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Regulations Governing the Practice of Medicine, Osteopathic Medicine, Podiatry, and Chiropractic [18 VAC 85 ‑ 20]
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4/17/22  8:51 pm
Commenter: Michael J Schultz

Petitioner's Response to Comments - Part 2
 

Response to Specific Commenters In Opposition to Prohibiting Masking

As the petitioner, I feel the need to respond to multiple commenters claiming, without evidence, that masking is effective in stopping transmission of the COVID-19 virus, and masking “protects vulnerable populations.”  Comments such as “Compliance with CDC recommendations regarding disclosure of vaccination status, masking to permit transmission of pathogens, and other infectious disease protocols is vital for my own safety and that of my patients,” or “I oppose regulations which would undermine access to health care for immune-compromised patients or those with co-morbidities,” completely ignore the vast body of scientific evidence clearly established by hundreds of peer-reviewed studies on the efficacy of masks and completely deny the concept of patient autonomy.  This proposed regulation does not undermine access to health care for immune-compromised patients or any patients in any way.  No one will be denied medical treatment if a practitioner is prohibited from forcing someone to wear a useless mask against their will – on the contrary, this regulation would actually ensure that practitioners cannot deny treatment to those who choose to not wear a mask and need such care, since denying individuals the right to receive compassionate medical care on that basis alone is unethical.  Multiple other proven, effective infection control protocols can be put in place to adequately protect immunocompromised patients, such as enhanced hand washing, and temperature screening. Nowhere in this petition does it state practitioners are forbidden from treating immune-compromised patients who choose to not wear a mask.  In fact, practitioners in the Commonwealth (and across the United States, for that matter) routinely treated tens of millions of immune-compromised patients, without wearing a mask prior to 2020, and no practitioners denied treatment of someone who chose to not wear a mask or refused to take an experimental “vaccine.”  Statements about undermining access to health care are pure hyperbole and unsupported by facts.

Nothing in the petition states practitioners can’t treat individuals who also refuse to disclose if they have not received the COVID-19 “vaccine” (practitioners currently by and large do not ask (as a precondition to receiving care) if you have been vaccinated for any infectious disease as a condition of treating you for any ailment, injury, or illness regardless), and no commenter has provided any evidence showing that those who don’t take the COVID-19 “vaccine” or refuse to disclose whether they have taken it are driving COVID-19 infection rates higher than “vaccinated” patients.  What this regulation does is return to the patient the autonomy and decision as to whether they will wear a mask, not the Practitioner.  This returns to the patient the decision whether they will be able to receive life-saving treatment, regardless of their vaccination status, not the Practitioner.  Unfortunately what the public has also seen over the past two years is egregious behavior by some practitioners refusing to treat patients or prospective patients because they have refused to receive the COVID-19 “vaccine,” which has been proven by recent FDA Freedom of Information Act disclosures over the past 2 months to have dangerous side effects in many immunocompromised and otherwise healthy patients (https://childrenshealthdefense.org/defender/1-million-covid-vaccine-injuries-27000-deaths-reported-vaers-cdc-data/ and here: https://childrenshealthdefense.org/defender/pfizer-vaccine-injuries-more-severe-people-under-55/.

There have been cases across the country, and even in the Commonwealth of Virginia, where individuals who needed life-saving organ transplants that were removed from an organ donor recipient list at the last minute because the individual chose not to receive the COVID-19 “vaccine.” This removal was due to a hospital or practitioner making the discriminatory (and highly unethical) decision to deny that person life-saving medical care because of the patient’s choice to not receive a COVID-19 “vaccine.” This proposed regulation would prohibit that discriminatory behavior by practitioners. Here is the evidence: https://theroanokestar.com/2022/02/04/unvaccinated-patients-denied-organ-transplants-everywhere/. Now where are the claims by opponents of this petition of "undermining access to health care for immune-compromised patients or those with co-morbidities?"

Hundreds of peer reviewed studies show little to no evidence of the efficacy of mask wearing on stopping transmission or receipt of the virus that causes COVID-19, and of many other respiratory diseases. These links below are just a sampling of the overwhelming body of literature demonstrating the futility of enforcing masking as an infection control technique against the virus that causes COVID-19, both in medical facilities and in the general population.

1. “CDC data shows 85% of those who contracted COVID-19 during July 2020 were mask wearers.”
https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6936a5-H.pdf

2. “The COVID-19 pandemic has led to critical shortages of medical-grade PPE. Alternative forms of facial protection offer inferior protection”: https://pubmed.ncbi.nlm.nih.gov/32371574/

3. “There is moderate certainty evidence that wearing a mask probably makes little or no difference to the outcome of laboratory-confirmed influenza compared to not wearing a mask.” https://pubmed.ncbi.nlm.nih.gov/33215698/

4.  Disposable surgical face masks for preventing surgical wound infection in clean surgery

“We included three trials, involving a total of 2106 participants. There was no statistically significant difference in infection rates between the masked and unmasked group in any of the trials.” https://pubmed.ncbi.nlm.nih.gov/27115326/

5.  Disposable surgical face masks: a systematic review

“Two randomized controlled trials were included involving a total of 1453 patients. In a small trial there was a trend towards masks being associated with fewer infections, whereas in a large trial there was no difference in infection rates between the masked and unmasked group.” https://pubmed.ncbi.nlm.nih.gov/16295987/

6. Evaluating the efficacy of cloth facemasks in reducing particulate matter exposure

“Our results suggest that cloth masks are only marginally beneficial in protecting individuals from particles<2.5 μm.”  Scientific studies show the COVID-19 virus is approx. 0.125 μm in diameter.
https://pubmed.ncbi.nlm.nih.gov/27531371/

7.  Comparison of the Filter Efficiency of Medical Nonwoven Fabrics against Three Different Microbe Aerosols

“The filter efficiencies against influenza virus particles were the lowest”

“We conclude that the filter efficiency test using the phi-X174 phage aerosol may overestimate the protective performance of nonwoven fabrics with filter structure compared to that against real pathogens such as the influenza virus” https://pubmed.ncbi.nlm.nih.gov/29910210/

8. The efficacy of standard surgical face masks: an investigation using “tracer particles”

“Since the microspheres were not identified on the exterior of these face masks, they must have escaped around the mask edges and found their way into the wound”. Human albumin cells, aka aborted fetal tissue, is much larger than the virus and still escaped the mask. https://pubmed.ncbi.nlm.nih.gov/7379387/

9. Using half-facepiece respirators for H1N1

“Increasing the filtration level of a particle respirator does not increase the respirator’s ability to reduce a user’s exposure to contaminants” https://pubmed.ncbi.nlm.nih.gov/19927872/

10. Why Masks Don’t Work Against COVID-19

https://www.citizensforfreespeech.org/why_masks_don_t_work_against_covid_19?fbclid=IwAR0Qviyvt6BObOg aMij03Cj0fgTcm_gm5jhXcMkO8GcH3Kur-bwib0o8rf8

11. Masks Don’t Work: A Review of Science Relevant to COVID-19 Social Policy

https://www.rcreader.com/commentary/masks-dont-work-covid-a-review-of-science-relevant-to-covide-19-social-policy?fbclid=IwAR0Qviyvt6BObOgaMij03Cj0fgTcm_gm5jhXcMkO8GcH3Kur-bwib0o8rf8

12. Face masks to prevent transmission of influenza virus: a systematic review

There is less data to support the use of face masks or respirators to prevent becoming infected.
https://pubmed.ncbi.nlm.nih.gov/20092668/

13. Use of face masks by non-scrubbed operating room staff: a randomized controlled trial:
Surgical site infection rates did not increase when non-scrubbed personnel did not wear face masks.
2010 Study article: https://pubmed.ncbi.nlm.nih.gov/20575920/

14. Surgical face masks in modern operating rooms – a costly and unnecessary ritual?

When the wearing of face masks by non-scrubbed staff working in an operating room with forced ventilation seems to be unnecessary. https://pubmed.ncbi.nlm.nih.gov/1680906/

15. Masks: a ward investigation and review of the literature

Wearing multi-layer operating room masks for every visit had no effect on nose and throat carriage rates. https://pubmed.ncbi.nlm.nih.gov/2873176/

16. Masks for prevention of viral respiratory infections among health care workers and the public: PEER umbrella systematic review.  Meta analysis review that says there is limited evidence to suggest that the use of masks may reduce the risk of spreading viral respiratory infections. https://pubmed.ncbi.nlm.nih.gov/32675098/

17. Modeling of the Transmission of Coronaviruses, Measles Virus, Influenza Virus, Mycobacterium tuberculosis, and Legionella pneumophila in Dental Clinics

Evidence to suggest that transmission probability is strongly driven by indoor air quality, followed by patient effectiveness and the least by respiratory protection via mask use. https://pubmed.ncbi.nlm.nih.gov/32614681/

18. Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings-Personal Protective and Environmental Measures

The use of face masks, either by infected or non-infected persons, does not have a significant effect on influenza transmission. https://pubmed.ncbi.nlm.nih.gov/32027586/

19. Effectiveness of personal protective measures in reducing pandemic influenza transmission: A systematic review and meta-analysis

Meta analyses suggest that regular hand hygiene provided a significant protective effect over face masks and their insignificant protection. https://pubmed.ncbi.nlm.nih.gov/28487207/

20. Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta- analysis

Use of n95 respirators compared to surgical masks is not associated with a lower risk of laboratory confirmed influenza.
https://pubmed.ncbi.nlm.nih.gov/32167245/

21. Adolescents’ face mask usage and contact transmission in novel Coronavirus

Face mask surfaces can become contamination sources. People are storing them in their pockets, bags, putting them on tables, people are reusing them etc. This is why this study is relevant: https://pubmed.ncbi.nlm.nih.gov/32582579/

22. Visualizing the effectiveness of face masks in obstructing respiratory jets

Loosely folded face masks and “bandana style” face coverings provide minimum stopping capability for the smallest aerosolized droplets.  This applies to anyone who folds or shoves a mask into their pockets or bag. It also applies to cloth and homemade cloth masks: https://pubmed.ncbi.nlm.nih.gov/32624649/

23. Use of surgical face masks to reduce the incidence of the common cold among health care workers in Japan: a randomized controlled trial. Face mask use in healthcare workers has not been demonstrated to provide benefit in terms of colds symptoms or getting colds.
https://pubmed.ncbi.nlm.nih.gov/19216002/

24. A cluster randomized trial of cloth masks compared with medical masks in healthcare workers

Penetration of cloth masks by influenza particles was almost 97 percent and medical masks 44 percent. So cloth masks are essentially useless, and “medical grade” masks don’t provide adequate protection.
https://pubmed.ncbi.nlm.nih.gov/25903751/

25. Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS CoV-2 Infection in Danish Mask Wearers : A Randomized Controlled Trial

“The recommendation to wear surgical masks to supplement other public health measures did not reduce the SARS-CoV-2 infection rate among wearers by more than 50 percent in a community with modest infection rates, some degree of social distancing, and uncommon general mask use”: https://pubmed.ncbi.nlm.nih.gov/33205991/

26. Mask mandates and use are not associated with slower state-level COVID-19 spread during COVID-19 growth surges.
https://www.medrxiv.org/content/10.1101/2021.05.18.21257385v1

In addition to the numerous internet citations provided above that document overwhelming evidence that masking does not prevent the contracting of the virus, nor stop transmission, of particular relevance is a comment submitted by Mr. Mark Fraser, PhD, Aerosol Scientist and OSHA Safety Officer in support of revoking the Virginia Standard for Infectious Disease Prevention of the SARSCoV-2 Virus That Causes COVID-19 (16VAC25-220).  Mr. Fraser’s comment shows that masking is completely ineffective as a means of infection control against the SARS-CoV-2 Virus, summarized below: (https://townhall.virginia.gov/L/viewcomments.cfm?commentid=120823)

“The Standard, subsection 40(G), specifies the mandated Personal Protective Equipment (PPE): “employees shall wear a face covering or surgical mask that covers the nose and mouth to contain the wearer's respiratory droplets and help protect others and potentially themselves.” This selection of PPE was unfortunate because these types of masks bear no certification of effectiveness against germs and viruses and, in fact, were known to be ineffective against these pathogens at the beginning of the COVID outbreak1. . .  Sufficient data have been acquired to allow the performance of Mask Mandates to be assessed.  The unmistakable conclusion is that COVID infections were driven largely by seasonal and endemic factors, whereas Mask Mandates had no discernable impact on infections here in the U.S.4 . . .

The Standard also failed to address the possibility of short and long-term health issues raised by prolonged use of PPE.  These issues include: difficulty in breathing, skin rashes, and CO2 intoxication.4 

Conclusions: Considering the PPE specified under the Standard provided little or no protection against the SARS-CoV-2 virus and long-term use presents health risks to employees, the Standard should be revoked.”

So, since masking has been overwhelmingly shown through multiple peer reviewed studies to have not stopped or slowed the spread of the virus that causes COVID-19, why does the Board of Medicine still allow practitioners to force patients to wear one as a condition to receiving care?

Several commenters have stated that any patient or prospective patient doesn’t have to wear a mask, as they could seek a practitioner that aligns with their philosophy on mask wearing if they choose not to wear one.  While this sounds feasible in theory, unfortunately if there are only a minimal number of practitioners in one’s local area, patients would be unfairly discriminated against for their choice should all practitioners demand that a mask be worn, even just in order to be seen for an initial appointment! In reality in densely populated locations such as Fairfax County, there is no way for a patient or prospective patient to adequately research or filter practitioners for this option without an exhaustive time and resource-intensive search.  No practitioners in the Commonwealth advertise “mask free,” or “masks optional,” on their websites, or in their practice’s literature, or brochures. There is no county government, or Association of medical providers, or medical guild that advertises “mask free” practitioners.  So, while this initially sounds like a reasonable option for patients to have their autonomy respected, in reality this is an undue burden that patients or prospective patients must not be required to bear in order to simply receive compassionate, unrestricted medical care. The more reasonable option is to simply prohibit practitioners from acting as defacto agents of the Local or State Board of Health, where they have not been accorded any authority under Virginia State law or Board of Health regulation to continue to force masking on patients.

In addition, as explained in my rationale submitted to the Board, forced masking violates patient autonomy by requiring a patient to wear ineffective facial masks that actually can be shown to make individuals sick, as is clearly outlined in multiple studies cited in the above internet links (for example, University of New South Wales. (2015, April 22). Cloth masks: Dangerous to your health? ScienceDaily. Retrieved March 19, 2022 from https://www.sciencedaily.com/releases/2015/04/150422121724.htm

How is it ethical (or in the interest of patient safety) then, to force a patient to wear a mask as a condition to receiving care, when that mask can actually make them sicker than they are to begin with, or possibly negatively contribute to their health? No practitioner is checking a patient for proper fit and wear, quality of mask, or cleanliness of mask, to begin with. So, even on that basis alone, forced masking must be prohibited as a condition of receiving care. 

CommentID: 121795