthopaedics.
Tags: patients, patient advice, health care, doctors
What Are the Truly Verifiable Facts Surrounding COVID-19?
Global Research, August 14, 2020“Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less.”
Those words, uttered by two-time Nobel Prize-winning chemist and physicist Marie Curie, are as relevant today as they were in her era (1867–1934). With most of the planet under some form of medical martial law, we would do well to follow her advice: understand more and fear less about the pandemic. The way to do that is to establish the verifiable, scientific facts about the SARS-CoV-2 virus and separate those facts from the fiction being touted by a fear-mongering news media. Only then will we stop surrendering our inherent freedoms to COVID-19 propaganda.
Fiction #1: Wearing a face mask will protect you and others from the coronavirus.
Fact #1: Contrary to what many medical and government officials tell us, there is no evidence to support the claim that face masks—whether N95, surgical, or cloth—protect the wearer from any virus. These so-called “medical experts” usually reference a purportedly scientific publication to support their claim. However, when the studies they point to—namely, in The Lancet and from the Mayo Clinic—are put under closer scrutiny, they fail to pass one crucial test: they never used a Randomized Controlled Trial (RCT). Reputable scientists consider the RCT the Holy Grail when it comes to conducting a study on a large group of people, because it eliminates the possibility of any population bias in the testing.
When we look at trials that have used the RCT method to analyze the efficacy of face masks, we find starkly different results from those that have not.
For instance, an exhaustive dental study conducted in 2016 revealed that disposable surgical face masks are incapable of providing protection from respiratory pathogens. Continue...
By Dr. Betty Martini, D.Hum.
Note – The following is for informational purposes ONLY.
If you are sick, see your doctor. This is one person’s opinion and is not suggested as a cure or treatment for anything.
It is just a point of information from the net.I don’t know who provided this formula but if you click on the URL you will see they censored the link. In any event I was able to get it. One doctor said in a video he was using Hydroxychloroquine for his lupus patients and the pharmacist wouldn’t fill it. Ohio had tried to ban it and the Governor intervened. It’s been used for 65 years.
Dr. Judy Mikovits who wrote “Plague of Corruption” has written another book I just received called “Plague”. She writes about chronic fatigue syndrome among other diseases. About the time of the release of aspartame the Epstein Barr Association changed their name to Chronic Fatigue. The Atlanta Journal Constitution wrote over an entire page and a half called “The Enemy Within” on Chronic Fatigue. They said it came out in the early 1980’s which is when aspartame was marketed through the political chicanery of Don Rumsfeld. The aspartame pandemic is now called Rumsfeld’s Plague.
Dr. H. J. Roberts and I attended the American College of Physicians in Atlanta in March 1995. You could join different discussions in classes and we choose one that advertised Chronic Fatigue, It was next to the last subject and wouldn’t you know it, the professor said “we don’t know where this came from so we will skip it”. We wanted to advise the group the connection is aspartame. Cher suffered from Epstein Barr and was advertising Equal. I sent her information and she turned down the $900,000 they offered her to continue to advertise this addictive, excitoneurotoxic, genetically engineered, carcinogenic, teratogen, drug and adjuvant.
In “Aspartame Disease: An Ignored Epidemic” by the late world expert H. J. Roberts, M.D. he goes into the autoimmune diseases that can be triggered or precipitated by aspartame. Dr. James Bowen said about lupus: “The ability of methyl alcohol/formaldehyde to create antigenicity, especially as combined in aspartame molecules is so great as to cause severe autoimmune reactions to the tissues deformed by formaldehyde polymerization, adduct formation. The immune system turns against the victim’s tissues: Lupus.”
Dr. Mikovits also speaks of autism. MIT said by 2025 one out of two babies will be born with autism. One aspartame victim said she has three children by two husbands and drank diet soda through pregnancy. All three children have autism. They work two jobs for a trust to care for their children when they are gone. It has been known for years aspartame causes autism as well as vaccinations. It has also been attributed to Round Up. G. D. Searle made a deal with the FDA to seal the teratology studies and it took me 8 years to find them. Read the Bressler Report. My web site is http://mpwhi.com/
Social media has censored the site because there you can find the FDA reports, scientific peer reviewed research, the real CDC investigation along with congressional hearings and other documents that are suppose to be a matter of public record.
Read on for the formula for Hydroxychloroquine.
Dr. Betty Martini, D.Hum, Founder
Mission Possible World Health Intl
1. HOME RECIPE FOR HYDROXYCHLOROQUINE (HCQ) :
THE DRUG THAT IS CURRENTLY TREATING THIS VIRUS…WATCH BELOW AS I SHOW YOU THE RECIPE AND HOW TO MAKE THIS SOLUTION AT HOME, MINUS BIG PHARMA’S FILLERS AND PRESERVATIVES.
2. THAT’S RIGHT…THIS IS THE REAL REASON THAT THE DRUG COMPANIES WERE FURIOUS ABOUT THIS CURE. NOT ONLY HAS IT PROVEN TO ELIMINATE THIS VIRUS…BUT OTHERS AS WELL. IT WAS SUPPOSED TO BE A BIG KEPT SECRET…BUT TRUMP BLEW THAT FOR THEM RIGHT AWAY.
3. WHAT IS HYDROXYCHLOROQUINE EXACTLY? IT IS NOTHING BUT QUININE. SOMETHING THAT ANYONE CAN MAKE AT HOME…AND SOMETHING THAT IS BEING MANUFACTURED EACH AND EVERY DAY IN THE FORM OF SOMETHING WE HAVE ALL SEEN AT THE GROCERY AND LIQUOR STORES…NONE OTHER THAN TONIC WATER.
4. HIS DRUG BEING USED TO TREAT THE COVID VIRUS HAS. THIS WAS NEVER SUPPOSED TO BE LEAKED OUT…BECAUSE EVEN A FULL TREATMENT REGIME OF PILLS FROM THE DOCTOR IS LESS THAN A 100.00 FOR SOMEONE THAT DOES NOT HAVE INSURANCE.
5. SOMETHING ELSE YOU MAY FIND INTERESTING IS THAT WHEN THEY CREATED THIS VIRUS, THEY ALSO PUT A STRAIN OF HIV IN IT. THIS WAS TO MAKE IT EVEN MORE FATAL. BUT… GUESS WHAT?
6. THE QUININE KILLED THAT PART OF THE AIDS VIRUS AS WELL. CAN YOU SEE NOW WHY THEY WERE SCREAMING THAT THIS WAS A DANGEROUS DRUG AND NOT TO DARE USE IT. BEHIND THE SCENE STUDIES ARE NOW COMING FORTH THAT SHOW IT BEING EFFECTIVE OTHER DISEASES AS WELL AND EVEN ON CANCERS.
7. I THINK IN THE DAYS TO COME, WE ARE GOING TO FIND OUT A WHOLE LOT MORE THAN WE EVER THOUGHT WE KNEW. IF YOU LISTENED TO OUR PRESIDENT THIS WEEK, HE SAID THAT IN ONE YEAR, EVERY TREATMENT THAT WE ARE NOW USING IN THE HOSPITALS WILL BE OBSOLETE . WHAT DOES HE KNOW?
8. HE KNOWS THAT THEY HAVE WITHHELD THESE CURES TO KEEP PEOPLE SICK AND TO MAKE MILLIONS OFF OF INSURANCE COMPANIES.
9. QUININE HAS MANY USES AND APPLICATIONS. IT IS ANALGESIC, ANESTHETIC, ANTI -ARRHYTHMIC, ANTIBACTERIAL, ANTIMALARIAL, ANTIMICROBIAL, ANTIPARASITIC, ANTIPYRETIC, ANTISEPTIC, ANTISPASMODIC, ANTIVIRAL, ASTRINGENT, BACTERICIDE, CYTOTOXIC, FEBRIFUGE, FUNGICIDE, INSECTICIDE, NERVINE.
10. STOMACH, TONIC…SO YOU CAN BE SURE THAT BIG PHARMA IS SCARED TO DEATH AT THIS POINT AND SCREAMING THAT THIS DRUG DOES NOT WORK…WHEN THE ENTIRE WORLD SEES THAT IT IS WORKING.
11. IF YOU EVER FEEL A CHEST COLD COMING ON OR JUST FEEL LIKE CRAP…MAKE YOUR OWN QUININE. IT IS MADE OUT OF THE PEELINGS OF GRAPEFRUITS AND LEMONS, …BUT ESPECIALLY GRAPEFRUITS. I WILL GIVE YOU THE RECIPE HERE AND YOU TAKE THIS CONCOCTION THROUGHOUT THE DAY…
12. OR YOU CAN MAKE A TEA OUT OF IT AND DRINK IT ALL DAY. THIS SHOULD TAKE AWAY ALL YOUR FEARS ABOUT THIS VIRUS, BECAUSE YOU NOW HAVE THE DEFENSE AGAINST IT AND MANY OTHER THINGS.
13. IF YOU TAKE ZINC WITH THIS RECIPE, THE ZINC PROPELS THE QUININE INTO YOUR CELLS FOR A MUCH FASTER HEALING.
Where possible use organic ingredients.
Seeds high in zinc content https://www.myfooddata.com/articles/high-zinc-nuts-seeds.php
14. HERE IS ALL YOU NEED TO DO TO MAKE YOUR VERY OWN QUININE……TAKE THE RIND OF 2-3 LEMONS, 2-3 GRAPEFRUITS. TAKE THE PEEL ONLY AND COVER IT WITH WATER ABOUT 3 INCHES ABOVE THE PEELS. PUT A GLASS LID ON YOUR POT IF YOU HAVE ONE, A METAL ONE IS FINE IF YOU DON’T.
15. LET IT SIMMER FOR ABOUT 2 HOURS. DO NOT TAKE THE LID OFF OF THE POT TILL IT COOLS COMPLETELY AS THIS WILL ALLOW THE QUININE TO ESCAPE IN THE STEAM.
16. SWEETEN THE TEA WITH HONEY OR SUGAR SINCE IT WILL BE BITTER. TAKE 1 TABLESPOON EVERY COUPLE OF HOURS TO BRING UP THE PHLEGM FROM YOUR LUNGS. DISCONTINUE AS SOON AS YOU GET BETTER.
17. PLEASE SHARE THIS WITH THOSE THAT NEED TO REDUCE FEAR AND ALLOW THEM TO SEE THAT GOD IN ALL OF HIS GLORY, PROVIDES US WITH ALL THAT WE NEED.
18. JUST FOR TRUTHS SAKE, LET IT BE KNOWN THAT IN ADDITION TO THIS, DOCTORS ARE ALSO PRESCRIBING THE ANTIBIOTIC AZYTHROMICIN (Z-PACK). FOR THE RECORD, I AM NOT A DOCTOR OF ANY SORTS AND ONLY OFFER THIS FROM MY OWN DATA RESEARCH.
19. I AM NOT PRESCRIBING THIS IN ANY WAY, AND IT IS UP TO THE INDIVIDUAL READING THIS TO DO WITH THIS INFORMATION WHAT THEY WANT, IN ACCORDANCE WITH OUR FREEDOM FROM THE UNITED STATES CONSTITUTION.
Dr. Betty Martini, D.Hum, Founder
Mission Possible World Health Intl
9270 River Club Parkway
Duluth, Georgia 30097
More information on www.wnho.net and www.holisticmed.com/aspartame Source with thanks https://rense.com/general96/home-recipe-for-hydroxychloroquine-hcq.php
Dentists sound alarm over damage caused by masksBuild your immunity now and keep it strong to stay ahead of, and above whatever is thrown at us next, and please share so others can benefit also. https://twitter.com/roccogalatilaw/status/1292843358218530817?cn=ZmxleGlibGVfcmVjcw%3D%3D&refsrc=email
Without Prejudice and Without Recourse
Doreen A Agostino
Sent via hardwired computer
All wireless turned off to safeguard life
Dedicated to physicians who have been trained in the most comprehensive medical education on earth, who know how to restore and maintain health, and whose highest professional allegiance is to their patients.
Colleen Huber, NMD
July 6, 2020
At this writing, there is a recent surge in widespread use by the public of facemasks when in public places, including for extended periods of time, in the United States as well as in other countries. The public has been instructed by media and their governments that one’s use of masks, even if not sick, may prevent others from being infected with SARS-CoV-2, the infectious agent of COVID-19.
A review of the peer-reviewed medical literature examines impacts on human health, both immunological, as well as physiological. The purpose of this paper is to examine data regarding the effectiveness of facemasks, as well as safety data. The reason that both are examined in one paper is that for the general public as a whole, as well as for every individual, a risk-benefit analysis is necessary to guide decisions on if and when to wear a mask.
Are masks effective at preventing transmission of respiratory pathogens?
In this meta-analysis, face masks were found to have no detectable effect against transmission of viral infections. (1) It found: “Compared to no masks, there was no reduction of influenza-like illness cases or influenza for masks in the general population, nor in healthcare workers.”
This 2020 meta-analysis found that evidence from randomized controlled trials of face masks did not support a substantial effect on transmission of laboratory-confirmed influenza, either when worn by infected persons (source control) or by persons in the general community to reduce their susceptibility. (2)
Another recent review found that masks had no effect specifically against Covid-19, although facemask use seemed linked to, in 3 of 31 studies, “very slightly reduced” odds of developing influenza-like illness. (3)
This 2019 study of 2862 participants showed that both N95 respirators and surgical masks “resulted in no significant difference in the incidence of laboratory confirmed influenza." (4)
This 2016 meta-analysis found that both randomized controlled trials and observational studies of N95 respirators and surgical masks used by healthcare workers did not show benefit against transmission of acute respiratory infections. It was also found that acute respiratory infection transmission “may have occurred via contamination of provided respiratory protective equipment during storage and reuse of masks and respirators throughout the workday.” (5)
A 2011 meta-analysis of 17 studies regarding masks and effect on transmission of influenza found that “none of the studies established a conclusive relationship between mask/respirator use and protection against influenza infection.” (6) However, authors speculated that effectiveness of masks may be linked to early, consistent and correct usage.
Face mask use was likewise found to be not protective against the common cold, compared to controls without face masks among healthcare workers. (7)
Airflow around masks
Masks have been assumed to be effective in obstructing forward travel of viral particles. Considering those positioned next to or behind a mask wearer, there have been farther transmission of virus-laden fluid particles from masked individuals than from unmasked individuals, by means of “several leakage jets, including intense backward and downwards jets that may present major hazards,” and a “potentially dangerous leakage jet of up to several meters.” (8) All masks were thought to reduce forward airflow by 90% or more over wearing no mask. However, Schlieren imaging showed that both surgical masks and cloth masks had farther brow jets (unfiltered upward airflow past eyebrows) than not wearing any mask at all, 182 mm and 203 mm respectively, vs none discernible with no mask. Backward unfiltered airflow was found to be strong with all masks compared to not masking.
For both N95 and surgical masks, it was found that expelled particles from 0.03 to 1 micron were deflected around the edges of each mask, and that there was measurable penetration of particles through the filter of each mask. (9)
Penetration through masks
A study of 44 mask brands found mean 35.6% penetration (+ 34.7%). Most medical masks had over 20% penetration, while “general masks and handkerchiefs had no protective function in terms of the aerosol filtration efficiency.” The study found that “Medical masks, general masks, and handkerchiefs were found to provide little protection against respiratory aerosols.” (10)
It may be helpful to remember that an aerosol is a colloidal suspension of liquid or solid particles in a gas. In respiration, the relevant aerosol is the suspension of bacterial or viral particles in inhaled or exhaled breath.
In another study, penetration of cloth masks by particles was almost 97% and medical masks 44%. (11)
Honeywell is a manufacturer of N95 respirators. These are made with a 0.3 micron filter. (12) N95 respirators are so named, because 95% of particles having a diameter of 0.3 microns are filtered by the mask forward of the wearer, by use of an electrostatic mechanism. Coronaviruses are approximately 0.125 microns in diameter.
This meta-analysis found that N95 respirators did not provide superior protection to facemasks against viral infections or influenza-like infections. (13) This study did find superior protection by N95 respirators when they were fit-tested compared to surgical masks. (14)
This study found that 624 out of 714 people wearing N95 masks left visible gaps when putting on their own masks. (15)
This study found that surgical masks offered no protection at all against influenza. (16) Another study found that surgical masks had about 85% penetration ratio of aerosolized inactivated influenza particles and about 90% of Staphylococcus aureus bacteria, although S aureus particles were about 6x the diameter of influenza particles. (17)
Use of masks in surgery were found to slightly increase incidence of infection over not masking in a study of 3,088 surgeries. (18) The surgeons’ masks were found to give no protective effect to the patients.
Other studies found no difference in wound infection rates with and without surgical masks. (19) (20)
This study found that “there is a lack of substantial evidence to support claims that facemasks protect either patient or surgeon from infectious contamination.” (21)
This study found that medical masks have a wide range of filtration efficiency, with most showing a 30% to 50% efficiency. (22)
Specifically, are surgical masks effective in stopping human transmission of coronaviruses? Both experimental and control groups, masked and unmasked respectively, were found to “not shed detectable virus in respiratory droplets or aerosols.” (23) In that study, they “did not confirm the infectivity of coronavirus” as found in exhaled breath.
A study of aerosol penetration showed that two of the five surgical masks studied had 51% to 89% penetration of polydisperse aerosols. (24)
In another study, that observed subjects while coughing, “neither surgical nor cotton masks effectively filtered SARS-CoV-2 during coughs by infected patients.” And more viral particles were found on the outside than on the inside of masks tested. (25)
Cloth masks were found to have low efficiency for blocking particles of 0.3 microns and smaller. Aerosol penetration through the various cloth masks examined in this study were between 74 and 90%. Likewise, the filtration efficiency of fabric materials was 3% to 33% (26)
Healthcare workers wearing cloth masks were found to have 13 times the risk of influenza-like illness than those wearing medical masks. (27)
This 1920 analysis of cloth mask use during the 1918 pandemic examines the failure of masks to impede or stop flu transmission at that time, and concluded that the number of layers of fabric required to prevent pathogen penetration would have required a suffocating number of layers, and could not be used for that reason, as well as the problem of leakage vents around the edges of cloth masks. (28)
Masks against Covid-19
The New England Journal of Medicine editorial on the topic of mask use versus Covid-19 assesses the matter as follows:
“We know that wearing a mask outside health care facilities offers little, if any, protection from infection. Public health authorities define a significant exposure to Covid-19 as face-to-face contact within 6 feet with a patient with symptomatic Covid-19 that is sustained for at least a few minutes (and some say more than 10 minutes or even 20 minutes). The chance of catching Covid-19 from a passing interaction in a public space is therefore minimal. In many cases, the desire for widespread masking is a reflexive reaction to anxiety over the pandemic.” (29)
Are masks safe?
During walking or other exercise
Surgical mask wearers had significantly increased dyspnea after a 6-minute walk than non-mask wearers. (30)
Researchers are concerned about possible burden of facemasks during physical activity on pulmonary, circulatory and immune systems, due to oxygen reduction and air trapping reducing substantial carbon dioxide exchange. As a result of hypercapnia, there may be cardiac overload, renal overload, and a shift to metabolic acidosis. (31)
Risks of N95 respirators
Pregnant healthcare workers were found to have a loss in volume of oxygen consumption by 13.8% compared to controls when wearing N95 respirators. 17.7% less carbon dioxide was exhaled. (32) Patients with end-stage renal disease were studied during use of N95 respirators. Their partial pressure of oxygen (PaO2) decreased significantly compared to controls and increased respiratory adverse effects. (33) 19% of the patients developed various degrees of hypoxemia while wearing the masks.
Healthcare workers’ N95 respirators were measured by personal bioaerosol samplers to harbor influenza virus. (34) And 25% of healthcare workers’ facepiece respirators were found to contain influenza in an emergency department during the 2015 flu season. (35)
Risks of surgical masks
Healthcare workers’ surgical masks also were measured by personal bioaerosol samplers to harbor for influenza virus. (36)
Various respiratory pathogens were found on the outer surface of used medical masks, which could result in self-contamination. The risk was found to be higher with longer duration of mask use. (37)
Surgical masks were also found to be a repository of bacterial contamination. The source of the bacteria was determined to be the body surface of the surgeons, rather than the operating room environment. (38) Given that surgeons are gowned from head to foot for surgery, this finding should be especially concerning for laypeople who wear masks. Without the protective garb of surgeons, laypeople generally have even more exposed body surface to serve as a source for bacteria to collect on their masks.
Risks of cloth masks
Healthcare workers wearing cloth masks had significantly higher rates of influenza-like illness after four weeks of continuous on-the-job use, when compared to controls. (39)
The increased rate of infection in mask-wearers may be due to a weakening of immune function during mask use. Surgeons have been found to have lower oxygen saturation after surgeries even as short as 30 minutes. (40) Low oxygen induces hypoxia-inducible factor 1 alpha (HIF-1). (41) This in turn down-regulates CD4+ T-cells. CD4+ T-cells, in turn, are necessary for viral immunity. (42)
Weighing risks versus benefits of mask use
In the summer of 2020 the United States is experiencing a surge of popular mask use, which is frequently promoted by the media, political leaders and celebrities. Homemade and store-bought cloth masks and surgical masks or N95 masks are being used by the public especially when entering stores and other publicly accessible buildings. Sometimes bandanas or scarves are used. The use of face masks, whether cloth, surgical or N95, creates a poor obstacle to aerosolized pathogens as we can see from the meta-analyses and other studies in this paper, allowing both transmission of aerosolized pathogens to others in various directions, as well as self-contamination.
It must also be considered that masks impede the necessary volume of air intake required for adequate oxygen exchange, which results in observed physiological effects that may be undesirable. Even 6- minute walks, let alone more strenuous activity, resulted in dyspnea. The volume of unobstructed oxygen in a typical breath is about 100 ml, used for normal physiological processes. 100 ml O2 greatly exceeds the volume of a pathogen required for transmission.
The foregoing data show that masks serve more as instruments of obstruction of normal breathing, rather than as effective barriers to pathogens. Therefore, masks should not be used by the general public, either by adults or children, and their limitations as prophylaxis against pathogens should also be considered in medical settings.
1 T Jefferson, M Jones, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. MedRxiv. 2020 Apr 7.
2 J Xiao, E Shiu, et al. Nonpharmaceutical measures for pandemic influenza in non-healthcare settings – personal protective and environmental measures. Centers for Disease Control. 26(5); 2020 May.
3 J Brainard, N Jones, et al. Facemasks and similar barriers to prevent respiratory illness such as COVID19: A rapid systematic review. MedRxiv. 2020 Apr 1.
4 L Radonovich M Simberkoff, et al. N95 respirators vs medical masks for preventing influenza among health care personnel: a randomized clinic trial. JAMA. 2019 Sep 3. 322(9): 824-833.
5 J Smith, C MacDougall. CMAJ. 2016 May 17. 188(8); 567-574.
6 F bin-Reza, V Lopez, et al. The use of masks and respirators to prevent transmission of influenza: a systematic review of the scientific evidence. 2012 Jul; 6(4): 257-267.
7 J Jacobs, S Ohde, et al. Use of surgical face masks to reduce the incidence of the common cold among health care workers in Japan: a randomized controlled trial. Am J Infect Control. 2009 Jun; 37(5): 417-419.
8 M Viola, B Peterson, et al. Face coverings, aerosol dispersion and mitigation of virus transmission risk.
9 S Grinshpun, H Haruta, et al. Performance of an N95 filtering facepiece particular respirator and a surgical mask during human breathing: two pathways for particle penetration. J Occup Env Hygiene. 2009; 6(10):593-603.
10 H Jung, J Kim, et al. Comparison of filtration efficiency and pressure drop in anti-yellow sand masks, quarantine masks, medical masks, general masks, and handkerchiefs. Aerosol Air Qual Res. 2013 Jun. 14:991-1002.
11 C MacIntyre, H Seale, et al. A cluster randomized trial of cloth masks compared with medical masks in healthcare workers. BMJ Open. 2015; 5(4)
12 N95 masks explained. https://www.honeywell.com/en-us/newsroom/news/2020/03/n95-masks-explained
13 V Offeddu, C Yung, et al. Effectiveness of masks and respirators against infections in healthcare workers: A systematic review and meta-analysis. Clin Inf Dis. 65(11), 2017 Dec 1; 1934-1942.
14 C MacIntyre, Q Wang, et al. A cluster randomized clinical trial comparing fit-tested and non-fit-tested N95 respirators to medical masks to prevent respiratory virus infection in health care workers. Influenza J. 2010 Dec 3.
15 M Walker. Study casts doubt on N95 masks for the public. MedPage Today. 2020 May 20.
16 C MacIntyre, Q Wang, et al. A cluster randomized clinical trial comparing fit-tested and non-fit-tested N95 respirators to medical masks to prevent respiratory virus infection in health care workers. Influenza J. 2010 Dec 3.
17 N Shimasaki, A Okaue, et al. Comparison of the filter efficiency of medical nonwoven fabrics against three different microbe aerosols. Biocontrol Sci. 2018; 23(2). 61-69.
18 T Tunevall. Postoperative wound infections and surgical face masks: A controlled study. World J Surg. 1991 May; 15: 383-387.
19 N Orr. Is a mask necessary in the operating theatre? Ann Royal Coll Surg Eng 1981: 63: 390-392.
20 N Mitchell, S Hunt. Surgical face masks in modern operating rooms – a costly and unnecessary ritual? J Hosp Infection. 18(3); 1991 Jul 1. 239-242.
21 C DaZhou, P Sivathondan, et al. Unmasking the surgeons: the evidence base behind the use of facemasks in surgery. JR Soc Med. 2015 Jun; 108(6): 223-228.
22 L Brosseau, M Sietsema. Commentary: Masks for all for Covid-19 not based on sound data. U Minn Ctr Inf Dis Res Pol. 2020 Apr 1.
23 N Leung, D Chu, et al. Respiratory virus shedding in exhaled breath and efficacy of face masks Nature Research. 2020 Mar 7. 26,676-680 (2020).
24 S Rengasamy, B Eimer, et al. Simple respiratory protection – evaluation of the filtration performance of cloth masks and common fabric materials against 20-1000 nm size particles. Ann Occup Hyg. 2010 Oct; 54(7): 789-798.
25 S Bae, M Kim, et al. Effectiveness of surgical and cotton masks in blocking SARS-CoV-2: A controlled comparison in 4 patients. Ann Int Med. 2020 Apr 6.
26 S Rengasamy, B Eimer, et al. Simple respiratory protection – evaluation of the filtration performance of cloth masks and common fabric materials against 20-1000 nm size particles. Ann Occup Hyg. 2010 Oct; 54(7): 789-798.
27 C MacIntyre, H Seale, et al. A cluster randomized trial of cloth masks compared with medical masks in healthcare workers. BMJ Open. 2015; 5(4)
28 W Kellogg. An experimental study of the efficacy of gauze face masks. Am J Pub Health. 1920. 34-42.
29 M Klompas, C Morris, et al. Universal masking in hospitals in the Covid-19 era. N Eng J Med. 2020; 382 e63.
30 E Person, C Lemercier et al. Effect of a surgical mask on six minute walking distance. Rev Mal Respir. 2018 Mar; 35(3):264-268.
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© 2020, Colleen Huber, NMD
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