The SCIENCE of MASKS

CP and SLR debate about how Masks affect Humans...

The maxim of reason is never passive for it implies; one thinks and reasons for oneself. Immanuel Kant said, “if reason will not subject itself to the laws it gives itself, it has to bow under the yoke of laws given by another; for without any law, nothing—not even nonsense—can play its game for long.” Indeed, that is true for all time and for all places. This brings me to the central tenet of this discussion, about masks.

So, here is how you put on the mask over your face. If it has a single elastic band, you pull it over your head and carefully let it snap into place around your head and over your ears. If it has two vertical sidebands, then pull them around you’re the ears and make it snug by compressing the mask around your nose, to limit the ingress of any air from around the mask into your nostrils. If it has two horizontal bands the idea is to use the lower band around the neck and the upper band around and over the top-back-end of your head. Again, pinch around the nostrils and make sure there are no open areas between the contours of your face and the architecture of the mask. That’s it!

Now if you are a feral skeptic, this brings up some neck-hairs to stand on end and perhaps for good reasons? In the first address by the powers to be, the masks were not important, not because they were not important, but because they said, “they were not important.” The rationale in the early part of spring was that there would not be enough for the healthcare workers who take care of COVID infected patients. But meanwhile, if that evaluation is correct, everyone else was to go about their daily business, spreading the infectious COVID agent around like, applying liberal icing on a cake! A classy response that only came to light when the lofty scientists broke that code of silence on that minor bit of information. Dutifully, everyone who was in on the gamification of this virus nodded and accepted it as gospel. “Oh, that was so thoughtful and wonderfully orchestrated by the experts that we are speechless and in awe of such intellect,” they breathed in unison. Now suddenly facial masks are the most important mechanism in curbing the spread of COVID infection. An amazing turnaround, perhaps, even for those people with short-term amnesia, whose past memory does not extend beyond 6 weeks.

Then in an amazing feat, as if by a flip of a switch, the entire machinery of the government in the United States turned on to produce masks to protect and defend the 340-million populace from this horrid of all diseases that usurp life by infiltrating through tiny pores in the endothelial layers of the mucous membrane. “That should stop the progress of the disease!” claimed the mighty machine behind the megaphone. As if by clockwork, the daily dose of harm, against the encircled wagons filled with skeptics, caused by ridicule-and-venom-tainted arrows, fired with flames lit, at will at anyone brave enough to ask, “Can I please have some more…information?” Needless to say, the masks were to become the totality of thought in this current breed of civilization, worn at all times under all circumstances in any condition. “For the sake of everyone’s life and yours. You idiot!” They chanted. Of course, there was a preeminent ethicist with many capital letters after his name, who propounded that if you do not socially distance and do what you are told, you should forgo any potential future medical help if you contract the infection.” As if that wasn't enough, the newspaper and the television meanwhile, the source of constant verbal badgering, lionized every COVID death and broadcast the daily numbers of infected cases in banner headlines for all to see and shrivel in fear. “Wear the mask or hope to die,” is what they seem to imply.

Yet there was this lingering scratch of scientific facts that seem to want a satisfying itch. The science of oxygenation. That tidy bit of factual data which has alluded all except a few. What about this breathing thing behind the mask, called the human? Is there potentially some harm to him or her? Does wearing the mask while driving cause some cognitive breakdown, akin to lowering of lights in a once brightly lit room? Does it? To answer that question, I came across this report buried under a mountain of “Hail to the Experts” reports. A car that veered off the road and hit a lonely tree. The driver of the car was wearing a mask and the conclusion was that the driver might have been mildly hypoxic (as in low oxygen in the blood). Some chock it to assumption and others as an anecdote, but scientific facts remain (1). There was something in it that piqued the brain cells into action and started firing electrical impulses all over the two cerebral hemispheres, especially among the skeptics.

SLR and CP 

The feral nature of that alarm triggered the bells. “Indeed, perhaps one should look at it.” The Cautionary Principle worried about minutia, the Scientific Lab Rat dug deeper into scientific facts.

Cautionary Principle: “So, what happens when you enclose the breathing mouth inside the mask?”

Scientific Lab Rat replied in his fake Yoda-ish speak: Interesting question, you ask CP?

CP: Well, what is it?

SLR: The atmospheric oxygen partial pressure at sea level is 20.94% of the composition of air. In those lung sacs, after you take a breath, the exerted oxygen partial-pressure is greater than that present in the tiny capillaries (blood vessels). The oxygen being at a higher pressure in the sacs and lower in the capillaries creates an oxygen exchange between high pressure and low pressure or from the sacs and into the tiny blood vessels, while the carbon dioxide as a byproduct of work from the rest of the body, has more pressure in the capillaries (for delivery to the lungs) compared to the sacs, hence, carbon dioxide flows from the capillaries and into the sacs to be breathed out.

CP: Nifty principle of nature. Mother Nature has her act together. I always knew it.

SLR: Yes! But since you bring this mask business into the equation, we have to change some of those parameters, don’t we?

CP: Do we? I don’t know but go ahead with your sermon, Mr. Rat.

SLR: I prefer my full name if you would please.

CP: Ok, Mr. Scientific Lab Rat, go on…



SLR: The breathed-out air or exhaled air as it is called has some different characteristics. It has only 16% pressure and additionally there is 4% of Carbon Dioxide mixed in it.

CP: So, how much was the Carbon Dioxide partial pressure in the fresh air, you say?

SLR: I didn’t, but the answer is 0.04% See this chart:

CP: You mean that the exhaled air has 400 times more carbon dioxide in it then inhaled air?

SLR: You catch on quickly CP!

CP: But that is preposterous!

SLR: It is if you don’t believe in science. Here see the chart:

CP: Skinny little whiskered rodent, that you are, I’ll let that go. Ok, so how does that matter in the scheme of things?

SLR: Well, let me put it simply; if you inhale 4% carbon dioxide (CO2) and only 16% oxygen you are causing combinatorial damage on your respiratory system and downstream into the rest of your body, your brain, your heart, your kidneys, etc.

CP: How so?

SLR: You would over time develop hypoxic hypoxia, I know that sounds like a typical duplicative use of the word, but technically that means that you are depriving your body of oxygen.

CP: So all those organs develop some bad consequences from low oxygen?

SLR: Yes Sherlock and, adding insult to injury, that CO2 causes something called hypercarbia, which can cause mild to moderate respiratory distress. It causes capillary leaking inside the lungs and leads to fluid stagnation inside the lung in the form of "wet lung" or pneumonia. The heart has to pump faster to get the same amount of oxygen and the added CO2 causes acidity in the blood and increases blood pressure, while the kidneys have to work harder to get rid of the excess acidity. All that acidity is bad for the body to fight off infections. See the irony there? or is that a whoosh off the top of your head?

images from Respiratory Care journal

CP: That’s bad, isn't it?

SLR: No kidding, genius. You know CP there is something eerily familiar about you and your policymakers. You are all the same, gifted with the principles of vacuum.

CP: Are you insulting me? I am more intelligent than any average human out there. You see, all activity flows after I have assessed the risk of that activity. Too little import of my ideas and businesses run awry. Too much and they become rudderless. I am Hamlet’s ship of state; too little regard or too much and both end in disaster.

SLR: Hamlet? Who is he?

CP: Move along, little fellow, that is beyond your comprehension.

SLR: Anyway, there is a Shakespearean tragedy in the making if you do not pay attention.

CP: My principles are up and taking notes. Go ahead, spill em out.

SLR: Hypoxia combined with hypercarbia (or increased CO2) leads to dysfunction of the brain. Hey, CP...Somewhere, at the beginning of this treatise, this author who writes about our dialog, has also written about a car accident. I believe, that definitely sounds like brain impairment from too little oxygenation of the brain cells. Perhaps you should read a little about this…(Read) and this (Read)

CP: Hmm…I will, in my spare time. Right now, give me the skinny on this. I have mounds of paper-work on my desk to read. Now give me an example of any other way such hypoxia can occur.

SLR: Climb up a mountain to about 7000 feet from your current level and do some exercise. You will be huffing and puffing with headaches, nausea, and a decline in your physical prowess in no time (2). Here is a snapshot of varying altitudes and oxygen partial pressures:

CP: Umm…you might be correct there. I do get short of breath when I go skiing in the Colorado mountains every year for the first few days. So how would that affect a person traveling in the airline wearing a mask?

SLR: You go skiing, especially with all the cautionary stuff you blab about all day?

CP: A Principle has to do what the Principle has to do.

SLR: As far as the airline travel, obviously it is easy to extrapolate; you are further reducing the oxygen since the cabin pressure altitude in most commercial airlines is at 7000-8000 feet and hence at 16% and wearing a mask is further increasing the relative hypercarbia (4% CO2) and hypoxia (around 13-14% oxygen partial pressure) with potentially deleterious effects (3). See the chart above:

CP: So why are they mandating masks in the airlines during travel?
SLR: Ask them. Oh and by the way, here is some interesting news for what it’s worth, “hypercarbic obese patients required longer to perform the executive and attention tasks.” I hope the pilots up in the cockpit are not wearing masks.

CP: Are you calling me fat?

SLR: No, never, just mentioning factual data to correlate with readily visible information. Although you do seem a bit rotund from my perspective. But hypercarbia in people with sleep apnea can be very harmful as well.

CP: I will ignore that for now. So, you say, that effect is similar to what would happen if you put a mask on?

SLR: I am saying, if you vary the oxygen and carbon dioxide ratios in your breathed in the air you will suffer the same fate. Here is some compelling information to digest; “hypercarbia may slow brain neural activity and cause neurobehavioral impairment. In a brain imaging study, breathing 5% CO2 significantly reduced all functional connectivity MRI indices in 14 healthy volunteers and resulted in a suppression of cerebral metabolic rate of oxygen (CMRO2), which was proportional to the end-tidal CO2 change. Another study found that 5% CO2 attenuated evoked and spontaneous magnetoencephalogram (MEG) spectral activity and decreased early sensory components in both auditory and visual modalities as well as cognitive components related to memory and language in 7 healthy volunteers. Hypoxia has been considered as a key determinant of neurocognitive dysfunction. impairment may well be due to a mixed effect of hypercapnia and hypoxia, and hypercapnia may play an even more important role.”

CP: Hmm…what Caution can I give on this principle? After all, the science bosses and the other high ly trained experts seem diligent and quite forceful in their mandates to have the masks on all the time in public and any place where there is another human being present.

SLR: That’s your problem. I’m here to give you relevant facts. Here is one more; “A majority of studies have reported impairments in the short-term verbal, and visual memory, as well as the long-term semantic memory, and procedural memory. Hypercapnia is a non-permissive environment.”
You, my dear expert CP, are now aware of the facts, now, you can decide what principles you want to adopt and the appropriate cautions you want to express.

CP: Yes, but these humans are weird. They do weird things.

SLR: Indeed, they do! For instance, the news-media was gushing at all the protestors and looters in the streets across the nation these past few days, while the protestors were protesting without masks and not social distancing and you guessed it, wearing masks! Clearly, your caution was not adhered to, that is if you did mention it to that crowd?

CP: Of course, I did! Caution, my dear little fella, is my advice about a hazard that could be a potential risk. So, don’t try your cheeky little probes with me.

SLR: So, the humans decided to throw your caution to the wind?

CP: They appeared to have?

SLR: (Silent).

CP: Darn these humans. They just keep upping the ante by doing something without clearly checking my cautionary principled mandates in-toto.

SLR: Yes, I have got to go. Toto and Dorothy are waiting, for Dorothy to click her heels as we speak.
CP: Smartass! Hey, don’t forget to wear your mask.

SLR: I will be by her red slippers and much nearer to Toto, so quite a distance from Dorothy’s mouth and hands. Don't think Toto is infected.

Liberation from prejudices and superstitions is enlightenment. Understanding is the key to making rational decisions. So, where does this mask story take us? That question can be answered with a fair degree of certainty if one spends an evening with reason itself, instead of following the dictates of popular pundits of the hour. In the end, wearing a mask may have little to do with protection and more to do with changing how society moves forward into the future. For prevention, the cautionary principles are quite certain and exact: Good hygiene (wash hands with soap and water, don't touch the eyes, nose, and mouth with unwashed hands and keep at least 6 feet of distance from those that are ill, have a cough or sneeze or talk loudly. The people most at risk should abide by these cautionary principles, stay home, away from social gatherings if possible or socially distance if not able, and keep good hygiene until the virus dies its natural death thru contact with humans immunized via past infections, or via immunization (if a valid 100% effective vaccine is available). The risk of total disregard of these simple basic principles and throwing caution to the wind. far outweighs that being rash or ignorant.

1.     Wang, D., Thomas, R. J., Tee, B. J. & Grunstein, R. R. Hypercapnia is more important than hypoxia in the neuro-outcomes of sleep-disordered breathing. J. Appl. Physiol. 120, 1484–6 (2016)

2.     
      BMJ. 1998 Oct 17; 317(7165): 1063–1066. Oxygen and Altitude

3.     
      Xu F, Uh J, Brier MR, Hart J Jr, Yezhuvath US, Gu H, Yang Y, Lu H. The influence of carbon dioxide on brain activity and metabolism in conscious humans. J Cereb Blood Flow Metab 31: 58–67, 2011.

The Assistant Professor

Any human being is a virtuoso piece of biological architecture. And each develops a character, specific to him or her. It is the Lamarckian pressures that mold and twist the vagaries of one's behavior. This is a story about two of them. 

He was mostly dressed in grey pants and a white shirt. He had his spectacles in the shirt pocket for easy retrieval. And he carried about an air of knowledge and wisdom as most in his position are wont to project. His head mostly bent looking at the two feet of pace ahead of him as if in deep thought. I always wondered what he was thinking. He was after all a tenured professor in a university and that carried gravitas amongst the other lowly wretched souls trying to reach his lofty circles.  Over the three years I had known him, he had turned from what I entertained him to be a congenial sort into an irascible individual. He still carried the quirk of his smirk, that seemed to say, “I own you.” He came late to work exiting the elevator on the twelfth floor, looking directly at his secretary for any information that would ignite his slow burn into a full boil. At times he would be rewarded and other times nothing was passed between them and he paced his way into his 10 by 10 office and shut the door behind him, loud enough with that specific creak, that everyone in the adjoining room, knew he was in. The office itself was cluttered with papers and xeroxed articles from various medical journals, some half-opened, and others just collecting dust stacked in order of their time when received through the years. His desk was oddly half the size of the room with barely enough room to walk around it and on one wall on his right was a cryptic photo of someone much younger than him but kind of looked like him. No one had dared ask him about it, so no one knew the answer to the question that had piqued everyone’s curiosity.

His claim to fame was an isolated paper he had written several decades ago about an obscure pathological phenomenon that occurred in some malignant diseases of the white cells. His reputation had gained quite a few rungs on the ladder of fame in academic circles. And he seemed to deftly use that meteoric rise by giving lectures at various universities, propounding the importance of that esoteric finding. Soon, however, after his professorship was confirmed, the world moved on to other esoterica and he was left holding that dimly lit candle with almost no wick, in his hands. Periodically the past would provoke him, especially when new students showed up, where he would spend at least some time discussing the value of that arcane finding.  Few were impressed, others just nodded with politeness and still others showed little interest. His keen eye discerned those who would be his favorites for the duration of their time spent with him. I fell into the litter box to be filed away into obscurity. To those sucked in, into his vortex, he was a giant, and to prove his dominion over objects he would lean against door jams or hover over his desk with his head cocked and his fisted hand resting on a 5^th edition Hematology textbook.

His secretary however had his number and he would tiptoe around her without any sidewinding cryptic remarks. “Janet, would you please do such and such?” Everyone else was greeted with a smirk and a complex sentence filled with syllables to prove his intellect. Janet though was a no-nonsense person that took her duties seriously and had no room for frivolity or his bravado. The only other person who remained aloof from the professor’s gyre was his assistant professor whom he had hired recently. This one was a genius and was dedicated to the real science of medicine. The professor would often try to ride his coattails using his junior’s research as that emanating from “his” department. Try as he must, he could not rid the beast that burdened his shoulders and gave him his slight hunchback that could not be hidden within the one size too big lab coat. There was bitterness in him the kind that seeps through in short sentences and protracted but valueless dialogue. It erupted every time he met someone who could solve a quick riddle, answer a question without hesitation, or show the base level superior intellect that alluded him. Every encounter furthered his obsession to prove himself worthy of any intellectual company he encountered. But each time the fall back on his own sword bruised and gashed his ego and after a thousand such cuts, the shell of irascibility and petulance emerged as his defined character. 

My personal irritation began when after months of work, I completed a research paper on a particular malignancy. He wanted to see the paper before the galley proofs. I, of course, complied and showed him the paper. The next day he came in with a frown and eyes projected the inner turmoil and anger, indicating there had been some shorted fuses in his circuitry and the entire central processing unit of his brain was going to blow up when he started to speak. Composed himself, he did, with some mastery and a trembling hand on the edge of the desk. With veins popping on the dorsum of his hand from the angry flow of the adrenaline, he regained his composure. 

“You already submitted this paper?” 

“Yes, why, is there a problem?” 

“Indeed," his hand involuntarily flipped open the textbook with a vehemence quite accustomed by the wretched and frayed prop, "you are supposed to put my name in this paper as a second author!" He demanded.

“But you had nothing to do with it and did not work on it at all?” I protested. 

“I am the chief of the department and that is an automatic courtesy and a rule in this department.” Spit surfed the ether in my direction, and I backed up a bit to avoid the hit.

“What would you have me do?”

“Call the publisher and advise them of the omission.”

“Ok,” I said quietly and walked out of the room. Now my anger had the best of me. And that was the last time, I wrote a research paper. The fun juice had been sucked out of the entire process. I voluntarily recalled the paper from the publisher, citing errors, and never submitted it again. The battle of right and wrong had just turned red and the black print on the white manuscript gave me little solace or sense of accomplishment, anymore.

The year moved along at its petty pace. With icicles as arrows shot every so often and directed at me, the frigid air between us turned white with the unsaid words of anger, burnt to a crisp. I avoided dinner parties and kept to my own circle of friends. Those buddies kept trying to help bury the hatchet between us, but that station had passed many train whistles ago and so I bided my time to finish in that department. When the day came, I quietly, without fanfare, exited the department and the university.

He, the professor did not disappoint as a character always wins out. I remember receiving a copy of a letter that he wrote to the department head where I worked, in which he fomented his anger via words against me on my time spent in his department. Fortunately, that was countered with glowing respect, I received from the assistant professor. The latter was simple, direct, and complimentary and the former was filled with innuendos and stuff that vile is brewed from. No harm came of that. But the memory lives on and sculpts my behavior of how to be.

Luckily, my time at the university was not all in vain. The assistant professor saw some potential and asked if I wanted to spend time in his lab for a few weeks. I took that on and so began my love of all things “Basic Science.” This gentleperson was a wellspring of knowledge and a quintessential tinkerer in the domain of unresolved questions. He explored the microenvironment of the cellular function as his personal adventure; cataloging every surface and interior blemish under the focal vision of an electron-microscope. He also sketched in my mind the question of “why?” In business and fraud, they say, you must follow the money to get to the answer behind any problem that needs a solution. In this tiny lab the solution to any problem lay in questioning the obvious and the esoteric with the “why and how does it do that.” The quiet, soft-spoken, bowtie wearing, crisp blue shirt a day, assistant professor instilled in me the virtue of skepticism in all things called science. A virtue, to this date, I cherish. There are few people like the assistant professor, that one might place in their memory chest, genuine and true like Amadeus Mozart and there are many like the professor mean and vengeful that surround us in our daily lives, like Salieri, that one chooses to forget before the microsecond is history. 

My fervent wish for all students and physicians, young and old is that they learn to be skeptics. To question what Richard Feynman called conventional scientific cargo-cultism. For in that wisdom of skepticism, lie some of the greatest of insights and solutions to our most perplexing problems. I also hope and pray that all who seek to learn and enjoy science, have the benefit and the wealth of a man, like the one, I have called the assistant professor.