A mechanism by which facemasks contribute to the COVID-19 case fatality rate

Zacharias Fögen, MD

Abstract

Extensive evidence in the literature supports the mandatory use of
facemasks to reduce the infection rate of severe acute respiratory
syndrome coronavirus 2, which causes the coronavirus disease (COVID-19). However, the effect of mask use on the disease course remains
controversial. This study aimed to determine whether mandatory mask use influenced the case fatality rate in Kansas, USA between August 1st and
October 15th 2020.

This study applied secondary data on case updates, mask mandates, and demographic status related to Kansas State, USA. A parallelization
analysis based on county-level data was conducted on these data. Results
were controlled by performing multiple sensitivity analyses and a negative control.

A parallelization analysis based on county-level data showed that in
Kansas, counties with mask mandate had significantly higher case fatality
rates than counties without mask mandate, with a risk ratio of 1.85 (95% confidence interval [95% CI]: 1.51–2.10) for COVID-19-related deaths. Even after adjusting for the number of “protected persons,” that is, the number of persons who were not infected in the mask-mandated group compared to
the no-mask group, the risk ratio remained significantly high at 1.52 (95%
CI: 1.24–1.72). By analyzing the excess mortality in Kansas, this study determines that over 95% of this effect can solely be attributed to
COVID-19.

These findings suggest that mask use might pose a yet unknown threat to the user instead of protecting them, making mask mandates a debatable
epidemiologic intervention.

The cause of this trend is explained herein using the “Foegen effect” theory; that is, deep re-inhalation of hypercondensed droplets or pure
virions caught in facemasks as droplets can worsen prognosis and might be linked to long-term effects of COVI

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9282120/pdf/medi-101-e28924.pdf

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