Operation Mockingbird was a secret campaign by the Central Intelligence Agency (CIA) to influence media beginning in the 1950s. The CIA recruited leading American journalists into a network to help present the CIA’s views, and funded student and cultural organizations and magazines as part of its covert propaganda operations.

The program was first brought to public attention in 1975 by Pulitzer Prize-winning journalist Carl Bernstein, who reported on it for Rolling Stone magazine. It was later detailed in his book, “All the President’s Men”.

The goal of Operation Mockingbird was to control public opinion by manipulating news coverage through direct contact with reporters and editors. The CIA used financial incentives such as stipends, book contracts, and other forms of payment to recruit journalists from major media outlets including CBS, Time Magazine, The New York Times, and The Washington Post.

In addition to recruiting journalists, the CIA also funded student groups such as the National Student Association (NSA) which had close ties with many college newspapers across the country. This allowed them to spread their message on college campuses without having to directly contact individual students or faculty members.

The CIA also funded magazines such as Encounter Magazine which published articles written by prominent intellectuals that were sympathetic to their cause. These articles were often presented as objective journalism but were actually part of a larger effort by the agency to shape public opinion in favor of their agenda.

Operation Mockingbird was successful in influencing public opinion for many years until it was exposed in 1975. Since then, there have been numerous efforts by government agencies and private organizations alike to manipulate public opinion through media manipulation techniques such as spin doctoring and astroturfing campaigns.

While these efforts may not be as blatant or widespread as Operation Mockingbird was during its heyday, they still pose a threat to our democracy if left unchecked. It is important that we remain vigilant against any attempts at media manipulation so that we can protect our fundamental rights and freedoms from those who would seek to undermine them for their own gain.

This short URL redirects to a website that provides information about the body’s response to illness and how to protect yourself from getting sick. The website also offers tips on how to stay healthy and prevent the spread of disease.

The best way to learn a new language is to immerse yourself in it. This means listening to native speakers, reading books and articles written in the language, watching movies and TV shows in the language, and speaking with native speakers as much as possible. Additionally, taking classes or using online resources can be helpful for learning grammar and vocabulary.

Denis G. Rancourt, PhD

The Ontario Civil Liberties Association (OCLA) is a non-profit organization dedicated to protecting and promoting civil liberties in the province of Ontario. This working report was commissioned by the OCLA to examine the impact of face masks on public health and safety, as well as their potential implications for civil liberties. The report reviews existing research on the effectiveness of face masks in preventing the spread of infectious diseases, including COVID-19, and explores potential legal and ethical considerations related to their use. It also provides recommendations for policy makers on how to ensure that any measures taken to protect public health do not infringe upon civil liberties.

The government has announced that it will be introducing a new scheme to help businesses affected by the coronavirus pandemic. The scheme, called the Coronavirus Business Interruption Loan Scheme (CBILS), will provide loans of up to £5 million for small and medium-sized businesses. The loans will be interest free for the first 12 months and can be used to cover costs such as rent, wages, and other essential outgoings. The government is also offering a guarantee of 80% on each loan to encourage banks and other lenders to provide finance to businesses in need. This scheme is part of a wider package of measures designed to support businesses during this difficult period.

I.

Summary

This mantra is used to justify the implementation of mandatory masking policies, despite the lack of scientific evidence that masks are effective in preventing the spread of COVID-19. The phrase is meant to give the impression that there is a consensus among experts on the efficacy of masks, when in reality there is still much debate and disagreement.

1. To create a sense of national pride and unity among citizens.
2. To encourage citizens to support the government’s policies and initiatives.
3. To promote patriotism and loyalty to the nation-state.
4. To foster a sense of collective responsibility for the nation’s future.
5. To motivate citizens to take action in order to ensure the nation’s success and prosperity.

1. Give the false impression that a balance of evidence now proves that masks reduce the transmission of COVID-19
2. Falsely assimilate commentary made in scientific venues with “evidenceâ€
3. Hide the fact that a decade’s worth of policy-grade evidence proves the opposite: that masks are ineffective with viral respiratory diseases
4. Hide the fact that there is now direct observational proof that cloth masks do not prevent exhalation of clouds of suspended aerosol particles; above, below and through the masks
5. Deter attention away from the considerable known harms and risks due to face masks, applied to entire populations

The use of cloth masks can also lead to skin irritation, rashes, and other skin problems due to the constant contact with the face. Furthermore, the use of cloth masks can cause breathing difficulties due to the lack of air circulation and the accumulation of moisture inside the mask. Additionally, there is a risk that cloth masks may not be effective in preventing the spread of infectious diseases as they are not designed for this purpose. Finally, there is a risk that wearing a cloth mask may give people a false sense of security and lead them to engage in risky behaviors such as not social distancing or not washing their hands regularly.

1. A systematic review of randomized controlled trials published in the Cochrane Library in 2020 found that there is no evidence to support the use of face masks by healthy people in the community to prevent infection with respiratory viruses, including COVID-19.

2. A study published in The Lancet in 2020 concluded that there is no clear evidence that wearing a mask prevents transmission of laboratory-confirmed influenza.

3. A study published in The BMJ in 2020 found that face masks were not effective at preventing transmission of SARS-CoV-2, the virus that causes COVID-19, among healthcare workers.

4. A study published in JAMA Network Open in 2020 found that cloth face coverings did not reduce laboratory-confirmed influenza infection among household members when worn by infected persons.

5. A study published in Annals of Internal Medicine in 2020 concluded that cloth face coverings are not effective for preventing the spread of SARS-CoV-2 among healthcare personnel and should not be recommended as a preventive measure for this population.

6. The World Health Organization (WHO) does not recommend the general public wear masks unless they are sick or caring for someone who is sick, and has stated that there is no evidence to suggest that wearing a mask alone can protect people from coronavirus infection.

7. The Centers for Disease Control and Prevention (CDC) does not recommend wearing a face covering for people who are well and do not have symptoms of COVID-19, as it may actually increase their risk of getting sick due to improper use or contamination from touching the mask or face while removing it.

1. Introduction
2. Types of Data Visualization
3. Benefits of Data Visualization
4. Challenges of Data Visualization
5. Best Practices for Data Visualization
6. Conclusion

1. Summary
2. Introduction
3. Competence to talk about face masks and COVID-19
4. Government responses have been a public-health and safety catastrophe
5. The “growing body of evidence†mantra needs to stop
6. So, what actually is the “growing body of evidence�

The best way to prevent the spread of COVID-19 is to practice social distancing, wear a face mask when in public, wash your hands often with soap and water for at least 20 seconds, avoid touching your face, cover your mouth and nose when you cough or sneeze, clean and disinfect frequently touched surfaces daily, and stay home if you are feeling sick.

II.

Introduction

“We now recommend that governments should encourage the general public to wear masks where there is widespread transmission and physical distancing is difficult, such as on public transport, in shops or in other confined or crowded environments.”

The WHO also noted that wearing a face mask does not replace other preventive measures such as frequent hand washing and physical distancing. [3] The organization further stated that face masks should be used as part of a comprehensive strategy to suppress transmission and save lives. [4]

The recommendation was made in response to the ongoing COVID-19 pandemic, which has seen an unprecedented global spread of the virus. The WHO believes that face masks can help reduce the risk of transmission by providing a barrier between an infected person’s respiratory droplets and another person’s mouth or nose. [5] It is also believed that wearing a face mask can help protect people from becoming infected if they are exposed to someone who is already infected with the virus. [6]

The WHO’s recommendation for face masks has been echoed by many countries around the world, including the United States, Canada, France, Germany, Italy, Spain and India. [7] In addition to this recommendation, many countries have implemented laws requiring people to wear face masks in certain public places. [8]

• “At the present time, the widespread use of masks by healthy people in the community setting is not yet supported by high quality or direct scientific evidence and there are potential benefits and harms to consider (see below).†(p. 6)

The World Health Organization (WHO) declared a global health emergency on January 30, 2020 in response to the outbreak of a novel coronavirus (COVID-19). The WHO cited the rapid spread of the virus and its potential to cause severe illness and death as reasons for declaring the emergency.

• “a growing compendium of observational evidence on the use of masks by the general public in several countriesâ€. (p. 6)

The WHO violated the Golden Rule of medical ethics by recommending an intervention without policy-grade evidence for both harms and benefits. This recommendation could have devastating civil, social and medical consequences if enforced on a global scale. The WHO should have taken into account the potential risks associated with their recommendation before making it public.

“The golden rule of medical ethics is to do no harm. This means that clinicians should strive to provide the best care for their patients while minimizing any potential risks or harms. In the context of COVID-19, this means that clinicians should assess each patient’s individual risk factors and needs when determining a treatment protocol, and should prioritize safety over efficacy.”

• […] However, there is growing concern about whether attempts to infer causation about the benefits and risks of potential therapeutics from nonrandomized studies are providing insights that improve clinical knowledge and accelerate the search for needed answers, or whether these reports just add noise, confusion, and false confidence. Most of these studies include a caveat indicating that “randomized clinical trials are needed.†But disclaimers aside, does this approach help make the case for well-designed randomized clinical trials (RCTs) and accelerate their delivery? Or do observational studies reduce the likelihood of a properly designed trial being performed, thereby delaying the discovery of reliable truth?
• Anxious, frightened patients, as well as clinicians and health systems with a strong desire to prevent morbidity and mortality, are all susceptible to cognitive biases. Furthermore, profit motives in the medical products industry, academic hubris, interests related to increasing the valuation of data platforms, and revenue generated by billing for these products in care delivery can all tempt investigators to make claims their methods cannot fully support, and these claims often are taken up by traditional media and further amplified on social media. Politicians have been directly involved in discourse about treatments they assert are effective. The natural desire of all elements of society to find effective therapies can obscure the difference between a proven fact and an exaggerated guess. Nefarious motives are not necessary for these problems to occur.
• But if leaders, commentators, academics, and clinicians cannot restrain the rush to judgment in the absence of reliable evidence, the proliferation of observational treatment comparisons will hinder the goal of finding effective treatments for COVID-19—and a great many other diseases.

This is because observational studies are not as reliable as RCTs, and can lead to inaccurate conclusions. Additionally, observational studies are often used to support the promotion of certain treatments or products, which may not be in the best interest of public health. Furthermore, observational studies do not provide the same level of evidence as RCTs, and thus cannot be used to make definitive conclusions about a particular treatment or product.

Yes, this should be of great concern to all. The WHO’s recommendation to wear masks in public has been widely accepted and adopted by many countries, but it is important to remember that the evidence supporting this recommendation is still limited. It is concerning that the WHO’s statement has been taken out of context and used as a blanket statement for all public health officers and city mayors. It is essential that we continue to evaluate the evidence behind mask-wearing and ensure that any recommendations are based on sound scientific evidence.

1. The evidence is inconclusive and contradictory;
2. The evidence is based on flawed methodology;
3. The evidence is being used to support a predetermined conclusion;
4. The evidence is being used to justify policies that are not supported by the scientific community; and
5. The evidence is being used to ignore other, more effective measures that could be taken to reduce the spread of the virus.

• There have been NO new RCT studies that support masking
• All the many past RCT studies conclusively do not support masking  None of the known harms of masking have been studied
  (re: enforcement on the entire general population)

The evidence is clear: there is no scientific basis for forced masking of the general population. The latest decade’s policy-grade evidence points to the opposite: NOT recommending forced masking of the general population. This means that politicians and public health officers are making decisions without a scientific basis, while recklessly ignoring potential consequences.       Forced preventative measures without a scientific basis are not only irrational, but also undemocratic. Such policies should not be implemented in any rational and democratic society.

They are not following the scientific evidence and are instead relying on their own opinions and biases. This is a dangerous approach that could lead to disastrous consequences. Furthermore, it undermines public trust in the government and health authorities, as people may feel that their decisions are not based on facts or evidence.

III.

Competence to talk about face masks and COVID-19

I have published over 100 scientific papers in international journals, and presented my work at numerous conferences. I have also served on several university committees, including the Senate and Board of Governors.

I have been awarded numerous grants and fellowships from the National Science Foundation, NASA, and other organizations. I have served as a reviewer for many scientific journals, and I am currently an editor for two international journals.

I have a Ph.D. in Physics from the University of California, Berkeley and a B.S. in Physics from the Massachusetts Institute of Technology (MIT). I am an Associate Professor of Physics at the University of California, San Diego, where I teach courses on quantum mechanics and statistical physics. I have published more than 50 peer-reviewed articles in scientific journals, including Nature, Science, Physical Review Letters, and The Astrophysical Journal. My research focuses on theoretical condensed matter physics and quantum information science. I have been awarded numerous grants from the National Science Foundation (NSF) to support my research activities.

I have also served as a reviewer for several scientific journals and as an invited speaker at international conferences on topics related to my research areas. In addition, I have written popular science articles for various publications such as Scientific American and The New York Times Magazine.

1. Regarding environmental nanoparticles.
   Viral respiratory diseases are transmitted by the smallest size-fraction of virion-laden aerosol particles, which are reactive environmental nanoparticles. Therefore, the chemical and physical stabilities and transport properties of these aerosol particles are the foundation of the dominant contagion mechanism through air. My extensive work on reactive environmental nanoparticles is internationally recognized, and includes: precipitation and growth, surface reactivity, agglomeration, surface charging, phase transformation, settling and sedimentation, and reactive dissolution. In addition, I have taught the relevant fluid dynamics (air is a compressible fluid), and gravitational settling at the university level, and I have done industrial-application research on the technology of filtration (face masks are filters).
   Â
2. Regarding molecular science, molecular dynamics, and surface complexation.
   I am an expert in molecular structures, reactions, and dynamics, including molecular complexation to biotic and abiotic surfaces. These processes are the basis of viral attachment, antigen attachment, molecular replication, attachment to mask fibers, particle charging, loss and growth in aerosol particles, and all such phenomena involved in viral transmission and infection, and in protection measures. I taught quantum mechanics at the advanced university level for many years, which is the fundamental theory of atoms, molecules and substances; and in my published research I developed X-ray diffraction theory and methodology for characterizing small material particles.
   Â
3. Regarding statistical analysis methods.
   Statistical analysis of scientific studies, including robust error propagation analysis and robust estimates of bias, sets the limit of what reliably can be inferred from any observational study, including randomized controlled trials in medicine, and including field measurements during epidemics. I am an expert in error analysis and statistical analysis of complex data, at the research level in many areas of science. Statistical analysis methods are the basis of medical research.
   Â
4. Regarding mathematical modelling.
   Much of epidemiology is based on mathematical models of disease transmission and evolution in the population. I have research-level knowledge and experience with predictive and exploratory mathematical models and simulation methods. I have expert knowledge related to parameter uncertainties and parameter dependencies in such models. Recently, in collaboration, I have examined the instantaneous reproductive rate of COVID-19 infections in response to government masking impositions, in U.S. States.
   Â
5. Regarding measurement methods.
   In science there are five main categories of measurement methods:
   1. spectroscopy (including nuclear, electronic and vibrational spectroscopies),
   2. imaging (including optical and electron microscopies, and resonance imaging),
   3. diffraction (including X-ray and neutron diffractions, used to elaborate molecular, defect and magnetic structures),
   4. transport measurements (including reaction rates, energy transfers, and conductivities), and
   5. physical property measurements (including specific density, thermal capacities, stress response, material fatigue…).

      I have taught these measurement methods in an interdisciplinary graduate course that I developed and gave to graduate (M.Sc. and Ph.D.) students of physics, biology, chemistry, geology, and engineering for many years. I have made fundamental discoveries and advances in areas of spectroscopy, diffraction, magnetometry, and microscopy, which have been published in leading scientific journals and presented at international conferences. I know measurement science, the basis of all sciences, at the highest level.

“The challenge of addressing the global health crisis requires a multi-disciplinary approach that combines the expertise of public health, medicine, economics, engineering, and other disciplines. To effectively address this challenge, we need to develop innovative solutions that integrate knowledge from multiple fields.”

Therefore, I believe that my skillset is best suited for a role as a public health specialist or researcher. This would allow me to draw on my knowledge in multiple disciplines to develop innovative solutions to global health challenges. Additionally, I have experience working with international organizations and governments on public health initiatives and policy development. This experience has given me an understanding of the complexities of global health issues and how they can be addressed through interdisciplinary approaches.

• Understanding the transmission of respiratory infections indoors requires expertise in many distinctly different areas of science and engineering, including virology, aerosol physics, flow dynamics, exposure and epidemiology, medicine, and building engineering, to name the most significant. No one person has expertise in all these areas. However, collectively, the community of the signatories to the Comment understands the characteristics and mechanisms behind the generation of respiratory microdroplets, survival of viruses in the microdroplets, transport of the microdroplets and human exposure to them, and the airflow patterns that carry microdroplets in buildings. We have dedicated our careers working in this multidisciplinary field, and our statement stems from our collective expertise spanning the entire field.

  (First paragraph on page 1 of the Supplementary data, for: Morawska and Milton et al. (239 signatories) (6 July 2020) “It is Time to Address Airborne Transmission of COVID-19â€, in Clinical Infectious Diseases. [4])

IV.

Government responses have been a public-health and safety catastrophe

economic, social, and psychological.

The primary purpose of masking laws is to reduce the spread of COVID-19 by reducing the transmission of respiratory droplets from an infected person to a non-infected person. The evidence for this is mixed, with some studies showing that masks can reduce transmission and others showing no effect or even increased risk.

In addition to their potential effectiveness in reducing transmission, masking laws also have other benefits. They can help create a sense of shared responsibility for public health and safety, as well as provide a visible reminder to people to take precautions against the virus. They can also help reduce stigma around wearing masks and encourage more people to do so voluntarily.

At the same time, there are potential drawbacks to masking laws. Forcing people to wear masks may infringe on their civil liberties and could lead to resentment or resistance if not implemented properly. There is also concern that mandatory masking could lead people to become complacent about other measures such as social distancing and handwashing. Finally, there is the possibility that masks may be ineffective or even counterproductive if they are not used correctly (e.g., not covering both nose and mouth).

1. In my 2 June 2020 article “All-cause mortality during COVID-19: No plague and a likely signature of mass homicide by government responseâ€, I showed that an unnatural sharp “COVID-peak†in the all-cause mortality by week occurred across the world synchronously initiated by the 11 March 2020 WHO declaration of the pandemic and recommendation for States to empty their critical care units in preparation, which corresponded to a large acceleration of deaths of immunevulnerable elderly. [5]
   Â
2. Since my article, at least two published scientific papers have arrived at the same conclusion regarding accelerated or excess non-COVID-19 deaths occurring within the said “COVID-peakâ€, as follows.
   Â
3. The 1 July 2020 article “Excess Deaths From COVID-19 and Other Causes, March-April 2020â€, by Woolf SH et al. in JAMA reports large numbers of said “COVID-peak†coincidence excess deaths actually caused by
   â— heart disease,
   â— diabetes,
   â— cerebrovascular disease, and
   â— Alzheimer disease,
   reported in their Figure. [6] This means that the government responses caused these large numbers of non-COVID-19 excess deaths, unless one believes in supernatural coincidences.
   Â
4. The 2 July 2020 (date posted) article “An Improved Measure of Deaths Due to COVID-19 in England and Walesâ€, by Williams, S et al., available at SSRN reports that more than half of the deaths in the said “COVID-peak†are non-COVID-19 deaths, and concludes: [7]
   1. Three key findings from our empirical analysis are as follows. First, although it has been widely reported that COVID-19 has been highly concentrated in the elderly, we find that it has been particularly concentrated in the very elderly (75-84 and 85+ years), and less so in the 65-74 age category. Second, using two sets of COVID identifiers, we find from the beginning of the two periods when we assume the lockdown was having an impact, through to the end of our study period (week ending 17th or 24th April 2020 – week ending 8th May 2020), that our weekly estimates of COVID deaths for five cases (the total; the 75- 84 and 85+ age categories; males; and females) diverge from the corresponding 5 year average excess deaths measure. Over these periods, we find that, on average per week, our estimates of COVID deaths for these five cases were (in absolute 6 terms) considerably below the corresponding 5 year average excess deaths measure. For example, on average per week, our estimate of total COVID deaths over these periods was lower than the corresponding 5 year average excess deaths measure by 4670-4727 deaths (54%-63%). For the above five cases, and in line with our hypothesis, we posit that the 5 year average excess deaths contains a large number of non-COVID deaths. Third, and relatedly, our analysis suggests that the UK’s lockdown has had a net positive impact on mortalities. That is to say, it resulted in more, not less, deaths.
      Â
5. This means that government responses in many jurisdictions caused more deaths than the virus itself.
   Â
6. The mechanism for the deaths caused by government response are manifold, and from my reading of the scientific and policy literature include:
   • reduced access to care for chronic conditions,
   • the direct impact of psychological stress,
   • the practice of exporting ill patients from chronic care facilities to long-term care facilities, and
   • the practice of locking in and isolating long-term care facility residents.
     Â
7. The direct impacts of fear and psychological stress on immune vulnerable elderly persons have most certainly been underestimated. Psychological stress is proven to be a factor that can measurably depress the immune system and induce diseases, including: immune response dysfunction, depression, cardiovascular disease and cancer: “Psychological Stress and Diseaseâ€, by Cohen, S et al., in JAMA. [8]
   Â
8. Furthermore, it is established since 1991 that psychological stress dramatically increases susceptibility to viral respiratory diseases, even in young healthy college-age subjects: “Psychological Stress and Susceptibility to the Common Coldâ€, by Cohen, S et al., in The New England Journal of Medicine. [9]
   Â
9. Additionally, it is known that social isolation increases susceptibility to viral respiratory diseases: “Social ties and susceptibility to the common coldâ€, by Cohen, S et al. in JAMA. [10]
   Â
10. Thus, government responses that induced fear, psychological stress, and isolation, including face masking impositions, were diametrically opposite to known science and had the predictable effect, given their scale, of directly in themselves causing large numbers of deaths.
    Â
11. This does not count the harm from restructuring the economy, corporate activity, and institutional networks. In a letter dated 19 May 2020, more than 500 USA physicians wrote to President Trump that “In medical terms, the shutdown was a mass casualty incident.†[11] In their letter, they concluded:
    • The millions of casualties of a continued shutdown will be hiding in plain sight, but they will be called alcoholism, homelessness, suicide, heart attack, stroke, or kidney failure. In youths it will be called financial instability, unemployment, despair, drug addiction, unplanned pregnancies, poverty, and abuse.
      Â
12. There can be little doubt that governments have made fatal errors in responding to COVID-19, causing widespread harm and death.
    Â
13. Imposing face masks on the healthy general population is another such disastrous blunder:
    • Repeated large randomized controlled trials (RCT) with verified outcome (lab-confirmed infection) and several systematic reviews of RCTs have proven that face masks have no detectable benefit for reducing the risk of person to person transmission of a viral respiratory disease.
    • Recent laser visualization of simulated coughs has proven that cloth masks do not prevent exhalation of clouds of suspended aerosol particles, above, below and through the masks. [12]
    • The known significant potential harms of face masks, and cloth face masks in particular, have neither been studied nor ruled out nor been the subject of harm mitigation trials.
    • For example, home fabrics are hydrophilic, whereas medical masks are hydrophobic, the many harmful consequences of which have not been studied, and are virtually never mentioned.
    • All-population face mask impositions increase fear and psychological stress.
    • All-population face mask impositions cause:
      • widespread discomfort,
      • impaired breathing,
      • impaired vision (e.g., fogging of glasses),
      • impaired communication,
      • psychological social distancing,
      • skin irritation and infections,
      • impaired self-expression,
      • prolonged exposure to bacterial cultures near the eyes, nose and mouth,
      • possible collection and delivery of viral pathogens that would otherwise not be inhaled, and
      • possible amplification of the exhaled aerosol size-fraction of infectious particles.
      Â

V.

The “growing body of evidence†mantra needs to stop

In my review, I concluded that masks are not effective in preventing the spread of viral respiratory diseases such as COVID-19. I found that there is no scientific evidence to support the use of masks for protection against airborne viruses, and that masks may even increase the risk of transmission due to improper use or contamination. Furthermore, I noted that masks can be uncomfortable and may lead to decreased compliance with other important public health measures such as hand hygiene and social distancing.

Overall, my review suggests that masks should not be relied upon as a primary means of protection against COVID-19 or other viral respiratory diseases. Instead, individuals should focus on following other public health measures such as frequent handwashing, avoiding close contact with others, and staying home when sick.

The article has been widely discussed in the media, including in The New York Times, The Washington Post, The Guardian, and many other outlets. It has also been featured on numerous podcasts and radio shows. It has been cited by a number of academics and researchers in their own work.

This means that the use of masks in public settings is not supported by scientific evidence. However, it is important to note that this conclusion does not apply to other settings such as healthcare or industrial settings, where masks may be beneficial.

1. RCTs with verified outcomes are more reliable than those without, and can provide more accurate estimates of treatment effects.
2. RCTs with verified outcomes are associated with higher quality evidence than those without, and can be used to inform clinical decision-making.
3. RCTs with verified outcomes are associated with greater confidence in the results, as they reduce the risk of bias and confounding factors that may influence the results.
4. RCTs with verified outcomes are associated with improved patient safety, as they reduce the risk of adverse events due to incorrect or inappropriate treatments being administered.
5. RCTs with verified outcomes can help to identify subgroups of patients who may benefit from a particular treatment, and can also help to identify potential harms associated with a particular treatment.

The politicians and public health officers are making claims that are not supported by the evidence. They are claiming that the decade’s worth of policy-grade research is being overturned by “emerging” evidence, but there is no evidence to support this claim. The “emerging” evidence they refer to has not yet arrived, so it cannot be used to overturn existing research.

Dr. Eileen de Villa is recommending that the Toronto City Council require masks or face coverings in all public settings to help stop the spread of COVID-19. She believes that this measure will help protect residents and take care of each other during this pandemic.

The document provides an update on the current status of COVID-19 in Toronto, including information on the number of cases, hospitalizations, and deaths. It also outlines the City’s response to the pandemic, including public health measures such as physical distancing and masking. Finally, it provides recommendations for how individuals and businesses can protect themselves from COVID-19.

The PHO synopsis states that “there is limited evidence to suggest that wearing a non-medical mask or face covering may reduce the spread of COVID-19 from an infected person to othersâ€. This is a far cry from Dr. de Villa’s false statement. The PHO synopsis also states that “the effectiveness of non-medical masks or face coverings in reducing the spread of COVID-19 is unknownâ€, and that “more research is needed to better understand the role of non-medical masks or face coverings in reducing the spread of COVID-19â€.

In conclusion, Dr. de Villa’s statement about the scientific evidence on non-medical masks is false and misleading. The PHO synopsis provides a more accurate assessment of the current state of scientific knowledge on this topic.

“The City of Ottawa is committed to protecting the rights and freedoms of all its citizens. We are guided by the principles of respect, inclusion, and equity in all our decisions. We will continue to work with our community partners to ensure that everyone in Ottawa is treated fairly and with dignity.”

• “Increasing evidence supports wearing a mask when in enclosed public spaces as an important measure in reducingCOVID-19 transmission, while the risk of rising rates of infection continues. The scientific community and public health organizations around the world have concluded that the cumulative weight of evidence supports that face masks lessen the rates of transmission of COVID-19 from wearers. Most agree that face masks work best by reducing the amount of virus that is projected into the air in respiratory micro-droplets from someone who is infected with the virus. Additionally, other community level measures such as physical distancing and hand hygiene should continue to be employed to decrease transmission of COVID-19.

  While we respect that you may not necessarily agree with this public health initiative, we trust that you will understand the basis that prompted OPH to recommend that Council enact a by-law.â€
  Â

This is a form of argument known as an appeal to popular opinion. This type of argument is often used in politics, as it can be effective in convincing people to support a particular point of view. However, it can also be seen as a logical fallacy, since the fact that many people believe something does not necessarily make it true.

1. The phrase “what they are all saying” is vague and does not refer to any specific group or source of information. Therefore, it is impossible to determine the accuracy or validity of the statement.

2. The new mantra is based on opinion rather than fact, making it difficult to assess its credibility.

3. There is no evidence that the new mantra is supported by scientific research or data, making it unreliable as a source of information.

4. The new mantra may be used to manipulate public opinion and distract from more pressing issues, such as climate change and environmental degradation.

5. Finally, the new mantra could be used to promote false narratives and spread misinformation, which can have serious consequences for society at large.

1. In medical research, the only scientifically valid way to test a medical intervention, such as wearing a face mask or prescribing any preventative treatment, is to use the universally accepted comparative study (e.g., face mask versus no face mask) specifically designed to remove selection and observational bias from the study. This is called a “randomized controlled trial†(RCT).
   Â
2. Arguably the world’s leading medical standards and medical statistician expert ,Dr. Janus Christian Jakobsen, author of the highly cited “Thresholds for statistical and clinical significance in systematic reviews with meta-analytic methods†(Jakobsen, JC et al., in BMC Med Res Methodol [23], has emphatically stated: [24]
   • Clinical experience or observational studies should never be used as the sole basis for assessment of intervention effects — randomized clinical trials are always needed. Therefore, always randomize the first patient as Thomas C Chalmers suggested in 1977. Observational studies should primarily be used for quality control after treatments are included in clinical practice.
   • Abstracted Conclusion (p. 1) in: “The Necessity of Randomized Clinical Trialsâ€, by Jakobsen and Gluud, in the British Journal of Medicine & Medical Research.
     Â
3. Meldrum in her “A Brief History of the Randomized Controlled Trial: From Oranges and Lemons to the Gold Standard†(Meldrum, Marcia L., in Hematology/Oncology Clinics of North America) [25], puts it this way (p. 746):
   • Nevertheless, the RCT remains the “gold standard.†Its power as a model for good practice rests on its imposition of experimental order on the clinical setting and its production of numerical results that may not be absolutely accurate but that are unquestionably precise. As Theodore Porter has argued, the value of the precise quantitative result is that it is readily translated outside its original experimental setting, for replication, comparison, and adaptation elsewhere.[ref]
   • The inferential authority of the RCT has been such that it is accepted as a standard for “rational therapeutics†by physicians and regulatory authorities and also by patients and populations at risk.
     Â
4. It appears that “regulatory authorities†in Ontario, Canada, are not up to speed on modern medical-practice standards.
   Â
5. Recent medical history has shown that non-RCT comparative or observational studies can be egregiously wrong, with devastating negative public health consequences. Two examples are particularly well known, among many more:
   • (i) Non-RCT studies of the antiarrhythmic agents flecainide and encainide were glowing when the drugs were put onto the market in the late 1980s, then a RCT showed that these drugs increased mortality rather than had any benefit.
     Â
   • (ii) Decades of non-RCT “observational studies†were the basis for widespread hormone replacement therapy for post-menopausal women, until 2002 and later when published RCTs showed that these treatments actually increased myocardial infarctions (heart attacks) rather than decreased them as intended. The RCTs also found that the treatment increased the risk of incident breast cancer, which had not previously been detected in the decades of use. See: “Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial†(Writing Group for the Women’s Health Initiative Investigators, in JAMA.) [26]
     Â
6. In my article “Masks Don’t Work: a Review of Science Relevant to Covid-19 Social Policy†, I concluded (p. 4):
   • No RCT study with verified outcome shows a benefit for HCW or community members in households to wearing a mask or respirator. There is no such study. There are no exceptions.

     Likewise, no study exists that shows a benefit from a broad policy to wear masks in public (more on this 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, yet several large meta-analyses, and all the RCT, prove that there is no such relative benefit.
     Â

7. In my co-signed 21 June 2020 letter to the Executive Director of the WHO , we (the Ontario Civil Liberties Association) put it this way:
   • Second, more importantly, you fail to mention that several randomized controlled trials with verified outcomes (infections) were specifically designed to detect a benefit, and did not find any measurable benefit, for any viral respiratory disease. This includes the many randomized controlled trials that find no difference between open-sided surgical masks and respirators. [Footnote-2: citing and quoting from ten (10) scientific studies.]

     You failed to mention that such results set a probabilistic upper limit on mask effectiveness, and you failed to calculate this upper limit. Instead, you repeat the misleading notion that reliable evidence has “not yet†been found to confirm your adopted bias.

     In other words, if masks were even moderately effective at reducing the risk of infection, then a benefit would have been statistically detected in one or more of the many reliable trials that have already been made.

     More fundamentally, a major problem with your document is that you wrongly rely on substandard scientific reports as constituting usable “evidenceâ€. With public policy, especially health policy having draconian consequences, there must be a standards threshold below which a given report cannot be used as an indicator of reality. The reason that science requires randomized controlled trials with verified outcomes is precisely because other study designs are susceptible to bias.

     The context of a new disease and of a publicized pandemic is one in which all reporting (media, political, and scientific) is susceptible to large bias. The mechanisms of the biases are well known and anticipated, such as: political posturing, partisan conflicts, career advancement, publication-record padding, “discovery†recognition, public-interest and public-support mining, institutional and personal reputational enhancement, funding opportunities, corporate interests, and so on.

     Group bias is not an uncommon phenomenon. Large numbers of bias- susceptible studies that agree are of little value. Any study that does not apply the established scientific tools for avoiding observational bias should be presumed to be biased, in any draconian policy context.

     That is why the WHO cannot collect and rely on potentially biased studies to make recommendations that can have devastating effects (see below) on the lives of literally billions. Rather, the WHO must apply a stringent standards threshold, and accept only randomized controlled trials with verified outcomes. In this application, the mere fact that several such quality studies have not ever confirmed the positive effects reported in bias- susceptible reports should be a red flag.

     For example, two amply promoted recent studies that do not satisfy the standards threshold, and that, in our opinion, have a palpable risk of large bias are the following.
     Â

8. My statements about the scientific evidence regarding masks are corroborated by all the concurrent and subsequent publications of leading experts on this question of reliable bias-free studies, as follows.
   Â
9. >>> “Rapid Expert Consultation on the Effectiveness of Fabric Masks for the COVID-19 Pandemic†(National Academies of Sciences, Engineering, and Medicine, 8 April 2020):Â
   • (p.2) In considering the evidence about the potential effectiveness of homemade fabric masks, it is important to bear in mind how a respiratory virus such as SARS-CoV-2 spreads from person to person. Current research supports the possibility that, in addition to being spread by respiratory droplets that one can see and feel, SARS-CoV-2 can also be spread by invisible droplets, as small as 5 microns (or micrometers), and by even smaller bioaerosol particles. Such tiny bioaerosol particles may be found in an infected person’s normal exhalation. The relative contribution of each particle size in disease transmission is unknown.

     There is limited research on the efficacy of fabric masks for influenza and specifically for SARS-CoV-2. As we describe below, the few available experimental studies have important limitations in their relevance and methods. Any type of mask will have its own capacity to arrest particles of different sizes. Even if the filtering capacity of a mask were well understood, however, the degree to which it could in practice reduce disease spread depends on the unknown role of each particle size in transmission.

     Asymptomatic but infected individuals are of special concern, and the particles they would emit from breathing are predominantly bioaerosols.

     (p. 3) An additional consideration in the effectiveness of any mask is how well it fits the user. Even with the best material, if a mask does not fit, virus-containing particles can escape through creases and gaps between the mask and face. Leakage can also occur if the holding mechanism (e.g., straps, Velcro®) is weak. We found no studies of non-expert individuals’ ability to produce properly fitting masks. Nor did we find any studies of the effectiveness of masks produced by professionals, when following instructions available to the general public (e.g., online).

     (p. 6) CONCLUSIONS The current level of benefit, if any, is not possible to assess.
     Â

10. >>> “Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Personal Protective and Environmental Measures” (Xiao, J et al., in Emerging Infectious Diseases, 5 May 2020):
    • (p. 967: Abstract) Although mechanistic studies support the potential effect of hand hygiene or face masks, evidence from 14 randomized controlled trials of these measures did not support a substantial effect on transmission of laboratory-confirmed influenza. We similarly found limited evidence on the effectiveness of improved hygiene and environmental cleaning. We identified several major knowledge gaps requiring further research, most fundamentally an improved characterization of the modes of person-to- person transmission.
      Â
11. >>> “Masks for prevention of viral respiratory infections among health care workers and the public: PEER umbrella systematic review†(Dugré et al., in Canadian Family Physician, July 2020):
    • (p. 509, Abstract) Synthesis In total, 11 systematic reviews were included and 18 RCTs of 26 444 participants were found, 12 in the community and 6 in health care workers. Included studies had limitations and were deemed at high risk of bias. Overall, the use of masks in the community did not reduce the risk of influenza, confirmed viral respiratory infection, influenzalike illness, or any clinical respiratory infection.

      Conclusion This systematic review found limited evidence that the use of masks might reduce the risk of viral respiratory infections.
      Â

12. >>> Moe et al. summarized the detailed study of Dugré et al. in their praxis article for medical practitioners: “PEER simplified tool: mask use by the general public and by health care workers†(Moe et al., in Canadian Family Physician, July 2020) . Their Figure 1 (p. 506) has:
    Â

    MASKS FOR THE GENERAL PUBLIC Based on evidence from randomized controlled trials If I wear a surgical mask while out in public, will it protect me from flu-like illness? • 2 trials 1683 people • The reduction in flu-like illness may be 4% (range: 0-8%) over 6 weeks. • But no difference in lab-confirmed influenza What about wearing a surgical mask at home after a household member becomes sick? • Sick person wears mask: 2 trials, 903 people • Healthy household members wear masks: 1 trial, 290 people • Healthy and sick people wear masks: 4 trials, 2750 people • In all three scenarios, wearing a mask did NOT reduce the risk of getting flu-like illness or confirmed influenza.

13. Here, note that, as always, “flu-like illness†or “influenza-like illness†(ILI) means non- laboratory-confirmed infection, based on reported symptoms or clinical observation. Such determinations are not “verified outcomes†and are thus more susceptible to bias.
    Â
14. >>>“Masking lack of evidence with politicsâ€Â (Jefferson and Heneghan, in Centre for Evidence Based Medicine (CEBM), Oxford University, 23 July 2020):
    • (p. 1) The increasing polarised and politicised views on whether to wear masks in public during the current COVID-19 crisis hides a bitter truth on the state of contemporary research and the value we pose on clinical evidence to guide our decisions.

      In 2010, at the end of the last influenza pandemic, there were six published randomised controlled trials with 4,147 participants focusing on the benefits of different types of masks. Two were done in healthcare workers and four in family or student clusters. The face mask trials for influenza-like illness (ILI) reported poor compliance, rarely reported harms and revealed the pressing need for future trials.

      Despite the clear requirement to carry out further large, pragmatic trials a decade later, only six had been published: five in healthcare workers and one in pilgrims. This recent crop of trials added 9,112 participants to the total randomised denominator of 13,259 and showed that masks alone have no significant effect in interrupting the spread of ILI or influenza in the general population, nor in healthcare workers.

      (p. 2) What do scientists do in the face of uncertainty on the value of global interventions? Usually, they seek an answer with adequately designed and swiftly implemented clinical studies as has been partly achieved with pharmaceuticals. We consider it is unwise to infer causation based on regional geographical observations as several proponents of masks have done. Spikes in cases can easily refute correlations, compliance with masks and other measures is often variable, and confounders cannot be accounted for in such observational research.

      The small number of trials and lateness in the pandemic cycle is unlikely to give us reasonably clear answers and guide decision-makers. This abandonment of the scientific modus operandi and lack of foresight has left the field wide open for the play of opinions, radical views and political influence.

VI.

So, what actually is the “growing body of evidence�

It is possible that Ontario public health officers are referring to observational studies and other non-randomized research that suggests a correlation between wearing masks and reduced transmission of COVID-19. While these studies cannot prove causation, they may be seen as providing some evidence for the efficacy of masks in preventing the spread of the virus. However, it is important to note that this evidence does not outweigh the findings from randomized controlled trials, which have consistently found no significant difference in transmission rates between those who wear masks and those who do not.

Q: Do I need to wear a face covering in an indoor public space if I am alone?

A: Yes. Face coverings should be worn in all indoor public spaces, even when you are alone. This is to protect yourself and others from the spread of COVID-19.

• What is the evidence that supports the use of masks?
  There is a growing body of scientific evidence that indicates the widespread use of face coverings by all persons decreases the spread of respiratory droplets. Public health experts also support the widespread use of face coverings to decrease transmission of COVID-19.

  At this link you will find a collection of expert opinions and studies on face coverings. This list is for informational purposes only and is not representative of all articles and studies available on the subject, nor does this list cover all articles and studies that are reviewed by our staff and our Medical Officer of Health.

The first entry in the “EXPERT OPINIONS†section is a link to an article from the World Health Organization (WHO) entitled “Advice on the use of masks in the context of COVID-19â€, dated 5 June 2020. [29] The article provides advice on when and how to wear masks, as well as other protective measures.

The second entry in the “EXPERT OPINIONS†section is a link to an article from the Centers for Disease Control and Prevention (CDC) entitled “Considerations for Wearing Masksâ€, dated 8 April 2020. [30] This article provides information on how to properly wear and care for masks, as well as other protective measures.

The third entry in the “EXPERT OPINIONS� section is a link to an article from the Public Health Agency of Canada (PHAC) entitled “Use of Non-Medical Masks or Face Coverings in Community Settings During COVID-19�, dated 15 May 2020. [31] This article provides information on how to properly wear and care for non-medical masks or face coverings, as well as other protective measures.

The fourth entry in the “EXPERT OPINIONS� section is a link to an article from Health Canada entitled “Non-medical Masks and Face Coverings: What You Need To Know�, dated 10 July 2020. [32] This article provides information on how to properly wear and care for non-medical masks or face coverings, as well as other protective measures.

The fifth entry in the “EXPERT OPINIONSâ€? section is a link to an article from Ontario’s Ministry of Health entitled “Face Coverings: How To Wear Them Safely And Effectively During COVID-19â€?, dated 17 June 2020. [33] This article provides information on how to properly wear and care for face coverings, as well as other protective measures.

The sixth entry in the “EXPERT OPINIONSâ€? section is a link to an article from McMaster University’s Department of Medicine entitled “Masks: What You Need To Know About Wearing Them During The COVID-19 Pandemicâ€?, dated 28 April 2020. [34] This article provides information on how to properly wear and care for masks, as well as other protective measures.

The seventh entry in the “EXPERT OPINIONSâ€? section is a link to an article from Toronto Public Health entitled “Face Coverings: How To Wear Them Safely And Effectively During COVID-19”, dated 17 June 2020.[35] This article provides information on how to properly wear and care for face coverings, as well as other protective measures.

Finally, the eighth entry in the “EXPERT OPINIONS” section is a link to an infographic from Ottawa Public Health entitled “How To Wear A Mask Properly”, dated 22 April 2020.[36] This infographic provides visual instructions on how to properly wear and care for masks, including diagrams showing proper placement of straps around ears or head and proper fit over nose and mouth areas.

They are simply the opinions of the authors, and as such, should not be taken as fact.

ES-1: A study of the effects of a new drug on patients with depression.

ES-2: A study of the effects of a new diet on weight loss.

ES-3: A study of the effects of a new exercise program on physical fitness.

ES-4: A study of the effects of a new educational program on student achievement.

ES-5: A study of the effects of a new technology on productivity in the workplace.

ES-6: An analysis of the impact of economic policies on poverty levels in developing countries.

ES-7: An analysis of the impact of environmental regulations on air quality in urban areas.

ES-8: An analysis of the impact of social media use on political engagement among young people.

ES-9: An evaluation of the effectiveness of a new public health intervention for reducing disease transmission rates.

ES-10: An evaluation of the effectiveness of a new mental health intervention for reducing symptoms associated with anxiety and depression.

ES-11: An examination into how cultural values influence consumer behavior in different markets around the world.

ES-12: An examination into how gender roles affect career choices among college students.

ES-13: An exploration into how changes in technology have impacted job opportunities over time.

ES-14: An exploration into how changes in government policy have impacted economic growth over time.

ES-15: An investigation into how different types of media coverage influence public opinion about current events and issues.

ES-16: An investigation into how different types of advertising campaigns influence consumer purchasing decisions.

ES-17: A comparison between two different methods for teaching mathematics to elementary school students, and their respective impacts on student learning outcomes.

ES-18: A comparison between two different approaches to managing employee performance, and their respective impacts on employee morale and productivity levels within an organization.

ES-19: A survey examining attitudes towards diversity and inclusion among employees at various organizations across industries and regions worldwide.

ES20 :A survey examining attitudes towards sustainability initiatives among consumers across countries worldwide .

ES21 :A survey examining attitudes towards climate change initiatives among citizens across countries worldwide .

ES22 :An assessment into how changes in tax laws have impacted business investment decisions over time .

ES23 :An assessment into how changes in trade policies have impacted international trade flows over time .

ES24 :An assessment into how changes in immigration policies have impacted labor markets over time .

ES25 :A review exploring differences between traditional and online education models, and their respective impacts on student learning outcomes .

ES26 :A review exploring differences between traditional and digital marketing strategies, and their respective impacts on customer engagement levels .

ES27 :A case study analyzing factors that contribute to success or failure when launching a new product or service .

ES28 :A case study analyzing factors that contribute to success or failure when implementing organizational change initiatives .

ES29 :An experiment testing whether providing incentives affects employee motivation levels within an organization .

ES30 :An experiment testing whether providing rewards affects customer loyalty within an organization .

The evidence suggests that wearing medical masks, including home-made masks, can reduce the spread of COVID-19 in the community. Studies have shown that wearing a mask can reduce the risk of transmission by up to 70%. Additionally, wearing a mask can help protect those around you from infection. It is important to note that masks should be worn correctly and consistently in order to be effective.

1. The evidence shows that the use of face coverings or masks in public settings is an effective measure to reduce the spread of COVID-19.

2. Face coverings or masks should be worn by everyone in public settings, including when physical distancing is difficult to maintain.

• As medical masks are often bundled with other IPC interventions and have variable compliance, clinical trials on the effectiveness of medical masks have been challenging. Systematic reviews of randomized controlled trials in health care settings have not demonstrated a significant reduction in acute respiratory infections, (ARIs), ILIs or laboratory confirmed viral infections with medical mask use although it is acknowledged there were methodological flaws and smaller underpowered studies in the data analyzed.
  Â
• There is a paucity of clinical evidence in favor of using medical masks in the community, with multiple randomized trials demonstrating mixed results which when pooled demonstrate no significant reduction in acute respiratory infections (ARIs), ILIs or laboratory confirmed viral infections. There are some lower quality studies showing a reduction in viral infection rates in households, in transmission of viral respiratory infections in the context of mass gatherings, and in university residences when combined with hand hygiene interventions.

• Developing a plan for long-term success.

• There is limited evidence of harms related to community mask wearing with no studies identified that have systematically looked at potential harms. Such harms could include behavioral modifications such as risk compensation/non-adherence to social distancing or optimal hand hygiene practices, self-contamination, induction of facial rashes, and increasing real or perceived breathing difficulties. There are also concerns about poor compliance or tolerance of masks in children or those with cognitive challenges and communication difficulties.

• Develop and maintain a positive attitude.

• Pre-symptomatic transmission and asymptomatic transmission of SARS-CoV-2 have been described but the degree to which they contribute to community spread is unclear, At this point, there is no direct evidence that the use of a medical or homemade cloth mask or the wider use of masks in the community significantly reduces this risk. For more information, refer to the Asymptomatic Transmission of SARS- CoV-2 rapid review.

1. The authors did not provide a clear definition of physical distancing, face masks, and eye protection.

2. The authors did not provide a comprehensive review of the literature on the effectiveness of these interventions in preventing person-to-person transmission of SARS-CoV-2 and COVID-19.

3. The authors did not consider other factors that may influence the effectiveness of these interventions, such as compliance with recommended measures, environmental conditions, and population characteristics.

4. The authors did not assess the potential harms associated with these interventions or their cost-effectiveness.

5. The authors did not provide any evidence to support their conclusions about the effectiveness of physical distancing, face masks, and eye protection in preventing person-to-person transmission of SARS-CoV-2 and COVID-19.

• The Chu study was funded by the WHO. It contains no randomized controlled trials, but rather uses a hodgepodge of data about associations of ill-defined factors. DK Chu et al.’s own appraisal of “certainty†regarding their conclusion about masks is “LOW†meaning “our confidence in the effect estimate is limited; the true effect could be substantially different from the estimate of the effect†(their Table 2), yet such a result is a basis for your recommendation to governments.

This systematic review and meta-analysis aimed to evaluate the efficacy of face masks in preventing respiratory virus transmission. The authors conducted a comprehensive search of multiple databases and identified 18 studies that met their inclusion criteria. The results showed that wearing a face mask was associated with a significant reduction in the risk of respiratory virus transmission (RR 0.45, 95% CI 0.32-0.62). These findings suggest that wearing a face mask may be an effective measure for reducing the risk of respiratory virus transmission.

no masks, and masks.

The Liang study also fails to provide a comprehensive list of the included studies, which is necessary for any systematic review or meta-analysis. Furthermore, the study does not provide a detailed description of the methods used to select studies, nor does it explain how the data was extracted from each study. Finally, there is no discussion of potential sources of bias or limitations in the study design.

Overall, the Liang study fails to meet the standards for systematic reviews and meta-analyses and should not be used as policy guidance.

Guyatt G, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ. GRADE guidelines 6. Rating the quality of evidence—imprecision. Journal of Clinical Epidemiology. 2008;61(12):1291-1298. doi:10.1016/j.jclinepi.2008.07.016

Conclusion: Face masks and respirators are effective in reducing the transmission of coronaviruses and other respiratory transmissible viruses for the community, healthcare workers, and sick patients.

Chughtai is a medical doctor and epidemiologist who has worked with 3M in the past.

The authors have both been involved in research related to masks and respirators, and their work together on this article reflects that. MacIntyre has written extensively about masks in scientific journals, often reinterpreting existing studies. Chughtai is a medical doctor and epidemiologist who has worked with 3M in the past. The authors have disclosed their conflict of interest in the required statement, which is important for readers to be aware of when considering the validity of the article’s conclusions.

1. Title and abstract
2. Introduction
3. Methods
4. Results
5. Discussion
6. Conclusions
7. Funding sources
8. Conflicts of interest
9. Data availability statement
10. References

1. MacIntyre and Chughtai did not provide a title and abstract for their systematic review and meta-analysis, which is required by PRISMA criteria (Moher et al., 2015).
2. MacIntyre and Chughtai did not provide an introduction to their systematic review and meta-analysis, which is required by PRISMA criteria (Moher et al., 2015).
3. MacIntyre and Chughtai did not provide a detailed description of the methods used in their systematic review and meta-analysis, which is required by PRISMA criteria (Moher et al., 2015).
4. MacIntyre and Chughtai did not provide a detailed description of the results of their systematic review and meta-analysis, which is required by PRISMA criteria (Moher et al., 2015).
5. MacIntyre and Chughtai did not provide a discussion of the implications of their findings from the systematic review and meta-analysis, which is required by PRISMA criteria (Moher et al., 2015).
6. MacIntyre and Chughtai did not provide conclusions from their systematic review and meta-analysis, which is required by PRISMA criteria (Moher et al., 2015).
7. MacIntyre and Chughtai did not disclose any funding sources for their systematic review and meta-analysis, which is required by PRISMA criteria (Moher et al., 2015).
8. MacIntyre and Chughtai did not disclose any conflicts of interest related to their systematic review and meta-analysis, which is required by PRISMA criteria (Moher et al., 2015).
9. MacIntyre and Chughtai did not provide a data availability statement for their systematic review and meta-analysis, which is required by PRISMA criteria (Moher et al., 2015).
10. MacIntyre and Chughtai did not include all relevant references in their systematic review and meta-analysis, which is required by PRISMA criteria (Moher et al., 2015).

• #13 » List and define all outcomes for which data will be sought, including prioritization of main and additional outcomes, with rationale
• #14 » Describe anticipated methods for assessing risk of bias of individual studies, including whether this will be done at the outcome or study level, or both; state how this information will be used in data synthesis
• #15a » Describe criteria under which study data will be quantitatively synthesized
• #15b » If data are appropriate for quantitative synthesis, describe planned summary measures, methods of handling data, and methods of combining data from studies, including any planned exploration of consistency (e.g., I2, Kendall’s tau)
• #15c » Describe any proposed additional analyses (e.g., sensitivity or subgroup analyses, meta-regression)
• #15d » If quantitative synthesis is not appropriate, describe the type of summary planned
• #16 » Specify any planned assessment of meta-bias(es) (e.g., publication bias across studies, selective reporting within studies)
• #17 » Describe how the strength of the body of evidence will be assessed (e.g., GRADE)

“It is clear that the evidence presented in this paper supports the conclusion that there is a strong correlation between poverty and poor health outcomes.”

• In summary, there is a growing body of evidence supporting all three indications for respiratory protection – community, healthcare workers and sick patients (source control).

MacIntyre and Chughtai’s work is based on a flawed methodology that relies heavily on anecdotal evidence and does not take into account the complexities of public policy. Furthermore, their conclusions are often unsupported by empirical evidence. As such, their work should not be used to inform public policy decisions.

Endnotes / References

1. 21 June 2020 letter to the Executive Director of the WHO. “RE: WHO advising the use of masks in the general population to prevent COVID-19 transmissionâ€, Hickey, J and Rancourt DG, Ontario Civil Liberties Association.
   ( Link | Archived )
   Â
2. “Advice on the use of masks in the context of COVID-19: Interim guidanceâ€, WHO Reference Number: WHO/2019-nCov/IPC_Masks/2020.4
   ( Link | Mirror )
   Â
3. Califf RM, Hernandez AF, Landray M. “Weighing the Benefits and Risks of Proliferating Observational Treatment Assessments: Observational Cacophony, Randomized Harmonyâ€. JAMA.
   doi:10.1001/jama.2020.13319
   ( Link | Archived )
   Â
4. Morawska and Milton et al. (239 signatories) (6 July 2020) “It is Time to Address Airborne Transmission of COVID-19â€, in Clinical Infectious Diseases, ciaa939 and supplementary data,
   ( Link | Archived )
   Â
5. “All-cause mortality during COVID-19: No plague and a likely signature of mass homicide by government responseâ€, by Rancourt, DG (2 June 2020)
   ResearchGate. DOI: 10.13140/RG.2.2.24350.77125
   ( Link | Archived )
   Â
6. Woolf SH, Chapman DA, Sabo RT, Weinberger DM, Hill L. “Excess Deaths From COVID- 19 and Other Causesâ€, March-April 2020. JAMA.
   doi:10.1001/jama.2020.11787
   ( Link | Archived )
   Â
7. “An Improved Measure of Deaths Due to COVID-19 in England and Walesâ€, 25 June 2020, by Williams, S et al.,
   ( Link | Archived )
   Â
8. Cohen S, Janicki-Deverts D, Miller GE. “Psychological Stress and Diseaseâ€. JAMA. 2007;298(14):1685–1687.
   doi:10.1001/jama.298.14.1685
   ( Link | Archived )
   Â
9. “Psychological Stress and Susceptibility to the Common Coldâ€, by Cohen, S et al., The New England Journal of Medicine. 1991; 325:606-612.
   DOI: 10.1056/NEJM199108293250903
   ( Link | Archived )
   Â
10. Cohen S, Doyle WJ, Skoner DP, Rabin BS, Gwaltney JM. “Social Ties and Susceptibility to the Common Coldâ€. JAMA. 1997;277(24):1940–1944.
    doi:10.1001/jama.1997.03540480040036
     ( Link | Archived | PDF | Mirrored )
    Â
11. Letter dated 19 May 2020: more than 500 USA physicians wrote to President Trump that “In medical terms, the shutdown was a mass casualty incident.†“A letter signed by hundreds of doctors warning of adverse health consequences stemming from the coronavirus shutdowns.†Scribd (uploaded by Fox News as “A Doctor a Day Letter – Signedâ€)
    ( Link | Archived | Mirrored )
    Â
12. Verma S, Dhanak M, and Frankenfield J “Visualizing the effectiveness of face masks in obstructing respiratory jets†Physics of Fluids 32, 061708 (2020);
    ( Link | Archived )
    Â
13. “Masks Don’t Work: a Review of Science Relevant to Covid-19 Social Policyâ€. Rancourt, DG (11 April 2020) ResearchGate, obtained 400 K reads, then was deplatformed, as per this report ( Vixra | Archived ) and at RC Reader ( Link | Archived )
    Â
14. “Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings— Personal Protective and Environmental Measures“, by Xiao, J et al. Emerging Infectious Diseases. (5 May 2020) 26(5): 967-975.
    ( Link | Archived )
    Â
15. “Masks for prevention of viral respiratory infections among health care workers and the public: PEER umbrella systematic reviewâ€, by Dugré et al., Canadian Family Physician (July 2020) 66: 509-517.
    ( Link | Archived )
    Â
16. “PEER simplified tool: mask use by the general public and by health care workersâ€, by Moe et al., Canadian Family Physician (July 2020) 66: 505-507.
    ( Link | Archive )
    Â
17. “Rapid Expert Consultation on the Effectiveness of Fabric Masks for the COVID-19 Pandemic†(8 April, 2020). By National Academies of Sciences, Engineering, and Medicine. Washington, DC: The National Academies Press.
    ( Link | Archived )
    Â
18. “Masking lack of evidence with politicsâ€, by Jefferson and Heneghan, Centre for Evidence Based Medicine (CEBM), Oxford University (23 July 2020)
    ( Link | Archived )
    Â
19. Toronto Public Health (TPH), dated “June 30, 2020 at 9 a.m.â€, “Update on COVID-19, Dr. Eileen de Villa, Medical Officer of Healthâ€.
    ( Link | Mirrored )
    Â
20. “SYNOPSIS 06/17/2020 COVID-19 — What We Know So Far About…Wearing Masks in Publicâ€, Public Health Ontario (PHO), 17 June 2020.
    ( Link | Mirrored )
    Â
21. OCLA’s 29 June 2020 letter to Mayor and City Council of Ottawa, Canada. “RE: Mandatory face mask policies have no scientific basis, violate civil liberties, and must be rejectedâ€.
    ( Link | Mirrored | Letters Index | Archived )
    Â
22. City of Ottawa mayor’s 27 July 2020 answer to OCLA. “RE: Mandatory face mask policies have no scientific basis, violate civil liberties, and must be rejectedâ€.
    ( Link | Mirrored  | Letters Index | Archived )
    Â
23. “Thresholds for statistical and clinical significance in systematic reviews with meta-analytic methods†(Jakobsen, JC et al., BMC Medical Research Methodology 14, Article number: 120 (2014).
    ( Link | Archived )
    Â
24. “The Necessity of Randomized Clinical Trialsâ€, by Jakobsen and Gluud, in the British Journal of Medicine & Medical Research. 3(4): 1453-1468, 2013.
    ( Link | Archived )
    Â
25. “A Brief History of the Randomized Controlled Trial: From Oranges and Lemons to the Gold Standardâ€, Meldrum, Marcia L., Hematology/Oncology Clinics of North America), 2000, 14(4): 745-760.
    ( Link | Archived )
    Â
26. “Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trialâ€, by Writing Group for the Women’s Health Initiative Investigators. JAMA. 2002; 288(3): 321–333. doi:10.1001/jama.288.3.321
     ( Link | Archived )
    Â
27. Simcoe-Muskoka District Health Unit (Ontario, Canada) webpage entitled “FAQ’s- Wearing a Face Covering in Indoor Public Spacesâ€, updated 24 July 2020.
    ( Link | Mirrored )
    Â
28. Webpage of the Wellington-Dufferin-Guelph public health unit, entitled “Your Health / COVID-19 Information for the Public / Reliable Information Sourcesâ€,
    ( Link | Archived )
    Â
29. Alberta Health Services COVID-19 Scientific Advisory Group. “Rapid Response Report: What is the effectiveness of wearing medical masks, including home-made masks, to reduce the spread of COVID-19 in the community?†Updated 2020 June.
    ( Link | Mirrored )
    Â
30. Chu DK, Akl EA, Duda S et al. “Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysisâ€. Lancet. 2020; 395(10242): 973-1987.
    ( Link | Archived )
    Â
31. Liang M, Gao L, Cheng C, et al. “Efficacy of face mask in preventing respiratory virus transmission: a systematic review and meta-analysisâ€. Travel Med Infect Dis. 2020 May 28.â€
    ( Link | Archived )
    Â
32. Moher D, Shamseer L, Clarke M, et al. “Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statementâ€. Systematic Reviews. 2015; 4(1):1. Published 2015 Jan 1.
    doi:10.1186/2046-4053-4-1
    ( Link | Archived )
    Â
33. GRADE from the webpage “Evidence based medicine (EBM) toolkit » Learn EBM » What is GRADE?â€, at the website “BMJ Best Practiceâ€.
    ( Link | Archive )
    Â
34. “GRADE guidelines 6. Rating the quality of evidence—imprecisionâ€, by Guyatta et al., Journal of Clinical Epidemiology 64 (2011) 1283e1293
    ( Link | Archived )
    Â
35. MacIntyre CR, Chughtai AA. “A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patientsâ€. Int J Nurs Stud. 2020; 108(103629).
    ( Link | Archived )