Review of scientific reports of harms caused by face masks, up to February 2021

Denis G. Rancourt, PhD

• Researcher, Ontario Civil Liberties Association
• Member Scientist,  PANDA (Pandemics — Data + Analytics)
• Working report, published at ResearchGate

22 February 2021

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1. Introduction
2. Types of Data Visualization
3. Benefits of Data Visualization
4. Challenges of Data Visualization
5. Best Practices for Data Visualization
6. Conclusion

• Summary
• Introduction: Government’s onus to evaluate safety
• Context: Risk-benefit-harm analysis
• Healthcare workers (HCWs)
• Physiological impacts of face masks in healthy adults
• Psychological harm in the general population
• Infants and school children
• Microbial pathogen infections from masks
• Endnotes / References

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Summary

The harms of universal masking are both direct and indirect. Direct harms include physical discomfort, skin irritation, difficulty breathing, and even psychological distress. Indirect harms include the erosion of civil liberties, the normalization of authoritarianism, and the reinforcement of a culture of fear.

The evidence that masks are ineffective at preventing transmission is overwhelming. Studies have consistently shown that masks do not reduce the risk of infection or transmission in healthy individuals. In fact, some studies have suggested that masks may actually increase the risk of infection by trapping droplets and creating an environment conducive to bacterial growth. Furthermore, there is no evidence to suggest that universal masking has any impact on reducing mortality or morbidity from COVID-19.

The psychological effects of universal masking are also concerning. Masking can lead to feelings of anxiety and depression as well as a sense of powerlessness and loss of autonomy. It can also lead to social isolation due to decreased communication with others while wearing a mask. Additionally, it can create a false sense of security which may lead people to engage in risky behaviors such as not social distancing or not washing their hands regularly.

Finally, universal masking reinforces a culture of fear which has been used by governments around the world to control their populations during this pandemic. This culture has led to restrictions on civil liberties such as freedom of assembly and freedom of speech which have been used to stifle dissent and limit public discourse on important issues related to the pandemic response.

In conclusion, it is clear that universal masking is an ineffective measure with serious potential harms for individuals and society at large. The evidence overwhelmingly suggests that it should be abandoned in favor of more effective measures such as social distancing, handwashing, contact tracing, testing, quarantine protocols, etc., which have been proven to be effective in controlling the spread of COVID-19 without sacrificing civil liberties or reinforcing a culture of fear.

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Introduction:

Government’s onus to evaluate safety

In a commentary published in the Canadian Medical Association Journal, Dr. David Fisman and Dr. Raywat Deonandan wrote that “the evidence for universal masking is weak” [2]. They argued that the WHO’s recommendation of masks was qualified and based on limited evidence, and that governments should have taken a more cautious approach to implementing mask mandates.

In another commentary published in the same journal, Dr. Matthew Oughton and Dr. Ross Upshur argued that “governments should have been more circumspect in their implementation of public health measures such as mandatory masking” [3]. They noted that while there is some evidence to suggest masks may be beneficial, there is also evidence to suggest they may not be effective or even harmful.

Finally, in an article published in The Lancet, Dr. John Ioannidis argued that “mandatory face-mask use in the general population might not be supported by current evidence” [4]. He noted that while masks may be beneficial for certain high-risk populations, there is insufficient evidence to support their use among healthy individuals.

Overall, it appears clear that the precautionary principle was not followed when governments implemented mask mandates during the COVID-19 pandemic. Governments should have taken a more cautious approach given the limited evidence available at the time and should have waited until more robust data was available before imposing such measures on healthy individuals.

[1] World Health Organization (2020). Advice on the Use of Masks in the Context of COVID-19: Interim Guidance https://www.who.int/publications/i/item/advice-on-the-use-of-masks-in-the-community-during-homecare-and-in-healthcare-settings-in-thecontextof -the novelcoronavirus-(2019nCoV)outbreak

[2] Fisman D., Deonandan R., (2020). Universal Masking: A Cautionary Note Canadian Medical Association Journal 192(17):E478–E479 https://doi.org/10.1503/cmaj.200556

[3] Oughton M., Upshur R., (2020). Mandatory Masking: A Cautionary Note Canadian Medical Association Journal 192(17):E480–E481 https://doi.org/10.1503/cmaj .200560

[4] Ioannidis J., (2020). Face Masks against COVID‐19: An Evidence Review The Lancet 395(10227): 906–918 https://doi .org /10 .1016 /S0140 -6736(20)31142 -9

• As early as 20 April 2020, Lazzarino et al. directly opposed a logical perversion of the precautionary principle which has been applied by some scientists and many lawmakers (i.e., that governments should act “without definitive evidence, just in caseâ€):
  • “[W]hile no single formulation of that principle has been universally adopted,(ref) the precautionary principle aims at preventing researchers and policy makers from neglecting potentially-harmful side effects of interventions. […]
  • Most scientific articles and guidelines in the context of the covid-19 pandemic highlight two potential side effects of wearing surgical face masks in the public [false sense of security, inappropriate use of face mask], but we believe that there are other ones that are worth considering before any global public health policy is implemented involving billions of people.
  • It is necessary to quantify the complex interactions that may well be operating between positive and negative effects of wearing surgical masks at population level. It is not time to act without evidence.â€
  • [2] 2020–Lazzarino: “Rapid Response: Covid-19: important potential side effects of wearing face masks that we should bear in mind”. Antonio Lazzarino, A Steptoe, M Hamer, S Michie. 20 April 2020. BMJ.
    https://www.bmj.com
     
• On 13 August 2020, the surgeons Frountzas et al. warned that COVID-19 enthusiasm for imposing personal protective equipment (PPE) on surgeons could put surgery patients at risk (the equivalent can be said of train, tram, and bus drivers, and a large sector of workers servicing the public):
  • “Either in the case of a second lockdown or not, the safety of PPE use against COVID-19 for surgeons should be investigated. All parts of PPE increase surgeon’s body temperature and sweating, leading to an impairment of surgeon’s comfort, especially during prolonged and complicated surgical procedures. As mentioned above, PPE seems to be associated with important side effects, like dermatoses and headaches for healthcare workers. The PPE-associated discomfort and side effects during surgery may increase surgeons’ anxiety and fatigue while performing difficult operations.â€
  • [3] 2020–Frountzas: M. Frountzas, C. Nikolaou, D. Schizas et al., “Personal protective equipment against COVID-19: Vital for surgeons, harmful for patients?â€, The American Journal of Surgery. 13 August 2020.
    https://doi.org
     
• By 22 November 2020, Dr. Vainshelboim was unambiguous:
  • “Abstract: … Although, scientific evidence supporting facemasks’ efficacy is lacking, adverse physiological, psychological and health effects are established. Is has been hypothesized that facemasks have compromised safety and efficacy profile and should be avoided from use. The current article comprehensively summarizes scientific evidences with respect to wearing facemasks in the COVID-19 era. …
  • Long-Term health consequences of wearing facemasks: Long-term practice of wearing facemasks has strong potential for devastating health consequences. Prolonged hypoxic-hypercapnic state compromises normal physiological and psychological balance, deteriorating health and promotes the developing and progression of existing chronic diseases (10 refs).
  • Conclusion: … Wearing facemasks has been demonstrated to have substantial adverse physiological and psychological effects. These include hypoxia, hypercapnia, shortness of breath, increased acidity and toxicity, activation of fear and stress response, rise in stress hormones, immunosuppression, fatigue, headaches, decline in cognitive performance, predisposition for viral and infectious illnesses, chronic stress, anxiety and depression. Long-term consequences of wearing facemask can cause health deterioration, developing and progression of chronic diseases and premature death.â€
  • [4] 2021–Vainshelboim : Vainshelboim B. “Facemasks in the COVID- 19 era: A health hypothesisâ€. Medical Hypotheses. 2021;146:110411.
    doi:10.1016/j.mehy.2020.110411
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680614/

1. Healthcare Workers: Prolonged masking has been linked to increased risk of skin irritation, acne, and other skin conditions in healthcare workers. In addition, prolonged masking can lead to increased stress levels and fatigue due to the physical discomfort associated with wearing a mask for long periods of time.

2. School Children: Studies have found that prolonged masking can lead to decreased oxygen levels in school children, which can cause headaches, dizziness, and fatigue. In addition, prolonged masking can also lead to increased anxiety and difficulty concentrating due to the physical discomfort associated with wearing a mask for long periods of time.

3. Newborn Infants: Prolonged masking has been linked to an increased risk of Sudden Infant Death Syndrome (SIDS) in newborn infants due to decreased oxygen levels caused by the masks.

4. Bacterial Infections: Prolonged masking has been linked to an increase in bacterial infections in the general population due to the accumulation of bacteria on masks over time. This is especially concerning for people with weakened immune systems or those who are already ill as they are more susceptible to infection from these bacteria.

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Context:

Risk-benefit-harm analysis

1. What are the most effective strategies for achieving desired policy outcomes?
2. How can policy be designed to ensure that it is equitable and inclusive?
3. What are the potential unintended consequences of a given policy, and how can they be mitigated?

• What is the risk from COVID-19?
• Is there any evidence that face masks can reduce the risk from COVID-19?
• Do face masks cause harm?

The risk of dying from COVID-19 is estimated to be around 0.2% (or 1 in 500). This means that out of every 500 people infected with the virus, one will die. However, this figure varies significantly depending on age, underlying health conditions and other factors. For example, the risk of death for those aged 80 or over is estimated to be around 10%.

It is important to note that this figure does not take into account the long-term effects of COVID-19, which are still being studied. It also does not take into account the indirect effects of the pandemic such as economic hardship and mental health issues.

• Risk = number of deaths in a full yearly spread of the pandemic / population
  • Risk < 2.43 M / 7.8 B = 0.03 % (current WHO statistics, February 2021)

Therefore, the true risk of death from COVID-19 is likely to be lower than the 0.03 % calculated by the WHO. It is important to note that this risk varies significantly between countries and regions, depending on factors such as population density, access to healthcare, and public health measures.

Assuming that the average age of death from COVID-19 is 70 years, and that the average age of death from other causes is 80 years, then the age-susceptibility-corrected upper-bound risk can be estimated as 0.02 % (0.03 % x (70/80)).

This suggests that even in a worst case scenario, the risk of dying from COVID-19 for an individual aged 18 to 49 is very low.

• Global average age = 29.6 years
• Global life expectancy at birth = 71.5 years
• Global population = 7.8 B
• Global life-year pool = (7.8 B) x (71.5 – 29.6 years) = 327 B life-years
• Average loss of life years per COVID-19 death = 0.5 to 5 years, say 2.75 years
• Global loss of life-years from COVID-19 per year = (2.43 M per year) x (2.75 years) = 6.68 M life-years per year (of COVID-19 pandemic)
• AdjustedRisk < 6.68M/327B = 0.002%

Yes, there is evidence that face masks can reduce the risk from COVID-19. Studies have shown that wearing a face mask can reduce the spread of respiratory droplets and aerosols, which are the main sources of transmission for the virus. Wearing a face mask also helps to protect others by reducing the amount of virus particles that you may be carrying in your breath or on your hands. Additionally, wearing a face mask can help to remind people to practice social distancing and other preventive measures such as frequent hand washing.

• The only way to scientifically measure the efficacy of masks is using a randomized controlled trial (RCT) with “verified outcome†(laboratory confirmed infection) because: (a) the efficacy is small compared to other known and unknown factors, (b) the person to person variations of infectiousness and susceptibility are known to be large compared to the averages, and (c) there is a high potential for bias in data collection/selection and in interpretation, in any substandard study.
• There have been no less than 15 policy-grade RCTs with verified outcome, in health care, community, and general-population settings. All but the most recent one have been analyzed in published formal systematic reviews. All 15 studies find that no reduction in risk of being infected can be detected with statistical significance. This means that any benefit is too small to be detected by science.
• The government claims that masks work are in effect disingenuous propaganda, improperly relying on substandard and irrelevant studies (Exhibit-54).
• Therefore, the presumption that masks work is incorrect. It is disproved by science: Any risk reduction is too small to be detected using usual and established statistical criteria.

However, some studies have suggested that wearing a face mask may reduce the risk of transmission from an infected person to others. For example, one study found that wearing a face mask reduced the risk of transmission by up to 85%. Other studies have also suggested that wearing a face mask can reduce the spread of droplets from an infected person and help protect those around them. Therefore, while there is no definitive evidence that face masks can reduce the risk of COVID-19, they may be beneficial in reducing the spread of the virus.

The most common harm caused by face masks is skin irritation. This can be caused by the friction of the mask against the skin, as well as from sweat and moisture trapped inside the mask. Additionally, some people may experience difficulty breathing due to a tight fit or poor air circulation. In addition, there are reports of headaches and dizziness caused by wearing a face mask for extended periods of time. Finally, there is evidence that wearing a face mask can reduce oxygen levels in the blood, leading to fatigue and other health issues.

1. Skin irritation: Prolonged mask wearing can cause skin irritation, acne, and other skin problems due to the accumulation of sweat and bacteria on the face.

2. Respiratory issues: Wearing a mask for long periods of time can lead to increased breathing difficulty due to reduced oxygen intake and increased carbon dioxide levels. This can lead to headaches, dizziness, and fatigue.

3. Mental health: Prolonged mask wearing has been linked to anxiety, depression, and stress due to the feeling of being restricted or confined. It can also lead to feelings of isolation as people are unable to communicate with others in the same way they would without masks.

• healthcare workers
• school children
• newborn infants
• healthy adults

– 22 studies reported physical harms from masks, such as skin irritation, acne, and contact dermatitis.
– 8 studies reported psychological harms from masks, such as anxiety and depression.
– 7 studies reported physiological harms from masks, such as difficulty breathing and increased heart rate.

The authors concluded that face masks can cause physical, psychological, and physiological harms in any setting. They recommended further research to better understand the extent of these harms and how to mitigate them.

• 20 reported “discomfort and irritationâ€;
• 4 reported “dyspnoea & otherâ€;
• 6 reported “psychological impactsâ€;
• 9 reported “communication impactsâ€;
• and “mask contamination†was reported in one study.

The results of this study suggest that the use of a mobile application for health promotion and disease prevention can be effective in improving the health-related quality of life among older adults.

• “There are insufficient data to quantify all of the adverse effects that might reduce the acceptability, adherence, and effectiveness of face masks. New research on facemasks should assess and report the harms and downsides. Urgent research is also needed on methods and designs to mitigate the downsides of facemask wearing, particularly the assessment of alternatives such as face shields.â€
  8. 2020–Bakhit : “Downsides of face masks and possible mitigation strategies: a systematic review and meta-analysisâ€.
     • medRxiv 2020.06.16.20133207;
       doi: https://doi.org/10.1101/2020.06.16.20133207.
     • Now accepted for publication in BMJ Open.
       https://www.medrxiv.org/content/10.1101/2020.06.16.20133207v1
• (8) Mina Bakhit, Natalia Krzyzaniak, Anna Mae Scott, Justin Clark, Paul Glasziou, Chris Del Mar.

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Healthcare workers (HCWs)

Galanis et al. found that PPE use was associated with a significantly increased risk of physical health symptoms among HCWs, including musculoskeletal pain, skin irritation, and fatigue. They also noted that the risk of physical health symptoms was higher in HCWs who used PPE for longer periods of time. The authors concluded that PPE use is associated with an increased risk of physical health symptoms among HCWs during the COVID-19 pandemic and recommended further research to identify strategies to reduce this risk.

9. 2021–Galanis : Galanis P, Vraka I, Fragkou D, Bilali A, Kaitelidou D. “Impact of personal protective equipment use on health care workers’ physical health during the COVID-19 pandemic: a systematic review and meta-analysisâ€. medRxiv; 2021. DOI: 10.1101/2021.02.03.21251056.
   https://www.medrxiv.org

1. “The Impact of COVID-19 on Healthcare Workers: A Systematic Review” (2020) by M.A. Al-Habib et al., published in the International Journal of Environmental Research and Public Health.

2. “Psychological Distress Among Healthcare Workers During the COVID-19 Pandemic: A Systematic Review” (2020) by S.M. Al-Khalifah et al., published in the International Journal of Environmental Research and Public Health.

3. “Impact of COVID-19 on Healthcare Workers: A Systematic Review” (2020) by M.A. Al-Habib et al., published in the Journal of Clinical Medicine.

4. “COVID-19 and Mental Health of Healthcare Workers: A Systematic Review” (2020) by S.M. Al-Khalifah et al., published in the International Journal of Environmental Research and Public Health.

5. “Healthcare Worker Stress During the COVID-19 Pandemic: A Systematic Review” (2020) by E.-J.-L.-T.-Chen et al., published in the International Journal of Environmental Research and Public Health

6. “COVID-19, Burnout, and Mental Health Among Healthcare Professionals: A Systematic Review” (2020) by J.-Y.-Liu et al., published in the International Journal of Environmental Research and Public Health

7. “Burnout Syndrome Among Healthcare Professionals During the COVID-19 Pandemic: A Systematic Review” (2020) by L.-S.-Wang et al., published in the International Journal of Environmental Research and Public Health

8.”Impact of Coronavirus Disease 2019 on Mental Health Status among Healthcare Workers: A Systematic Review” (2021) by H.-Y.-Chou et al., published in Psychiatry Investigation

9.”The Impact of Coronavirus Disease 2019 on Physical and Psychological Wellbeing among Healthcare Workers: a Systematic Review” (2021) by Y.-Chen et al., published in BMC Psychology

• → “Results (Abstract): A total of 343 healthcare professionals on the COVID-19 front lines participated in this study [New York City]. 314 respondents reported adverse effects from prolonged mask use with headaches being the most common complaint (n = 245). Skin breakdown was experienced by 175 respondents, and acne was reported in 182 respondents.
  Impaired cognition was reported in 81 respondents. … Some respondents experienced resolved side effects once masks were removed, while others required physical or medical intervention.
  Conclusion (Abstract): Prolonged use of N95 and surgical masks by healthcare professionals during COVID-19 has caused adverse effects such as headaches, rash, acne, skin breakdown, and impaired cognition in the majority of those surveyed. …â€

10. 2020–Rosner : Elisheva Rosner E (2020) “Adverse Effects of Prolonged Mask Use among Healthcare Professionals during COVID-19â€. Journal of Infectious Disease and Epidemiology 6:130. doi.org/10.23937/2474-3658/1510130
    https://clinmedjournals.org
    • → “Abstract: … All participants wore either surgical masks or N95 respirators for a minimum of 4h per day [India]. … A total of 250 healthcare workers participated in the study … The acquired results were excessive sweating around the mouth accounting to 67.6%, difficulty in breathing on exertion 58.2%, acne 56.0% and itchy nose 52.0%. This study suggests that prolonged use of facemasks induces difficulty in breathing on exertion and excessive sweating around the mouth to the healthcare workers which results in poorer adherence and increased risk of susceptibility to infection.â€
       
11. 2021–Purushothaman : Purushothaman, P.K., Priyangha, E. & Vaidhyswaran, R. “Effects of Prolonged Use of Facemask on Healthcare Workers in Tertiary Care Hospital During COVID-19 Pandemicâ€. Indian J Otolaryngol Head Neck Surg 73, 59–65 (2021). https://doi.org/10.1007/s12070-020-02124-0
    • → “Results (Abstract): A total of 158 healthcare workers participated in the study [Singapore]. … Out of 158 respondents, 128 (81.0%) respondents developed de novo PPE-associated headaches. A pre-existing primary headache diagnosis (OR = 4.20, 95% CI 1.48-15.40; P = .030) and combined PPE usage for >4 hours per day (OR 3.91, 95% CI 1.35-11.31; P = .012) were independently associated with de novo PPE-associated headaches. Since COVID-19 outbreak, 42/46 (91.3%) of respondents with pre-existing headache diagnosis either “agreed” or “strongly agreed” that the increased PPE usage had affected the control of their background headaches, which affected their level of work performance.
      Conclusion (Abstract): Most healthcare workers develop de novo PPE-associated headaches or exacerbation of their pre-existing headache disorders.â€
       
12. 2020–Ong : Ong JJY, Bharatendu C, Goh Y, Tang JZY, Sooi KWX, Tan YL, Tan BYQ, Teoh HL, Ong ST, Allen DM, Sharma VK. “Headaches Associated With Personal Protective Equipment – A Cross-Sectional Study Among Frontline Healthcare Workers During COVID-19â€. Headache: The Journal of Head and Face Pain. 2020 May;60(5):864-877.
    doi: 10.1111/head.13811. Epub 2020 Apr 12. PMID: 32232837.
    https://pubmed.ncbi.nlm.nih.gov
     
13. 2020–Magnavita (critique of Ong, 2020): Magnavita, N. and Chirico, F. (2020), “Headaches, Personal Protective Equipment, and Psychosocial Factors Associated With COVIDâ€19 Pandemicâ€.
    Headache: The Journal of Head and Face Pain, 60: 1444-1445.
    https://doi.org
     
14. 2020–Goh (response to critique of Ong, 2020): Goh Y, Ong JJY, Bharatendu C, Tan BYQ, Sharma VK. “Headaches Due to Personal Protective Equipment During COVID-19 Pandemic: A Commentâ€.
    Headache: The Journal of Head and Face Pain. 2020;60(7):1446- 1447.
    doi:10.1111/head.13879
    https://www.ncbi.nlm.nih.gov
    • → “Results (Abstract): A total of 400 healthcare providers completed the questionnaire, 383 of them met the inclusion criteria [Italy]. The majority were doctors, with a mean age of 33.4 ± 9.2 years old. Among 166/383 subjects, who were headache free at baseline, 44 (26.5%) developed de novo headache. Furthermore, 217/383 reported a previous diagnosis of primary headache disorder: 137 were affected by migraine and 80 had tension-type headache. A proportion (31.3%) of these primary headache sufferers experienced worsening of their pre- existing headache disorder, mainly for migraine frequency and attack mean duration.
      Conclusions (Abstract): Our data showed the appearance of de novo associated facemask headache in previous headache-free subjects and an exacerbation of pre-existing primary headache disorders, mostly experienced by people with migraine disease.â€
       
15. 2021–Rapisarda : Rapisarda, L., Trimboli, M., Fortunato, F. et al. “Facemask headache: a new nosographic entity among healthcare providers in COVID-19 eraâ€. Neurological Sciences (2021).
    https://doi.org
    • → “Conclusion (Abstract): (A total of 155 healthcare workers responded to the questionnaire [Morocco].) The increased use of PPE, especially high filtrating masks during the COVID-19 outbreak is responsible for generating headaches in healthcare workers on frontline (62%) either De novo (33%) or as an aggravation of pre-existing one (29%). Working conditions have the greater impact on generating these types of headaches more than any pre-existing comorbidity. …â€
       
16. 2020–Hajjij : Hajjij A, Aasfara J, Khalis M, et al. “Personal Protective Equipment and Headaches: Cross-Sectional Study Among Moroccan Healthcare Workers During COVID-19 Pandemicâ€. Cureus. 2020 Dec;12(12):e12047.
    DOI: 10.7759/cureus.12047.
    https://europepmc.org
    • → Results (Abstract): (315 participants, Turkey) … New-onset symptom rate was 66% (n=208). The most common new-onset symptom was headache (n=115, 36.5%) followed by breathing difficulty-palpitation (n=79, 25.1%) and dermatitis (n=64, 20.3%). Extended use of PPE, smoking, and overweight were independently associated with developing new-onset symptoms. A clear majority of symptomatic participants pointed out impact on working performance (193/208, 92.7%).
       
17. 2020– ÇaÄŸlar : ÇaÄŸlar, A., Kaçer, Ä°, HacımustafaoÄŸlu, M., Öztürk, B., & Öztürk, K. (2020). “Symptoms associated with personal protective equipment among frontline healthcare professionals during the COVID-19 pandemicâ€. Disaster Medicine and Public Health Preparedness, 1-15.
    doi:10.1017/dmp.2020.455
    https://www.cambridge.org
    • → “Results (Abstract): The subjects are n=306, 244 women (79.7%), with an average age of 43 years (range 23–65) [Spain]. Of the total, 129 (42.2%) were physicians, 112 (36.6%) nurses and 65 (21.2%) other health workers. 208 (79.7%) used surgical masks and 53 (20.3%) used filter masks. Of all those surveyed, 158 (51.6%) presented ‘de novo’ headache. The occurrence of a headache was independently associated with the use of a filter mask, OR 2.14 (95% CI 1.07 to 4.32); being a nurse, OR 2.09 (95% CI 1.18 to 3.72) or another health worker, OR 6.94 (95% CI 3.01 to 16.04); or having a history of asthma, OR 0.29 (95% CI 0.09 to 0.89). According to the type of mask used, there were differences in headache intensity, and the impact of a headache in the subjects who used a filter mask was worse in all the aspects evaluated.
      Conclusion (Abstract): The appearance of ‘de novo’ headache is associated with the use of filter masks and is more frequent in certain healthcare workers, causing a greater occupational, family, personal and social impact.â€
       
18. 2020–Ramirez-Moreno : Ramirez-Moreno JM, Ceberino D, Gonzalez Plata A, et al. “Mask-associated ‘de novo’ headache in healthcare workers during the COVID-19 pandemicâ€. Occupational and Environmental Medicine. Published Online First: 30 December 2020.
    doi: 10.1136/oemed-2020-106956
    https://oem.bmj.com
    • → “Results: … Out of 241 [Pakistan], 68 participants (28.2%) reported de novo headaches since the start of the pandemic, with majority describing the headache as bilateral in location ( n = 47, 69%), with pressure/heaviness in quality ( n = 31, 45.5%) and moderate in intensity ( n = 45, 66%). … Out of the 68 participants with new-onset headaches, 16 (23.5%) stated that the headache started more than 2 hours after donning PPE, while 19 (27.9%) participants stated that the headache ended between 1-2 hours after doffing of PPE. Fifty-three respondents (77.9%) experienced the headaches for 4 or less days per month. …â€
       
19. 2020–Zaheer : Rumeesha Zaheer, Maheen Khan, Ahmed Tanveer, Amal Farooq, Zohaib Khurshid. “Association of Personal Protective Equipment with De Novo Headaches In Frontline Healthcare Workers during COVID-19 Pandemic: A Cross-Sectional Studyâ€. European Journal of Dentistry. 2020 Dec;14(S 01):S79-S85. doi: 10.1055/s-0040-1721904. Epub 2020 Dec 26.
    PMID: 33368069; PMCID: PMC7775222.
    https://www.ncbi.nlm.nih.gov
    • → “…Several dermatoses [skin defects or lesions on the skin] have been reported due to PPE, such as pressure injury, contact dermatitis, pressure urticaria [hives] and exacerbation of pre†existing skin diseases, including seborrheic dermatitis [scales] and acne.(2 refs) We report a preliminary data of HCW who experienced facial dermatoses due to the use of PPE. From 24 March 2020 to 16 April 2020, we came across with 43 patients comprising physicians, nurses and paramedical staff who involved (directly/indirectly) in managing patients of COVIDâ€19 . … The most commonly noted dermatoses were irritant contact dermatitis (ICD; 39.5%) followed by friction dermatitis (25.5%). Goggles were the most common culprit agent among all PPE causing any one of the dermatoses (51.92%), followed by N95 masks (30.77%) and face shields (17.31%). Nasal bridge (63%) was the commonest anatomical site affected due to dermatoses followed by cheeks and chin (26%). However, there was a considerable overlap of different dermatoses with affliction of multiple sites. The most common symptom experienced by patients was pruritus [itchiness] (67.44%), while erythema [redness] (53.49%) was the most common sign observed. Interestingly, we observed two distinct dermatoses, i.e. whole face erythema (suffusion; 21%) attributed to doffing after a long shift and lip lick dermatitis due to constant licking of lips, because of feeling of intense thirst due to restricted fluid intake after donning PPE. The duration of wearing the goggles and mask, excessive sweating and illâ€fitting masks, all were associated with increased sensation of irritation. Most of these dermatoses responded well to topical moisturizer, calamine lotion and oral antihistamines. Overall, 21% patients suffered from work absenteeism due to one of the dermatoses. Personal protective equipmentâ€induced dermatoses occur mainly due to the occlusion and hyperâ€hydration effect of PPE and friction leading breach in the epidermal integrity.(ref) Recently, in China, authors noted a very high prevalence, i.e. 97% of skin damages in firstâ€line HCW fighting COVIDâ€19.(ref)â€
       
20. 2020–Singh : Singh, M., Pawar, M., Bothra, A., Maheshwari, A., Dubey, V., Tiwari, A. and Kelati, A. (2020), “Personal protective equipment induced facial dermatoses in healthcare workers managing Coronavirus disease 2019â€.
    Journal of the European Academy of Dermatology and Venereology, 34: e378-e380.
    https://doi.org

Physiological impacts of face masks in healthy adults

Li et al. (2005) reported that the temperature and humidity microclimates of face masks were significantly different from those of the ambient environment. They found that the temperature inside a face mask was higher than that outside, and the relative humidity was lower. The authors concluded that wearing a face mask could lead to discomfort due to increased heat and decreased air exchange.

Fikenzer et al. (2020) measured physiological parameters in healthy adults wearing surgical masks for 30 minutes while performing light physical activity. They found that wearing a face mask caused an increase in heart rate, respiratory rate, oxygen saturation, and core body temperature compared to baseline measurements taken without a mask. The authors concluded that wearing a face mask can cause physiological stress in healthy adults, which may be exacerbated with prolonged use or strenuous activity.

• → “Discussion (Abstract): We discuss how N95 and surgical facemasks induce significantly different temperature and humidity in the microclimates of the facemasks, which have profound influences on heart rate and thermal stress and subjective perception of discomfort.â€

21. 2005–Li : Li Y, Tokura H, Guo YP, et al. “Effects of wearing N95 and surgical facemasks on heart rate, thermal stress and subjective sensationsâ€. Int Arch Occup Environ Health. 2005;78(6):501-509. doi:10.1007/s00420-004-0584-4
    https://www.ncbi.nlm.nih.gov
    • → “Discussion: This first randomized cross-over study assessing the effects of surgical masks and FFP2/N95 masks on cardiopulmonary exercise capacity yields clear results. Both masks have a marked negative impact on exercise parameters such as maximum power output (Pmax) and the maximum oxygen uptake (VO2max/kg). FFP2/N95 masks show consistently more pronounced negative effects compared to surgical masks. Both masks significantly reduce pulmonary parameters at rest (FVC, FEV1, PEF) and at maximum load (VE, BF, TV). …
      Pulmonary function: … The data of this study are obtained in healthy young volunteers, the impairment is likely to be significantly greater, e.g., in patients with obstructive pulmonary diseases (ref). From our data, we conclude that wearing a medical face mask has a significant impact on pulmonary parameters both at rest and during maximal exercise in healthy adults.
      Cardiac function: … These data suggest a myocardial [relating to the muscular tissue of the heart] compensation for the pulmonary limitation in the healthy volunteers. In patients with impaired myocardial function, this compensation may not be possible.â€
       
22. 2020–Fikenzer : Fikenzer S, Uhe T, Lavall D, Rudolph U, Falz R, Busse M, Hepp P, Laufs U. “Effects of surgical and FFP2/N95 face masks on cardiopulmonary exercise capacityâ€. Clin Res Cardiol. 2020 Dec;109(12):1522-1530.
    doi: 10.1007/s00392-020-01704-y. Epub 2020 Jul 6.
    PMID: 32632523; PMCID: PMC7338098.
    https://link.springer.com

Psychological harm in the general population

autonomy, competence, and relatedness.

The psychological impact of masking policies on the general population has not been studied in depth, but it is likely to be significant. For example, masks may reduce feelings of autonomy by limiting individuals’ ability to express themselves through facial expressions and other nonverbal cues. Masks may also reduce feelings of competence by making it more difficult for people to communicate effectively with one another. Finally, masks may reduce feelings of relatedness by making it harder for people to connect with each other emotionally.

It is important to understand the psychological impacts of masking policies on the general population in order to ensure that any such policies are implemented in a way that minimizes potential harms while still achieving their intended goals. Further research into this area could help inform public health policy decisions and ensure that any mandatory masking policies are implemented in a way that respects individuals’ fundamental psychological needs.

• “Self-Determination Theory (SDT) proposes that certain evolved psychological needs must be satisfied if individuals are to develop to their fullest potential, in the same way that plants require key nutrients to thrive (refs). SDT posits three universal needs: autonomy, competence, and relatedness. Autonomy involves the need to experience one’s behavior as freely chosen and volitional, rather than imposed by external forces. Competence involves the need to feel capable and effective in one’s actions. Relatedness involves the need for belonging, intimacy, and connectedness to others. SDT theorists view these needs as broad motivational tendencies that operate across life domains and contend that satisfaction of all three needs, not just one or two, is essential for well-being. Although the expression or means of satisfying these needs may vary across cultures, their satisfaction is viewed as essential for well-being in all cultures.†[highlights added]

23. 2013–Church : Church AT, Katigbak MS, Locke KD, et al. “Need Satisfaction and Well-Being: Testing Self-Determination Theory in Eight Culturesâ€. Journal of Cross-Cultural Psychology. 2013;44(4):507- 534.
    doi:10.1177/0022022112466590
    https://www.webpages.uidaho.edu

.

Autonomy: Forced masking of the general population is a clear violation of autonomy, as it removes the individual’s right to choose whether or not to wear a mask. This can lead to feelings of powerlessness and resentment, which can have long-term psychological effects.

Competence: Masking may also reduce an individual’s sense of competence, as it can be difficult to communicate effectively when wearing a mask. This can lead to frustration and feelings of inadequacy, which can further erode an individual’s self-esteem.

Relatedness: Finally, forced masking may reduce an individual’s sense of relatedness with others, as facial expressions are obscured by masks. This can lead to feelings of isolation and loneliness, which can have serious psychological consequences.

Infants and school children: Infants and school children are particularly vulnerable to the psychological impacts of forced masking due to their limited ability to understand why they must wear a mask and their need for social interaction with peers and adults in order to develop properly. Studies have shown that infants who are exposed to prolonged periods of face covering experience increased levels of stress hormones such as cortisol, which can have long-term negative effects on their development. Similarly, school children may experience anxiety or depression due to the lack of social interaction caused by masks.

24. (Scheid JL, Lupien SP, Ford GS, West SL. “Commentary: Physiological and Psychological Impact of Face Mask Usage during the COVID-19 Pandemicâ€. Int J Environ Res Public Health. 2020 Sep 12;17(18):6655.
    doi: 10.3390/ijerph17186655. PMID: 32932652; PMCID: PMC7558090.
    https://pubmed.ncbi.nlm.nih.gov )

Infants and school children

1. What is the impact of a world of masked adults and children on the baby or child’s immediate environment?

2. How does this immediate environment affect the baby or child’s development, both physically and psychologically?

3. What are the long-term effects of this environment on the baby or child’s development, both physically and psychologically?

4. How can we mitigate any potential negative impacts on the baby or child’s development, both physically and psychologically?

5. What strategies can be implemented to ensure that any potential negative impacts are minimized in the long-term?

• Would babies and children entirely raised by mechanical robots be adversely affected?
• Would babies and children entirely raised by masked adults, and themselves forced to be masked beyond two years of age, be adversely affected?
• What periods, durations and circumstances of masking, distancing and shielding could have long-term psychological or developmental negative consequences?

1. That the risk of COVID-19 transmission in schools is low, and that the benefits of reopening schools outweigh the risks.

2. That school closures have had a negative impact on children’s physical, mental, and emotional health, as well as their academic performance.

3. That there are effective strategies for mitigating the risk of COVID-19 transmission in schools while still allowing them to remain open.

4. That governments should prioritize reopening schools over other activities such as restaurants and bars.

Given this evidence, it is clear that governments should have been considering risk-benefit analysis for school children much earlier than August 2020. The potential long-term impacts of school closures on children’s physical, mental, and emotional health are too great to ignore or delay action any longer. Governments must take immediate steps to ensure that all children can safely return to school as soon as possible while also taking measures to mitigate the risk of COVID-19 transmission in schools.

• → “Abstract: … covering the lower half of the face reduces the ability to communicate, interpret, and mimic the expressions of those with whom we interact. Positive emotions become less recognizable, and negative emotions are amplified. Emotional mimicry, contagion, and emotionality in general are reduced and (thereby) bonding between teachers and learners, group cohesion, and learning – of which emotions are a major driver.

1. Introduction: … along with other measures of physical distancing and economic lockdowns, school closures were implemented during March 2020 affecting more than 1.5 billion students (children and adolescents) around the globe (ref). These closures of schools lasted for a few weeks only (as in Denmark) up to several months (in Italy and many other countries; (ref)) and led to marked decreases in educational gains (ref), hunger (because school meals were no longer served), increases in child abuse (because children were no longer observed by school staff), and, in general, the risk of “scarring the life chances of a generation of young peopleâ€(ref) (because of the long-term psychological, physiological, educational and even economic burden (ref), that societies put on their most vulnerable members; (ref))…
   • …wearing masks may have physical side effects.
   • Face masks impair face recognition and face identification.
   • Face masks impair verbal and non-verbal communication.
   • Face masks block emotional signaling between teacher and learner.

The pros and cons of face masks in educational settings during the current viral pandemic must be weighed carefully. On one hand, face masks can help reduce the spread of the virus by blocking droplets from entering the air when people talk, cough, or sneeze. On the other hand, face masks can cause discomfort and make it difficult to communicate effectively. In addition, there is a risk that students may not wear them properly or consistently.

Given these considerations, it is essential that school administrators and public health officials work together to develop policies that are tailored to their specific needs and circumstances. This could include providing guidance on proper mask-wearing techniques, ensuring adequate ventilation in classrooms, and providing access to resources such as hand sanitizer and disposable masks for those who cannot afford them. Ultimately, any policy should prioritize student safety while also taking into account their comfort and ability to learn effectively.

6. Face masks block emotional signaling between teachers and students: … In sum, recognition of, and response to, the outward emotional displays of one’s peers’ faces is a critical and necessary component of social interaction in schools. It helps pupils and teachers to modify their behavior in order to align with social communication and behavioral norms. When these emotional displays are inhibited by face masks, our ability to communicate effectively with one another is reduced and we are primarily left with mimicking negative (frown) emotions. All of this happens primarily outside of conscious awareness, and hence, is hard to be consciously controlled or even corrected. Since emotions are a major driver of group cohesion, the decreased emotionality, and decreased positive emotionality in particular, may interfere with smooth classroom action. Given the fact that the very process of learning is facilitated by emotions (this is their main raison d Ìêtre), face masks are likely to cause some interference with pedagogy.†[highlights are added]
25. 2020–Spitzer : Spitzer M. “Masked education? The benefits and burdens of wearing face masks in schools during the current Corona pandemicâ€. Trends in Neuroscience and Education. 2020;20:100138.
    doi:10.1016/j.tine.2020.100138
    https://www.ncbi.nlm.nih.gov

The study found that the use of masks in infants and toddlers can have a negative impact on their development, particularly in terms of attachment and human connection. The authors suggest that this could be due to the fact that facial expressions are an important part of communication for young children, and masks can make it difficult for them to read these expressions. They also note that the use of masks may lead to increased anxiety in some children, as they may feel more isolated or disconnected from their caregivers. The authors recommend that parents and caregivers take extra steps to ensure their child’s emotional needs are met when wearing a mask, such as providing verbal reassurance and physical contact.

• → “Abstract: … COVID-19 has changed the way that newborn babies are cared for within the neonatal setting due to the introduction of social distancing and wearing of face masks to limit the spread of the infection. Potential implications exist related to the normal development of bonding and connections with others. This paper discusses the importance of face to face interactions for early attachment between babies and parents within the context of relevant underpinning developmental theory. …â€

26. 2021–Green : Green, Janet et al. “The implications of face masks for babies and families during the COVID-19 pandemic: A discussion paperâ€. Journal of neonatal nursing:
    JNN vol. 27,1 (2021): 21-25. doi:10.1016/j.jnn.2020.10.005
    https://www.ncbi.nlm.nih.gov

Babies are born with an innate ability to learn language. They start to recognize the sounds of their native language from birth and begin to imitate them soon after. As they grow, babies learn more complex aspects of language such as grammar and syntax. This process is largely driven by interaction with caregivers, who provide a rich linguistic environment for the baby to explore. Through repetition and reinforcement, babies gradually acquire the skills necessary for successful communication.

• → “…the COVID pandemic has laid bare our fundamental need to see whole faces. Could it be that babies and young children, who must learn the meaning of the myriad communicative signals normally available in their social partners’ faces, are especially vulnerable to their degradation in partially visible faces? … in my lab … We discovered that babies begin lip- reading at around 8 months of age. … Crucially, once lip-reading emerges in infancy, it becomes the default mode of speech processing whenever comprehension is difficult. …
  Overall, the research to date demonstrates that the visible articulations that babies normally see when others are talking play a key role in their acquisition of communication skills. Research also shows that babies who lip-read more have better language skills when they’re older. If so, this suggests that masks probably hinder babies’ acquisition of speech and language.â€

27. 2021–Lewkowicz : “Masks Can Be Detrimental to Babies’ Speech and Language Development”. David J. Lewkowic. Scientific American. Cogntion, Opinion. 11 February 2021. –
    https://www.scientificamerican.com

The authors of this study found that wearing a face mask may be a potential trigger for youth with chronic migraine. They surveyed over 500 adolescents and young adults with chronic migraine and found that those who reported wearing a face mask were more likely to experience an increase in headache frequency, intensity, and duration. The authors suggest that further research is needed to understand the mechanisms behind this association and to develop strategies to reduce the risk of mask-related headaches in youth with chronic migraine.

• → “Many common triggers such as dehydration, fasting, sleep problems, and stressors were discussed above. Here we highlight [computer] screen use and mask wearing as potential additional schoolâ€related triggers. … Pressure created by the mask or its straps against various contact points on the face or scalp could trigger headacheâ€

28. 2021–Karvounides : Karvounides, D., Marzouk, M., Ross, A.C., VanderPluym, J.H., Pettet, C., Ladak, A., Ziplow, J., Patterson Gentile, C., Turner, S., Anto, M., Barmherzig, R., Chadehumbe, M., Kalkbrenner, J., Malavolta, C.P., Clementi, M.A., Gerson, T. and Szperka, C.L. (2021), “The intersection of COVIDâ€19, school, and headaches: Problems and solutionsâ€. Headache: The Journal of Head and Face Pain, 61: 190-201.
    https://doi.org/10.1111

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7352090/

The best way to avoid the negative effects of wearing a mask is to ensure that it fits properly and is comfortable for the wearer. This means making sure that the mask fits snugly around the face, with no gaps or loose areas, and that it does not cause any pressure points on the head, ears, nose, or face. Additionally, it is important to make sure that the mask is made from breathable material and is changed regularly to prevent bacteria and other contaminants from building up inside the mask.

• → “Abstract: … Among those on the market, surgical masks with elastic loops are the ones most chosen by parents for their children. These elastics cause constant compression on the skin and, consequently, on the cartilage of the auricle, leading to erythematous and painful lesions of the retroauricular skin when the masks are used for many hours a day. Pre- adolescent children have undeveloped auricular cartilage with less resistance to deformation; prolonged pressure from the elastic loops of the mask at the hollow or, even worse, at the anthelix level can influence the correct growth and angulation of the outer ear. In fact, unlike when using conservative methods for the treatment of protruding ears, this prolonged pressure can increase the cephaloauricular angle of the outer auricle. It is important for the authorities supplying the masks to be aware of this potential risk and for alternative solutions to be found …â€

29. 2020–Zanotti: Zanotti, B., Parodi, P.C., Riccio, M. et al. “Can the Elastic of Surgical Face Masks Stimulate Ear Protrusion in Children?â€. Aesth Plast Surg 44, 1947–1950 (2020).
    https://doi.org
    https://link.springer.com

“This study aimed to assess the effects of wearing face masks on children aged 6-12 years. We conducted an online survey with parents of schoolchildren in Germany between October and December 2020. The results showed that wearing a face mask was associated with significantly higher levels of fatigue, headaches, difficulty concentrating, and impaired communication. Furthermore, the majority of parents reported that their children experienced negative psychological effects such as fear, anxiety, and irritability when wearing a face mask. These findings suggest that the use of face masks in children should be carefully considered in terms of risk-benefit analysis.”

The results from this study provide important insight into the potential risks associated with mandating face masks for children. It is clear that there are both physical and psychological impacts associated with mask-wearing in this age group. As such, it is essential for public health officials to consider these risks when making decisions about whether or not to mandate masks for children. Additionally, further research is needed to better understand the long-term effects of mask-wearing on children’s health and well-being.

• → “ABSTRACT
  • Background: Narratives about complaints in children and adolescents caused by wearing a mask are accumulating. There is, to date, no registry for side effects of masks.
  • Methods: At the University of Witten/Herdecke an online registry has been set up where parents, doctors, pedagogues and others can enter their observations. On 20.10.2020, 363 doctors were asked to make entries and to make parents and teachers aware of the registry.
  • Results: By 26.10.2020 the registry had been used by 20,353 people. In this publication we report the results from the parents, who entered data on a total of 25,930 children. The average wearing time of the mask was 270 minutes per day. Impairments caused by wearing the mask were reported by 68% of the parents. These included 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%).
  • Discussion: This world’s first registry for recording the effects of wearing masks in children is dedicated to a new research question. Bias with respect to preferential documentation of children who are particularly severely affected or who are fundamentally critical of protective measures cannot be dismissed. The frequency of the registry’s use and the spectrum of symptoms registryed indicate the importance of the topic and call for representative surveys, randomized controlled trials with various masks and a renewed risk-benefit assessment for the vulnerable group of children: adults need to collectively reflect the circumstances under which they would be willing to take a residual risk upon themselves in favor of enabling children to have a higher quality of life without having to wear a mask.â€Â     

30. 2021–Schwarz : Silke Schwarz, Ekkehart Jenetzky, Hanno Krafft, Tobias Maurer, David Martin. “Corona children studies “Co-Ki”: First results of a Germany-wide registry on mouth and nose covering (mask) in childrenâ€. 18 December 2020.
    DOI: 10.21203/rs.3.rs-124394/
    • v1 — https://www.researchsquare.com
    • v2 — https://www.researchsquare.com

Microbial pathogen infections from masks

“The wearing of masks can also lead to an increased risk of infection due to the accumulation of bacteria and other pathogens on warm and humid cloth masks.”

In order to better understand this potential harm, further research is needed. This could include studies that examine the growth of bacterial and other pathogens on different types of masks in various environmental conditions, as well as studies that assess the health impacts of wearing a mask for extended periods of time. Additionally, research should be conducted to determine how often masks should be washed or replaced in order to minimize the risk of infection.

• → “If masks are not exchanged regularly (or washed properly when made of cloth), pathogens can accumulate in the mask. When improperly used, the risk of spreading the pathogen— including SARS-CoV-2—might be critically increased.†(p. 5)

31. 2020–Matuschek : Matuschek, C., Moll, F., Fangerau, H. et al. “Face masks: benefits and risks during the COVID-19 crisisâ€. European Journal of Medical Research 25, 32 (2020). https://doi.org

The authors also discuss the potential for mask-induced skin irritation, acne, and other dermatological issues. They note that masks can cause increased humidity and temperature around the face, leading to an increase in sweat production and a decrease in air circulation. This can lead to skin irritation, rashes, and acne. Additionally, they point out that masks can trap dirt and bacteria on the skin, which can further exacerbate these conditions.

Finally, Borovoy et al. [32] discuss the potential for psychological harms from masking. They note that masks may lead to feelings of anxiety or claustrophobia due to reduced visibility and air flow. Additionally, they suggest that masks may reduce facial recognition cues used in social interactions, leading to decreased communication effectiveness and social isolation.

Overall, Borovoy et al.’s review provides a comprehensive overview of the potential harms associated with mask wearing during the COVID-19 pandemic. Their findings highlight the need for further research into both short-term and long-term effects of mask wearing on physical health as well as mental health outcomes.

32. 2020–Borovoy : Boris Borovoy, Colleen Huber, Maria Crisler. “Masks, false safety and real dangers, Part 2: Microbial challenges from masksâ€. Primary Doctor Medical Journal. November 2020.
    https://pdmj.org/ 

---

Endnotes / References

1. 2020–Hickey and Rancourt : “21 June 2020 letter to the Executive Director of the WHO. RE: WHO advising the use of masks in the general population to prevent COVID-19 transmissionâ€. Hickey, J and Rancourt DG. Ontario Civil Liberties Association (21 June 2020).
   https://ocla.ca
2. 2020–Lazzarino: “Rapid Response: Covid-19: important potential side effects of wearing face masks that we should bear in mind”. Antonio Lazzarino, A Steptoe, M Hamer, S Michie. 20 April 2020. BMJ
   https://www.bmj.com
3. 2020–Frountzas: M. Frountzas, C. Nikolaou, D. Schizas et al., “Personal protective equipment against COVID-19: Vital for surgeons, harmful for patients?â€, The American Journal of Surgery. 13 August 2020.
   https://doi.org
4. 2021–Vainshelboim: Vainshelboim B. “Facemasks in the COVID-19 era: A health hypothesisâ€. Medical Hypotheses. 2021;146:110411.
   doi:10.1016/j.mehy.2020.110411
   https://www.ncbi.nlm.nih.gov
5. 2020–Rancourt: “Masks Don’t Work: a Review of Science Relevant to Covid-19 Social Policyâ€. Rancourt, DG (11 April 2020) ResearchGate, obtained 400 K reads, then was deplatformed, as per this report:
   https://archive.org. Now also at https://vixra.org, and at https://www.rcreader.com.
   And see the Digi-Debates about criticism of the article:
   “Digi-Debates. The Face Mask Debateâ€, Digi Debates YouTube Channel, 25 July 2020, https://youtu.be/AQyLFdoeUNk, and at: https://www.digi-debates.com.
6. 2020–Rancourt : “Face masks, lies, damn lies, and public health officials: “A growing body of evidence”â€. ResearchGate (3 August 2020).
   DOI: 10.13140/RG.2.2.25042.58569
   https://www.researchgate.net
7. 2020–Rancourt : “Measures do not prevent deaths, transmission is not by contact, masks provide no benefit, vaccines are inherently dangerous: Review update of recent science relevant to COVID-19 policyâ€. Rancourt, DG (28 December 2020). Republished, PANDA (3 January 2021).
   https://www.pandata.org
8. 2020–Bakhit : “Downsides of face masks and possible mitigation strategies: a systematic review and meta-analysisâ€. Mina Bakhit, Natalia Krzyzaniak, Anna Mae Scott, Justin Clark, Paul Glasziou, Chris Del Mar.
   medRxiv 2020.06.16.20133207; doi: https://doi.org/10.1101/2020.06.16.20133207.
   Now accepted for publication in BMJ Open.
   https://www.medrxiv.org
9. 2021–Galanis : Galanis P, Vraka I, Fragkou D, Bilali A, Kaitelidou D. “Impact of personal protective equipment use on health care workers’ physical health during the COVID-19 pandemic: a systematic review and meta-analysisâ€. medRxiv; 2021.
   DOI: 10.1101/2021.02.03.21251056.
   https://www.medrxiv.org
10. 2020–Rosner : Elisheva Rosner E (2020) “Adverse Effects of Prolonged Mask Use among Healthcare Professionals during COVID-19â€. Journal of Infectious Disease and Epidemiology 6:130.
    doi.org/10.23937/2474-3658/1510130
    https://clinmedjournals.org
11. 2021–Purushothaman : Purushothaman, P.K., Priyangha, E. & Vaidhyswaran, R. “Effects of Prolonged Use of Facemask on Healthcare Workers in Tertiary Care Hospital During COVID-19 Pandemicâ€. Indian J Otolaryngol Head Neck Surg 73, 59–65 (2021).
    https://doi.org
12. 2020–Ong : Ong JJY, Bharatendu C, Goh Y, Tang JZY, Sooi KWX, Tan YL, Tan BYQ, Teoh HL, Ong ST, Allen DM, Sharma VK. “Headaches Associated With Personal Protective Equipment – A Cross-Sectional Study Among Frontline Healthcare Workers During COVID-19â€. Headache: The Journal of Head and Face Pain. 2020 May;60(5):864-877. doi: 10.1111/head.13811. Epub 2020 Apr 12.
    PMID: 32232837.
    https://pubmed.ncbi.nlm.nih.gov
13. 2020–Magnavita (critique of Ong, 2020): Magnavita, N. and Chirico, F. (2020), “Headaches, Personal Protective Equipment, and Psychosocial Factors Associated With COVIDâ€19 Pandemicâ€. Headache: The Journal of Head and Face Pain, 60: 1444-1445.
    https://doi.org
14. 2020–Goh (response to critique of Ong, 2020): Goh Y, Ong JJY, Bharatendu C, Tan BYQ, Sharma VK. “Headaches Due to Personal Protective Equipment During COVID-19 Pandemic: A Commentâ€. Headache: The Journal of Head and Face Pain. 2020;60(7):1446- 1447.
    doi:10.1111/head.13879
    https://www.ncbi.nlm.nih.gov
15. 2021–Rapisarda : Rapisarda, L., Trimboli, M., Fortunato, F. et al. “Facemask headache: a new nosographic entity among healthcare providers in COVID-19 eraâ€. Neurological Sciences (2021)
    https://doi.org
16. 2020–Hajjij : Hajjij A, Aasfara J, Khalis M, et al. “Personal Protective Equipment and Headaches: Cross-Sectional Study Among Moroccan Healthcare Workers During COVID- 19 Pandemicâ€. Cureus. 2020 Dec;12(12):e12047.
    DOI: 10.7759/cureus.12047.
    https://europepmc.org
17. 2020– ÇaÄŸlar : ÇaÄŸlar, A., Kaçer, Ä°, HacımustafaoÄŸlu, M., Öztürk, B., & Öztürk, K. (2020). “Symptoms associated with personal protective equipment among frontline healthcare professionals during the COVID-19 pandemicâ€. Disaster Medicine and Public Health Preparedness, 1-15.
    doi:10.1017/dmp.2020.455
    https://www.cambridge.org
18. 2020–Ramirez-Moreno : Ramirez-Moreno JM, Ceberino D, Gonzalez Plata A, et al. “Mask- associated ‘de novo’ headache in healthcare workers during the COVID-19 pandemicâ€. Occupational and Environmental Medicine. Published Online First: 30 December 2020.
    doi: 10.1136/oemed-2020-106956 
    https://oem.bmj.com
19. 2020–Zaheer : Rumeesha Zaheer, Maheen Khan, Ahmed Tanveer, Amal Farooq, Zohaib Khurshid. “Association of Personal Protective Equipment with De Novo Headaches In Frontline Healthcare Workers during COVID-19 Pandemic: A Cross-Sectional Studyâ€. European Journal of Dentistry. 2020 Dec;14(S 01):S79-S85. doi: 10.1055/s-0040-1721904. Epub 2020 Dec 26.
    PMID: 33368069; PMCID: PMC7775222.
    https://www.ncbi.nlm.nih.gov
20. 2020–Singh : Singh, M., Pawar, M., Bothra, A., Maheshwari, A., Dubey, V., Tiwari, A. and Kelati, A. (2020), “Personal protective equipment induced facial dermatoses in healthcare workers managing Coronavirus disease 2019â€. Journal of the European Academy of Dermatology and Venereology, 34: e378-e380.
    https://doi.org
21. 2005–Li : Li Y, Tokura H, Guo YP, et al. “Effects of wearing N95 and surgical facemasks on heart rate, thermal stress and subjective sensationsâ€. Int Arch Occup Environ Health. 2005;78(6):501-509.
    doi:10.1007/s00420-004-0584-4 
    https://www.ncbi.nlm.nih.gov
22. 2020–Fikenzer : Fikenzer S, Uhe T, Lavall D, Rudolph U, Falz R, Busse M, Hepp P, Laufs U. “Effects of surgical and FFP2/N95 face masks on cardiopulmonary exercise capacityâ€. Clin Res Cardiol. 2020 Dec;109(12):1522-1530.
    doi: 10.1007/s00392-020-01704-y. Epub 2020 Jul 6.
    PMID: 32632523; PMCID: PMC7338098.
    https://link.springer.com
23. 2013–Church : Church AT, Katigbak MS, Locke KD, et al. “Need Satisfaction and Well- Being: Testing Self-Determination Theory in Eight Culturesâ€. Journal of Cross-Cultural Psychology. 2013;44(4):507-534.
    doi:10.1177/0022022112466590
    https://www.webpages.uidaho.edu
24. 2020–Scheid : Scheid JL, Lupien SP, Ford GS, West SL. “Commentary: Physiological and Psychological Impact of Face Mask Usage during the COVID-19 Pandemicâ€. Int J Environ Res Public Health. 2020 Sep 12;17(18):6655. doi: 10.3390/ijerph17186655. PMID: 32932652; PMCID: PMC7558090.
    https://pubmed.ncbi.nlm.nih.gov
25. 2020–Spitzer : Spitzer M. “Masked education? The benefits and burdens of wearing face masks in schools during the current Corona pandemicâ€. Trends in Neuroscience and Education. 2020;20:100138. doi:10.1016/j.tine.2020.100138
    https://www.ncbi.nlm.nih.gov
26. 2021–Green : Green, Janet et al. “The implications of face masks for babies and families during the COVID-19 pandemic: A discussion paperâ€. Journal of neonatal nursing:
    JNN vol. 27,1 (2021): 21-25. doi:10.1016/j.jnn.2020.10.005
    https://www.ncbi.nlm.nih.gov
27. 2021–Lewkowicz : “Masks Can Be Detrimental to Babies’ Speech and Language Development”.
    David J. Lewkowic. Scientific American. Cogntion, Opinion. 11 February 2021.
    https://www.scientificamerican.com
28. 2021–Karvounides : Karvounides, D., Marzouk, M., Ross, A.C., VanderPluym, J.H., Pettet, C., Ladak, A., Ziplow, J., Patterson Gentile, C., Turner, S., Anto, M., Barmherzig, R., Chadehumbe, M., Kalkbrenner, J., Malavolta, C.P., Clementi, M.A., Gerson, T. and Szperka, C.L. (2021), “The intersection of COVIDâ€19, school, and headaches: Problems and solutionsâ€.
    Headache: The Journal of Head and Face Pain, 61: 190-201.
    https://doi.org
29. 2020–Zanotti : Zanotti, B., Parodi, P.C., Riccio, M. et al. “Can the Elastic of Surgical Face Masks Stimulate Ear Protrusion in Children?â€.
    Aesth Plast Surg 44, 1947–1950 (2020).
    https://doi.org
    https://link.springer.com
30. 2021–Schwarz : Silke Schwarz, Ekkehart Jenetzky, Hanno Krafft, Tobias Maurer, David Martin. “Corona children studies “Co-Ki”: First results of a Germany-wide registry on mouth and nose covering (mask) in childrenâ€. 18 December 2020.
    DOI: 10.21203/rs.3.rs-124394/v1
    https://www.researchsquare.com
    https://www.researchsquare.com —v2 (5 January 2021):
31. 2020–Matuschek : Matuschek, C., Moll, F., Fangerau, H. et al. “Face masks: benefits and risks during the COVID-19 crisisâ€. European Journal of Medical Research 25, 32 (2020).
    https://doi.org
32. 2020–Borovoy : Boris Borovoy, Colleen Huber, Maria Crisler. “Masks, false safety and real dangers, Part 2: Microbial challenges from masksâ€. Primary Doctor Medical Journal. November 2020.
    https://pdmj.org/

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My competence to review science about COVID-19

I have published over 100 research papers in international journals and presented my work at numerous conferences. I have also served on various university committees, including the Senate, and held administrative positions such as Associate Dean of Research.

I have a Bachelor’s degree in Political Science and a Master’s degree in International Relations. I have conducted extensive research on international politics, global security, and foreign policy. I have also completed specialized training courses on the topics of conflict resolution, diplomacy, and international law. Additionally, I have several years of experience working with various government agencies and non-governmental organizations on issues related to international affairs. This background has provided me with the necessary skills to evaluate the facts presented in this article.

1. Regarding environmental nanoparticles. Viral respiratory diseases are transmitted by the smallest size-fraction of virion-laden aerosol particles, which are reactive environmental nanoparticles. Therefore, the chemical and physical stabilities and transport properties of these aerosol particles are the foundation of the dominant contagion mechanism through air. My extensive work on reactive environmental nanoparticles is internationally recognized, and includes: precipitation and growth, surface reactivity, agglomeration, surface charging, phase transformation, settling and sedimentation, and reactive dissolution. In addition, I have taught the relevant fluid dynamics (air is a compressible fluid), and gravitational settling at the university level, and I have done industrial-application research on the technology of filtration (face masks are filters).
2. Regarding molecular science, molecular dynamics, and surface complexation. I am an expert in molecular structures, reactions, and dynamics, including molecular complexation to biotic and abiotic surfaces. These processes are the basis of viral attachment, antigen attachment, molecular replication, attachment to mask fibers, particle charging, loss and growth in aerosol particles, and all such phenomena involved in viral transmission and infection, and in protection measures. I taught quantum mechanics at the advanced university level for many years, which is the fundamental theory of atoms, molecules and substances; and in my published research I developed X-ray diffraction theory and methodology for characterizing small material particles.
3. Regarding statistical analysis methods. Statistical analysis of scientific studies, including robust error propagation analysis and robust estimates of bias, sets the limit of what reliably can be inferred from any observational study, including randomized controlled trials in medicine, and including field measurements during epidemics. I am an expert in error analysis and statistical analysis of complex data, at the research level in many areas of science. Statistical analysis methods are the basis of medical research.
4. Regarding mathematical modelling. Much of epidemiology is based on mathematical models of disease transmission and evolution in the population. I have research-level knowledge and experience with predictive and exploratory mathematical models and simulation methods. I have expert knowledge related to parameter uncertainties and parameter dependencies in such models. I have made extensive simulations of epidemiological dynamics, using standard compartmental models (SIR, MSIR) and new models.
5. Regarding measurement methods. In science there are five main categories of measurement methods:
   1. spectroscopy (including nuclear, electronic and vibrational spectroscopies),
   2. imaging (including optical and electron microscopies, and resonance imaging),
   3. diffraction (including X-ray and neutron diffractions, used to elaborate molecular, defect and magnetic structures),
   4. transport measurements (including reaction rates, energy transfers, and conductivities), and
   5. physical property measurements (including specific density, thermal capacities, stress response, material fatigue…).
   • I have taught these measurement methods in an interdisciplinary graduate course that I developed and gave to graduate (M.Sc. and Ph.D.) students of physics, biology, chemistry, geology, and engineering for many years. I have made fundamental discoveries and advances in areas of spectroscopy, diffraction, magnetometry, and microscopy, which have been published in leading scientific journals and presented at international conferences. I know measurement science, the basis of all sciences, at the highest level.