by Silviu “Silview” Costinescu_ Buy Me a Coffee at ko-fi.com

In my latest article I dared everyone to find out the identity of Klaus Schwab’s parents (the mastermind behind WEF / The Great Reset). No one has provided so far, the call is still open for all researchers. But at least I’m now able to prove who his spiritual parent is and how that falls in the grand scheme.

Since the first day I got introduced to Klaus Schwab’s Great Reset I’ve seen Kissinger’s fingerprints all over it, but I had no hard evidence. Now we have it.
Second question that arose upon research was how did this engineer become the prime-minister of world’s shadow government? I’ve seen much brighter people die in misery. I see his main financial backing was from Rothschilds / World Bank, is/was his mother a Rothschild maybe? We can only speculate since he erased his family from Internet records.
But this video I’ve just unearthed (taken from a conference in Singapore, in 2016) cements him near Soros and Kissinger, as part of the ideological and executive triad that engineered the Rothschild – China alliance. As I’ve shown in a previous article, this alliance is at the core of the high-tech-globalist-communist regime that’s being rolled over the world right now under The Great Reset / Fourth Industrial Revolution brands and under the Covid-19 pandemic as a cover. Even the #Kraken can be traced back to them.
Below is the rest of the illustrated scheme. I tried to keep it as brief as possible, which was not an easy task given the abundance of ignored evidences.

Read
From South China Morning Post
Chinese Premier Li Keqiang greets Klaus Schwab during 2017’s WEF in China
Who said #Kraken?

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by Silviu “Silview” Costinescu_ Buy Me a Coffee at ko-fi.com

This makes my blood boil, so I will refrain from more comments in this state, here are the facts.

A new study estimates the pandemic could cause over 400,000 deaths in the U.S. this year. It includes those who died of COVID-19 and people who died due to disruptions caused by the pandemic, NPR reports.
Just more fill-up for their FearPornHub, I thought. At first I couldn’t care about any more of this type of inane drivel, knowing the virus hasn’t been isolated and purified as per Koch’s postulates, they have no tests for Covid, thus they can’t to come up with any statistics, so it’s all just marketing mambo-jumbo to cover for The Great Reset and The Fourth Industrial Revolution, their official names for Covidiocracy.
BUT
One sequence made my red light blink. On review, it blew up my BS detectors:

ALCA: So why the discrepancy between the numbers they’re getting and the numbers that are being reported? Well, they think there are two reasons. Woolf says one of the reasons is that some people just aren’t having COVID-19 listed on their death certificates.
STEVEN WOOLF: The second is people who do not have COVID-19 but die because of disruptions caused by the pandemic. So an example would be somebody has chest pain. They’re scared to call 911 because they don’t want to get the virus, and they die of a heart attack.
CHANG: OK, but that’s not the same as dying from COVID-19.
PALCA: No, but if you’re trying to estimate the burden of the pandemic on American health and the nation’s health, then it’s certainly reasonable to count those kinds of deaths as related to – as blaming them on the pandemic.

So now, let’s say if I return to hunger-strike to protest their lies and literal terrorism, and if I die as a result of the protest, then I end up on their list and they will use me to sell more Covidiocracy.
This kinda leaves me no choice other than to make sure I die AFTER I eliminated Covidiocracy.

Below you have the full transcript of the NPR report:

AILSA CHANG, HOST:

The total number of deaths related to COVID-19 in this country could top 400,000 by the end of the year. That’s according to a study out today in the medical journal JAMA. Four hundred thousand is about the number of Americans who died in World War II. Joining me now to talk about how researchers came up with this number is NPR science correspondent Joe Palca. Hey, Joe.

JOE PALCA, BYLINE: Hi, Ailsa.

CHANG: So, you know, we’ve been reporting that the number of COVID deaths is a bit more than 200,000 now. I don’t get it. Is that number actually going to double by the end of the year?

PALCA: Well, no because the study out today suggests that there’s an undercounting of deaths that could be related to COVID-19. Let me explain. So Steven Woolf is director of the Center on Society and Health at Virginia Commonwealth University, and he and his colleagues looked at deaths from all causes this year and compared those to historical death rates. And this year was higher, so they figured that the explanation is COVID-19 because that’s been the main difference in the health situation.

CHANG: Right.

PALCA: So why the discrepancy between the numbers they’re getting and the numbers that are being reported? Well, they think there are two reasons. Woolf says one of the reasons is that some people just aren’t having COVID-19 listed on their death certificates.

STEVEN WOOLF: The second is people who do not have COVID-19 but die because of disruptions caused by the pandemic. So an example would be somebody has chest pain. They’re scared to call 911 because they don’t want to get the virus, and they die of a heart attack.

CHANG: OK, but that’s not the same as dying from COVID-19.

PALCA: No, but if you’re trying to estimate the burden of the pandemic on American health and the nation’s health, then it’s certainly reasonable to count those kinds of deaths as related to – as blaming them on the pandemic.

CHANG: OK. So I take these numbers are for the U.S. as a whole, but are there regional differences when it comes to the impact of COVID?

PALCA: Yes, there were. In fact, states like New York and Massachusetts and Connecticut that responded aggressively when they saw their excess death rates ramp up at the start of the year also saw them come back to normal historical levels in about May – so about seven or eight weeks later. But states that never brought their outbreaks under control – they still continue to see a surge in these excess deaths, suggesting that public health measures was a big part in controlling things.

CHANG: And do we have any idea whether these excess deaths, as you call them, from the pandemic are showing up in other countries?

PALCA: Yes, this is a pattern that scientists are seeing in other countries. But there’s an interesting twist. So there’s a paper also being published in JAMA that compares how the excess death rates in the United States due to the pandemic compare to death rates in other countries that were hit hard like Italy and Spain and France. And remember; these are rates, not actual numbers because these are different-sized countries.

Ezekiel Emanuel of the University of Pittsburgh is a co-author of that study. And he says at the start of the year, the excess deaths in those countries were fairly comparable with the United States. But then they started dropping down to levels closer to what they were before the pandemic. And Emanuel says that wasn’t the case in the U.S. So what those countries – so what were those countries doing that we weren’t doing?

EZEKIEL EMANUEL: They didn’t have a vaccine that we didn’t have. They didn’t have some special cocktail treatment that we didn’t have. The difference is how conscientiously did we implement public health measures – physical distancing, masks, keeping crowds small, not moving inside for social gatherings? And we performed poorly.

CHANG: So is it possible to do better at this point and improve the situation here in the U.S.?

PALCA: Yes. Both Emanuel and Steven Woolf from Virginia Commonwealth University say that implementing those measures that Emanuel was just talking about would make a big difference, and the death rate could come down significantly by the end of the year. And a vaccine will help. Although when we get the vaccine and who will be able to get it, that’s a topic for another day.

CHANG: That’s NPR’s Joe Palca. Thank you, Joe.

PALCA: You’re welcome.


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by Silviu “Silview” Costinescu_ Buy Me a Coffee at ko-fi.com

Never believe what we say, always research what we say.
As for CDC, if you research what they say you end up finding out they have 85% failure rates.

This is the recent CDC report, in PDF format, sourced from the CDC website.
And below is my sufficient commentary in visual form. There’s nothing else to say, the official narrative is dead and buried, at this point we’re just burning calories if we keep flogging it.

PS: #stopstealingoxygen

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BY Shanti Das for The Sunday Times

Companies collecting data for pubs and restaurants to help them fulfil their contact-tracing duties are harvesting confidential customer information to sell.

Legal experts have warned of a “privacy crisis” caused by a rise in companies exploiting QR barcodes to take names, addresses, telephone numbers and email details, before passing them on to marketers, credit companies and insurance brokers.

The “quick response” mobile codes have been widely adopted by the hospitality, leisure and beauty industries as an alternative to pen-and-paper visitor logs since the government ordered businesses to collect contact details to give to NHS Test and Trace if required.

Any data collected should be kept by the business for 21 days and must not be used “for any purposes other than for NHS Test and Trace”, according to government guidelines.

But some firms used by businesses to meet the new requirements have clauses in their terms and conditions stating they can use the information for reasons other than contact tracing, including sharing it with third parties. The privacy policy of one company used by a restaurant chain in London says it stores users’ data for 25 years.

Gaurav Malhotra, director of Level 5, a software development company that supplies the government, said data could end up in the hands of scammers. “If you’re suddenly getting loads of texts, your data has probably been sold on from track-and-trace systems,” he said.

One of the firms claiming to offer a privacy-compliant QR code service is Pub Track and Trace (PUBTT), an organisation based in Huddersfield charging pubs £20 a month to keep track of visitors, who are asked to provide their name, phone number and email address.

Despite its claim to be a “simple” service, its privacy policy, which users must accept, explains how personal data of people accessing its website can be used to “make suggestions and recommendations to you about goods or services that may be of interest to you” and shared with third parties including “service providers or regulatory bodies providing fraud prevention services or credit/background checks.”

It may also “collect, use, store and transfer” records of access to certain premises including “time, ID number and CCTV images”.

PUBTT, which works with pubs in England and Wales, said users agreed to its privacy policy before using the service and claimed it had not passed data to third parties. A spokesman, identified only as Adam H, said: “The data we collect is only for use of the Test and Trace service or where a user has agreed for the venue to use their information for marketing purposes.”

Ordamo, which provides track and trace services for restaurants, states that data from website visitors is “retained for 25 years”, a duration Hazel Grant, head of privacy at Fieldfisher, a law firm, said would be “very difficult to justify”. Ordamo did not respond to requests for comment.

The Information Commissioner’s Office is assessing 15 companies that “provide services to venues to collect customer logs”.


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by Silviu “Silview” Costinescu_ Buy Me a Coffee at ko-fi.com

Just an idea and some memes

#STOPSTEALINGOXYGEN
#STOPSTEALINGOXYGEN

SHARE THE MEMES

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by Silviu “Silview” Costinescu_ Buy Me a Coffee at ko-fi.com

According to the reputed truth-gods of Fb, Gates and WHO and the other Event 201 attendees spewed Rona conspiracies in a video they made in October last year, which implies pre-science and vindicates the people calling covid a “plandem1c”


Many revere and admire the elites for their grandiose plan to enslave the whole humanity, but in fact all their plan is dumb AF from its fundamentals down to its executives, and this is just one of the many evidences.
I mean you want to control the world but you can’t even automate censorship on Internet and you end up shooting yourself in the both knees relentlessly? Imagine a fanfare of clowns with megalomaniac delusions, applauded by a congregation of geese. Covidiocracy is destined to cannibalise itself, starting with its propaganda machine, see the SJW/cancel culture.

I made this post very visual and simple so fact-checkers can understand it:
They targeted us but it’s their people’s video and it’s made last year. We work mainly with their sources precisely because they’re dumb and predictable and we knew we’ll have to deflect back these BS attacks when they occur. And they fell right into it as soon as they could. They’re a buncha morons with too much money and too many toys.

Basically, Facebook and a host of its “fact-checkers” such as USA Today, Factcheck.org and more, have claimed that one of our latest video uploads “repeats information identified by independent fact-checkers [themselves] as false”.

Thing is we’re not the authors of the content, we just mirrored (reuploaded) a video from Johns Hopkins, untouched, we’re just platforming these people, Facebook told us they’re good credible people :D.

Original source, pls watch all their videos, preferably the mirrors on our channel so we can benefit, not these conspiracy theorists! 😉



So the authors of the missinformation in the video are, among others:
WHO
Bill & Melinda Gates Foundation
World Bank
World Economic Forum
Johns Hopkins
Lufthansa
and many more

Bonus: the video has actually NOTHING, ZERO, 0 to do with the BS fact-checkers are munching there, it’s not about the man-made origins of the virus or anything like that.
Remember:

It doesn’t matter what Facebook says

Silviu “Silview” Costinescu
I think Facebook’s combat style is called Fact-Fu


I don’t know it but I bet factcheck.org took money from Gates to label him as a conspiracy head.

Please watch and share our Facebook upload, if not to raise awareness, at least just to piss off these douchebags!

First hour of the simulation is already on our Bitchute, Youtube, we have a BrandNewTube channel too now. All full of “conspiracies”.

At least good thing Facebook and its “independent fact-checkers” are not mere narrative-enforcers and smear-machines 😀

And if you got to here, you also need to read:

DIY: HOW TO EASILY PROVE FACEBOOK STEALS MONEY BY FAKING REPORTS

JOIN THE PEOPLE FOR FAUCI FASHION NOW! [UPDATED]

[EXCLUSIVE] FINAL EVIDENCE COVID-19 IS A ‘SIMEX’ – PLANNED SIMULATION EXERCISE BY WHO AND WORLD BANK

Our current Facebook cover

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SOURCE

by Silviu “Silview” Costinescu_ Buy Me a Coffee at ko-fi.com

Experts say it acts like a booster for mental strength and self confidence.
For me.

Just finished it today, looks like this:

If really don’t like it, maybe this one is for you, on the modern tip:

Did anyone just say “This man bad, don’t listen to him”?

by Silviu “Silview” Costinescu_ Buy Me a Coffee at ko-fi.com

Among other things, I have a 25years-long career in music. Electronic, mainly.
And one thing led to anoher…
If you think this is a joke, you are correct. If you think this is damn serious, you are sharp.

Hello World! We’re here to take over all screens with a message of love and acceptance for the Fauci Fashion phenomenon.
Too many people still prioritise brain oxygenation and freedom over Fauci Fashion and that is wrong. (We have established that oxygen fits all definitions for “drug”).
Youtube is stealing our views and we were helplessly watching our counter going backwards. That is very wrong! (good thing they don’t count Rona cases with the same accuracy and intentions)
Our muse and guiding lighthouse in Covidiocracy, Dr. Tony Fauci, gets diminished and that’s unacceptable!!! (almost used caps…)
So enough of that!
We’re asking your help to get Fauci Fashion (as seen below) into all music charts, and send out a message to everyone that we can’t be silenced. (it’s actually very doable)
Fauci Fashion is here to stay and give you Maskne! (it’s like acne, but from the mask, we’ll post links later if you need)
If you want to join the movement, read all our posts and follow your conscience. A developed conscience will know what to make of this, the rest won’t and they won’t matter 

The People for Fauci Fashion
Fauci IS Fashion

This is the introductory word to the work of an enthusiastic supporter, with all the help I and other supporters can provide. Can’t put it in words how grateful I am!
Yes, with your support, we want to attack official charts with this tune, as a way to get our voice where only Eminems and Cardi Bs can. The track is officially registered and every official stream and download counts, just use these sources.

As a music industry insider, I have the data and the method to mathematically calculate that it’s doable. We planned this carefully and we can mobilise a few thousand involved supporters that can move millions more, that can move billions. If we put together a few of your clicks with our products, know-how and strategy, we have a good shot at it.

Media is already starting to show interest, but it’s way too early to brag, we’ve just launched the initiative.

The music track (and many more)is available for free download from our Bandcamp page, this is not a business or about sales, this is about breaking a blockade. It’s “name your price” release, feel free to insert 0 if that’s the case, I still want you to have them all when you need them, even if you can’t contribute now.
We contribute what we can, when we can, IF we WANT.

And we devised a few simple and effortless ways you can get involved in our fake grassroots movement with a secret dark agenda to sabotage Covidiocracy. Because this can’t work without people like you, but can move things in the right direction with you aboard.

The short help course reads like this:
 It’s all about attention, we live in an attention economy now, we need a bit of yours to join ours and kickstart until this provides for itself. You can basically help us get more attention two main ways:
– By streaming, sharing and downloading the F out of Fauci Fashion from these official links: https://fanlink.to/cc1
– By using the Donate button on our shadow organisation’s webpage, which is right here, see the main menu on top 🙂
These funds are meant to buy ads, hire promoters and bribe media. Of course we will use most of it like Gates and Bono’s charities: in personal interest; but the rest will achieve our goals and everyone will be happy.
If you really need serious money talk: all money in the world are worthless when you have no future, like humanity under Covidiocracy. So I’m already putting everything in this work, with or without help, but it might not be enough without you. Either way, sponsoring change is the only way I can make money worth anything now.

The true Faucy Style

If you want to achieve maximum impact with your resources, here’s the details you need to know:
most efficient tools you have are
* official downloads from sites like Amazon or Juno, one track download equals 100 free streams. And one stream from a paid/premium account = about 5-6 free streams. They are also better reported and accounted too, there’s less accounts of fraud, while Youtube robbed us blind to our faces, turning back the counter;
Bundle purchases help less than individual track purchases, for some reasons related to how the charts are calculated.
* direct donations; because we have the data on how and where funds can make the best impact at a certain moment and its technically impossible to share all that knowledge and know-how.
For Paypal, use the button on this website, for cards hit the Bandcamp page, download what you like and pay what you like.
Unfortunately no crypto wallets available.
* website embeds and social shares. All platforms love that and google favors it a lot. However, Facebook hates external links, so if it’s not a paid post, it’s best to share the Facebook page itself.
Here’s a win-win trick you can do if you have a Facebook page, let’s say:
Instead of donating to us, make a dope post with the video or the Spotify player and use the money to buy promotion for it. This way you drive attention to both your page and our initiative, double win!

Soon we will devise more ways to grow this.

https://www.facebook.com/FauciFashion/

And if you really don’t like Fauci Fashion, we understand, feel free to purchase Covidiocracy T-shirts and hats from our shop. But most of those money won’t go to us, our percentage is tiny.
We don’t make any blood money on the masks, that’s manufacturer’s price.

updates:

This will most probably become like a running thread because we have interesting developments almost daily. Here are some of them

August 3rd 2020:
This happened. And even more interesting than the video is what happened when we uploaded it on Facebook, see below!

We uploaded this video on our Facebook page too and guess what happened to two people (me and a friend, in fact) the second we started to share it in private messages, verbatim copy incidents: We get locked out by Facebook who was claiming the accounts got hacked and they need to re-secure them. So we went through password changing and a whole f-ing test to regain access.
The hacking never actually happened, it was basically a false flag by Facebook, who have been long time shilling for China and Fauci.
Most of you users must have got the news that Fakebook’s just launched the new official private message censorship policy, which is basically an AI set to ban keywords and links. Much more complicated than that, but basically that. And the new toaster wasn’t set yet to the right temperature when we started to share inconvenient content.
Facebook’s pretense that two of our accounts were attacked, coincidentally and precisely when they were sharing the same video in PM’s – that’s dumb af, Suckerborg!

In other news, EDM Nations mag is with us more vigorously than China 🙂

The Swag is strong with this one

September 13th:
This escalated faster the we anticipated and we had to re-title our video to better reflect the developments:

Ever watched a heist live online? Hit the video and watch the counters.

Long story short:
Our target with The People for Fauci Fashion was 10,000 Youtube views and about as many streams on Spotify first half of September. Spotify went well since Day#1, no worries there.
First days we got the video some bumps in traffic, a solid few hundred views went away, we hardly documented it because we couldn’t believe our eyes we’re watching the counter going backwards.
We went over the shock, took it as an accident, got some more press, tricked the Facebook robots to approve our clips and literally paid Suckerborg to distribute out video across Facebook, mobilised some supporters and got things going, with a few ups and downs.
By Friday 11th we were at about 8,500 Youtube views and imaginary Champagne bottles went to the freezer before I went to bed.
Saturday morning I woke up to only about 8,900 views, I raised an eyebrow, but OK.
Before I finished my coffee we were down to around 7,300. Took me a while to process and react, mobilise some people etc, so first screenshot is from the afternoon at around 6,300 views.
Made noise, tons more people watched the video, Sunday afternoon we’re down 100 views and about 10 likes.
Regardless of what you think of our initiative, from Youtubers’ household budgets to entire industries, we all are hugely influenced by Youtube, Facebook and Twitter numbers and reports. And they are arbitrary. They insert there whatever figures they damn please. If you have doubts about that, read here how you yourself can prove Facebook is pick-pocketing users and advertisers, we learned it the hard way, and a lot more while promoting this project.

Meanwhile, reality has become even harder to distinguish from memes and parodies.


Is it a meme, is it “fake news”, is it “real news”?

By Sunday afternoon everything turned again…
#LMAO @ #Youtube: I Did a little roll call, pushed back, outed them everywhere and whatcha guess, the power is back. Not the views, though.
Did everyone just die this week-end?!
Youtube almost brags and rubs in our face the thick chunk of views they took from our video. Globalist scum, basically.

Monday: Same story reloaded, this time we kinda streamed it live on Facebook and other socials.

Before
Now



“Fauci Fashion” is part of a larger music release that has just been made available on most quality digital platforms that support electronic dance music.

Imagine a fist with five middle fingers up. Even 6 on Bandcamp or Youtube.
This is the official description of Alien Pimp’s newest EP.
Straight from the depths of the deepest Coronavirus mental and emotional depression, with one hand swinging the sword of comedy and with the other – the hammer of tragedy, here comes the sound of the “New Normal”. It’s angry, pissed, acid, deep, dark, ironic, silly, it’s everything punk aspired to be, but with computers and true care for the sound engineering. It doesn’t even matter if you like it, this EP is here to take a snap of history and set a stone. Alien Pimp did that before a few times, he pushed the bass music hybridization 10 years ago, and precisely 20 years ago he got featured on CNN for the pioneering internet as a medium for audio-visual collaborations. And now a new age awaits a new turn, especially in arts, you can be part of it or part of the past. And it’s pointless to even try stopping it, berating and belittling it, as it is pointless to ignore it. It is, it happened and it won’t go away, more so than the times that lead to its creation.
Every track comes ‘equipped” with visual support created by the musician himself. He practices something he calls “new media” or “Silview media” (from his own name and website), it’s a fusion of formats and aesthetics shaped by the current times and technology. It blends a bit of everything, from retro-futurism to memes and tiktok. Some tracks have vertical videos designed for phones, other resemble animated gifs and so forth.
In short: this is the sound o’ the times.
“Don’t like it? Imagine how much I love living the times that inspired it! Like it? You know what to do…”, says Alien Pimp.

Alien-Pimp.com

Enough blah now, this will be updated, it’s action time, thank you for everything!

So how do you go…

…from this (2016)

… to this…

… in less than four years? Must be some breakthrough science again, maybe viruses are getting fat like Brits, or maybe they invented invisible masks now, right?
No. Politics and media narratives changed. Nature works the same, masks are as lame as they ever were when it comes to virus protection.
See for yourself and you will understand why this article is not up anymore.

When did they embraced dogma, yesterday or today? Why?

Below is the full, unedited article, in all its beauty.
Probably the most valuable part is the references collection, as well as this little announcement hanged by the Oral Health collective at the end of the piece, just to trash it a bit later for no actual reason:

Oral Health welcomes this original article.

Why Face Masks Don’t Work: A Revealing Review

October 18, 2016
by John Hardie, BDS, MSc, PhD, FRCDC

Yesterday’s Scientific Dogma is Today’s Discarded Fable

Introduction
The above quotation is ascribed to Justice Archie Campbell author of Canada’s SARS Commission Final Report. 1 It is a stark reminder that scientific knowledge is constantly changing as new discoveries contradict established beliefs. For at least three decades a face mask has been deemed an essential component of the personal protective equipment worn by dental personnel. A current article, “Face Mask Performance: Are You Protected” gives the impression that masks are capable of providing an acceptable level of protection from airborne pathogens. 2 Studies of recent diseases such as Severe Acute Respiratory Syndrome (SARS), Middle Eastern Respiratory Syndrome (MERS) and the Ebola Crisis combined with those of seasonal influenza and drug resistant tuberculosis have promoted a better understanding of how respiratory diseases are transmitted. Concurrently, with this appreciation, there have been a number of clinical investigations into the efficacy of protective devices such as face masks. This article will describe how the findings of such studies lead to a rethinking of the benefits of wearing a mask during the practice of dentistry. It will begin by describing new concepts relating to infection control especially personal protective equipment (PPE).

Trends in Infection Control
For the past three decades there has been minimal opposition to what have become seemingly established and accepted infection control recommendations. In 2009, infection control specialist Dr. D. Diekema questioned the validity of these by asking what actual, front-line hospital-based infection control experiences were available to such authoritative organization as the Centers for Disease Control and Prevention (CDC), the Occupational Safety and Health Association (OSHA) and the National Institute for Occupational Safety and Health (NIOSH). 3 In the same year, while commenting on guidelines for face masks, Dr. M. Rupp of the Society for Healthcare Epidemiology of America noted that some of the practices relating to infection control that have been in place for decades, ”haven’t been subjected to the same strenuous investigation that, for instance, a new medicine might be subjected.” 4 He opined that perhaps it is the relative cheapness and apparent safety of face masks that has prevented them from undergoing the extensive studies that should be required for any quality improvement device. 4 More recently, Dr. R. MacIntyre, a prolific investigator of face masks, has forcefully stated that the historical reliance on theoretical assumptions for recommending PPEs should be replaced by rigorously acquired clinical data. 5 She noted that most studies on face masks have been based on laboratory simulated tests which quite simply have limited clinical applicability as they cannot account for such human factors as compliance, coughing and talking. 5

Covering the nose and mouth for infection control started in the early 1900s when the German physician Carl Flugge discovered that exhaled droplets could transmit tuberculosis. 4 The science regarding the aerosol transmission of infectious diseases has, for years, been based on what is now appreciated to be “very outmoded research and an overly simplistic interpretation of the data.” 6 Modern studies are employing sensitive instruments and interpretative techniques to better understand the size and distribution of potentially infectious aerosol particles. 6 Such knowledge is paramount to appreciating the limitations of face masks. Nevertheless, it is the historical understanding of droplet and airborne transmission that has driven the longstanding and continuing tradition of mask wearing among health professionals. In 2014, the nursing profession was implored to “stop using practice interventions that are based on tradition” but instead adopt protocols that are based on critical evaluations of the available evidence. 7

A December 2015 article in the National Post seems to ascribe to Dr. Gardam, Director of Infection Prevention and Control, Toronto University Health Network the quote, “I need to choose which stupid, arbitrary infection control rules I’m going to push.” 8 In a communication with the author, Dr. Gardam explained that this was not a personal belief but that it did reflect the views of some infection control practitioners. In her 2014 article, “Germs and the Pseudoscience of Quality Improvement”, Dr. K Sibert, an anaesthetist with an interest in infection control, is of the opinion that many infection control rules are indeed arbitrary, not justified by the available evidence or subjected to controlled follow-up studies, but are devised, often under pressure, to give the appearance of doing something. 9

The above illustrate the developing concerns that many infection control measures have been adopted with minimal supporting evidence. To address this fault, the authors of a 2007 New England Journal of Medicine (NEJM) article eloquently argue that all safety and quality improvement recommendations must be subjected to the same rigorous testing as would any new clinical intervention. 10 Dr. R. MacIntyre, a proponent of this trend in infection control, has used her research findings to boldly state that, “it would not seem justifiable to ask healthcare workers to wear surgical masks.” 4 To understand this conclusion it is necessary to appreciate the current concepts relating to airborne transmissions.

Airborne Transmissions
Early studies of airborne transmissions were hampered by the fact that the investigators were not able to detect small particles (less than 5 microns) near an infectious person. 6 Thus, they assumed that it was the exposure of the face, eyes and nose to large particles (greater than 5 microns) or “droplets” that transmitted the respiratory condition to a person in close proximity to the host. 6 This became known as “droplet infection”, and 5 microns or greater became established as the size of large particles and the traditional belief that such particles could, in theory, be trapped by a face mask. 5 The early researchers concluded that since only large particles were detected near an infectious person any small particles would be transmitted via air currents, dispersed over long distances, remain infective over time and might be inhaled by persons who never had any close contact with the host. 11 This became known as “airborne transmission” against which a face mask would be of little use. 5

Through the use of highly sensitive instruments it is now appreciated that the aerosols transmitted from the respiratory tract due to coughing, sneezing, talking, exhalation and certain medical and dental procedures produce respiratory particles that range from the very small (less than 5 microns) to the very large (greater than a 100 microns) and that all of these particles are capable of being inhaled by persons close to the source. 6, 11 This means that respiratory aerosols potentially contain bacteria averaging in size from 1-10 microns and viruses ranging in size from 0.004 to 0.1 microns. 12 It is also acknowledged that upon their emission large “droplets” will undergo evaporation producing a concentration of readily inhalable small particles surrounding the aerosol source. 6

The historical terms “droplet infection” and “airborne transmission” defined the routes of infection based on particle size. Current knowledge suggests that these are redundant descriptions since aerosols contain a wide distribution of particle sizes and that they ought to be replaced by the term, “aerosol transmissible.” 4, 5 Aerosol transmission has been defined as “person –to – person transmission of pathogens through air by means of inhalation of infectious particles.” 26 In addition, it is appreciated that the physics associated with the production of the aerosols imparts energy to microbial suspensions facilitating their inhalation. 11

Traditionally face masks have been recommended to protect the mouth and nose from the “droplet” route of infection, presumably because they will prevent the inhalation of relatively large particles. 11 Their efficacy must be re-examined in light of the fact that aerosols contain particles many times smaller than 5 microns. Prior to this examination, it is pertinent to review the defence mechanism of the respiratory tract.

Respiratory System Defences
Comprehensive details on the defence mechanisms of the respiratory tract will not be discussed. Instead readers are reminded that; coughing, sneezing, nasal hairs, respiratory tract cilia, mucous producing lining cells and the phagocytic activity of alveolar macrophages provide protection against inhaled foreign bodies including fungi, bacteria and viruses. 13 Indeed, the pathogen laden aerosols produced by everyday talking and eating would have the potential to cause significant disease if it were not for these effective respiratory tract defences.

These defences contradict the recently published belief that dentally produced aerosols, “enter unprotected bronchioles and alveoli.” 2 A pertinent demonstration of the respiratory tract’s ability to resist disease is the finding that- compared to controls- dentists had significantly elevated levels of antibodies to influenza A and B and the respiratory syncytial virus. 14 Thus, while dentists had greater than normal exposure to these aerosol transmissible pathogens, their potential to cause disease was resisted by respiratory immunologic responses. Interestingly, the wearing of masks and eye glasses did not lessen the production of antibodies, thus reducing their significance as personal protective barriers. 14 Another example of the effectiveness of respiratory defences is that although exposed to more aerosol transmissible pathogens than the general population, Tokyo dentists have a significantly lower risk of dying from pneumonia and bronchitis. 15 The ability of a face mask to prevent the infectious risk potentially inherent in sprays of blood and saliva reaching the wearers mouth and nose is questionable since, before the advent of mask use, dentists were no more likely to die of infectious diseases than the general population. 16

The respiratory tract has efficient defence mechanisms. Unless face masks have the ability to either enhance or lessen the need for such natural defences, their use as protection against airborne pathogens must be questioned.

Face Masks
History: Cloth or cotton gauze masks have been used since the late 19th century to protect sterile fields from spit and mucous generated by the wearer. 5,17,18 A secondary function was to protect the mouth and nose of the wearer from the sprays and splashes of blood and body fluids created during surgery. 17 As noted above, in the early 20th century masks were used to trap infectious “droplets” expelled by the wearer thus possibly reducing disease transmission to others. 18 Since the mid-20th century until to-day, face masks have been increasingly used for entirely the opposite function: that is to prevent the wearer from inhaling respiratory pathogens. 5,20,21 Indeed, most current dental infection control recommendations insist that a face mask be worn, “as a key component of personal protection against airborne pathogens”. 2

Literature reviews have confirmed that wearing a mask during surgery has no impact whatsoever on wound infection rates during clean surgery. 22,23,24,25,26 A recent 2014 report states categorically that no clinical trials have ever shown that wearing a mask prevents contamination of surgical sites. 26 With their original purpose being highly questionable it should be no surprise that the ability of face masks to act as respiratory protective devices is now the subject of intense scrutiny. 27 Appreciating the reasons for this, requires an understanding of the structure, fit and filtering capacity of face masks.

Structure and Fit: Disposable face masks usually consist of three to four layers of flat non-woven mats of fine fibres separated by one or two polypropylene barrier layers which act as filters capable of trapping material greater than 1 micron in diameter. 18,24,28 Masks are placed over the nose and mouth and secured by straps usually placed behind the head and neck. 21 No matter how well a mask conforms to the shape of a person’s face, it is not designed to create an air tight seal around the face. Masks will always fit fairly loosely with considerable gaps along the cheeks, around the bridge of the nose and along the bottom edge of the mask below the chin. 21 These gaps do not provide adequate protection as they permit the passage of air and aerosols when the wearer inhales. 11,17 It is important to appreciate that if masks contained filters capable of trapping viruses, the peripheral gaps around the masks would continue to permit the inhalation of unfiltered air and aerosols. 11

Filtering Capacity: The filters in masks do not act as sieves by trapping particles greater than a specific size while allowing smaller particles to pass through. 18 Instead the dynamics of aerosolized particles and their molecular attraction to filter fibres are such that at a certain range of sizes both large and small particles will penetrate through a face mask. 18 Accordingly, it should be no surprise that a study of eight brands of face masks found that they did not filter out 20-100% of particles varying in size from 0.1 to 4.0 microns. 21 Another investigation showed penetration ranges from 5-100% when masks were challenged with relatively large 1.0 micron particles. 29 A further study found that masks were incapable of filtering out 80-85% of particles varying in size from 0.3 to 2.0 microns. 30 A 2008 investigation identified the poor filtering performance of dental masks. 27 It should be concluded from these and similar studies that the filter material of face masks does not retain or filter out viruses or other submicron particles. 11,31 When this understanding is combined with the poor fit of masks, it is readily appreciated that neither the filter performance nor the facial fit characteristics of face masks qualify them as being devices which protect against respiratory infections. 27 Despite this determination the performance of masks against certain criteria has been used to justify their effectiveness.2 Accordingly, it is appropriate to review the limitations of these performance standards.

Performance Standards: Face masks are not subject to any regulations. 11 The USA Federal Food and Drug Administration (FDA) classifies face masks as Class II devices. To obtain the necessary approval to sell masks all that a manufacturer need do is satisfy the FDA that any new device is substantially the same as any mask currently available for sale. 21 As ironically noted by the Occupational Health and Safety Agency for Healthcare in BC, “There is no specific requirement to prove that the existing masks are effective and there is no standard test or set of data required supporting the assertion of equivalence. Nor does the FDA conduct or sponsor testing of surgical masks.” 21 Although the FDA recommends two filter efficiency tests; particulate filtration efficiency (PFE) and bacterial filtration efficiency (BFE) it does not stipulate a minimum level of filter performance for these tests. 27 The PFE test is a basis for comparing the efficiency of face masks when exposed to aerosol particle sizes between 0.1 and 5.0 microns. The test does not assess the effectiveness of a mask in preventing the ingress of potentially harmful particles nor can it be used to characterize the protective nature of a mask. 32 The BFE test is a measure of a mask’s ability to provide protection from large particles expelled by the wearer. It does not provide an assessment of a mask’s ability to protect the wearer. 17 Although these tests are conducted under the auspices of the American Society of Testing and Materials (ASTM) and often produce filtration efficiencies in the range of 95-98 %, they are not a measure of a masks ability to protect against respiratory pathogens. Failure to appreciate the limitations of these tests combined with a reliance on the high filtration efficiencies reported by the manufacturers has, according to Healthcare in BC, “created an environment in which health care workers think they are more protected than they actually are.” 21 For dental personnel the protection sought is mainly from treatment induced aerosols.

Dental Aerosols
For approximately 40 years it has been known that dental restorative and especially ultrasonic scaling procedures produce aerosols containing not only blood and saliva but potentially pathogenic organisms. 33 The source of these organisms could be the oral cavities of patients and/or dental unit water lines. 34 Assessing the source and pathogenicity of these organisms has proven elusive as it is extremely difficult to culture bacteria especially anaerobes and viruses from dental aerosols. 34 Although there is no substantiated proof that dental aerosols are an infection control risk, it is a reasonable assumption that if pathogenic microbes are present at the treatment site they will become aerosolized and prone to inhalation by the clinician which a face mask will not prevent. As shown by the study of UK dentists, the inhalation resulted in the formation of appropriate antibodies to respiratory pathogens without overt signs and symptoms of respiratory distress. 14 This occurred whether masks were or were not worn. In a 2008 article, Dr. S. Harrel, of the Baylor College of Dentistry, is of the opinion that because there is a lack of epidemiologically detectable disease from the use of ultrasonic scalers, dental aerosols appear to have a low potential for transmitting disease but should not be ignored as a risk for disease transmission. 34 The most effective measures for reducing disease transmission from dental aerosols are pre-procedural rinses with mouthwashes such as chlorhexidine, large diameter high volume evacuators, and rubber dam whenever possible. 33 Face masks are not useful for this purpose, and Dr. Harrel believes that dental personnel have placed too great a reliance on their efficacy. 34 Perhaps this has occurred because dental regulatory agencies have failed to appreciate the increasing evidence on face mask inadequacies.

The Inadequacies
Between 2004 and 2016 at least a dozen research or review articles have been published on the inadequacies of face masks. 5,6,11,17,19,20,21,25,26,27,28,31 All agree that the poor facial fit and limited filtration characteristics of face masks make them unable to prevent the wearer inhaling airborne particles. In their well-referenced 2011 article on respiratory protection for healthcare workers, Drs. Harriman and Brosseau conclude that, “facemasks will not protect against the inhalation of aerosols.” 11 Following their 2015 literature review, Dr. Zhou and colleagues stated, “There is a lack of substantiated evidence to support claims that facemasks protect either patient or surgeon from infectious contamination.” 25 In the same year Dr. R. MacIntyre noted that randomized controlled trials of facemasks failed to prove their efficacy. 5 In August 2016 responding to a question on the protection from facemasks the Canadian Centre for Occupational Health and Safety replied:

  • The filter material of surgical masks does not retain or filter out submicron particles;
  • Surgical masks are not designed to eliminate air leakage around the edges;
  • Surgical masks do not protect the wearer from inhaling small particles that can remain airborne for long periods of time. 31

In 2015, Dr. Leonie Walker, Principal Researcher of the New Zealand Nurses Organization succinctly described- within a historical context – the inadequacies of facemasks, “Health care workers have long relied heavily on surgical masks to provide protection against influenza and other infections. Yet there are no convincing scientific data that support the effectiveness of masks for respiratory protection. The masks we use are not designed for such purposes, and when tested, they have proved to vary widely in filtration capability, allowing penetration of aerosol particles ranging from four to 90%.” 35

Face masks do not satisfy the criteria for effectiveness as described by Drs. Landefeld and Shojania in their NEJM article, “The Tension between Needing to Improve Care and Knowing How to Do It. 10 The authors declare that, “…recommending or mandating the widespread adoption of interventions to improve quality or safety requires rigorous testing to determine whether, how, and where the intervention is effective…” They stress the critical nature of this concept because, “…a number of widely promulgated interventions are likely to be wholly ineffective, even if they do not harm patients.” 10 A significant inadequacy of face masks is that they were mandated as an intervention based on an assumption rather than on appropriate testing.

Conclusions
The primary reason for mandating the wearing of face masks is to protect dental personnel from airborne pathogens. This review has established that face masks are incapable of providing such a level of protection. Unless the Centers for Disease Control and Prevention, national and provincial dental associations and regulatory agencies publically admit this fact, they will be guilty of perpetuating a myth which will be a disservice to the dental profession and its patients. It would be beneficial if, as a consequence of the review, all present infection control recommendations were subjected to the same rigorous testing as any new clinical intervention. Professional associations and governing bodies must ensure the clinical efficacy of quality improvement procedures prior to them being mandated. It is heartening to know that such a trend is gaining a momentum which might reveal the inadequacies of other long held dental infection control assumptions. Surely, the hallmark of a mature profession is one which permits new evidence to trump established beliefs. In 1910, Dr. C. Chapin, a public health pioneer, summarized this idea by stating, “We should not be ashamed to change our methods; rather, we should be ashamed not to do so.” 36 Until this occurs, as this review has revealed, dentists have nothing to fear by unmasking. OH


Oral Health welcomes this original article.

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