Hippocratic Oath

Hippocratic Oath

CH1 Podcast Andrew Rouchotas EP026 – Hippocratic Oath

Open Letter to Canadian Doctors and Healthcare Practitioners

When the scientific method is replaced by political ideologies, and our medical professionals react to political climates instead of acting in the best interests of humanity and fundamental human rights, unthinkable atrocities are sure to follow. When the scientific method and the hippocratic oath are ignored, the earth remains flat, people are beheaded by a guillotine and free countries fall to tyranny. Our medical institutions have become corrupt and are failing us. They are engaging heavily into the political sphere. They are choosing sides, they are creating division and polarization, and then they selectively utilize science, most notably highlighted by their selective omittance of particular science, along with their associated political affiliations, to fight political battles.

As a business owner, employer and tax payer of Canada, I must express my dismay at the politicization of our medical professionals, 2000+ of which, at the time of this posting, signed the following petition at change.org. 2000+ Canadian, tax funded Doctors and Medical professionals targeting a political candidate who, along with millions of tax paying citizens of this country, oppose the near tyrannical public health measures being imposed upon Canadians in our fight against COVID-19.

https://www.change.org/p/mpp-randy-hillier-open-letter-to-mpp-randy-hillier-regarding-covid-19-misinformation

I find it amazing the vigour with which medical professionals attack a single political representative, who, as they accurately pointed out, did indeed share some information which could be construed as misleading. However, I simultaneously find their refusal to speak out regarding all of the misinformation presented daily by our media and various ministers of public health to be hypocritical at best. Additionally, I consider it absolutely abhorrent behaviour, that in the open letter, the author, via selective science, and even more specifically, scientific omission, failed to accurately portray a holistic view with respect to our current COVID measures and their impact to both the individual lives of Canadians, as well as, the overall cost of life domestically and abroad.

Below are excerpts from the open letter in question, written by Dr Dietrich, along with my responses.

https://www.change.org/p/mpp-randy-hillier-open-letter-to-mpp-randy-hillier-regarding-covid-19-misinformation

You imply that COVID-19, the disease caused by SARS-CoV2 is not much worse than the common cold by saying, “Why are so many people living in, with such concern, in such dread and taking such precautions for something, for a virus, a coronavirus, that is more like the common cold than it isn’t.”  You state the infection fatality rate is “very similar to the flu.” (Hillier, 2020)  You put a link to an article that explains how coronaviruses can be mild and cause the common cold but there are also deadly ones such as SARS and MERS.

Dr Dietrich

Although it obviously is the case that Influenza and COVID-19 are not the same virus, there are similarities between the two. The natural tendency for those outside of the scientific and medical community would be to draw such comparisons, in order for the average person to be able to make rational decisions in their lives and determine their individual risk thresholds.

Perhaps a more rational approach to take with the public is to outline the similarities and differences between COVID and Influenza, instead of mocking and vilifying those who make such comparisons. Although the information and data is bit dated now, John Hopkins Medical did a reasonable job of this here

https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-disease-2019-vs-the-flu

Since the public is going to organically compare COVID to Influenza, as a natural point of reference, I do not believe a reasonable approach is to vilify such comparisons, but rather, to illustrate the comparisons and the differences – at least if educating the public and allowing them to perform their own risk assessments is in anyway the concern of the author or the signatories of this open letter.

As such, we should likely start with IFR (Infection Fatality Rates). Understanding that Influenza death rates and associated survival rates are constantly under review and assessment (as extensively outlined by the NIH below), for the purposes of this discussion, I will be utilizing the generic 99.9% survival and 0.1% death rates typically associated with Influenza – simply for the sake of comparison. I will also note, that considering we have been measuring COVID deaths as both “dying with” AND “dying of” COVID, it is very probable that historical re-assessments with respect to COVID will indeed alter the actual COVID deaths and death rates downwards – the deaths and death rates we are assuming to be accurate today. However, this is strictly a hypothesis I am making at this point based on similar such investigations done with respect to influenza. For example

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6815659/

According to the CDC, Infection Fatality Rate (IFR) and Survival Rates dramatically vary based on age demographics. Certainly much more so versus Influenza.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html

Utilizing the scenario 5, “Current Best Estimate”, the Infection Fatality Rate (IFR) breaks down as follows.

0-19 years: 0.00003
20-49 years: 0.0002
50-69 years: 0.005
70+ years: 0.054

Meaning, with respect to comparisons with Influenza, COVID is dramatically less fatal vs Influenza for those aged under 50. COVID is slightly more deadly to those aged 50-69, and according to the CDC, this is specifically isolated to those with co-morbidities such as obesity and diabetes – and significantly more fatal for anyone above the age of 70. 70 and above, COVID is exceptionally dangerous and deadly, and I think we all would agree that we should be protecting this population segment.

It is worth mentioning, that our current public health policies, seem to be leaving this population most vulnerable. We are leaving our loved ones, and most vulnerable to die alone and scared. They have been forbidden the mercy of being surrounded by their loved ones at their death, and they have even been forbidden the dignity of a proper funeral after their deaths. The public believes it is both unconscionable and inhumane to continue in such a way. As a result of the public health policies you are enforcing and demanding we follow, we needed to send the military in to deal with the atrocities your policies created.

Canadian Military Intervention needed at Ontario Long-term care facilities

A study in US Veteran’s Affairs hospitals compared 5453 hospitalized patients with influenza to 3948 hospitalized patients with COVID-19.  The mortality rate was approximately 5 times higher in COVID-19 patients compared to those with the flu.

Dr Dietrich

Based on the Infection Fatality Rate (IFR) from the CDC above, this would unfortunately and sadly be the case within a veterans hospital, where presumably the patients age range would almost certainly be around or over 70. Based on the CDC’s COVID IFR, one would expect a greater than 5 times higher mortality rate for this demographic. An appropriate public health policy would be aimed towards preventing this demographic from being infected at all, at least until such time where a vaccine can be available to them. A public health policy which seems specifically designed to slow the rate of infection, hospitalizations and death amongst this demographic, versus preventing infection to this demographic, is simply unconscionable.

  It is correct that the PCR test will detect pieces of viral RNA which may not have infectious potential.  The PCR test is specific to SARS-CoV2, the agent that causes COVID-19, not other viruses that cause the common cold and the CDC has stated that swabs may remain positive for up to 3 months after infection (Centers for Disease Control and Prevention, 2020), not 6 months.

Dr Dietrich

It is strange that Dr Dietrich focusses on the length of time swabs may remain positive. The intention here should not be to discredit a simple statement made by a single politician. Imagine if Dr Dietrich applied such standards to the media and the nonsensical content they publish hourly and daily. 6 months or 3 months is factually irrelevant and is simply presented here to discredit Mr Hillier.

According to Dr. Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health and Juliet Morrison, a Virologist at the University of California and the associated New York Times Article below, I think we are all looking in the wrong direction when discussing PCR testing.

New York Times – Your Coronavirus Test Is Positive. Maybe It Shouldn’t Be.

But similar PCR tests for other viruses do offer some sense of how contagious an infected patient may be: The results may include a rough estimate of the amount of virus in the patient’s body.

“We’ve been using one type of data for everything, and that is just plus or minus — that’s all,” Dr. Mina said. “We’re using that for clinical diagnostics, for public health, for policy decision-making.”

But yes-no isn’t good enough, he added. It’s the amount of virus that should dictate the infected patient’s next steps. “It’s really irresponsible, I think, to forgo the recognition that this is a quantitative issue,” Dr. Mina said.

New York Times / Dr Michael Mina

To utilize PCR testing and case numbers and then translate these numbers back into public policy, in my opinion, is nothing more than an unholy Frankenstein mix of bad science and atrocious politics. The answer to bad policy, created upon faulty scientific testing and conclusions, by tax funded civil servants, should not, and cannot be permitted to lead to such dramatic consequences against the tax payers of Canada.

One solution would be to adjust the cycle threshold used now to decide that a patient is infected. Most tests set the limit at 40, a few at 37. This means that you are positive for the coronavirus if the test process required up to 40 cycles, or 37, to detect the virus.

Tests with thresholds so high may detect not just live virus but also genetic fragments, leftovers from infection that pose no particular risk — akin to finding a hair in a room long after a person has left, Dr. Mina said.

Any test with a cycle threshold above 35 is too sensitive, agreed Juliet Morrison, a virologist at the University of California, Riverside. “I’m shocked that people would think that 40 could represent a positive,” she said.

A more reasonable cutoff would be 30 to 35, she added. Dr. Mina said he would set the figure at 30, or even less. Those changes would mean the amount of genetic material in a patient’s sample would have to be 100-fold to 1,000-fold that of the current standard for the test to return a positive result — at least, one worth acting on.

New York Times / Dr Michael Mina – Harvard / Juliet Morrison – Virologist – University of California

Essentially what this means is PCR testing in no way is representative of actual case numbers, and presents us zero visibility into population/herd immunity. These are not the basis under which we strip Canadians of their rights and freedoms and force 10’s of 1000’s of tax payers into bankruptcy, poverty and homelessness each and every month in Canada. This cannot be the test used, along with associated results, to drive public health policies in Canada and negatively impact potentially millions of Canadians.

I think a rational minded scientist, void of personal or political influences, would consider the following considerations

1)Forming policy using raw, stand alone case numbers is nonsensical

  • Utilizing raw case numbers and regularly presenting them in the media and by our various ministers of public health completely lacks merit. Sensationalized headlines commonly seen, such as “COVID case numbers reaches new heights and breaks previous levels – <insert-name-of-politician—here> threatens stricter lock down policies” is several folds more dangerous and misleading than anything Mr Hillier indicated with respect to the length of time swabs remaining positive (6 months vs 3 months for example).
  • Tracking case numbers relative to nothing is faulty science at best, and maliciously intended at worst. We are speaking simple division here. Enumerator over denominator. Thereby 1:10 = 10:100 = 100:1000 (source = grade 5 math). Our media and our ministers of public health should be tracking and presenting infection rates vs raw case numbers. When the public sees rising case numbers, along with rising testing numbers, along with sensationalized headlines, they start to believe that lockdowns are simply perpetrated maliciously by increasing the number of tests being completed, until the desired case numbers have been reached.
  • This is especially suspicious when business owners are forced into bankruptcy while the Costco or Walmart across the street are jammed packed full of shoppers.

2)Complete lack of Anti-body testing or utilization of PCR testing to determine the level of community/herd immunity which has been achieved

  • Why are we not Anti-Body testing as diligently as we are PCR testing? According to the BC CDC for example, as a public health policy, Canadian citizens cannot even request Anti-Body testing – http://www.bccdc.ca/health-info/diseases-conditions/covid-19/testing/antibody-testing – “You cannot yet request an antibody test from your health care provider. Antibody testing is being used for limited clinical and research uses and select outbreak investigations. Health providers may use antibody testing in limited settings, such as for patients in hospital who have less common symptoms of COVID-19 but need to have their COVID-19 infection confirmed to help direct their medical care.”
  • Why is PCR testing not being adjusted to report results with more granularity, which would indicate which positive tests require action, and which positive outcomes represent previous viral exposure, and presumably, immunity? At the very least, it would be representative of partial immunity.
  • Why are we not performing more widespread Anti-Body testing in order to determine what level of population immunity has already been reached?

3)Establish a path and a clear strategy towards achieving community/herd immunity and associated strategic vaccination

  • Shaming Canadians, and calling Canadians who challenge your endless lockdowns and your irresponsible reliance on PCR testing “conspiracy theorists” provides zero benefit to anyone. You cannot expect Canadians to walk themselves and their families out of their businesses, out of their houses and onto the streets, while being shamed and called selfish if they dare object. The associated cognitive dissonance demonstrated by our medical professionals, ministers of public health and politicians is simply astounding.
  • Based on the Infection Fatality Rates (IFR) from the CDC, it seems pretty clear who should be offered a vaccination and in what order. Considering the COVID Infection Fatality Rate (IFR) clearly only represents an existential threat for those over 70, and practically zero threat to children, one would think an appropriate strategy could be developed which doesn’t require millions of Canadians to suffer needlessly. One would also think that an appropriate protection strategy for the most vulnerable could be developed, until such time which they could all be vaccinated (those who choose to be of course).
  • A combination of anti-body testing and targeted vaccinations, with a clear mutual objective of achieving “herd immunity” could easily be developed and sold to Canadians. It certainly would not require the complete shutdown of our economy, nor the avoidable deaths from suicide and drug overdoses for example, which these public health policies are creating. Maybe we can even avoid a second atrocity in our elderly population and our long term care facilities. Certainly it is understood that our overall understanding of COVID has improved. Is it unreasonable to expect that we do not repeat the errors made previously, when we were not as informed?

I believe this is the plan outlined by Dr. Martin Kulldorff – professor of medicine at Harvard University, a biostatistician, and epidemiologist with expertise in detecting and monitoring infectious disease outbreaks and vaccine safety evaluations. Dr. Sunetra Gupta, professor at Oxford University, an epidemiologist with expertise in immunology, vaccine development, and mathematical modeling of infectious diseases. Dr. Jay Bhattacharya, professor at Stanford University Medical School, a physician, epidemiologist, health economist, and public health policy expert focusing on infectious diseases and vulnerable populations. Who, along with 50,000+ of the worlds leading subject matter experts have signed The Great Barrington Declaration indicating as much.

The Great Barrington Declaration

In it, they state the following. Surely with the availability of a vaccine now, this should be even more obvious and more easily attained.

As immunity builds in the population, the risk of infection to all – including the vulnerable – falls. We know that all populations will eventually reach herd immunity – i.e.  the point at which the rate of new infections is stable – and that this can be assisted by (but is not dependent upon) a vaccine. Our goal should therefore be to minimize mortality and social harm until we reach herd immunity. 

The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection. 

The Great Barrington Declaration

The world Health Organization (WHO) has echoed the sentiments of The Great Barrington Declaration

WHO Joins Top Epidemiologists in Emphasizing Harm Caused by Lockdowns

I am certain Dr Dietrich is an exceptional Doctor, and has nothing but the best intentions in mind here. However, I urge Doctor Dietrich to take a step back and understand the larger picture. Selectively cherry picking and refuting a few specific comments by Mr Hillier, from hours and hours of publicly available recorded content, is not the most productive approach. Such approaches typically only muddy intentions. That is, if indeed reaching a mutual understanding amongst all involved parties and initiating rational discussions and debates, along with constructive solutions, is in any way the ultimate objective here. Disenfranchising millions of Canadians by simply dismissing their concerns and attacking a politician who shares their concerns, is not the appropriate path towards building trust with our medical community, nor their policies. Holistically, public health is about so much more than COVID, and right now, our politicians, our public health officers, our media and many within our medical community – all of whom are publicly funded with our tax dollars – seem oblivious to this reality.

I could go on here and discuss the lack of efficacy with respect to our public health policies created under the presumption of the dangers represented by “asymptomatic spread”

  1. https://www.aier.org/article/asymptomatic-spread-revisited/ 
  2. https://www.nature.com/articles/s41467-020-19802-w 
  3. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774102
  4. University of Florida – https://rationalground.com/university-of-florida-researchers-find-no-asymptomatic-or-presymptomatic-spread/

Considering the findings with respect to the lack of evidence validating asymptomatic spread as the primary concern, one must question if such despotic public health policies, specifically designed to protect the population from asymptomatic spread, are scientifically rational.

Congruently, I will not bother discussing the decades of research, peer reviewed, referenced 1000’s and 1000’s of times, simply shattering the efficacy of mandatory masking of the population – with pieces of fabric no less. Let alone against a viron sized at 0.012 > 0.5 MICRONS. Instead, I’ll simply reference the associated materials in the podcast and reference notes below. I’ll also ignore the fact that the general population likely does not apply or wear masks properly, is quite likely to pick them up off the floor, and repeatedly wear them for extended lengths of time, which most likely represents a negative health benefit, far outweighing the only likely benefit to mandatory masking of the population – that being to address the societal level, and unhealthy level, of fear and anxiety our media, our medical community and our politicians have instilled upon us.

I’ll also, for now, avoid the entire discussion around the unthinkable damage our politicians, our media and our public health policies are perpetrating upon our children. Children, who according to the CDC Infection Fatality Rate data, face practically zero risk with respect to COVID infection. Children, who based on globally available data, do not represent a significant threat with respect to “asymptomatic spread”.

Fortunately, our understanding of the virus is growing. We know that vulnerability to death from COVID-19 is more than a thousand-fold higher in the old and infirm than the young. Indeed, for children, COVID-19 is less dangerous than many other harms, including influenza. 

The Great Barrington Declaration

Children, who we are masking, disrupting their normal development, dramatically and negatively impacting their socialization and their education. I will, again for now, ignore the fact that we dismissed the recommendations from the Toronto Sick Kids Hospital suggesting children be permitted to return to school normally, and instead used political motivations and pressures to force them to, after the fact, alter their recommendations and adhere to the nonsensical and harmful narrative that is our current, and flagrantly political, public health policy.

https://www.sickkids.ca/en/news/archive/2020/sickkids-releases-recommendations-for-school-reopening/

I’ll also, for now, ignore the fact that the World Health Organization (WHO), along with the UN and several other global governing bodies are indicating that our public health policies are collapsing supply chains globally and leading to a mass casualty event. An atrocity the likes of which may have never been witnessed in human history. Although lockdowns may end up killing more Canadians, and by an order of magnitude greater than COVID itself over the long haul, while further hurting and damaging millions of Canadians. It is estimated that if we continue with these lockdown measures in the western world, approximately 130 MILLION excessive deaths from STARVATION alone will be realized globally as a result. I think I speak for all rational Canadians when I say that is a price too great to bare.

https://www.nbcnews.com/news/world/u-n-warns-hunger-pandemic-amid-threats-coronavirus-economic-downturn-n1189326

and yet, you call us selfish

When our civil servants are most flagrantly guilty of limiting their view of public health to a single virus, the public loses trust. When our scientists are redefining science based on political pressures, the public loses trust. When our civil servants, via our tax funded media outlets, vilify and horrifically label those who have legitimate questions and concerns with respect to our public health policies, the public loses trust. When our civil servants publicly utilize abhorrent “naming and shaming” techniques to force compliance, the public loses trust. When our ministers of public health proudly conclude that Black Lives Matter protests during a pandemic present no threat to public safety, while protestors against our government policies are labelled as “conspiracy theorists” representing an existential threat to public safety and charged accordingly – the public loses trust. When our civil servants do not adhere to the very same policies they are enforcing upon their citizens, the public loses trust. When Doctors like Dr Dietrich pen an open letter, demonstrating selective science, and completely ignoring science contrary to her personal political opinions and narratives, and 2000+ medical professionals sign it, simply to launch a political attack – the public loses trust. When regular Canadians, the ones generating a large percentage of the tax dollars used to pay our civil servants are systemically targeted for bankruptcy, suffering, homelessness and poverty, while major corporations operate without restrictions – the public loses trust. When our politicians begin to speak of permanent losses of constitutionally guaranteed civil liberties unless we agree to be vaccinated, the public loses trust. When our governments spend $100’s and $100’s of BILLIONS of dollars, burying our grand children under insurmountable debt, and yet cannot provide the healthcare resources required to protect its citizens without turning authoritarian and tyrannical – the public loses trust.

I understand I am speaking to Medical Professionals, not historians or economists or political scientists. But, may I suggest everyone takes the time to study some historical references here. When the state spends tax payer dollars so inefficiently that it begins to look upon its citizens relative to their respective drain on resources, powered by ever growing despotic public health policies, perpetually stripping away citizens rights and freedoms while simultaneously labelling them as selfish – or radical, dangerous conspiracy theorists – the outcomes are rarely human highlights which are looked upon fondly. Lets try to avoid repeating that history.

Signed

Millions of Canadian Citizens

CH1 Podcast Andrew Rouchotas – EP026 – Hippocratic Oath

Podcast available on all of your favourite podcast platforms (iTunes, Google Play, Spotify, etc). You can also listen to the podcast in your browser directly from the CH1.ca platform.

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Podcast Notes & References

https://www.change.org/p/mpp-randy-hillier-open-letter-to-mpp-randy-hillier-regarding-covid-19-misinformation – Open Letter to Randy Hillier

https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-disease-2019-vs-the-flu – John Hopkins Medical. COVID vs FLU

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6815659/ – NIH Influenza death rate research

https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html – CDC Infection Fatality Rates by Age Demographic

Military Intervention into Ontario Long Term Care – https://globalnews.ca/news/7551057/coronavirus-ontario-health-coalition-military-long-term-care-homes/

New York Times / Dr Michael Mina – Harvard / Juliet Morrison – Virologist – University of California – PCR Testing – https://www.nytimes.com/2020/08/29/health/coronavirus-testing.html

http://www.bccdc.ca/health-info/diseases-conditions/covid-19/testing/antibody-testing – BC CDC Anti-Body Testing Policy

The Great Barrington Declaration – https://gbdeclaration.org

WHO Joins The Great Barrington Declaration emphasizing harm caused by lockdowns – https://reason.com/2020/10/14/who-joins-top-epidemiologists-in-emphasizing-harm-caused-by-lockdowns/

Lack of scientific evidence towards Asymptomatic Spread

  1. https://www.aier.org/article/asymptomatic-spread-revisited/ 
  2. https://www.nature.com/articles/s41467-020-19802-w
  3. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774102
  4. University of Florida – https://rationalground.com/university-of-florida-researchers-find-no-asymptomatic-or-presymptomatic-spread/

https://www.sickkids.ca/en/news/archive/2020/sickkids-releases-recommendations-for-school-reopening/ – Toronto Sick Kids Hospital recommendations for kids to return to normal schooling

https://www.nbcnews.com/news/world/u-n-warns-hunger-pandemic-amid-threats-coronavirus-economic-downturn-n1189326 – UN global starvation, COVID lockdowns

Scientific Evidence clearing demonstrating the lack of efficacy with respect to masking in order to prevent contamination 

Ritter et al., in 1975, found that “the wearing of a surgical face mask had no effect upon the overall operating room environmental contamination.”

Ha’eri and Wiley, in 1980, applied human albumin microspheres to the interior of surgical masks in 20 operations. At the end of each operation, wound washings were examined under the microscope. “Particle contamination of the wound was demonstrated in all experiments.”

Laslett and Sabin, in 1989, found that caps and masks were not necessary during cardiac catheterization. “No infections were found in any patient, regardless of whether a cap or mask was used,” they wrote. Sjøl and Kelbaek came to the same conclusion in 2002.

In Tunevall’s 1991 study, a general surgical team wore no masks in half of their surgeries for two years. After 1,537 operations performed with masks, the wound infection rate was 4.7%, while after 1,551 operations performed without masks, the wound infection rate was only 3.5%.

A review by Skinner and Sutton in 2001 concluded that “The evidence for discontinuing the use of surgical face masks would appear to be stronger than the evidence available to support their continued use.”

Lahme et al., in 2001, wrote that “surgical face masks worn by patients during regional anaesthesia, did not reduce the concentration of airborne bacteria over the operation field in our study. Thus they are dispensable.”

Figueiredo et al., in 2001, reported that in five years of doing peritoneal dialysis without masks, rates of peritonitis in their unit were no different than rates in hospitals where masks were worn.

Bahli did a systematic literature review in 2009 and found that “no significant difference in the incidence of postoperative wound infection was observed between masks groups and groups operated with no masks.”

Surgeons at the Karolinska Institute in Sweden, recognizing the lack of evidence supporting the use of masks, ceased requiring them in 2010 for anesthesiologists and other non-scrubbed personnel in the operating room. “Our decision to no longer require routine surgical masks for personnel not scrubbed for surgery is a departure from common practice. But the evidence to support this practice does not exist,” wrote Dr. Eva Sellden.

Webster et al., in 2010, reported on obstetric, gynecological, general, orthopaedic, breast and urological surgeries performed on 827 patients. All non-scrubbed staff wore masks in half the surgeries, and none of the non-scrubbed staff wore masks in half the surgeries. Surgical site infections occurred in 11.5% of the Mask group, and in only 9.0% of the No Mask group.

Lipp and Edwards reviewed the surgical literature in 2014 and found “no statistically significant difference in infection rates between the masked and unmasked group in any of the trials.”Vincent and Edwards updated this review in 2016 and the conclusion was the same.

Carøe, in a 2014 review based on four studies and 6,006 patients, wrote that “none of the four studies found a difference in the number of post-operative infections whether you used a surgical mask or not.”

Salassa and Swiontkowski, in 2014, investigated the necessity of scrubs, masks and head coverings in the operating room and concluded that “there is no evidence that these measures reduce the prevalence of surgical site infection.”

Da Zhou et al., reviewing the literature in 2015, concluded that “there is a lack of substantial evidence to support claims that facemasks protect either patient or surgeon from infectious contamination.”

Henning Bundgaard et al, in 2020, specifically with respect to COVID transmission, concluded that “A total of 3030 participants were randomly assigned to the recommendation to wear masks, and 2994 were assigned to control; 4862 completed the study. Infection with SARS-CoV-2 occurred in 42 participants recommended masks (1.8%) and 53 control participants (2.1%). The between-group difference was −0.3 percentage point (95% CI, −1.2 to 0.4 percentage point; P = 0.38) (odds ratio, 0.82 [CI, 0.54 to 1.23]; P = 0.33). Multiple imputation accounting for loss to follow-up yielded similar results. Although the difference observed was not statistically significant