Western Australia Primier fucked Indians for lying and cheating

[Leongsam]

That's where you see and saw in NZ. Here is Singapore. Results differ from individual to individual. Btw, if you're the owner of those 2 tele grps. You and your lackeys can go F yourself. Otherwise, have a good day ahead, m8.

Nobody wears masks in NZ. It is not required. That is why NZ has been successful in eliminating the virus. We know that masks don't work.

And fuck you too.

 

[Vlad Tepes]

Nobody wears masks in NZ. It is not required. That is why NZ has been successful in eliminating the virus. We know that masks don't work.

And fuck you too.

Arh, so you're the owner of those 2 grps? No wonder you guys have so much to hide when I wanted details. LoL! Guess, i was right all along
Also, I don't give a FF if anyone wears a mask in NZ or they got invaded by emus. That's how much i care abt NZ and its people.

 

[Hanslesley73]

Nobody wears masks in NZ. It is not required. That is why NZ has been successful in eliminating the virus. We know that masks don't work.

And fuck you too.

NZ is successful in eliminating the virus coz Jacinda Ardern controlled n protected NZ from incoming foreigners, especially those from high risk countries. Unlike Singapore.

No foreigners from high risk countries = no covid cases = no need for mask

 

[Vlad Tepes]

NZ is successful in eliminating the virus coz Jacinda Ardern controlled n protected NZ from incoming foreigners, especially those from high risk countries. Unlike Singapore.

No foreigners from high risk countries = no covid cases = no need for mask

The main concern from me wasn't abt NZ having a mandatory mask wearing regulation or not. My main concern is abt his 2 tele grps suspected of spreading misinfo and labelling themselves as "SG" and putting a Singapore flag icon on them. In other words, it could be deemed as subversion.

 

[Leongsam]

NZ is successful in eliminating the virus coz Jacinda Ardern controlled n protected NZ from incoming foreigners, especially those from high risk countries. Unlike Singapore.

No foreigners from high risk countries = no covid cases = no need for mask

There are loads of Ah Nehs coming back to NZ too and they are let in because citizens cannot be legally prevented from returning.

 

[Leongsam]

The main concern from me wasn't abt NZ having a mandatory mask wearing regulation or not. My main concern is abt his 2 tele grps suspected of spreading misinfo and labelling themselves as "SG" and putting a Singapore flag icon on them. In other words, it could be deemed as subversion.

Those telegram groups have nothing to do with me. However I fully support their creation and their function which is to provide info that would otherwise be censored.

People have a right to know the risks involved when it comes to vaccination. Any attempt to censor information only makes matters worse.

 

[Leongsam]

Those who want to know what the groups are all about can go to

https://t.me/SGVaccineInjuries (channel)

https://t.me/SGVaxInjuries (discussion group)

https://t.me/SGCovidDiscussion (discussion group)

I am not vouching for the accuracy or the authenticity of the content. However people have a right to read what others are saying and decide for themselves what to believe.

 

[Leongsam]

Here is a sample of the content :

 

[Leongsam]

Here is a sample of the content :

View attachment 110806

This has been countered by the ST

No evidence that vaccines can directly cause heart attacks and strokes: HSA​

HSA said that no deaths from heart attacks, strokes or any other causes suspected to be associated with the vaccines have been reported locally.ST PHOTO: ALPHONSUS CHERN

Joyce Teo

• Published
  May 7, 2021, 8:53 am SGT

SINGAPORE - There has been no uptick in heart attacks or strokes among vaccinated people, and no evidence that the Covid-19 vaccines used here can directly cause them, the Health Sciences Authority (HSA) said on Thursday (May 6).
"A greater frequency of heart attacks and strokes has not been observed in vaccinated persons locally and to date, there is also no evidence that the vaccines can directly cause these events," HSA said in its first update on the safety of the mRNA vaccines used here. Only the Pfizer-BioNTech and Moderna vaccines are used here.
"No deaths from heart attacks, strokes or any other causes suspected to be associated with the vaccines have been reported locally," HSA said.

 

[Leongsam]

So one party says they have healthy relatives who have fallen victim to the vaccination while the official mouthpiece of the government categorically states that the vaccine does not cause strokes and heart attacks.

Where does the truth lie? Your guess is as good as mine.

 

[Leongsam]

 

[Leongsam]

 

[Leongsam]

Update re Joann’s BIL who suffered multiple strokes after the vaccination.

Is it really safe (https://www.facebook.com/Is-it-real...PmJh8Mtcp3s9F250yGDFwund6Q&__tn__=-UC,P-y-R)?
Update (): 11 May
Past few days BIL condition fluctuated. Didnt want to affect others so only update today when he is better. He was still fighting fever despite antibiotic via IV drip and oral Ibufen. He was also fed other medication via tube so very drowsy and not as responsive. He drifted in and out of sleep. Good thing is he is more aware of the surrounding but he also started to feel agitated and frustrated. He started to subconsciously pulled out the feeding tube; I think he just did it again last night, the tube he is using today is new

He also started to pull the tubes attached on his body. We are so blessed the patient next bed helped to alert the nurses whenever he sees him pulling. Maybe that's why his hands are tied till the very end. Pulling out the tube is easy, reinserting is painful. Try putting a straw into your nostril, deep inside... this is only the beginning, the tube goes to his stomach.

That's why I don't dare to loosen him even when I am there. I cannot bear the guilt if he pulled the tube under my watch. We played Charade during good days, I tried to guess what he is saying, can feel his frustration. He tried to write, look at the 2 art pieces he did tonight. I didnt take another piece which H E is very clear. HELP?

Both his hands are tied and actually today, his left was to a point he cant even reach his stomach. He was coughing and I was trying to calm him as his BP started to escalate and he tried to lift his hands but cant. I felt so sorry for him. He is 100% dependent on others for all his needs for now. He is still being tube fed, urine catheter attached (they removed and reinserted!) both legs attached to a machine to pump every few minute to promote blood circulation (24 hours) and both hands tied. I am sorry but it is living hell to me. I am sorry for being negative and pray it is short term.

When his condition stabilize, weeks or months of physio and speech therapy will be planned. Till date, doctors are still not able to determine his level of competency in the coming months but hospital has came twice to talk about sending him for integrated care and if we are planning to arrange for nursing home.

Does discharging the patient equate to "recovered" so one decimal down on the injury? Does the ministry understand, that is where the patients needs to adjust to the new norm? A new life not just for the patient but for his family too. Please have mercy on us.

I was disappointed when ministry said stroke and cardiac arrest can happen to anyone even without vaccination. Totally agree. Give me a like if you also agree that if my BIL did not go for his vaccination on 18 April, he may still be watching TV at home now.

Looking at the press release on ministry reply to the opposition party query. I hope my BIL falls under the 0.004%. I hope the application for VIFAP from this 0.004% group will be seriously considered and approved. I applaud HSA on the appointment of 3 expert panels to review neurological, cardiac and hypersensitivity adverse event that occurs after the vaccination.

No clinical test doesn't mean it wont happen. The 0.004% are your clinical trial sample. ministry kept saying majority recovered from the adverse reaction, but there is a small group that will never fully recover, DAMAGE IS PERMANENT.

Ministry should also be more proactive in the education of vaccine safety.
For example, giddiness is one of the known side effect, but the promo video made it so chill, people still go to work or drink kopi, there are people who fainted and ended in hospital. My advice to all, please REST and REST after the vaccine. It is only a few days of inconvenience. I dont think anyone is really for a permanent disability.

We were told to be responsible, take the vaccine to protect our family but on the contrary, my BIL case has changed the lives of everyone in the family. He needs an answer, we too.

FB Link for sharing:
https://www.facebook.com/Is-it-really-safe-102038542038486

 

[Leongsam]

 

[Leongsam]

Doctors for Covid Ethics
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Urgent Open Letter from Doctors and Scientists to the European Medicines Agency regarding COVID-19 Vaccine Safety Concerns​

Doctors, scientists, lawyers and colleagues in allied disciplines can sign the open letter by sending their name, qualifications, areas of expertise and country of practice to: [email protected], with web verification (eg workplace or registration link, not for publication).​

Doctors for Covid Ethics
Mar 11·14 min read


Emer Cooke, Executive Director, European Medicines Agency, Amsterdam, The Netherlands
28 February 2021
Dear Sirs/Mesdames,
FOR THE URGENT PERSONAL ATTENTION OF: EMER COOKE, EXECUTIVE DIRECTOR OF THE EUROPEAN MEDICINES AGENCY
As physicians and scientists, we are supportive in principle of the use of new medical interventions which are appropriately developed and deployed, having obtained informed consent from the patient. This stance encompasses vaccines in the same way as therapeutics.
We note that a wide range of side effects is being reported following vaccination of previously healthy younger individuals with the gene-based COVID-19 vaccines. Moreover, there have been numerous media reports from around the world of care homes being struck by COVID-19 within days of vaccination of residents. While we recognise that these occurrences might, every one of them, have been unfortunate coincidences, we are concerned that there has been and there continues to be inadequate scrutiny of the possible causes of illness or death under these circumstances, and especially so in the absence of post-mortems examinations.
In particular, we question whether cardinal issues regarding the safety of the vaccines were adequately addressed prior to their approval by the European Medicines Agency (EMA).
As a matter of great urgency, we herewith request that the EMA provide us with responses to the following issues:
1. Following intramuscular injection, it must be expected that the gene-based vaccines will reach the bloodstream and disseminate throughout the body [1]. We request evidence that this possibility was excluded in pre-clinical animal models with all three vaccines prior to their approval for use in humans by the EMA.
2. If such evidence is not available, it must be expected that the vaccines will remain entrapped in the circulation and be taken up by endothelial cells. There is reason to assume that this will happen particularly at sites of slow blood flow, i.e. in small vessels and capillaries [2]. We request evidence that this probability was excluded in pre-clinical animal models with all three vaccines prior to their approval for use in humans by the EMA.
3. If such evidence is not available, it must be expected that during expression of the vaccines’ nucleic acids, peptides derived from the spike protein will be presented via the MHC I — pathway at the luminal surface of the cells. Many healthy individuals have CD8-lymphocytes that recognize such peptides, which may be due to prior COVID infection, but also to cross-reactions with other types of Coronavirus [3; 4] [5]. We must assume that these lymphocytes will mount an attack on the respective cells. We request evidence that this probability was excluded in pre-clinical animal models with all three vaccines prior to their approval for use in humans by the EMA.
4. If such evidence is not available, it must be expected that endothelial damage with subsequent triggering of blood coagulation via platelet activation will ensue at countless sites throughout the body. We request evidence that this probability was excluded in pre-clinical animal models with all three vaccines prior to their approval for use in humans by the EMA.
5. If such evidence is not available, it must be expected that this will lead to a drop in platelet counts, appearance of D-dimers in the blood, and to myriad ischaemic lesions throughout the body including in the brain, spinal cord and heart. Bleeding disorders might occur in the wake of this novel type of DIC-syndrome including, amongst other possibilities, profuse bleedings and haemorrhagic stroke. We request evidence that all these possibilities were excluded in pre-clinical animal models with all three vaccines prior to their approval for use in humans by the EMA.
6. The SARS-CoV-2 spike protein binds to the ACE2 receptor on platelets, which results in their activation [6]. Thrombocytopenia has been reported in severe cases of SARS-CoV-2 infection [7]. Thrombocytopenia has also been reported in vaccinated individuals [8]. We request evidence that the potential danger of platelet activation that would also lead to disseminated intravascular coagulation (DIC) was excluded with all three vaccines prior to their approval for use in humans by the EMA.
7. The sweeping across the globe of SARS-CoV-2 created a pandemic of illness associated with many deaths. However, by the time of consideration for approval of the vaccines, the health systems of most countries were no longer under imminent threat of being overwhelmed because a growing proportion of the world had already been infected and the worst of the pandemic had already abated. Consequently, we demand conclusive evidence that an actual emergency existed at the time of the EMA granting Conditional Marketing Authorisation to the manufacturers of all three vaccines, to justify their approval for use in humans by the EMA, purportedly because of such an emergency.
Should all such evidence not be available, we demand that approval for use of the gene-based vaccines be withdrawn until all the above issues have been properly addressed by the exercise of due diligence by the EMA.
There are serious concerns, including but not confined to those outlined above, that the approval of the COVID-19 vaccines by the EMA was premature and reckless, and that the administration of the vaccines constituted and still does constitute “human experimentation”, which was and still is in violation of the Nuremberg Code.
In view of the urgency of the situation, we request that you reply to this email within seven days and address all our concerns substantively. Should you choose not to comply with this reasonable request, we will make this letter public.
This email is copied to:
Charles Michel, President of the Council of Europe
Ursula von der Leyen, President of the European Commission.

Doctors and scientists can sign the open letter by emailing their name, qualifications, areas of expertise, country and any affiliations they would like to cite, to [email protected]

• References
[1] Hassett, K. J.; Benenato, K. E.; Jacquinet, E.; Lee, A.; Woods, A.; Yuzhakov, O.; Himansu, S.; Deterling, J.; Geilich, B. M.; Ketova, T.; Mihai, C.; Lynn, A.; McFadyen, I.; Moore, M. J.; Senn, J. J.; Stanton, M. G.; Almarsson, Ö.; Ciaramella, G. and Brito, L. A.(2019).Optimization of Lipid Nanoparticles for Intramuscular Administration of mRNA Vaccines, Molecular therapy. Nucleic acids 15 : 1–11.
[2] Chen, Y. Y.; Syed, A. M.; MacMillan, P.; Rocheleau, J. V. and Chan, W. C. W.(2020). Flow Rate Affects Nanoparticle Uptake into Endothelial Cells, Advanced materials 32 : 1906274.
[3] Grifoni, A.; Weiskopf, D.; Ramirez, S. I.; Mateus, J.; Dan, J. M.; Moderbacher, C. R.; Rawlings, S. A.; Sutherland, A.; Premkumar, L.; Jadi, R. S. and et al.(2020). Targets of T Cell Responses to SARS-CoV-2 Coronavirus in Humans with COVID-19 Disease and Unexposed Individuals, Cell 181 : 1489–1501.e15.
[4] Nelde, A.; Bilich, T.; Heitmann, J. S.; Maringer, Y.; Salih, H. R.; Roerden, M.; Lübke, M.; Bauer, J.; Rieth, J.; Wacker, M.; Peter, A.; Hörber, S.; Traenkle, B.; Kaiser, P. D.; Rothbauer, U.; Becker, M.; Junker, D.; Krause, G.; Strengert, M.; Schneiderhan-Marra, N.; Templin, M. F.; Joos, T. O.; Kowalewski, D. J.; Stos-Zweifel, V.; Fehr, M.; Rabsteyn, A.; Mirakaj, V.; Karbach, J.; Jäger, E.; Graf, M.; Gruber, L.-C.; Rachfalski, D.; Preuß, B.; Hagelstein, I.; Märklin, M.; Bakchoul, T.; Gouttefangeas, C.; Kohlbacher, O.; Klein, R.; Stevanović, S.; Rammensee, H.-G. and Walz, J. S.(2020). SARS-CoV-2-derived peptides define heterologous and COVID-19-induced T cell recognition, Nature immunology.
[5] Sekine, T.; Perez-Potti, A.; Rivera-Ballesteros, O.; Strålin, K.; Gorin, J.-B.; Olsson, A.; Llewellyn-Lacey, S.; Kamal, H.; Bogdanovic, G.; Muschiol, S. and et al.(2020). Robust T Cell Immunity in Convalescent Individuals with Asymptomatic or Mild COVID-19, Cell 183 : 158–168.e14.
[6] Zhang, S.; Liu, Y.; Wang, X.; Yang, L.; Li, H.; Wang, Y.; Liu, M.; Zhao, X.; Xie, Y.; Yang, Y.; Zhang, S.; Fan, Z.; Dong, J.; Yuan, Z.; Ding, Z.; Zhang, Y. and Hu, L.(2020). SARS-CoV-2 binds platelet ACE2 to enhance thrombosis in COVID-19, Journal of hematology & oncology 13 : 120.
[7] Lippi, G.; Plebani, M. and Henry, B. M.(2020).Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis, Clin. Chim. Acta 506 : 145–148.
[8] Grady, D. (2021). A Few Covid Vaccine Recipients Developed a Rare Blood Disorder, The New York Times, Feb. 8, 2021.
Yours faithfully,
Professsor Sucharit Bhakdi MD, Professor Emeritus of Medical Microbiology and Immunology, Former Chair, Institute of Medical Microbiology and Hygiene, Johannes Gutenberg University of Mainz (Medical Doctor and Scientist) (Germany and Thailand)
Dr Marco Chiesa MD FRCPsych, Consultant Psychiatrist and Visiting Professor, University College London (Medical Doctor) (United Kingdom and Italy)
Dr C Stephen Frost BSc MBChB Specialist in Diagnostic Radiology, Stockholm, Sweden (Medical Doctor) (United Kingdom and Sweden)
Dr Margareta Griesz-Brisson MD PhD, Consultant Neurologist and Neurophysiologist (studied Medicine in Freiburg, Germany, speciality training for Neurology at New York University, Fellowship in Neurophysiology at Mount Sinai Medical Centre, New York City; PhD in Pharmacology with special interest in chronic low level neurotoxicology and effects of environmental factors on brain health), Medical Director, The London Neurology and Pain Clinic (Medical Doctor and Scientist) (Germany and United Kingdom)
Professor Martin Haditsch MD PhD, Specialist (Austria) in Hygiene and Microbiology, Specialist (Germany) in Microbiology, Virology, Epidemiology/Infectious Diseases, Specialist (Austria) in Infectious Diseases and Tropical Medicine, Medical Director, TravelMedCenter, Leonding, Austria, Medical Director, Labor Hannover MVZ GmbH (Medical Doctor and Scientist) (Austria and Germany)
Professor Stefan Hockertz, Professor of Toxicology and Pharmacologym, European registered Toxicologist, Specialist in Immunology and Immunotoxicology, CEO tpi consult GmbH. (Scientist) (Germany)
Dr Lissa Johnson, BSc, BA(Media) MPsych(Clin) PhD, Clinical Psychologist and Behavioural Scientist, Expertise in the social psychology of atrocity, torture, collective violence and propaganda, former member, professional body Public Interest Advisory Group (Psychologist) (Australia)
Professor Ulrike Kämmerer PhD, Associate Professor of Experimental Reproductive Immunology and Tumor Biology at the Department of Obstetrics and Gynaecology, University Hospital of Würzburg, Germany, Trained molecular virologist (Diploma, PhD-Thesis) and Immunologist (Habilitation), Remains engaged in active laboratory research (Molecular Biology, Cell Biology (Scientist) (Germany)
Associate Professor Michael Palmer MD, Department of Chemistry (studied Medicine and Medical Microbiology in Germany, has taught Biochemistry since 2001 in present university in Canada; focus on Pharmacology, metabolism, biological membranes, computer programming; experimental research focus on bacterial toxins and antibiotics (Daptomycin); has written a textbook on Biochemical Pharmacology, University of Waterloo, Ontario, Canada (Medical Doctor and Scientist) (Canada and Germany)
Professor Karina Reiss PhD, Professor of Biochemistry, Christian Albrecht University of Kiel, Expertise in Cell Biology, Biochemistry (Scientist) (Germany)
Professor Andreas Sönnichsen MD, Professor of General Practice and Family Medicine, Department of General Practice and Family Medicine, Center of Public Health, Medical University of Vienna, Vienna (Medical Doctor) (Austria)
Dr Wolfgang Wodarg, Specialist in Pulmonary and Bronchial Internal Medicine, Hygiene and Environmental Medicine, Epidemiology, and Public Health; Honorary Member of the Parliamentary Assembly of the Council of Europe and former Head of the Health Committee of the Parliamentary Assembly of the Council of Europe; former Member of Parliament, German Bundestag; Initiator and Spokesman for the study commission ‘Ethics and Law in Modern Medicine’; Author and University Lecturer (Medical Doctor) (Germany)
Dr Michael Yeadon BSc (Joint Honours in Biochemistry and Toxicology) PhD (Pharmacology), Formerly Vice President & Chief Scientific Officer Allergy & Respiratory, Pfizer Global R&D; Co-founder & CEO, Ziarco Pharma Ltd.; Independent Consultant (Scientist) (United Kingdom)

Endorsing signatories​

Dr Reem Abu-Sbaih, DO, Doctor of Osteopathy, Associate Professor Osteopathic Manipulative Medicine/ Neuromusculoskeletal Medicine (Medical Doctor) (USA)
Dr Véronique Ahari, General Practitioner (France)
Dr. Elizabeth Bastian, BSc (Genetics and Microbiology), MDCM, Family Medicine, General Practitioner in Oncology, sub specialty trained in Palliative Care (Medical Doctor) (Canada)
Dr Michael D Bell, MB, ChB (1978 Edinburgh) MRCGP (1989), General Practitioner (Medical Doctor) (United Kingdom)
Rev. Reuben P. Bell, DO, MS, MDiv, PhD, Osteopathic family physician since 1982, Bachelors and Masters degrees in Zoology, Professor of Biology (including Molecular Genetics and Developmental Biology) at the Bryn Athyn College of the New Church, 1989–1998, M.Div. and Ph.D. in theological studies, with attention to issues of science and religion (Medical Doctor and Scientist) (USA)
Dr Francisco Lacruz Bescos, MD, PhD, Consultant Neurologist with special training and dedication to Neuroimmunology and Multiple Sclerosis (Retired) (Medical Doctor) (Spain)
Dr Thomas Binder, MD, specialised in Cardiology and Internal Medicine, thesis in Immunology and Virology, with 32 years experience in diagnosis and treatment of Acute Respiratory Illness (Medical Doctor) (Switzerland)
Sarah Binns, MA VetMB, MS, MRCVS, MSc, PhD, DipLSHTM, Former Veterinary Infectious Disease Epidemiologist (United Kingdom)
Dr Rainer Bliefert, Dentist (Switzerland)
Dr Rachel Brown, MBChB, LLM (Medical Law & Ethics), MRCPsych CFMP, Consultant Psychiatrist (Medical Doctor) (United Kingdom)
Dr Roxana Bruno, PhD in Immunology, Researcher in Biochemistry, Immunology, Neuroinmunology and Genetics (Scientist) (Argentina)
Dr Elizabeth Burton, MBChB, General Medical Practitioner (Retired)(Medical Doctor) (United Kingdom)
Dr Ronald S. Carlson, AB Chem/Bio, DDS, Dentist (USA)
Dr Vernon Coleman, MB, ChB, General Practice Principal (Retired) (Medical Doctor) (United Kingdom)
Dr David Critchley, BSc, PhD, Clinical Research Scientist with more than 30 years experience, including projects in Virology and Immunology (Scientist) (United Kingdom)
Professor Barbara A Crothers, DO, Associate Professor, Pathology, Gynecologic, Breast and Cytopathology (USA)
Dr Rita Darby, General Practitioner (Medical Doctor) (Wales)
Dr. Daniel de la Torre Llorente, Biology Professor, Biotechnology-Plant Biology Department. Agronomic, Food and Biosystems Engineering School (ETSIAAB) Universidad Politécnica de Madrid (Scientist) (Spain)
Dr Nyjon Eccles, BSc, MBBS, MRCP, PhD, Specialist in Functional & Environmental Medicine (United Kingdom)
Dr Kjetil H. Elvevold, Senior Scientist, worked as Senior Scientist in a Contract Research Organization (CRO) in Norway that performed pre-clinical experiments for the pharmaceutical industry (Scientist) (Norway)
Dr Andreas Emmert, Specialist in Microbiology, Head Physician at Østfold Regional Hospital, Norway (Medical Doctor) (Norway)
Merit Enckell, Civ. Ing, PhD, Independent researcher, Structural Health Monitoring and Emerging Technologies, Formerly of KTH Royal Institute of Technology (Scientist) (Sweden)
Dr Radimé Farhumand, Specialist in Anesthesia (Medical Doctor) (Germany)
Dr Thomas Faulkner, MChiro, DC, Managing Director and Chiropractor (United Kingdom)
Dr Susan Flett, Specialist in Psychiatry, Child Psychiatry and Psychotherapy (Semi-retired) (Medical Doctor) (United Kingdom)
Dr Konstantinos Fountzoulas, MD, PGDiP Orth Eng., FEBOT, FRCS (Tr & Orth), Consultant Trauma and Orthopaedic Surgeon (Medical Doctor) (England and Italy)
Dr Carrie Ganek, MD, Adult Psychiatry (Medical Doctor) (USA)
Dr Martin E Ganek, MD, Board Certified Paediatrician (Medical Doctor) (USA)
Dr Parisi Giovanni, Specialist in Ophthalmology and Sports Medicine (Medical Doctor) (Italy)
Dr Céline Guérin, PhD in Neurosciences, Master in Microbiology and Genetics (Scientist-Practitioner) (France)
Dr. Olga Petrovna Guzova, Pediatrician, Dermatologist and Dermatopathologist (Medical Doctor) (Panama)
Dr Roman Häussler, General Medicine (Austria)
Dr Jutta Heinrich-Nols, Doctor and Clinical Pharmacologist (Medical Doctor and Scientist) (Germany)
Dr April M. Hurley, MD, Family Physician for 35 years (Medical Doctor) (USA)
William Ip, BSc. MIBMS, Former NHS Biomedical Scientist (Specialist in Microbiology), for over 30 years (Sicentist) (United Kingdom)
Dr Hervé Janecek, Veterinarian (France)
Jerzy Jaskowski, MD, PhD, MS, Specialties in General Surgery, Environmental Medicine, Physics and Biophysics (Retired)(Medical Doctor and Scientist) (Poland)
Dr. Elisabeth Jenik, General Medicine, Occupational Medicine and Psychosomatic Medicine (Medical Doctor) (Austria)
Dr Alain Joseph, General Medicine Specialist (Retired) (Medical Doctor) (France)
Dr Konstantinos Kakleas, MD, MRCPCH, MSc, PhD, Paediatric Allergy Consultant, Leicester Royal Infirmary Hospital (Medical Doctor) (United Kingdom)
Dr Hootan Kazemi, BDS Dental Surgeon, MSc(Distinc.) Clinical Biochemistry, BSc(Hons) Physiology (General Dental Practitioner) (United Kingdom)
Dr Ingrid Kiesel, Specialist in Psychiatry, Psychotherapy and General Medicine (Medical Doctor) (Germany)
Dr Wiltrud Kling, Specialist in General Medicine (Medical Doctor) (Germany)
Dr Ewa Konik, MD, Heart Transplant Cardiologist (Medical Doctor) (USA)
Dr Doris Krien, Assistant Doctor, Günzburg District Hospital (Medical Doctor) (Germany)
Brigitte Lacroix, clinical PKPD and PBPK modeler (Pharma industry), PhD in Pharmacy (Paris XI University), PhD in Pharmacometrics (Uppsala University) (Scientist) (France, Sweden)
Dr Andreas Lang, MD (Medical Doctor) (Germany)
Dr Paul Laursen, PhD, Adjunct Professor, AUT University (Scientist) (New Zealand and Canada)
Dr Michael S Lavender, Consultant Anaesthetist (Medical Doctor) (Australia)
Dr Tess Lawrie, MBBCh, PhD, Guideline methodologist and evidence synthesis expert, Director of The Evidence Based Medicine Consultancy Ltd, Bath UK. Honorary Researcher at the Royal United Hospital, Bath UK (Medical Doctor and Scientist) (United Kingdom)
Dr Bronia Lee, MBBCh, MRCGP, Retired General Practitioner (Medical Doctor) (United Kingdom)
Dr Katrina Lewis, MD, BSc in Immunology and Physiological Chemistry, triple Board certified ( USA) in Anesthesiology, Pain Medicine and Functional Medicine (Medical Doctor) (South Africa, USA)
Dr Derek Lohan, Consultant Radiologist and Director, Helix Radiology (Medical doctor) (Ireland)
Dr. Adele Lorigan, BSC (Chiro), Chiropractor (Australia)
Dr Antje Lueg, Specialist in Opthamology (Medical Doctor) (Germany)
Dr Kulvinder S. Manik, MBChB, MA, LLM, MRCGP, GP (Medical Doctor) (England)
Dr. Rosemarie Mayr, Specialist in Psychiatry and Psychotherapeutic Medicine and Child and Adolescent Psychiatry, ÖÄK Diploma for Homeopathy (Retired) (Medical Doctor) (Germany)
Dr Janet Menage, MA, MB, ChB, General Medical Practitioner (Retired) Qualified Psychological Counsellor (Medical Doctor) (United Kingdom)
Dr Niall McCrae, PhD, MSc, RMN, Mental health researcher, Psychiatric Nurse (United Kingdom)
Professor Nathalie McDonell, MD, PhD (human genetics), Professor of Molecular and Cell Biology (Medical Doctor and Scientist) (France)
Dr Sabine de Monvallier, General Practitoner (Medical Doctor) (France)
Dr Amir Mortasawi, Physician and author (Germany)
Dr Souha Nasreddine, MD, Ob/Gyn, Graduated from the Free University of Brussels Belgium, Holistic Gynecology (Lebanon)
Dr Terezia Novotna, General Practitioner, Emergency Doctor, and Anesthesiologist in Training (Medical Doctor) (Austria)
Akhmetzhanova Tamara Nikolaevna, Therapist and Cardiologist, the Republican Medical Genetic Center, Ufa (Medical Doctor) (Russia)
Ole C G Olesen, Double specialist in General Surgery, as well as Orthopedic Surgery and Trauma (Medical Doctor) (Denmark, Norway, Sweden and United Kingdom)
Dr Waltraud Parta-Kehry, Biologist and Doctor for Gynaecology and Reproductive Medicine (Medical Doctor) (Germany)
Dr Arun Kumar Patel, MBBS, MPH, MRCPH, FFPH, Medical Public Health Specialist (Retired), NHS (Medical Doctor) (United Kingdom)
Dr. Cristina Pinho, MD, Gastroenterologist (Medical Doctor) (Portugal)
Dr Hélène Potrich, General Practitioner (Medical Doctor) (France)
Dr Fabio Quirici, Swiss Medical Association (Medical Doctor) (Switzerland)
Professor Denis Rancourt, PhD, Researcher, Ontario Civil Liberties Association, Member scientist, PANDA (Pandemics Data & Analysis), Retired former Full Professor of Physics, University of Ottawa, with expertise in environmental nanoparticles, molecular science, molecular dynamics, statistical analysis methods and mathematical and epidemiological modelling (Scientist) (Canada)
Claudia Riempp, Psychologist and psychotherapist, expert in health education (Germany)
Dr Nicola Reiser, Anaesthetist and Intensive Care Physician, Senior Physician at the University Clinic UMEÅ (Medical Doctor) (Sweden)
Rhys Rogers, BSc, Physiotherapy, 12 years experience as a frontline Physiotherapist (United Kingdom)
Dr Tred J Rissacher, DC, Chiropractor specialising in obesity and diabetes (USA)
Professor Simon Ruijsenaars, Professor in Mathematical Physics, School of Mathematics, University of Leeds (Scientist) (United Kingdom)
Dr Sam Saidi, MB, ChB, BSc, FRCOG, PhD, University of Sydney (Medical Doctor and Scientist) (Australia)
Dr Pamela Shervanick, DO, Medical doctor and Doctor of Osteopathic Medicine, with specialization in Psychiatry (Medical Doctor) (USA)
Dr Guido Spanoghe, Gastroenterologist (Medical Doctor) (Belgium)
Dr Paul Steven Spradbery, Forensic and Research Biologist, Foundation for Science and Technology, Lisbon, Intertek Life Sciences, London (Scientist) (United Kingdom)
Dr Duncan Syme, MBBS, FRACGP, Dip Prac Derm University of Cardiff, Graduate Monash University 1987, General Practitioner (Medical Doctor) (Australia)
Dr Carol Taccetta, MD, FCAP (Fellow of the College of American Pathologists), Pharmaceutical Physician for over 25 years, specializing in drug safety (Medical Doctor) (USA)
Dr Noel Thomas, MA, MB, ChB, DCH, DObsRCOG, DTM&H, MFHom. Semi retired NHS GP and homeopath (Medical Doctor) (United Kingdom)
Dr Corinne Tilloy, General Practitioner, (Medical Doctor) (France)
Dr Gilbert Tominez, General Practitioner (Retired) (Medical Doctor) (France)
De Georgy Urushadze, Naturopathic Doctor, Pediatrician (Pirogov Russian National Medical University), Emergency Doctor, Physiotherapist, Homeopath, Researcher (Russia)
Dr Jasmina Vucic-Peev, PhD, studied in Freiburg, Germany, training in Psychiatry in Switzerland (Medical Doctor) (Germany, Switzerland, Portugal)
Dr Jo Waller, UK State registered Biomedical Scientist since 1990 (Scientist) (United Kingdom)
Dr Maja Waibel, Dermatologist with specialty in Melanoma prevention (Medical Doctor) (Germany)
Dr Gerard A Waters, Mb, Bch, BAO, MICGP, General Practitioner, Recently suspended from Irish medical register for refusing to administer C 19 vaccine and objecting to Covid lockdowns (Medical Doctor) (Ireland)
Dr Ronald Weikl, Gynecologist and General Practitioner (Medical Doctor) (Germany)
Dr Helen Westwood MBChB (Hons), MRCGP, DCH, DRCOG, GP (Medical Doctor) (United Kingdom)
Dr Madhu Wickremaratchi, MBChB, MRCP, Acute and General Medicine (United Kingdom)
Dr Clive Wilder-Smith, FRCP, AGAF, MD, Consultant Gastroenterologst, Director of Research (Medical Doctor) (Switzerland)
Thomas Robin Wilks, MA, BSc(Hons) FHEA, CPhys, MInstP, University Science Lecturer, Maths, Mathematical Modelling and Physics, Open University (Scientist) (United Kingdom)
Dr Christopher Wood, MBBS, Retired General Practitioner (Medical Doctor) (United Kingdom)
Signatures of Colleagues in Allied Disciplines relating to Ethics and Human Rights
Dr Violeta Sotirova, MPhil, PhD, Lecturer in English (United Kingdom)

Doctors for Covid Ethics​

We are doctors and scientists from 30 countries, seeking to uphold medical ethics, patient safety and human rights in response to COVID-19. t: @Drs4CovidEthics

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Masks may work in a controlled lab experiment but in the real world they are not effective because people don't adhere to the strict protocols required to ensure that masks don't end up being vectors for transmission rather than a barrier against infection.

I have yet to come across a single person outside of a medical setting who follows all the steps needed to ensure masks actually work.

View attachment 110803

Wrong. Again. Call it 0 for 222 tries. All failed

https://www.pnas.org/content/118/4/e2014564118

An evidence review of face masks against COVID-19​

View ORCID ProfileJeremy Howard, Austin Huang, View ORCID ProfileZhiyuan Li, View ORCID ProfileZeynep Tufekci, Vladimir Zdimal, View ORCID ProfileHelene-Mari van der Westhuizen, View ORCID ProfileArne von Delft, View ORCID ProfileAmy Price, Lex Fridman, View ORCID ProfileLei-Han Tang, View ORCID ProfileViola Tang, View ORCID ProfileGregory L. Watson, View ORCID ProfileChristina E. Bax, View ORCID ProfileReshama Shaikh, View ORCID ProfileFrederik Questier, Danny Hernandez, View ORCID ProfileLarry F. Chu, View ORCID ProfileChristina M. Ramirez, and View ORCID ProfileAnne W. Rimoin

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PNAS January 26, 2021 118 (4) e2014564118; https://doi.org/10.1073/pnas.2014564118

1. Edited by Lauren Ancel Meyers, The University of Texas at Austin, Austin, TX, and accepted by Editorial Board Member Nils C. Stenseth December 5, 2020 (received for review July 13, 2020)

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Abstract​

The science around the use of masks by the public to impede COVID-19 transmission is advancing rapidly. In this narrative review, we develop an analytical framework to examine mask usage, synthesizing the relevant literature to inform multiple areas: population impact, transmission characteristics, source control, wearer protection, sociological considerations, and implementation considerations. A primary route of transmission of COVID-19 is via respiratory particles, and it is known to be transmissible from presymptomatic, paucisymptomatic, and asymptomatic individuals. Reducing disease spread requires two things: limiting contacts of infected individuals via physical distancing and other measures and reducing the transmission probability per contact. The preponderance of evidence indicates that mask wearing reduces transmissibility per contact by reducing transmission of infected respiratory particles in both laboratory and clinical contexts. Public mask wearing is most effective at reducing spread of the virus when compliance is high. Given the current shortages of medical masks, we recommend the adoption of public cloth mask wearing, as an effective form of source control, in conjunction with existing hygiene, distancing, and contact tracing strategies. Because many respiratory particles become smaller due to evaporation, we recommend increasing focus on a previously overlooked aspect of mask usage: mask wearing by infectious people (“source control”) with benefits at the population level, rather than only mask wearing by susceptible people, such as health care workers, with focus on individual outcomes. We recommend that public officials and governments strongly encourage the use of widespread face masks in public, including the use of appropriate regulation.

• COVID-19
• SARS-CoV-2
• masks
• pandemic

Policy makers need urgent guidance on the use of masks by the general population as a tool in combating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the respiratory virus that causes COVID-19. Masks have been recommended as a potential tool to tackle the COVID-19 pandemic since the initial outbreak in China (1), although usage during the outbreak varied by time and location (2). Globally, countries are grappling with translating the evidence of public mask wearing to their contexts. These policies are being developed in a complex decision-making environment, with a novel pandemic, rapid generation of new research, and exponential growth in cases and deaths in many regions. There is currently a global shortage of N95/FFP2 respirators and surgical masks for use in hospitals. Simple cloth masks present a pragmatic solution for use by the public. This has been supported by most health bodies. We present an interdisciplinary narrative review of the literature on the role of face masks in reducing COVID-19 transmission in the community.

Background​

Wu Lien Teh’s work to control the 1910 Manchurian Plague has been acclaimed as “a milestone in the systematic practice of epidemiological principles in disease control” (3), in which Wu identified the cloth mask as “the principal means of personal protection.” Although Wu designed the cloth mask that was used through most of the world in the early 20th century, he pointed out that the airborne transmission of plague was known since the 13th century, and face coverings were recommended for protection from respiratory pandemics since the 14th century (4). Wu reported on experiments that showed a cotton mask was effective at stopping airborne transmission, as well as on observational evidence of efficacy for health care workers. Masks have continued to be widely used to control transmission of respiratory infections in East Asia through to the present day, including for the COVID-19 pandemic (5).
In other parts of the world, however, mask usage in the community had fallen out of favor, until the impact of COVID-19 was felt throughout the world, when the discarded practice was rapidly readopted. By the end of June 2020, nearly 90% of the global population lived in regions that had nearly universal mask use, or had laws requiring mask use in some public locations (6), and community mask use was recommended by nearly all major public health bodies. This is a radical change from the early days of the pandemic, when masks were infrequently recommended or used.

Direct Evidence of the Efficacy of Public Mask Wearing​

If there is strong direct evidence, either a suitably powered randomized controlled trial (RCT), or a suitably powered metaanalysis of RCTs, or a systematic review of unbiased observational studies that finds compelling evidence, then that would be sufficient for evaluating the efficacy of public mask wearing, at least in the contexts studied. Therefore, we start this review looking at these types of evidence.

Direct Epidemiological Evidence.​

Cochrane (7) and the World Health Organization (8) both point out that, for population health measures, we should not generally expect to be able to find controlled trials, due to logistical and ethical reasons, and should therefore instead seek a wider evidence base. This issue has been identified for studying community use of masks for COVID-19 in particular (9). Therefore, we should not be surprised to find that there is no RCT for the impact of masks on community transmission of any respiratory infection in a pandemic.
Only one observational study has directly analyzed the impact of mask use in the community on COVID-19 transmission. The study looked at the reduction of secondary transmission of SARS-CoV-2 in Beijing households by face mask use (10). It found that face masks were 79% effective in preventing transmission, if they were used by all household members prior to symptoms occurring. The study did not look at the relative risk of different types of mask.
In a systematic review sponsored by the World Health Organization, Chu et al. (11) looked at physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2. They found that “face mask use could result in a large reduction in risk of infection.” However, the review included only three studies of mask use outside health care settings, all of which were of SARS, not of SARS-CoV-2, one of which was incorrectly categorized (it occurred in a hospital, but during family and friend visits), and one of which found that none of the households wearing masks had any infections, but was too underpowered to draw any conclusions (12). The remaining study found the use of masks was strongly protective, with a risk reduction of 70% for those that always wore a mask when going out (13), but it did not look at the impact of masks on transmission from the wearer. It is not known to what degree analysis of other coronaviruses can be applied to SARS-CoV-2. None of the studies looked at the relative risks of different types of mask.
There has been one controlled trial of mask use for influenza control in the general community (14). The study looked at Australian households, was not done during a pandemic, and was done without any enforcement of compliance. It found that “in an adjusted analysis of compliant subjects, masks as a group had protective efficacy in excess of 80% against clinical influenza-like illness.” However, the authors noted that they “found compliance to be low, but compliance is affected by perception of risk. In a pandemic, we would expect compliance to improve.” In compliant users, masks were highly effective at reducing transmission.
Overall, evidence from RCTs and observational studies is informative, but not compelling on its own. Both the Australian influenza RCT and the Beijing households observational trial found around 80% efficacy among compliant subjects, and the one SARS household study of sufficient power found 70% efficacy for protecting the wearer. However, we do not know whether the results from influenza or SARS will correspond to results for SARS-CoV-2, and the single observational study of SARS-CoV-2 might not be replicated in other communities. None of the studies looked specifically at cloth masks.

Reviews and RCTs of Mask Use for Other Respiratory Illnesses.​

A number of reviews have investigated masks during nonpandemic outbreaks of influenza and other respiratory diseases. It is not known to what degree these findings apply to pandemic SARS-CoV-2. When evaluating the available evidence for the impact of masks on community transmission, it is critical to clarify the setting of the research study (health care facility or community), whether masks are evaluated as source control or protection for the wearer, the respiratory illness being evaluated, and (for controlled trials) what control group was used.
A Cochrane review (15) on physical interventions to interrupt or reduce the spread of respiratory viruses included 67 RCTs and observational studies. It found that “overall masks were the best performing intervention across populations, settings and threats.” There is a similar preprint review by the same lead author (16), in which only studies where mask wearing was tested as a stand-alone intervention were included, without combining it with hand hygiene and physical distancing, and excluding observational studies. That review concluded that “there was insufficient evidence to provide a recommendation on the use of facial barriers without other measures.” MacIntyre and Chughtai (17) published a review evaluating masks as protective intervention for the community, protection for health workers, and as source control. The authors conclude that “community mask use by well people could be beneficial, particularly for COVID-19, where transmission may be pre-symptomatic. The studies of masks as source control also suggest a benefit, and may be important during the COVID-19 pandemic in universal community face mask use as well as in health care settings.”
The Usher Institute incorporated laboratory as well as epidemiological evidence in their review (18), finding that “homemade masks worn by sick people can reduce virus transmission by mitigating aerosol dispersal. Homemade masks worn by sick people can also reduce transmission through droplets.” One preprint systematic review (19) including epidemiological, theoretical, experimental, and clinical evidence found that “face masks in a general population offered significant benefit in preventing the spread of respiratory viruses especially in the pandemic situation, but its utility is limited by inconsistent adherence to mask usage.” On the other hand, a preprint systematic review that only included RCTs and observational studies (20) concluded, based on the RCTs, that there was only weak evidence for a small effect from mask use in the community, but that the RCTs often suffered from poor compliance and controls. It found that, in observational studies, the evidence in favor of wearing face masks was stronger.
Randomized control trial evidence that investigated the impact of masks on household transmission during influenza epidemics indicates potential benefit. Suess et al. (21) conducted an RCT that suggests household transmission of influenza can be reduced by the use of nonpharmaceutical interventions, namely the use of face masks and intensified hand hygiene, when implemented early and used diligently. Concerns about acceptability and tolerability of the interventions should not be a reason against their recommendation (21). In an RCT, Cowling et al. (22) investigated hand hygiene and face masks that seemed to prevent household transmission of influenza virus when implemented within 36 h of index patient symptom onset. These findings suggest that nonpharmaceutical interventions are important for mitigation of pandemic and interpandemic influenza. RCT findings by Aiello et al. (23) “suggest that face masks and hand hygiene may reduce respiratory illnesses in shared living settings and mitigate the impact of the influenza A (H1N1) pandemic.” A randomized intervention trial (24) found that “face masks and hand hygiene combined may reduce the rate of ILI [influenza-like illness] and confirmed influenza in community settings. These nonpharmaceutical measures should be recommended in crowded settings at the start of an influenza pandemic.” The authors noted that their study “demonstrated a significant association between the combined use of face masks and hand hygiene and a substantially reduced incidence of ILI during a seasonal influenza outbreak. If masks and hand hygiene have similar impacts on primary incidence of infection with other seasonal and pandemic strains, particularly in crowded, community settings, then transmission of viruses between persons may be significantly decreased by these interventions.”
Overall, direct evidence of the efficacy of mask use is supportive, but inconclusive. Since there are no RCTs, only one observational trial, and unclear evidence from other respiratory illnesses, we will need to look at a wider body of evidence.

A Framework for Considering the Evidence​

The standard RCT paradigm is well suited to medical interventions in which a treatment has a measurable effect at the individual level and, furthermore, interventions and their outcomes are independent across persons comprising a target population.
By contrast, the effect of masks on a pandemic is a population-level outcome where individual-level interventions have an aggregate effect on their community as a system. Consider, for instance, the impact of source control: Its effect occurs to other individuals in the population, not the individual who implements the intervention by wearing a mask. This also underlies a common source of confusion: Most RCT studies in the field examine masks as personal protective equipment (PPE) because efficacy can be measured in individuals to whom treatment is applied, that is, “did the mask protect the person who wore it?” Even then, ethical issues prevent the availability of an unmasked control arm (25).
The lack of direct causal identifiability requires a more integrative systems view of efficacy. We need to consider first principles—transmission properties of the disease, controlled biophysical characterizations—alongside observational data, partially informative RCTs (primarily with respect to PPE), natural experiments (26), and policy implementation considerations—a discursive synthesis of interdisciplinary lines of evidence which are disparate by necessity (9, 27).
The goal of such an analysis is to assess the potential benefits and risks, in order to inform policy and behavior. United Nations Educational, Scientific and Cultural Organization states that “when human activities may lead to morally unacceptable harm that is scientifically plausible but uncertain, actions shall be taken to avoid or diminish that harm” (28). This is known as the “precautionary principle.” It was implemented in an international treaty in the 1987 Montreal Protocol. The loss of life and economic destruction that has been seen already from COVID-19 are “morally unacceptable harms.”
In order to identify whether public mask wearing is an appropriate policy, we need to consider the following questions, and assess, based on their answers, whether mask wearing is likely to diminish harm based on the precautionary principle: 1) What could the overall population-level impact of public mask wearing be (population impact)? 2) Based on our understanding of virus transmission, what would be required for a mask to be effective (transmission characteristics)? 3) Do face masks decrease the number of people infected by an infectious mask wearer (source control)? 4) Do face masks impact the probability of the wearer becoming infected themselves (PPE)? 5) Can masks lead to unintended benefits or harm, for example, risk compensation behavior (sociological considerations)? 6) How can medical supply chains be maintained (implementation consideration)? We will evaluate each consideration in turn.

Population Impact​

There are now over 100 countries that have implemented mask requirements (29), and many regions such as US states that have their own mask mandates. Most of these requirements were instituted after there was a shortage of medical masks, so results in these countries are likely to reflect the reality of what masks the public is able to access in practice during a pandemic. By analyzing the timing of pandemic spread and mask use, along with confounders such as population and geographic statistics, and timings of other policy interventions, it is possible to estimate the impact of mask use at a policy level. Here we look at studies based on this approach, as well as looking at estimated outcomes based on models, as part of a broad population impact analysis.

Ecological Studies.​

Leffler et al. (29) used a multiple regression approach, including a range of policy interventions and country and population characteristics, to infer the relationship between mask use and SARS-CoV-2 transmission. They found that transmission was 7.5 times higher in countries that did not have a mask mandate or universal mask use, a result similar to that found in an analogous study of fewer countries (30). Another study looked at the difference between US states with mask mandates and those without, and found that the daily growth rate was 2.0 percentage points lower in states with mask mandates, estimating that the mandates had prevented 230,000 to 450,000 COVID-19 cases by May 22, 2020 (31).
The approach of Leffler et al. (29) was replicated by Goldman Sachs for both US and international regions, finding that face masks have a large reduction effect on infections and fatalities, and estimating a potential impact on US GDP of 1 trillion dollars if a nationwide mask mandate were implemented (32). Although between-region comparisons do not allow for direct causal attribution, they suggest mask wearing to be a low-risk measure with a potentially large positive impact.
A paper in the American Journal of Respiratory and Critical Care Medicine (33) which analyzed Google Trends, E-commerce, and case data found that early public interest in face masks may be an independently important factor in controlling the COVID-19 epidemic on a population scale. Abaluck et al. (34) extend the between-country analyses from a cost perspective, estimating the marginal benefit per cloth mask worn to be in the range from US$3,000 to US$6,000.
A study of COVID-19 incidence in Hong Kong noted that face mask compliance was very high, at 95.7 to 97.2% across regions studied, and that COVID-19 clusters in recreational ‘mask-off’ settings were significantly more common than in workplace “mask-on” settings (35).

Modeling.​

At the national and global scale, effective local interventions are aggregated into epidemiological parameters of disease spread. The standard epidemiological measure of spread is known as the basic reproduction number R0R0 which provides parameters for the average number of people infected by one person, in a susceptible population with no interventions. The goal of any related health care policy is to have an aggregate effect of reducing the effective reproduction number ReRe to below 1. ReRe is the average number of people infected by one person in a population in practice, including the impact of policies, behavior change, and already infected people.
Efficacy of face masks within local interventions would have an aggregate effect on the reproduction number of the epidemic. In this section, we look at models that have attempted to estimate the possible magnitude of such an effect. The basic reproduction number R0R0 is estimated to be in the range 2.4 to 3.9 (36).
Stutt et al. (37) explain that it is impossible to get accurate experimental evidence for potential control interventions, but that this problem can be approached by using mathematical modeling tools to provide a framework to aid rational decision-making. They used two complementary modeling approaches to test the effectiveness of mask wearing. Their models show that mask use by the public could significantly reduce the rate of COVID-19 spread, prevent further disease waves, and allow less stringent lockdown measures. The effect is greatest when 100% of the public wear face masks. They found that, with a policy that all individuals must wear a mask all of the time, a median effective COVID-19 ReRe of below 1 could be reached, even with mask effectiveness of 50% (for R0R0 = 2.2) or of 75% (for R0R0 = 4).
Kai et al. (38) presented two models for predicting the impact of universal mask wearing. Both models showed a significant impact under (near) universal masking when at least 80% of a population is wearing masks, versus minimal impact when only 50% or less of the population is wearing masks. Their models estimated that 80 to 90% masking would eventually eliminate the disease. They also looked at an empirical dataset, finding a very strong correlation between early universal masking and successful suppression of daily case growth rates and/or reduction from peak daily case growth rates, as predicted by their theoretical simulations.
Tian et al. (39) developed a simple transmission model that incorporated mask wearing and mask efficacy as a factor in the model. For wearing masks, they found that wearing masks reduces ReRe by a factor (1−mp)2(1−mp)2, where m is the efficacy of trapping viral particles inside the mask, and p is the percentage of the population that wears masks. When combined with contact tracing, the two effects multiply. The paper notes that an important issue not treated explicitly is the role played by asymptomatic carriers of the virus. In addition, if adherence is socioeconomically, demographically, or geographically clustered, the mass action model may overestimate the impact. This is a limitation that could apply to all of the models discussed in this review.
Under the Tian et al. (39) model, the largest effects are seen when R0R0 is high, since the factor discussed above is a multiplier of R0R0. Therefore, we will consider a conservative assessment applied to an assumed R0R0 of 2.4, which is at the low end of the range presented above, and also supported by other studies (40). With 50% mask usage and 50% mask efficacy level, (1−mp)2=0.56(1−mp)2=0.56. Thus an R0R0 of 2.4 is reduced to an ReRe of 2.4×0.56=1.342.4×0.56=1.34, a huge impact rendering spread comparable to the reproduction number of seasonal influenza. To put this in perspective, 100 cases at the start of a month become 584 cases by the month’s end (Re=1.34Re=1.34) under these assumptions, versus 31,280 cases (Re=2.4Re=2.4) if masks are not used. Such a slowdown in caseload protects health care capacity and renders a local epidemic amenable to contact tracing interventions that could eliminate the spread entirely.
A full range of efficacy m and adherence p based on an R0R0 of 2.4 is shown with the resulting ReRe in Fig. 1, illustrating regimes in which growth is dramatically reduced (Re<1Re<1) as well as pessimistic regimes (e.g., due to poor implementation or population compliance) that nonetheless result in a beneficial effect in suppressing the exponential growth of the pandemic. For different values of R0R0, the image would be identical, with just the color bar scale varying linearly with the change in R0R0.
Impact of public mask wearing under the full range of mask adherence and efficacy scenarios. The color indicates the resulting reproduction number Re from an initial R0 of 2.4 (40). Blue area is what is needed to slow the spread of COVID-19. Each black line represents a specific disease transmission level with the effective reproduction number Re indicated.
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Fig. 1.
Impact of public mask wearing under the full range of mask adherence and efficacy scenarios. The color indicates the resulting reproduction number ReRe from an initial R0R0 of 2.4 (40). Blue area is what is needed to slow the spread of COVID-19. Each black line represents a specific disease transmission level with the effective reproduction number ReRe indicated.

Ngonghala et al. (41) use a similar approach, covering a wider variety of interventions, and completing numerous numerical simulations. They find that “high use of face-masks in public could lead to COVID-19 elimination,” and that “combining face-masks and social-distancing is more effective in COVID-19 control.” Yan et al. (42) provide an additional example of an incremental impact assessment of respiratory protective devices using an augmented variant of a traditional SIR (susceptible, infectious, or recovered) model in the context of influenza with N95 respirators. They showed that a sufficiently high adherence rate (∼80% of the population) resulted in the elimination of the outbreak with most respiratory protective devices. Fisman et al. (43) used a next-generation matrix approach to estimate the conditions under which masks would reduce the reproduction number of COVID-19 under a threshold of 1. Their results find that masks, even with suboptimal efficacy in both prevention of acquisition and transmission of infection, could substantially decrease the reproduction number ReRe if widely used.
The models presented in this section are only as accurate as their assumptions and parameters. Kai et al. (38) did compare their model’s predictions with empirical results, and, overall, the models presented here are consistent with each other, and consistent with the empirical findings in the previous section. However, simulations and similar models are simplifications of the real world, and cannot fully model all of the interactions and drivers of results in practice.
Overall, population-level studies of the impact of wearing masks suggest that mask use may have been an important driver of differences in SARS-CoV-2 outcomes in different regions. These outcomes are in line with models that predict substantial population level impacts of widespread mask use.

Transmission Characteristics​

We have seen that the efficacy of public mask wearing is largely supported by epidemiological and ecological data, as well as models. This could be due to masks filtering virus from an infected wearer, or protecting the wearer from infectious people around them, or both. In order to understand who should wear what kind of mask, and in what situations, we need an understanding of virus transmission.
Some COVID-19 patients are asymptomatic, and nearly all have a presymptomatic incubation period ranging from 2 d to 15 d, with a median length of 5.1 d (44). Patients may be most infectious when symptoms are mildest or not present (45, 46). This characteristic differentiates SARS-CoV-2 (COVID-19) from SARS-CoV, as replication is activated early in the upper respiratory tract (URT) (47). A study of temporal dynamics inferred that infectiousness started from 2.3 d before symptom onset and peaked at 0.7 d before symptom onset (36).
High viral titers of SARS-CoV-2 are reported in the saliva of COVID-19 patients. These titers have been highest at time of patient presentation, and viral levels are just as high in asymptomatic or presymptomatic patients, and occur predominantly in the URT (46, 47). Asymptomatic people seem to account for approximately 40 to 45% of SARS-CoV-2 infections (48). An analysis of SARS-CoV-2 viral load by patient age showed that viral loads of SARS-CoV-2 in children are similar to adults (49). Another paper showed no significant difference in saliva loads between mildly symptomatic and asymptomatic children. These findings support the contention that everyone, adults and children, should wear masks (50).
A consequence of these disease characteristics is that any successful policy intervention must properly address transmission due to infectious patients that display few or no symptoms and may not realize that they are infected. Because people with symptoms, including coughing and sneezing, are generally expected to stay home, our focus will be on other transmission vectors: speaking, breathing, and contact.
This topic has been subject to added confusion due to debates about whether these particles should be referred to as droplets or aerosols, with implications about their ability to remain suspended in air over time (51, 52). Inconsistent use of terminology about respiratory particles that can transmit this disease has led to confusion for scientists, the public health community, and the general public. For this paper, we adopt the definition by Milton (52) that incorporates findings from modern aerosol physics which suggest that particles much larger than the 5-μm boundary (a number that is sometimes cited by public health authorities as a droplet/aerosol cutoff) can remain suspended in air for many minutes or more, can waft around, and, of significant consequence for public health implications for this pandemic, accumulate depending on currents of air and ventilation status of the environment (52). We will thus refer to these respiratory emissions as “respiratory particles” with the understanding that these include particles that are transmitted through the air in a manner beyond the “ballistic trajectories” traditionally assumed of respiratory droplets and thus include aerosols that can remain suspended in the air (52). While determining an exact number is not necessary for purposes of this review, according to latest research informed by modern aerosol physics, 100 μm is considered the boundary between aerosols and droplets (52).
Normal speaking produces thousands of oral fluid particles (aerosols and droplets) between 1 μm and 500 μm (53), which can harbor respiratory pathogens, including SARS-CoV-2 (54). Many of these emissions will then evaporate and turn into aerosolized particles that are threefold to fivefold smaller, and can float for 10 min or more in the air (54⇓–56). Speech is known to emit up to an order of magnitude more particles than breathing (51, 57, 58).
A recent analysis has found that transmission through talking may be a key vector (59), with louder speech creating increasing quantities and sizes of particles, and a small fraction of individuals behaving as “speech superemitters,” releasing an order of magnitude more aerosols than their peers (53). Vuorinen et al. (60) concluded, with a high level of certainty, that a major part of particles of respiratory origin stay airborne for a long enough time for them to be inhaled. They noted that the number of particles produced by speaking is significant, especially as it is normally done continuously over a longer period (60). Prather et al. (61) stated that aerosol transmission of viruses must be acknowledged as a key factor leading to the spread of infectious respiratory diseases, and that SARS-CoV-2 is silently spreading in aerosols exhaled by highly contagious infected individuals with no symptoms. They noted that masks provide a critical barrier. The site of inhalation is also affected by the size of these particles, with the smallest particles (≤5μ≤5μm) able to reach into the respiratory bronchioles and alveoli in the lungs and medium-sized ones (up to 10 μm to 15 μm) able to deposit in the “the trachea and large intrathoracic airways” (52).
Aerosolized transmission dynamics are pathogen specific, due to pathogen-specific peak shedding and inactivation rates (62, 63). Studies suggest that vibration of the vocal folds contributes more to particle atomization and the production of particles that carry microorganisms (62). SARS-CoV-2 is present in exhaled breath (64), but it is not known to what degree this route is responsible for transmission. A study of influenza suggests that vocalization might be critical for creation of infection breath particles (65).
The ability of masks to filter particles depends on the particle size and trajectory, with smaller floating aerosols more challenging to filter than larger particles with momentum (66). Because speech produces more particles containing the SARS-CoV-2 virus, and because transmission of SARS-CoV-2 without symptoms is associated with URT shedding, where particles formed through vocalization are likely to contain the virus, we should be particularly cognizant of the role of speech particles in transmission (59). Speech particles lose their momentum and become much smaller shortly after ejection, which is likely to make them easier to filter by source control (as egress at the wearer) than by PPE (at ingress to an susceptible person). We will look at source control and PPE efficacy in turn.

Source Control​

In this section, we study whether a face mask (particularly cloth or other unfitted masks) is likely to decrease the number of people infected by an infectious mask wearer. The use of mask wearing by potentially infectious people is known as “source control.”
There are two main ways to physically test a mask: 1) have someone wearing it vocalize, such as breathe, talk or cough, or 2) synthetically simulate these actions using a spray mechanism, such as a nebulizer. Because human actions are complex and hard to simulate correctly, the first approach is preferred where possible. There are, in turn, two ways to analyze the results of this approach: 1) directly or indirectly measure the amount of respiratory particles of differing sizes, or 2) measure the amount of infectious particles.

Human Studies: Infectious Particles.​

There are currently no studies that measure the impact of any kind of mask on the amount of infectious SARS-CoV-2 particles from human actions. Other infections, however, have been studied. One of the most relevant papers (67) is one that compares the efficacy of surgical masks for source control for seasonal coronaviruses (NL63, OC43, 229E, and HKU1), influenza, and rhinovirus. With 10 participants, the masks were effective at blocking coronavirus particles of all sizes for every subject. However, masks were far less effective at blocking rhinovirus particles of any size, or of blocking small influenza particles. The results suggest that masks may have a significant role in source control for the current coronavirus outbreak. The study did not use COVID-19 patients, and it is not yet known whether SARS-CoV-2 behaves the same as these seasonal coronaviruses, which are of the same family.
In a pair of studies from 1962 to 1975, a portable isolation box was attached to an Andersen Sampler and used to measure orally expelled bacterial contaminants before and after masking. In one study, during talking, unmasked subjects expelled more than 5,000 contaminants per 5 cubic feet; 7.2% of the contaminants were associated with particles less than 4 μm in diameter (68). Cloth-masked subjects expelled an average of 19 contaminants per 5 cubic feet; 63% were less than 4 μm in diameter. So overall, over 99% of contaminants were filtered. The second study used the same experimental setup, but studied a wider range of mask designs, including a four-ply cotton mask. For each mask design, over 97% contaminant filtration was observed (69).
Johnson et al. (70) found that no influenza could be detected by RT-PCR on sample plates at 20 cm distance from coughing patients wearing masks, while it was detectable without mask for seven of the nine patients. Milton et al. (71) found surgical masks produced a 3.4-fold (95% CI: 1.8 to 6.3) reduction in viral copies in exhaled breath by 37 influenza patients. Vanden Driessche et al. (72) used an improved sampling method based on a controlled human aerosol model. By sampling a homogeneous mix of all of the air around the patient, the authors could also detect any aerosol that might leak around the edges of the mask. Among their six cystic fibrosis patients producing infected aerosol particles while coughing, the airborne Pseudomonas aeruginosa load was reduced by 88% when wearing a surgical mask compared with no mask. Wood et al. (73) found, for their 14 cystic fibrosis patients with high viable aerosol production during coughing, a reduction in aerosol P. aeruginosa concentration at 2 m from the source by using an N95 mask (94% reduction, P < 0.001), or surgical mask (94%, P < 0.001). Stockwell et al. (74) confirmed, in a similar P. aeruginosa aerosol cough study, that surgical masks are effective as source control. One study (75) found surgical masks to decrease transmission of tuberculosis by 56% when used as source control and measuring differences in guinea pig tuberculosis infections, and another found similar results for SARS-CoV-2 infections in hamsters, using a “mask curtain” (76).
Multiple simulation studies show the filtration effects of cloth masks relative to surgical masks. Generally available household materials had between a 58% and 94% filtration rate for 1-μm bacteria particles, whereas surgical masks filtered 96% of those particles (77). A tea cloth mask was found to filter 60% of particles between 0.02 μm and 1 μm, where surgical masks filtered 75% (78). Simulation studies generally use a 30 L/min or higher challenge aerosol, which is around about 3 to 6 times the ventilation of a human at rest or doing light work (77). As a result, simulation studies may underestimate the efficacy of the use of unfitted masks in the community in practice.

Human Studies: Aerosol and Droplet Filtration.​

Anfinrud et al. (59) used laser light scattering to sensitively detect the emission of particles of various sizes (including aerosols) while speaking. Their analysis showed that visible particles “expelled” in a forward direction with a homemade mask consisting of a washcloth attached with two rubber bands around the head remained very close to background levels in a laser scattering chamber, while significant levels were expelled when speaking without a mask.
There are no studies that have directly measured the filtration of smaller or lateral particles in this setting, although, using Schlieren imaging, it has been shown that all kinds of masks greatly limit the spread of the emission cloud (79), consistent with a fluid dynamic simulation that estimated this filtration level at 90% (80). Another study used a manikin and visible smoke to simulate coughing, and found that a stitched cloth mask was the most effective of the tested designs at source control, reducing the jet distance in all directions from 8 feet (with no mask) to 2.5 inches (81).
One possible benefit of masks for source control is that they can reduce surface transmission, by avoiding droplets settling on surfaces that may be touched by a susceptible person. However, contact through surfaces is not believed to be the main way SARS-CoV-2 spreads (82), and the risk of transmission through surfaces may be small (83).
In summary, there is laboratory-based evidence that household masks have filtration capacity in the relevant particle size range, as well as efficacy in blocking aerosols and droplets from the wearer (67). That is, these masks help people keep their emissions to themselves. A consideration is that face masks with valves do not capture respiratory particles as efficiently, bypassing the filtration mechanism, and therefore offer less source control (84).

PPE​

In this section, we study whether a face mask is likely to decrease the chance of a potentially susceptible mask wearer becoming infected. The use of mask wearing by potentially susceptible people is known as “PPE.” Protection of the wearer is more challenging than source control, since the particles of interest are smaller. It is also much harder to directly test mask efficacy for PPE using a human subject, so simulations must be used instead. Masks can be made of different materials and designs (66) which influence their filtering capability.
There are two considerations when looking at efficacy: 1) the filtration of the material and 2) the fit of the design. There are many standards around the world for both of these issues, such as the US National Institute for Occupational Safety and Health (NIOSH) N95 classification. The “95” designation means that, when subjected to testing, the respirator blocks at least 95% of very small (0.3 μm) test particles. NIOSH tests at flow rates of 85 L/min, simulating a high work rate, which is an order of magnitude higher than rest or low-intensity breathing. These are designed to be tests of the worst case (i.e., it produces maximum filter penetration), because the test conditions are the most severe that are likely to be encountered in a work environment (85). These tests use particles that are much smaller than virus-carrying emissions, at much higher flow rates than normally seen in community settings, which means that masks that do not meet this standard may be effective as PPE in the community. The machines used for these studies are specifically designed for looking at respirators that hold their shape, which are glued or attached with beeswax firmly to the testing plate. Flexible masks such as cloth and surgical masks can get pulled into the hole in the testing plate, which makes it a less suitable testing method for these designs.
A study of filtration using the NIOSH approach (86), but with 78-nm particles, was used as the basis for a table in World Health Organization’s “Advice on the use of masks in the context of COVID-19” (87). There was over 90% penetration for all cotton masks and handkerchiefs, and 50 to 60% penetration for surgical masks and nonwoven nonmedical masks. Zhao et al. (88) used a similar approach, but at a lower 32 L/min (which is still 3 to 6 times higher than human ventilation during light work). They also tested materials after creating a triboelectric effect by rubbing the material with a latex glove for 30 s, finding that polyester achieved a quality factor (Q) of 40 kP/a, nearly 10 times higher than a surgical mask. Without triboelectric charging, it achieved a Q of 6.8, which was similar to a cotton t-shirt. They concluded that cotton, polyester, and polypropylene multilayered structures can meet or even exceed the efficiency of materials used in some medical face masks. However, it depends on the details of the material and treatment.
One recent study looked at the aerosol filtration efficiency of common fabrics used in respiratory cloth masks, finding that efficacy varied widely, from 12 to 99.9%, at flow rates lower than at-rest respiration (89). Many materials had ≥96% filtration efficacy for particles of >0.3 μm, including 600 threads per inch cotton, cotton quilt, and cotton layered with chiffon, silk, or flannel. A combination of materials was more effective than the materials on their own. These findings support studies reported in 1926 by Wu Lien Teh (4), which described that a silk face covering with flannel added over the mouth and nose was highly effective against pneumonic plague.
There are many designs of cloth masks, with widely varying levels of fit. There have been few tests of different designs. A simple mask cut from a t-shirt achieved a fit score of 67, offering substantial protection from the challenge aerosol and showing good fit with minimal leakage (90). One study looked at unfitted surgical masks, and used three rubber bands and a paper clip to improve their fit (91). All 11 subjects in the test passed the N95 fit test using this approach. Wu Lien Teh noted that a rubber support could provide good fit, although he recommended that a silk covering for the whole head (and flannel sewed over nose and mouth areas), with holes for the eyes, tucked into the shirt, is a more comfortable approach that can provide good protection for a whole day (4).
Research focused on aerosol exposure has found all types of masks are at least somewhat effective at protecting the wearer. Van der Sande et al. (78) found that “all types of masks reduced aerosol exposure, relatively stable over time, unaffected by duration of wear or type of activity,” and concluded that “any type of general mask use is likely to decrease viral exposure and infection risk on a population level, despite imperfect fit and imperfect adherence.”
The review from Chu et al. (11) included three observational studies of face mask use for SARS-CoV-2 in health care environments, all showing a risk ratio of 0.03 to 0.04. However, these studies were given a much lower weight in the review than studies of Middle East respiratory syndrome and SARS, and the overall risk ratio for mask use in health care was estimated at 0.30.
One of the most frequently mentioned, but misinterpreted, papers evaluating cloth masks as PPE for health care workers is one from MacIntyre et al. (25). The study compared a “surgical mask” group, which received two new masks per day, to a “cloth mask” group that received five masks for the entire 4-wk period and were required to wear the masks all day, to a “control group,” which used masks in compliance with existing hospital protocols, which the authors describe as a “very high level of mask use.” There was not a “no mask” control group because it was deemed “unethical.” The study does not inform policy pertaining to public mask wearing as compared to the absence of masks in a community setting. They found that the group with a regular supply of new surgical masks each day had significantly lower infection of rhinovirus than the group that wore a limited supply of cloth masks, consistent with other studies that show surgical masks provide poor filtration for rhinovirus, compared to seasonal coronaviruses (67).
Most of the research on masks as health worker PPE focuses on influenza, though it is not yet known to what extent findings from influenza studies apply to COVID-19 filtration. Wilkes et al. (92) found that “filtration performance of pleated hydrophobic membrane filters was demonstrated to be markedly greater than that of electrostatic filters.” A metaanalysis of N95 respirators compared to surgical masks (93) found “the use of N95 respirators compared with surgical masks is not associated with a lower risk of laboratory-confirmed influenza.” Radonovich et al. (94) found, in an outpatient setting, that “use of N95 respirators, compared with medical masks in the outpatient setting resulted in no significant difference in the rates of laboratory-confirmed influenza.”
One possible additional benefit of masks as PPE is that they do not allow hands to directly touch the nose and mouth, which may be a transmission vector. The lipid barrier that protects viruses is destroyed within 5 min of touching the hands (95), and wearing a mask during that period could be protective. However, there are no case reports or laboratory evidence to suggest that touching the mask can cause infection.
Overall, it appears that cloth face covers can provide good fit and filtration for PPE in some community contexts, but results will vary depending on material and design, the way they are used, and the setting in which they are used.

Sociological Considerations​

Some of the concerns about public mask wearing have not been around primary evidence for the efficacy of source control, but concerns about how they will be used.

Risk Compensation Behavior.​

One concern around public health messaging promoting the use of face covering has been that members of the public may use risk compensation behavior. This involves fear that the public would neglect other measures like physical distancing and hand hygiene, based on overvaluing the protection a mask may offer due to an exaggerated or false sense of security (96). Similar arguments have previously been made for HIV prevention strategies (97, 98), motorcycle helmet laws (99), seat belts (100), and alpine skiing helmets (101). However, contrary to predictions, risk compensation behaviors have not been significant at a population level, being outweighed by increased safety in each case (100, 102⇓⇓–105). These findings strongly suggest that, instead of withholding a preventative tool, accompanying it with accurate messaging that combines different preventative measures would display trust in the general public’s ability to act responsibly and empower citizens. Polling and observational data from the COVID-19 pandemic have shown mask wearing to be positively correlated with other preventative measures, including hand hygiene (106, 107), physical distancing (106, 107), and reduced face touching (108). Three preprint papers reporting observational data suggest that masks may be a cue for others to keep a wider physical distance. (109⇓–111).

Managing the Stigma Associated with Wearing a Mask.​

Stigma is a powerful force in human societies, and many illnesses come with stigma for the sick as well as fear of them. Managing the stigma is an important part of the process of controlling epidemics (112). Tuberculosis is an example of an illness where masks are used as source control but became a public label associated with the disease. Many sick people are reluctant to wear a mask if it identifies them as sick, in an effort to avoid the stigma of illness (113, 114). Some health authorities have recommended wearing masks for COVID-19 only if people are sick; however, reports of people wearing masks being attacked, shunned, and stigmatized have also been observed (115). In many countries, minorities suffer additional stigma and assumptions of criminality (116). Black people in the United States have reportedly been reluctant to wear masks in public during this pandemic for fear of being mistaken for criminals (117, 118). Thus, it may not even be possible to have sick people alone wear masks, due to stigma, employer restrictions, or simple lack of knowledge of one’s status, without mask wearing becoming universal policy.

Creating New Symbolism around Wearing a Mask.​

Ritual and solidarity are important in human societies and can combine with visible signals to shape new societal behaviors (119, 120). Universal mask wearing could serve as a visible signal and reminder of the pandemic. Signaling participation in health behaviors by wearing a mask as well as visible enforcement can increase compliance with public mask wearing, but also other important preventative behaviors (121). Historically, epidemics are a time of fear, confusion, and helplessness (122, 123). Mask wearing, and even mask making or distribution, can provide feelings of empowerment and self-efficacy (124). Health is a form of public good in that everyone else’s health behaviors improve the health odds of everyone else (125, 126). This can make masks symbols of altruism and solidarity (127). Viewing masks as a social practice, governed by sociocultural norms, instead of a medical intervention, has also been proposed to enhance longer-term uptake (128).

Implementation Considerations​

Globally, health authorities have followed different trajectories in recommendations around the use of face masks by the public. In China, Taiwan, Japan, and South Korea, face masks were utilized from the start of the pandemic (2). Other countries, like Czechia and Thailand, were early adopters in a global shift toward recommending cloth masks. We present considerations for the translation of evidence about public mask wearing to diverse countries across the globe, outside of the parameters of a controlled research setting.

 

[capamerica]

Nobody wears masks in NZ. It is not required. That is why NZ has been successful in eliminating the virus. We know that masks don't work.

And fuck you too.

Wrong. Again. Call it 0 for 223 tries. All failed

https://covid19.govt.nz/health-and-wellbeing/protect-yourself-and-others/wear-a-face-covering/

Wearing face coverings helps stop the spread of COVID-19​

Wearing a face covering helps keep you and others safe.

A face covering helps stop droplets spreading when someone speaks, laughs, coughs or sneezes. This includes someone who has COVID-19 but feels well or has no obvious symptoms.

Face coverings are particularly useful when physical distancing is not possible.

Face coverings are only 1 part of keeping yourself and others safe. Our strategy to protect New Zealand against COVID-19 is based on our border protections, testing, contact tracing and other public health measures, like washing hands and physical distancing. Face coverings are an extra protective physical barrier to help keep people safe.

At Alert Level 1, there is still a risk of COVID-19 returning to the community.

Public transport and domestic flights​

You legally must wear a face covering:

• on public transport
• on domestic flights
• by taxi and ride-share drivers — while it’s not compulsory for passengers to wear them, we strongly encourage you to.

There are exemptions for some people and services
Drivers and transport operators will not stop people without face coverings from boarding public transport. This is because some people will have legitimate reasons for not wearing a face covering. 
However, where possible, drivers will be encouraging passengers to wear a face covering.

Elsewhere​

We encourage you to wear face coverings when you cannot maintain physical distance in crowded indoor places, like in supermarkets.

Face coverings at Alert Level 2​

At Alert Levels 2 and above the risk of COVID-19 being present in the community is higher. So, wearing a face covering is more important.

Public transport and domestic flights​

You legally must wear a face covering:

• on public transport
• on domestic flights
• by taxi and ride-share drivers — while it’s not compulsory for passengers to wear them, we strongly encourage you to.

There are exemptions for some people and services
Drivers and transport operators will not stop people without face coverings from boarding public transport. This is because some people will have legitimate reasons for not wearing a face covering. 
However, where possible, drivers will be encouraging passengers to wear a face covering.

Elsewhere​

At Alert Level 2, when not on public transport, we recommend you consider wearing a face covering when you cannot maintain physical distance from people you do not know.

Face coverings at Alert Level 3​

At Alert Level 3, the risk of COVID-19 being present in the community is higher.

Public transport and domestic flights​

You legally must wear a face covering:

• on public transport
• on domestic flights
• by taxi and ride-share drivers — while it’s not compulsory for passengers to wear them, we strongly encourage you to.

There are exemptions for some people and services
Drivers and transport operators will not stop people without face coverings from boarding public transport. This is because some people will have legitimate reasons for not wearing a face covering. 
However, where possible, drivers will be encouraging passengers to wear a face covering.

Elsewhere​

You are also strongly encouraged to wear a face covering when you're outside your home and in a place where it’s hard to keep your distance from other people.

Who does not need to wear a face covering​

Face coverings do not need to be worn:

• by children under 12
• by students on school buses
• by passengers in taxis or ride-share services, but drivers are required to
• on ferry services carrying passengers between the North and South islands
• on pre-booked public transport services — bus or train services that collect your contact details before they depart, and allocate you a seat
• on jet boat tours
• on charter or group tours
• on private flights
• by drivers, pilots, staff or crew of the service if they are in a space completely separated from passengers, for example pilots in a cockpit or train drivers in a train cab.

You also do not need to wear face coverings if:

• it is unsafe, for example if wearing one means a driver cannot safely operate the vehicle
• there is an emergency
• you have a physical or mental health illness or condition or disability that makes wearing a face covering unsuitable
• you need to prove your identity
• you need to communicate with someone who is Deaf or hard of hearing
• you need to take medicine
• you need to eat or drink, if eating or drinking is usually allowed
• it is not required by law.

Drivers and transport operators will not stop people without face coverings from boarding public transport. This is because some people will have legitimate reasons for not wearing a face covering. 
However, where possible, drivers will be encouraging passengers to wear a face covering.

Exemption card for face coverings​

We know that some people who have a disability or health condition may not be able to wear a face covering safely or comfortably. If you cannot wear one, you can get an exemption card. You can show your exemption card when needed, for example to a bus driver.
You do not need to have an exemption card, but you may feel more comfortable showing something official to confirm you cannot wear a face covering.

Get an exemption card​

If you think you need an exemption card, call Healthline on 0800 358 5453.
You can get a printable version, or a card that you can show on your phone. If these are not suitable, Healthline will talk through other options with you.
If you prefer, you can download a card from the Disabled Persons Assembly NZ, or contact them on 04 801 9100 or at [email protected]
Download exemption card for face coverings(external link)

Video: Why we wear a face covering on planes and public transport​

How to wear a face covering safely​

When you wear a face covering, it's important you use it safely.
How to wear a face covering safely

Types of mask or face covering​

Non-medical-grade face coverings​

Most people can use non-medical-grade face coverings. These face coverings prevent the wearer from spreading diseases to others and could help protect the wearer from becoming infected.
Non-medical-grade face coverings can be either single-use or reusable.

• A single-use face covering can only be worn once, and we recommend you throw it away after wearing it.
• Fabric reusable face coverings can be washed and reused.

Non-medical-grade face coverings do not need to conform to any standard. This means they are not used in medical settings.
You can buy non-medical-grade face coverings online or in shops like pharmacies, supermarkets and hardware stores.
If you do not have a face covering, you do not need to rush out and buy one. You can use another kind of covering, like a bandana, scarf or t-shirt.
How to make a face covering

At-risk people​

At raised Alert Levels, people at higher risk of severe illness from COVID-19 are advised to avoid contact with the public. If you need to go out, and feel you are vulnerable, you may wish to discuss with your health provider whether using a medical mask is best for you.

Medical masks​

Medical masks are made to be used by healthcare workers. These masks provide a protective barrier between the healthcare worker and the people they are treating to reduce transmission of infectious diseases. They are used in combination with other measures such as hand hygiene and physical distancing when required. They are not reusable and must comply with the standard AS 4381:2015, or international equivalent.
Surgical masks are worn by healthcare professionals during healthcare procedures. They generally have a higher level of quality testing and are designed to reduce fluid splash and transmission of infectious diseases.
The Ministry of Health will make sure there is enough supply and distribution of medical and surgical masks for the wider health sector. Ensuring medical, surgical and N95 (or equivalent) masks are available for healthcare workers and those working in high-risk COVID-19 settings, such as border control, continues to be a priority.

Make a face covering​

Find 2 ways of making a face covering:

• Make a face covering in under 10 seconds with no sewing.
• Sew your own face covering.

How to make a face covering

 

[capamerica]

There are loads of Ah Nehs coming back to NZ too and they are let in because citizens cannot be legally prevented from returning.

you cant go anywhere because you would get arrested at the airport

makes sense, you are stupid

 

[capamerica]

Those telegram groups have nothing to do with me. However I fully support their creation and their function which is to provide info that would otherwise be censored.

People have a right to know the risks involved when it comes to vaccination. Any attempt to censor information only makes matters worse.

if you support it, must be a disaster like everything else you touch

 

[capamerica]

Those who want to know what the groups are all about can go to

https://t.me/SGVaccineInjuries (channel)

https://t.me/SGVaxInjuries (discussion group)

https://t.me/SGCovidDiscussion (discussion group)

I am not vouching for the accuracy or the authenticity of the content. However people have a right to read what others are saying and decide for themselves what to believe.

since you cannot post authentic anything, this is a stretch