Mask mandates have been a globally used epidemiologic intervention during the ongoing COVID-19 pandemic, above all based on the assumption of reduced infection rates. Although there is now much evidence for the latter, the effect of facemasks on the individual and its course of disease has remained controversial. While there are concepts suggesting a protective effect and a better outcome for the individual, public opinion has placed concepts with opposite outcomes in the vicinity of conspiracy theories.

However, here I show that counties with mask mandates in Kansas during the summer of 2020 had significantly higher case fatality rates compared to Kansas counties without mask mandates, with a risk ratio of 1.85 for death with COVID-19.

Even after adjusting for the number of ‘protected persons’, i.e. the number of persons who were not infected in the mask-mandated group compared to the no-mask group, the risk ratio remains highly significant at 1.52.

Over 95% of this effect can solely be attributed to COVID-19.

Why this happens and the possible connection between long-term effects associated with SARS-CoV-2 and facemasks are explained in theory herein by the 'foegen effect', which describes the deep reinhalation of pure virions that were caught in the facemasks as droplets.