Conclusion Regarding Masks
They Do Not Work
By Dr. Sherri Tenpenny, DO, AOBNMM, ABIHM

July 28, 2020


There are NO randomized, controlled trials (RCT) with verified outcomes that show a benefit to healthcare workers or community members for wearing a mask or a respirator. There is no such definitive study. Likewise, no study exists that shows a benefit from a broad policy to wear masks in public (documented below).
Furthermore, if there were any benefit to wearing a mask, because of the blocking power against droplets and aerosol particles, then there should be more benefit from wearing a respirator (N95) compared to a surgical mask. There is not. Neither masks nor respirators protect; cloth coverings are essentially worthless.

It should be noted that the surgical masks are primarily designed to protect the environment from the wearer, whereas the respirators are supposed to protect the wearer from the environment. (Balazy, et al).
Coronavirus are <0.125 microns in size. Masks and respirators filter particles 0.30 to 0.80 microns in size. Masks cannot possibly work. No bias-free study has ever found a benefit from wearing a mask or respirator in this application.
o Public Health Experts Keep Changing: Mask vs No Mask
• March 15, 2020 – Medical Science News “Reusing masks may increase your risk of
coronavirus infection.” https://www.news-medical.net/news/20200315/Reusing-masks-mayincrease-your-risk-of-coronavirus-infection-expert-says.aspx

Dr. Jenny Harries, England’s deputy chief medical officer, has warned that it was not
a good idea for the public to wear facemasks as the virus can get trapped in the
material and causes infection when the wearer breathes in. “For the average member
of the public walking down a street, it is not a good idea,” Dr. Harries said.

March 30, 2020: WHO Emergencies Press Conference on coronavirus disease
at 00:22:39)“We don’t generally recommend the wearing to masks in public by
otherwise well individuals because it has not been up to now associated with any
particular benefit…It does have benefit psychologically, socially and there are social
norms around that and we don’t criticize the wearing of masks and have not done so
but there is no specific evidence to suggest that the wearing of masks by the
mass population has any particular benefit. In fact, there’s some evidence to
suggest the opposite in the misuse of wearing a mask properly or fitting it properly or
taking it off and all the other risks that are otherwise associated with that.
March 31, 2020: https://www.newsmax.com/us/surgeon-general adamsmasks/2020/03/31/id/960679/
“You can increase your risk of getting COVID19 by wearing a mask if you are not a
health care provider. Folks who don’t know how to wear them properly tend to
touch their faces a lot and actually can increase the spread of coronavirus.” -Dr.
Jerome Adams, US Surgeon General
• April 3, 2020: https://time.com/5794729/coronavirus-face-masks/
According to the CDC, wearing a surgical mask won’t stop the wearer
from inhaling small airborne particles, which can cause infection. Nor
do these masks form a snug seal around the face. The CDC recommends surgical masks only for people who *already show symptoms* of coronavirus and must go outside. Wearing a mask can help prevent spreading the virus by protecting others nearby when you cough or sneeze.

• May 1, 2020: Illinois issued an order that a mask will be required in public when social
distancing isn’t an option.
• May 27, 2020: Virginia announced a statewide mask mandate.

• …..and many more states have followed suit.
o Healthy persons do not spread illness

• Leung, Nancy., et al. (2020) “Respiratory virus shedding in exhaled breath and efficacy of face masks.” Nature Medicine 26, 676-680. https://www.nature.com/articles/s41591-020- 0843-2
“…Among the samples collected without a face mask, we found that the majority
of participants with influenza virus and coronavirus infection did not shed
detectable virus in respiratory droplets or aerosols… given that each exhaled
breath collection was conducted for 30 min, this might imply that prolonged close
contact would be required for transmission to occur, even if transmission was
primarily via aerosols..”
• Gao, Ming. et al. “A Study of infectivity of asymptomatic SARS-CoV2 carriers.” Respiratory Medicine. 2020. Aug: 169:106026 https://pubmed.ncbi.nlm.nih.gov/32513410/
455 contacts who were exposed to the asymptomatic COVID-19 virus carrier: 35
patients, 196 family members and 224 hospital staffs. NONE of the 455 contacts
contracted the SARS-CoV-2 infection
o Mask Mandates as Public Policy is a Disaster

• Klompas, Michael., et al. (2020) “Universal Masking in Hospitals in the COVID-19 Era.”
NEJM 2020; 382:e63 https://www.nejm.org/doi/full/10.1056/NEJMp2006372?
We know that wearing a mask outside health care facilities offers little, if
any, protection from infection. Public health authorities define a significant
exposure to Covid-19 as face-to-face contact within 6 feet with a patient with
symptomatic Covid-19 that is sustained for at least a few minutes (and some say
more than 10 minutes or even 30 minutes). The chance of catching Covid-19
from a passing interaction in a public space is therefore minimal. In many
cases, the desire for widespread masking is a reflexive reaction to anxiety over
the pandemic.

• Brainard, Julii Suzanne, et al.(2020) “Facemasks and similar barriers to prevent respiratory illness such as COVID-19: A rapid systematic review.” medRxiv 2020.04.01.20049528
“There were 31 eligible studies (including 12 RCTs). Based on the RCTs we
would conclude that wearing facemasks can be very slightly protective against
primary infection from casual community contact, and modestly protective against
household infections when both infected and uninfected members wear facemasks. The evidence is not sufficiently strong to support widespread use of facemasks as a protective measure against COVID-19.
• Chandrasekaran, Baskaran. (2020) “Exercise with facemask: Are we handling a devil’s
sword?” – a physiological hypothesis. Med Hypotheses. Nov; 144:11002. 2020
Exercising with facemasks may reduce available Oxygen and increase air
trapping preventing substantial carbon dioxide exchange. The hypercapnic
hypoxia may potentially increase acidic environment, cardiac overload, anaerobic
metabolism and renal overload, which may substantially aggravate the underlying
pathology of established chronic diseases. Further contrary to the earlier thought,
no evidence exists to claim the facemasks during exercise offer additional
protection from the droplet transfer of the virus.
• Tam, Victor CW et al (2020) “A reality check on the use of face masks during the COVID 19 outbreak in Hong Kong.” EClinicalMedicine. 2020 May; 22:100356
In our study, 94.8% wore masks of which 83.7% wore disposable surgical
masks. However, 13.0% wore them incorrectly: with 35.5% worn ‘inside-out’ or
‘upside-down’; and 42.5% worn too low, exposing the nostrils or mouth.
Packaging of different brands of surgical mask sold locally were examined; very
few provided instructions on correct usage. [NOTE: IF NOT worn correctly,
there are doing nothing and should not be worn at all.]
o Particle Size: The Key to it All
• Zhu, Na, et al. (2020). “A Novel Coronavirus from Patients with Pneumonia in China, 2019” N Engl J Med 2020; 382:727-733. https://www.nejm.org/doi/full/10.1056/nejmoa2001017
Scientists were at a consensus that the diameter of the 2019-nCoV particles were
0.06 to 0.14 microns in size. Most N95 and N99 face masks can filter out 0.30
microns. Airborne coronavirus particle (<0.125 micron) will pass directly
through a N95 face mask.

• Balazy, Anna, et al. (2006). “Do N95 respirators provide 95% protection level against
airborne viruses, and how adequate are surgical masks?” Am J Infect Control. 2006
The N95 filtering face piece respirators may not provide the expected protection
level against small virions. As anticipated, the tested surgical masks showed a
much higher particle penetration because they are known to be less efficient than
the N95 respirators. Some surgical masks may let a significant fraction of
airborne viruses penetrate through their filters, providing very low protection
against aerosolized infectious agents in the size range of 10 to 80 nm.
o N95 Respirators

• Long, Y. et al. (2020). “Effectiveness of N95 respirators vs surgical masks against influenza: A systematic review and meta-analysis.” J Evidence Based Medicine. 2020;12:93-101.
“The current meta-analysis shows the use of N95 respirators compared to surgical
masks is not associated with a lower risk of laboratory-confirmed influenza.”

• Randonovich, Lewis, et al. (2019) “N95 Respirators vs Medical Masks for Preventing
Influenza Among Health Care Personnel: A Randomized Clinical Trial”. JAMA. 2019 Sept 3; (322(9):824-833. https://pubmed.ncbi.nlm.nih.gov/31479137/
“Among outpatient health care personnel, N95 respirators vs medical masks as
worn by participants in this trial resulted in no significant difference in the
incidence of laboratory-confirmed influenza.

• Offeddu, V. et al. (2017) “Effectiveness of Masks and Respirators Against Respiratory
Infections in Healthcare Workers: A Systematic Review and Meta-Analysis,” Clinical
Infectious Diseases, Volume 65, Issue 11, 1 December 2017, Pages 1934– 1942, https://academic.oup.com/cid/article/65/11/1934/4068747
“Self-reported assessment of clinical outcomes was prone to bias. Evidence of a
protective effect of masks or respirators against verified respiratory infection (VRI)
was not statistically significant.”

• Chou, Roger, et al. (2020) “Masks for Prevention of Respiratory Virus Infections, Including SARS-CoV-2, in Health Care and Community Settings.” Ann Intern Med June 24:M20-3213.
2020 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322812/
Randomized trials in community settings found possibly no difference between
N95 versus surgical masks and probably no difference between surgical versus
no mask in risk for influenza or influenza-like illness, but compliance was low.
Bothersome symptoms were common.

• Zhu JH, et al. “Effects of long-duration wearing of N95 respirator and surgical facemask: a pilot study.” J Lung Pulm Respir Res. 2014;1(4):97‒100.

Click to access JLPRR-01-00021.pdf

As the protection efficacy and possible effects on nasal functions and subjective
sensations of wearing N95 respirator/surgical facemask have been well
demonstrated, wearing of respirator and facemask altered the fractions of air
components and changed microclimate around the nasal cavity, which would
further affect the function of mucosa and its transportation rate.

• Cowling, B. et al. (2010) “Face masks to prevent transmission of influenza virus: A
systematic review.” Epidemiology and Infection, 138(4), 449-456.
N95-masked health-care workers (HCW) were significantly more likely to
experience headaches. Face mask use in HCW was not demonstrated to
provide benefit in terms of cold symptoms or getting colds.

• Smith, Jeffrey, et al. (2016) “Effectiveness of N95 respirators versus surgical masks in
protecting health care workers from acute respiratory infection: a systematic review and
meta-analysis.” CMAJ 2016 May 17;188(8):567-574
Although N95 respirators appeared to have a protective advantage over surgical
masks in laboratory settings, our meta-analysis showed that there were
insufficient data to determine definitively whether N95 respirators are
superior to surgical masks in protecting health care workers against
transmissible acute respiratory infections in clinical settings.

o Surgical Face Masks

• Isaacs, David, et al. (2020) “Do Facemasks protect against COVID-19?” J. of Pediatric and
Child Health, June. 56(6): 976-977. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7323223/
“The questionable benefits arguably do not justify health-care staff wearing
surgical masks when treating low-risk patients and may impede the normal
caring relationship between patients, parents and staff. We counsel against such
practice, at least at present.”

• Jacobs, J. L. et al. (2009) “Use of surgical face masks to reduce the incidence of the
common cold among health care workers in Japan: A randomized controlled trial,” American Journal of Infection Control, Volume 37, Issue 5, 417-
419. https://www.ncbi.nlm.nih.gov/pubmed/19216002
N95-masked health-care workers (HCW) were significantly more likely to
experience headaches. Face mask use in HCW was not demonstrated to
provide benefit in terms of cold symptoms or getting colds.

• Smith, J.D. et al. (2016) “Effectiveness of N95 respirators versus surgical masks in
protecting health care workers from acute respiratory infection: a systematic review and
meta-analysis,” CMAJ Mar 2016 https://www.cmaj.ca/content/188/8/567
“We identified six clinical studies …we found no significant difference between
N95 respirators and surgical masks in associated risk of (a) laboratory-confirmed
respiratory infection, (b) influenza-like illness, or (c) reported work-place

• Balazy, Anna, et al. (2006). “Do N95 respirators provide 95% protection level against
airborne viruses, and how adequate are surgical masks?” Am J Infect Control. 2006
The N95 filtering face piece respirators may not provide the expected protection
level against small virions. As anticipated, the tested surgical masks showed a
much higher particle penetration because they are known to be less efficient than
the N95 respirators. Some surgical masks may let a significant fraction of
airborne viruses penetrate through their filters, providing very low protection
against aerosolized infectious agents in the size range of 10 to 80 nm.

o Cloth masks

• MacIntyre, C Raina, et al. “A cluster randomized trial of cloth masks compared with medical masks in healthcare workers.” BMJ Open 2015; 5:e006577.
“Cloth masks also had significantly higher rates of influenza-like illness.
Penetration of viral particles through a cloth mask was almost 97%”

• Rengasamy, Samy, et al. “Simple Respiratory Protection – Evaluation of the filtration
performance of cloth masks and common fabric materials against 20-1000nm size particles”
The Annals of Occupational Hygiene, Vol 54, Issue 7, Oct 2010. Pg 789-798
Results obtained show that common fabric materials provide marginal protection
against nanoparticles including those in the size ranges of virus-containing
particles in exhaled breath.

• Shakya, Kabindra M, et al. “Evaluating the efficacy of cloth facemasks in reducing
particulate matter exposure.” J Expo Sci Environ Epidemiol. 2017;27(3):352-357.
“Our results suggest that cloth masks are only marginally beneficial in protecting
individuals from particles <2.5 μm (Note: coronaviruses are between .05 and 0.2

• MMWR: Weekly / July 17, 2020 / 69(28);930-932
At salon X in Springfield, Missouri, two stylists with COVID-19 symptoms worked
closely with 139 clients before receiving diagnoses of COVID-19, and none of
their clients developed COVID-19 symptoms. 67 were tested; 67 specimens were
positive. Close contacts because ill; apparently everyone recovered uneventfully.
CONCLUSION: 1) Exposure isn’t illness and 2) positive tests isn’t illness

o Wearing a mask blocks oxygen

• Wearing a mask is hazardous to your health.

• Kao, Tze-Wah, et al. (2004). The physiological impact of wearing an N95 mask during
hemodialysis as a precaution against SARS in patients with end-stage renal disease.” J
Formos Med Asso. 2004 Aug;103(8(:624-8
Thirty-nine patients (mean age, 57.2 yrs) in the study. 70% showed a reduction in
partial pressure of oxygen (PaO2), and 19% developed various degrees of
hypoxemia. Wearing an N95 mask significantly reduced the PaO2 level,
increased the respiratory rate, increased chest discomfort, and respiratory
distress. Wearing an N95 mask for 4 hours during HD significantly reduced
PaO2 and increased respiratory adverse effects in ESRD patients. [DOES THIS

• OSHA documents: https://www.osha.gov/laws-regs/standardinterpretations/2007-04-02-0
§ “People begin to suffer adverse health effects when the oxygen level of their
breathing air drops below 19.5 percent oxygen. The rule-making record for the
Respiratory Protection Standard clearly justifies adopting the requirement that air
breathed by employees must have an oxygen content of at least 19.5 percent.

• Beder, A et al. (2008) “Preliminary report on surgical mask induced deoxygenation during major surgery.” Neurocirugia (Astur) 2008 Apr;19(2):121-6.
A study on 53 surgeons using a pulse oximeter pre and postoperatively. Pulse
rates increased and SpO2 decrease after the first hour. Since a very small
decrease in saturation at this level, reflects a large decrease in PaO2, our findings
may have a clinical value for the health workers and the surgeons. [NOTE: SpO2
{O2 sat} is the saturation of hemoglobin with oxygen measured with a. pulse
oximeter. PaO2 is amount of oxygen in the blood, determined by an arterial blood
sample. Once the O2 sat falls below 90%, the PaO2 drops quickly into the
dangerously hypoxic.

o Wearing a mask increases CO2 – leading to cognitive dysfunction

• Zheng, Guo-quing, et al. (2008) “Chronic hypoxia-hypercapnia influences cognitive function: a possible new model of cognitive dysfunction in COPD.” Med Hypotheses. 2008;71(1):111-3

o “We propose that cognitive impairment is strongly related to combination of chronic hypoxia and hypercapnia.”

o The psychological impact of mask wearing

• TIME MAGAZINE (2020) “Public Health Experts Keep Changing Their Guidance on
Whether or Not to Wear Face Masks for Coronavirus.”
Lynn Bufka, a clinical psychologist and senior director for practice, research
and policy at the American Psychological Association, suspects that people
are clinging to masks for the same reason they knock on wood or avoid
walking under ladders. “Even if experts are saying it’s really not going to
make a difference, a little [part of] people’s brains is thinking, well, it’s not
going to hurt. Maybe it’ll cut my risk just a little bit, so it’s worth it to wear a
mask,” she says. In that sense, wearing a mask is a “superstitious
behavior.” https://time.com/5794729/coronavirus-face-masks/

• Potts, Susan Claire. “The Cult of the Mask.”
When people hide their faces, they feel they belong to something. They can show
their solidarity with the whole human race. They can feel good about
themselves. They can keep people safe. They can make a difference. The
freedom of the open-faced is seen as a threat to their safety and, more
significantly, to their sense of commitment to a great cause. Currently, the
weapons are psychological—shame, ostracism.

• Klompas, Michael., et al. (2020) “Universal Masking in Hospitals in the COVID-19 Era.”
NEJM 2020; 382:e63 https://www.nejm.org/doi/full/10.1056/NEJMp2006372
One might argue that fear and anxiety are better countered with data and
education than with a marginally beneficial mask, particularly in light of the
worldwide mask shortage, but it is difficult to get clinicians to hear this message
in the heat of the current crisis. Expanded masking protocols’ greatest
contribution may be to reduce the transmission of anxiety, over and above
whatever role they may play in reducing transmission of Covid-19.

o Masks dehumanize us

• Foley, Gretchen N, et al. (2010) “Nonverbal Communication in Psychotherapy.” Psychiatry (Edgmont). June 7(6):38-44 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2898840/
An estimated 60 to 65 percent of interpersonal communication is conveyed via
nonverbal behaviors.
Masks distort the structure of the face. The lower part of their face is disguised.
Identity is concealed. No non-verbal cues or emotion is communicated to a fellow
human being can be discerned; all facial communication is hidden under the

Four Key Reasons Why People Choose to Not Wear a Mask

1. Masks offer no protection to the wearer
a. Masks are not an effective way of protection from the new coronavirus, only N95 are,
and masks have disclaimers saying they cannot prevent someone from acquiring the
new coronavirus
2. Evidence is lacking that masks protect anyone: the wearer or the public
a. See the references above
3. Masks increase the risk of contracting an infection: COVID19 or others
a. Masks can become contaminated very quickly, and every time the wearer breathes in,
they inhale contaminants
4. Masks might harm the wearer
a. Masks limit oxygen intake and increase carbon dioxide (CO2)
b. Masks are dangerous for people with certain health conditions (COPD, asthma), as
they may restrict breathing
i. The WHO acknowledge that people living with asthma, chronic respiratory
conditions, or breathing problems may experience difficulties when wearing
face masks.
ii. The CDC recommend that anyone who has trouble breathing should not wear
a face covering. (Click to Source)
1. “No one has died of coronavirus.” https://www.globalresearch.ca/no-one-has-diedcoronavirus/5717668
2. “Masks don’t work.” https://www.rcreader.com/commentary/masks-dont-work-covid-areview-of-science-relevant-to-covide-19-social-policy
3. “Asymptomatic carriers don’t spread infection.”
4. “Exposure doesn’t mean death; doesn’t even mean illness.”
5. “Masks for all not based on sound data.” https://www.cidrap.umn.edu/newsperspective/2020/04/commentary-masks-all-covid-19-not-based-sound-data
6. “COVID19- PCR testing is Scientifically Meaningless” https://offguardian.org/2020/06/27/covid19-pcr-tests-are-scientifically-meaningless/


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