Why am I writing another post on dodgy information? Haven’t I got more positive things to do? Well I suppose the answer to that it yes, and I do them, but am am constantly amazed by the “infodemic” which is running alongside the pandemic. Yes, there are now “infodemiologists”. Through my career I’ve seen many health damaging myths become embedded in our culture and thankfully bite the dust after causing much grief on their way. Examples include notions such as sugar being part of a balanced diet, smoking being cool, vehicle exhaust not being bad for health, poverty being deserved, alcohol being good for you and many others. Yet, more myths emerge as we speak from the quagmire of bad information, crappy studies, wishful thinking and wilful manipulation.
Another example of misinformation doing the rounds came along the other day – the hypothesis is that masks are damaging the health of children in school. The issue of masks in schools is a complex one and for crowded school areas where social distancing is not possible, or for those vulnerable, mask wearing has made sense to try to drive down transmission. Wearing masks is hardly desirable from a personal point of view, yet are widely considered to be useful in terms of reducing aerosol spread and onward transmission. Despite this, any adverse effect of mask wearing is a worry and needs good science to define exactly what the risks are.
OK, this may not be such a burning issue over here right now. When I drop my delightful grandson off at school there is a total lack of face masks evident in the lower and higher primary school well as the kids who pile out of the local comp. This may be due to simple difficulties of mass mask wearing within institutions, the uncertain value in suppressing infections in the young and fit, negative social effects on healthy chatterboxes busy developing social skills, and the ever-neglected issue of waste. However, might this be at least be partially responsible for rapidly increasing levels of infection here in Devon? There are arguments too about schools being responsible for spread of outbreaks and the importance of not infecting teachers and staff who are more likely to have symptoms. As ever there are lots of grey areas. But masks directly damaging kid’s health? Really?
This came up before, early in the pandemic with early claims that masks reduced oxygen saturation levels in the blood, something that might be of concern to contemplating surgery under the masked surgeons knife, but is not in the least bit true.
I tried it myself with my own mask and Oxygen saturation meter – like others I found no effect at all.
With respect to masks, current UK Government guidance is:
We continue to recommend that face coverings should be worn by staff and visitors in situations outside of classrooms where social distancing is not possible (for example, when moving around in corridors and communal areas.” Wearing masks in class was a temporary measure at the height of the last winter wave.
The basis of the claim
Advice regarding masks varies according to the local pandemic rates and nation, so back to the issue of potential damage to children by wearing masks. At first glance, a paper suggesting this is the case seems convincing, is published in the well respected JAMA, and argues that masks increase the risk of excess CO2 levels in children who wear them and cause many children to complain. The paper has been widely quoted on line and on social media.
Oddly enough, the author is the very same Harald Walach who authored the (now retracted) paper I dissected in my last misinformation post which stated, using bizarre and highly misleading reasoning, that for every three lives saved by the vaccine, they kill two. This caused the resignation of a number of editors of “Vaccine”, furious that such nonsense could pass their peer review panel. Knowing this, my ears pricked up. Always check your sources! Looking at the paper, we don’t have to go too far to see that reality might be a little more nuanced. As early as their opening comments they state:
A large-scale survey in Germany of adverse effects in parents and children using data of 25,930 children has shown that 68% of the participating children had problems when wearing nose and mouth covering”
65% having problems! That’s terrible!…… or is it?
Its worth checking their reference; the source of this information has a few big caveats – it is damningly prefaced by the editors as follows:
“This study is based on a survey regarding the adverse effects of mask wearing in children. Due to multiple limitations, this study cannot demonstrate a causal relationship between mask wearing and the reported adverse effects in children. Most of the respondents were parents, and the survey was distributed preferentially in social media forums that, according to the authors, “criticize the government’s corona protection measures in principle”. The limitations of the study include sampling bias, reporting bias, and confounding bias as well as lack of a control group. The use of masks, together with other precautionary measures, significantly reduces the spread of COVID-19 and is considered safe for children over the age of two years old.“
“This study is based on a survey regarding the adverse effects of The limitations of the study include sampling bias, reporting bias, and confounding bias as well as lack of a control group.
The use of masks, together with other precautionary measures, significantly reduces the spread of COVID-19 and is considered safe for children over the age of two years old.“
Back to the paper – the authors describe elevated CO2 levels in the ‘dead space’ between the mask and the mouth of the children. The clinical relevance of this is uncertain for many reasons. Being published in a major peer reviewed journal means it is critically read by subscribers who are generally well qualified. Reading the rapid responses or comments is therefore a useful exercise and in this case revealing. The first comment from Alejandro Keller, PhD in Natural Sciences bring in some more damming feedback.
The more nuanced reality….
Keller states: “The authors use an CO2 incubator analyzer (0-20%) that has an accuracy of 1% of the range (i.e. 2000ppm) and a time response T^90<=20 seconds for CO2. This device is unsuitable for measuring the transient concentrations during the respiration processes. A normal respiration cycle has a duration of 3 to 4 seconds. Thus, it is impossible to separate the concentration of CO2 in inhaled and exhaled air using this device. This also explains why the authors measure average concentrations of around 2700ppm-CO2, way above the ambient value of 740ppm, even when no mask is present.”
So far, so bad. Another commentator John Murphy, PhD CIH ROH, highlights another fundamental error relating to the importance of the dead space:
“The authors refer to the dead volume behind the mask as the main problem. The relevant data would be the comparison between this dead volume and the lung capacity and/or the volume of one respiration cycle. The lungs never collapse completely during respiration. Together with the rest of the respiratory airways, the respiratory system has also a dead volume that is much larger than the dead volume between the mask and the face. The comparison of these volume is of extreme importance for the discussion and may change the author’s conclusions.”
Another supposition is that the levels of CO2 detected actually matter. They may not. Another respondent states “The CO2 indoor air standard is ultimately a ventilation effectiveness guideline, not a health-based exposure limit”
The comments go on and on describing the dubious methodology, spurious claims and the inherent bias of the authors against this and other COVID related interventions.
“…..the fact that this manuscript made it through editorial screening, peer-review, and approval is concerning. The need for the study was not well justified, the premise biased, the methodology flawed and thus the resultant data unhelpful and the conclusions inappropriate. I fear that those with political incentive to demonize mask-wearing will use this study as ‘scientific evidence’ to undermine public health strategies” Quite so!
Social media Chinese whispers….
Despite all the damming feedback from the experts, the paper with all its inherent errors (minus the critique) has been doing the rounds on social media platforms which ironically claim to help us “decode the science”, along with wildly inaccurate headlines of how we are damaging our children’s health with masks.
Many who don’t scratch under the surface to find the huge uncertainty in this study will now use it as “proof” that we are actively damaging children’s health by enforcing the use of masks…..and a million on-line Chinese whispers later is has become, for some, accepted truth, despite being based on some really terrible science.
Then to the lives children are leading and going to lead. All my life I have noted how society has marginalised children, particularly in the US and the UK where kids are at the bottom of the league when it comes to most measurements of well being.
We have largely destroyed the freedoms of children to play and mingle outdoors due to urban planning prioritising the needs of transport. We pollute the air they breath due, encourage the consumption of foods which damages health and development, place enormous pressure on educational achievement which is less and less effective at career building. This maltreatment continues into adulthood, with unaffordable housing, low pay and ever increasing rates of mental illness. Finally with climate change, sea level rise and species loss, they have to live with unprecedented uncertainty as to the short term future. The recent floods in Europe, and the catastrophic heat dome in the US are examples of the unfolding future we have created for our children. Pause for thought.
Given all this, the notion that wearing face masks damage children’s health, while being entirely misleading, also distracts from the harsher reality of how COVID19 has impacted on children’s health directly and indirectly as well as the various threats to their well being inherent in our modern world.
This is another striking example of how much care is needed to look beyond dramatic headlines and how easy it is to be misled.
After all that, it seems that JAMA have retracted the paper on CO2 inside the mask. Much like my indignation that something like this could get through the peer review process, many other have waded in too with criticisms of the paper: The JAMA editorial board state:
“Following publication, numerous scientific issues were raised regarding the study methodology, including concerns about the applicability of the device used for assessment of carbon dioxide levels in this study setting, and whether the measurements obtained accurately represented carbon dioxide content in inhaled air, as well as issues related to the validity of the study conclusions.
In their invited responses to these and other concerns, the authors did not provide sufficiently convincing evidence to resolve these issues, as determined by editorial evaluation and additional scientific review. Given fundamental concerns about the study methodology, uncertainty regarding the validity of the findings and conclusions, and the potential public health implications, the editors have retracted this Research Letter.”
Further to this, having two papers retracted in the space of a month was too much for the Walasch’s employers who have terminated his contract stating:
“We wish to emphasize that the claims included in dr Harald Walach’s recent article in @Vaccines_MDPI do not represent the position of @PUMS_tweets . We find that the article lacked scientific diligence and proper methodology. Dr. Walach’s affiliation with PUMS was now terminated.”
I’m sure that this will not only not prevent the use of Walach’s bad science to misinform, but will also, “Wakefield Style”, cast Walach as a yet another victim of the ‘establishment’ in his fight to expose the ‘hidden agenda’ which ‘they done want you to see’. Actually, it’s just bad behaviour, a failure of peer review and an example of the viral like spread of data. The article had over 650,000 views before being pulled. The infodemic marches on…..