At present, there is no evidence on the effectiveness of universal masking of healthy people in the community to prevent infection with respiratory viruses, including SARS-CoV-2. Mandatory use of masks in public open spaces, regardless of the risk of transmission or of whether or not the interpersonal safety distance can be kept, is an intrusive measure that restricts individual freedoms, and would not appear to be justified on the basis of available scientific evidence.
The results caution against the use of cloth masks. Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection. As a precautionary measure, cloth masks should not be recommended for HCWs, particularly in high-risk situations, and guidelines need to be updated.
German registry of parent-reported complaints in children and adolescents caused by wearing a mask, data on over 25k individuals. Average wearing time was 270mins. Impairments caused by mask-wearing were reported by 68% of the parents, including irritability (60%), headache (53%), difficulty concentrating (50%), less happiness (49%), reluctance to go to school/kindergarten (44%), malaise (42%) impaired learning (38%) and drowsiness or fatigue (37%). This suggests that the wearing of face masks does not allow children to be at their best to learn.
https://assets.researchsquare.com/files/rs-124394/v1/50eb83f9-5a10-44ee-80c4-4de6dd61c6f1.pdf
The potential disadvantages of mask use by healthy people in the general public include:
- headache and/or breathing difficulties, depending on type of mask used
- development of facial skin lesions, irritant dermatitis or worsening acne, when used frequently for long hours
- difficulty with communicating clearly, especially for persons who are deaf or have poor hearing or use lip reading
- discomfort
- a false sense of security leading to potentially lower adherence to other critical preventive measures such as physical distancing and hand hygiene
- poor compliance with mask wearing, in particular by young children
- waste management issues; improper mask disposal leading to increased litter in public places and environmental hazards
- disadvantages for or difficulty wearing masks, especially for children, developmentally challenged persons, those with mental illness, persons with cognitive impairment, those with asthma or chronic respiratory or breathing problems, those who have had facial trauma or recent oral maxillofacial surgery and those living in hot and humid environments.
https://apps.who.int/iris/bitstream/handle/10665/337199/WHO-2019-nCov-IPC_Masks-2020.5-eng.pdf
Face coverings negatively impacted hearing, understanding, engagement, and feelings of connection with the speaker. Face coverings impacted communication content, interpersonal connectedness, and willingness to engage in conversation; they increased anxiety and stress, and made communication fatiguing, frustrating and embarrassing – both as a speaker wearing a face covering, and when listening to someone else who is wearing one.
https://www.tandfonline.com/doi/full/10.1080/14992027.2020.1851401
Face masks surfaces can become contamination sources. People are storing them in their pockets, bags, putting them on tables, people are reusing them etc.
This leads in turn to impairments attributable to hypercapnia. A recent review concluded that there was ample evidence for adverse effects of wearing such masks. We suggest that decision-makers weigh the hard evidence produced by these experimental measurements accordingly, which suggest that children should not be forced to wear face masks.
https://jamanetwork.com/journals/jamapediatrics/fullarticle/2781743
If widespread masking continues, then the potential for inhaling mask fibers and environmental and biological debris continues on a daily basis for hundreds of millions of people. This should be alarming for physicians and epidemiologists knowledgeable in occupational hazards.
https://pdmj.org/papers/masks_false_safety_and_real_dangers_part1/
A comprehensive study analysing scientifically proven side effects of wearing masks, spanning psychological and physical deterioration as well as multiple symptoms described because of their consistent, recurrent and uniform presentation from different disciplines as a Mask-Induced Exhaustion Syndrome (MIES).
The authors conclude that “further research is particularly desirable in the gynecological (fetal and embryonic) and pediatric fields, as children are a vulnerable group that would face the longest and, thus, most profound consequences of a potentially risky mask use.”
Facemasks offer limited protection in preventing infection and aerosol transmission through mucous membranes (i.e. conjunctiva). Meanwhile, a negative impact on the patient’s perceived empathy and relational continuity can reduce potential therapeutic effects such as decreased depression, improved immune response, improved quality of life and improved health outcomes.
We know that wearing a mask outside healthcare facilities offers little, if any, protection from infection. Public health authorities define a significant exposure to CoVID-19 as face-to-face contact within 6 feet with a patient with symptomatic CoVID-19 that is sustained for at least a few minutes. The chance of catching CoVID-19 from a passing interaction in a public space is therefore minimal. In many cases, the desire for widespread masking is a reflexive reaction to anxiety over the pandemic.
It can be concluded that N95 and surgical facemasks can induce significantly different temperatures and humidity in the microclimates of facemasks, which have profound influences on heart rate and thermal stress and subjective perception of discomfort.
This study is an analysis of what has become known as ‘Mask Eye’. Air blowing upward from the mask into eyes likely accelerates the evaporation of the tear film which, with prolonged mask use, may result in ocular surface irritation or inflammation. This together with increasing eye rubbing and face touching due to discomfort from dry eyes create an increased concern for ocular infections secondary to prolonged mask wear. This risk is particularly worrisome during the current pandemic due to a well-documented probability of the novel coronavirus spreading through contact with the eye.
These findings support ongoing recommendations against the use of N95 masks by the general public during the COVID-19 pandemic. N95 mask use by the general public may not translate into effective protection but instead provide false reassurance. Beyond N95 masks, proficiency among the general public in donning surgical masks needs to be assessed.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2766070
Considering our findings, pulse rates of the surgeon’s increase and SpO2 decrease after the first hour. This early change in SpO2 may be either due to the facial mask or the operational stress. Since a very small decrease in saturation at this level, reflects a large decrease in PaO2, our findings may have a clinical value for the health workers and the surgeons.
The COVID-19 pandemic has led to critical shortages of medical-grade PPE. Alternative forms of facial protection offer inferior protection. More robust evidence is required on different types of medical-grade facial protection. As research on COVID-19 advances, investigators should continue to examine the impact on alternatives of medical-grade facial protection.
The use of surgical masks with ear loops in growing children for many hours a day not only leads to intolerance and decubitus of the retroauricular skin (as for adults), but can also influence the correct growth and angulation of the outer ear with the consequent increase in the incidence of protrusion of the outer auricle.
Out of 876 participants, only 27 people (3.1%) did not complain of any problems related to face mask-wearing. Out of all reported inconveniences, difficulty in breathing appeared to be the most common one (35.9%), followed by warming/sweating (21.3%), misting up of the glasses (21.3%), and slurred speech (12.3%). Interestingly, other skin bothersome reactions related to wearing of face masks were reported less often (itch–7.7%, skin irritation–0.9%).
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.
A systematic review and meta-analysis of randomised controlled trials and observational studies comparing face mask use to any active intervention or to control.
They concluded that “currently, existing research does not allow firm conclusions as there are insufficient data to quantify all of the adverse effects that might reduce the acceptability, adherence and effectiveness of face masks.” They recommended that “any new research on face masks should assess and report the harms and downsides, including behavioural issues (ie, risk compensation behaviour) and the psychological impact of mandated face mask wear.”
https://bmjopen.bmj.com/content/bmjopen/11/2/e044364.full.pdf
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.
Although surgical mask media may be adequate to remove bacteria exhaled or expelled by health care workers, they may not be sufficient to remove the submicrometer-size aerosols containing pathogens to which these health care workers are potentially exposed.
Face coverings may also be associated with an increased risk of bacterial skin infections, including impetigo, around the mouth. This may be particularly distressing for children and teenagers, affecting their confidence and self-image.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280724/pdf/DTH-9999-na.pdf
Face mask use in health care workers has not been demonstrated to provide benefit in terms of cold symptoms or getting colds. A larger study is needed to definitively establish noninferiority of no mask use.
There were 17 eligible studies… None of the studies established a conclusive relationship between mask ⁄ respirator use and protection against influenza infection.
https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1750-2659.2011.00307.x
We identified 6 clinical studies … In the meta-analysis of the clinical studies, we found no significant difference between N95 respirators and surgical masks in associated risk of a laboratory-confirmed respiratory infection or influenza-like illness.
The confirmed effectiveness of medical masks is crucially important for lower-resource and emergency settings lacking access to N95 respirators. In such cases, single-use medical masks are preferable to cloth masks, for which there is no evidence of protection and which might facilitate transmission of pathogens when used repeatedly without adequate sterilization.
Exercising with facemasks may reduce available Oxygen and increase air trapping preventing substantial carbon dioxide exchange. The hypercapnic hypoxia may potentially increase acidic environment, cardiac overload, anaerobic metabolism and renal overload, which may substantially aggravate the underlying pathology of established chronic diseases.
The N95 filtering face piece respirators may not provide the expected protection level against small virions. Some surgical masks may let a significant fraction of airborne viruses penetrate through their filters, providing very low protection against aerosolized infectious agents in the size range of 10 to 80 nm. It should be noted that the surgical masks are primarily designed to protect the environment from the wearer, whereas the respirators are supposed to protect the wearer from the environment.
The contamination problems of wearing masks for extended periods of time have been known for some time. They were so well known that Chinese doctors in 2018 conducted a study of masks in hospital surgeries to try to come up with guidelines on how to minimize the problem.
This study used dye to show if masks were contaminated. “As a result, masks surface become a contamination source. In the contact experiment, ten adults were requested to don and doff a surgical mask while doing a word processing task. The extended contamination areas were recorded and identified by image analysis.”
A Randomized Controlled Trial, Bundgaard, March 2021
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% in a community with modest infection rates, some degree of social distancing, and uncommon general mask use.
Breathing through N95 mask materials have been shown to impede gaseous exchange and impose an additional workload on the metabolic system of pregnant healthcare workers, and this needs to be taken into consideration in guidelines for respirator use. The benefits of using N95 mask to prevent serious emerging infectious diseases should be weighed against potential respiratory consequences associated with extended N95 respirator usage.
This study looked at health care workers using PPE and their experience of headaches. Whilst wearing PPE “most healthcare workers develop de novo PPE-associated headaches or exacerbation of their pre-existing headache disorders.”
There was a correlation between length of time in PPE and number of headaches and it was recommended to look at “reducing the exposure time by healthcare workers.“
https://headachejournal.onlinelibrary.wiley.com/doi/full/10.1111/head.13811
Of 212 healthcare workers required to wear the medical-grade N95 face mask found that 37% said the mask gave them headaches, and 32% of those people had headaches more than six times a month.
Of 212 healthcare workers required to wear the medical-grade N95 face mask found that 37% said the mask gave them headaches, and 32% of those people had headaches more than six times a month.
This study looked at health care workers using PPE and their experience of headaches. Whilst wearing PPE “most healthcare workers develop de novo PPE-associated headaches or exacerbation of their pre-existing headache disorders.”
There was a correlation between length of time in PPE and number of headaches and it was recommended to look at “reducing the exposure time by healthcare workers.“
https://headachejournal.onlinelibrary.wiley.com/doi/full/10.1111/head.13811
There is limited evidence for their effectiveness in preventing influenza virus transmission either when worn by the infected person for source control or when worn by uninfected persons to reduce exposure. Our systematic review found no significant effect of face masks on transmission of laboratory-confirmed influenza.
Breathing through N95 mask materials have been shown to impede gaseous exchange and impose an additional workload on the metabolic system of pregnant healthcare workers, and this needs to be taken into consideration in guidelines for respirator use.
https://aricjournal.biomedcentral.com/articles/10.1186/s13756-015-0086-z
