Well said

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Aug 31, 2022·edited Aug 31, 2022

I think more public energy has been expended fighting over masks than any other pandemic topic. To me, masks have become a religion for some, a source of oppression for others. In the US, they have become a talisman for the most woke, and almost serve to protect the wearer from Bad People, more than from microbes. It stands to reason that many would want their toddlers to participate in the religion. Sometimes, making rules for yourself to follow can be a source of comfort. Some people feel safe in their masks. Personally, I mostly feel unsafe, depending on the circumstance. Looking forward to this chapter of our lives being in the rear view mirror.

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It’s hard to believe that someone would need to state the obvious, but thank you. I honestly would love to see the rebuttal on this from the AAP, the CDC or any other “expert” entity. This issue has polarized me so much, I’m not objective, I just can’t see any other side.

Thank you again.

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Dear colleague Munro,

I am afraid I cannot agree with your starting point that “The effectiveness of facemasks is almost entirely dependant on the fit of the mask to the face, and the compliance of the wearer”.

First about fit:

While fit is indeed very important for inward protection, I would like to challenge its importance for outward protection, which contributes more to epidemic control than inward protection. In the previous century, Richard Riley, who confirmed the airborne nature of M. tuberculosis transmission, was unconcerned about leaks of air from an outward-protection perspective. He believed even simple cough etiquette should be effective because organisms leaving the mouth are still in droplets, which have not evaporated to droplet nuclei (aerosol) and are still large enough to impinge on an obstructing surface, such as the hand, and remain there.

2009 experiments with telescope mirrors show that even if a cough is covered with a surgical mask, the airflow is redirected upwards and downwards owing to leakage around the relatively loose fit of the mask.

So indeed, leaks of air out of a surgical mask are important because surgical masks don’t fit properly. But I believe Richard Riley was right, that these leaks are not as important as currently anticipated. In 2015 we demonstrated that regardless of these leaks, surgical masks stop 88% of cough aerosol from being generated (95% confidence interval 81–96%; P = 0.03). Our results were confirmed in 2018 by Lidia Morawska, who was the driving force behind the letter to the WHO that ultimately led to the world recognising the importance of aerosol transmission of Sars-CoV-2.

Secondly about compliance of toddlers:

You might be right that toddlers are less complaint when it comes to masks than adults, but to say it in your words: “It is incorrect to claim definitively that this is the case”. I see very poor compliance of health care professionals towards masking in hospitals these days, understandably, there is not so much COVID around these days. The compliance of a toddler being asked to mask by his/her kindergarten teacher could as well be higher compared to even health care professionals’ compliance these days. This leads us to another discussion: When are we past the expiration date of masks in health care facilities?

Disclaimer: While I can’t agree with your statements about fit and compliance, that does not mean that I believe we should ask toddlers to wear a mask in the classroom.

Kind regards,

Koen Vanden Driessche


Riley RL. Airborne infection. Am J Med. 1974;57:466–475

Tang et al. J R Soc Interface 2009; 6 (Suppl 6): S727–S736.

Vanden Driessche et al. AJRCCM 2015; 192(7):897-9

Wood et al. AJRCCM 2018 ; 197(3):348-355

Vanden Driessche et al. Lancet Respir Med 2021;9(4):340-342

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Aug 31, 2022·edited Aug 31, 2022

It seems to me that the sample statements you have chosen do put more weight on "con" arguments about mask utilization, and that you could have chosen a more balanced sample of equally "pro"-- and equally untested or untestable -- statements to prove the "reasonability" (don´t know if such a word exists) of doubts about the issue.

In my country, policy (not very successful, I admit) has rested on 4 joint elements: vaccination, ventilation, distancing and masking. The idea was that if you loosened one or two of those, you should strengthen the others. Political pressures (and a significant decline in contagions, severe disease and deaths) have given way to almost simultaneous removal of almost all of those requirements, with no due consideration of the precarious conditions of access to reasonable quality health services... And those of us who entertain reasonable doubts are accused of unreasonable disregard of evidence and irresponsible "stigmatization" of children (because, they claim, we are "blaming" them for adults´ diseases.

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I can only imagine how many times a poor child touches his face and even his eyes when wearing a mask. And we all know that touching your eyes can lead to all kinds of illnesses since they don’t offer even as much natural barrier as the nose or the mouth. Probably have to touch their little eyes to wipe their tears from being upset over wearing the mask. What a ridiculous and evil fiasco. Widespread, public and sadly, accepted, child abuse!

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using clear face shields is an imperfect, but potentially protective option. I spoke with a teacher of younger grades after a year of using these in the classroom instead of masks, and she observed a clear protective effect based upon the amount of face shield cleaning she had to do each day for coughing and sneezing kiddos -- and an apparent reduction in overall virus transmission in the classroom compared to unshielded years.

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