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MASK EMEMPTION
ON HEALTH RISK
GROUNDS IN IRISH
COVID REGULATIONS

by Fintan Dunne, 10 Aug, 2020 - New regulations on mandatory mask-wearing were introduced today by the Irish Government, but they contain a provision which can exempt from mask-wearing anyone with reasonable grounds to consider masks a personal health risk.

Section 5 of the SI296 regulation states that a person has reasonable excuse if they have decided to remove their face covering to "avoid harm or injury, or the risk of harm or injury." 

Unless you are on public transport, you can simply cite the health risk concerns you have and claim exemption under section 5(d) of SI296. Legal advice we sought was that it would likely constitute discrimination and therefore be illegal to refuse entry to someone who has a “reasonable excuse”.

On public transport you can also cite your health risk concerns and claim exemption, this time under section 6(d) of SI244. But the 'relevant person' can decide to reject your claim and insist on compliance.

But in all other places covered by these regulations, you are the legal arbiter of your own health risk. You decide.

So I will now show you that there are, in fact, many grounds for being concerned about your personal risk of harm or injury from wearing a facemask. You can cite this article and/or these grounds if questioned. 


RISKS FROM WEARING FACE MASKS 

A review of the peer-reviewed medical literature examines impacts on human health, both immunological, as well as physiological. The purpose of this paper is to examine data regarding the effectiveness of facemasks, as well as safety data. The reason that both are examined in one paper is that for the general public as a whole, as well as for every individual, a risk-benefit analysis is necessary to guide decisions on if and when to wear a mask.


Are Masks Safe During Walking or other Exercise? 

Surgical mask wearers had significantly increased dyspnea (hard breathing) after a 6-minute walk than non-mask wearers. (30)

Researchers are concerned about possible burden of facemasks during physical activity on pulmonary, circulatory and immune systems, due to oxygen reduction and air trapping reducing substantial carbon dioxide exchange. As a result of hypercapnia, there may be cardiac overload, renal overload, and a shift to metabolic acidosis. (31)


Risks of N95 respirators

Pregnant healthcare workers were found to have a loss in volume of oxygen consumption by 13.8% compared to controls when wearing N95 respirators. 17.7% less carbon dioxide was exhaled. (32) Patients with end-stage renal disease were studied during use of N95 respirators. Their partial pressure of oxygen (PaO2) decreased significantly compared to controls and increased respiratory adverse effects. (33) 19% of the patients developed various degrees of hypoxemia while wearing the masks.

Healthcare workers’ N95 respirators were measured by personal bioaerosol samplers to harbor influenza virus. (34) And 25% of healthcare workers’ facepiece respirators were found to contain influenza in an emergency department during the 2015 flu season. (35)​

One study found 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 a

Risks of surgical masks

Healthcare workers’ surgical masks also were measured by personal bioaerosol samplers to harbor for influenza virus. (36)

Various respiratory pathogens were found on the outer surface of used medical masks, which could result in self-contamination. The risk was found to be higher with longer duration of mask use. (37)

Surgical masks were also found to be a repository of bacterial contamination. The source of the bacteria was determined to be the body surface of the surgeons, rather than the operating room environment. (38) Given that surgeons are gowned from head to foot for surgery, this finding should be especially concerning for laypeople who wear masks. Without the protective garb of surgeons, laypeople generally have even more exposed body surface to serve as a source for bacteria to collect on their masks.


Risks of cloth masks

Healthcare workers wearing cloth masks were found to have 13 times the risk of influenza-like illness than those wearing medical masks. (27) Cloth masks were found to have low efficiency for blocking particles of 0.3 microns and smaller. Aerosol penetration through the various cloth masks examined in this study were between 74 and 90%. Likewise, the filtration efficiency of fabric materials was 3% to 33% (26) 

Healthcare workers wearing cloth masks had significantly higher rates of influenza-like illness after four weeks of continuous on-the-job use, when compared to controls. (39)

The increased rate of infection in mask-wearers may be due to a weakening of immune function during mask use. Surgeons have been found to have lower oxygen saturation after surgeries even as short as 30 minutes. (40) Low oxygen induces hypoxia-inducible factor 1 alpha (HIF-1). (41) This in turn down-regulates CD4+ T-cells. CD4+ T-cells, in turn, are necessary for viral immunity. (42)​


Dental and Heart Complications

Two top dentists in New York City say mask-wearing makes people breathe through their nose and subsequently causes their mouth to dry out

This results in a decrease of saliva in the mouth, which works to neutralize acid and prevent tooth decay and gum disease  'Gum disease will eventually lead to strokes and an increased risk of heart attacks,' one dentist claims, saying the long-term effects can be serious. 'Gum disease — or periodontal disease — will eventually lead to strokes and an increased risk of heart attacks,' according to dentist, Dr. Marc Sclafani.


Maskne Is Acne

Maskne — the most common kind of which is acne mechanica, led the American Academy of Dermatology to release advice on the subject. That’s because masks can worsen skin issues that already exist or cause new ones.


References

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https://www.medrxiv.org/content/10.1101/2020.03.30.20047217v2

2 J Xiao, E Shiu, et al. Nonpharmaceutical measures for pandemic influenza in non-healthcare settings – personal protective and environmental measures. Centers for Disease Control. 26(5); 2020 May.

https://wwwnc.cdc.gov/eid/article/26/5/19-0994_article

3 J Brainard, N Jones, et al. Facemasks and similar barriers to prevent respiratory illness such as COVID19: A rapid systematic review. MedRxiv. 2020 Apr 1.

https://www.medrxiv.org/content/10.1101/2020.04.01.20049528v1.full.pdf

4 L Radnovich M Simberkoff, et al. N95 respirators vs medical masks for preventing influenza among health care personnel: a randomized clinic trial. JAMA. 2019 Sep 3. 322(9): 824-833.

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5 J Smith, C MacDougall. CMAJ. 2016 May 17. 188(8); 567-574.

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7 J Jacobs, S Ohde, et al. Use of surgical face masks to reduce the incidence of the common cold among health care workers in Japan: a randomized controlled trial. Am J Infect Control. 2009 Jun; 37(5): 417-419.

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9 S Grinshpun, H Haruta, et al. Performance of an N95 filtering facepiece particular respirator and a surgical mask during human breathing: two pathways for particle penetration. J Occup Env Hygiene. 2009; 6(10):593-603.

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10 H Jung, J Kim, et al. Comparison of filtration efficiency and pressure drop in anti-yellow sand masks, quarantine masks, medical masks, general masks, and handkerchiefs. Aerosol Air Qual Res. 2013 Jun. 14:991-1002.

https://aaqr.org/articles/aaqr-13-06-oa-0201.pdf

11 C MacIntyre, H Seale, et al. A cluster randomized trial of cloth masks compared with medical masks in healthcare workers. BMJ Open. 2015; 5(4)

https://bmjopen.bmj.com/content/5/4/e006577.long

12 N95 masks explained. https://www.honeywell.com/en-us/newsroom/news/2020/03/n95-masks-explained

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https://academic.oup.com/cid/article/65/11/1934/4068747​

14 C MacIntyre, Q Wang, et al. A cluster randomized clinical trial comparing fit-tested and non-fit-tested N95 respirators to medical masks to prevent respiratory virus infection in health care workers. Influenza J. 2010 Dec 3.

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15 M Walker. Study casts doubt on N95 masks for the public. MedPage Today. 2020 May 20.

https://www.medpagetoday.com/infectiousdisease/publichealth/86601

16 C MacIntyre, Q Wang, et al. A cluster randomized clinical trial comparing fit-tested and non-fit-tested N95 respirators to medical masks to prevent respiratory virus infection in health care workers. Influenza J. 2010 Dec 3.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1750-2659.2011.00198.x?fbclid=IwAR3kRYVYDKb0aR-su9_me9_vY6a8KVR4HZ17J2A_80f_fXUABRQdhQlc8Wo

17 N Shimasaki, A Okaue, et al. Comparison of the filter efficiency of medical nonwoven fabrics against three different microbe aerosols. Biocontrol Sci. 2018; 23(2). 61-69.

https://www.jstage.jst.go.jp/article/bio/23/2/23_61/_pdf/-char/en

18 T Tunevall. Postoperative wound infections and surgical face masks: A controlled study. World J Surg. 1991 May; 15: 383-387.

https://link.springer.com/article/10.1007%2FBF01658736

19 N Orr. Is a mask necessary in the operating theatre? Ann Royal Coll Surg Eng 1981: 63: 390-392.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2493952/pdf/annrcse01509-0009.pdf

20 N Mitchell, S Hunt. Surgical face masks in modern operating rooms – a costly and unnecessary ritual? J Hosp Infection. 18(3); 1991 Jul 1. 239-242.

https://www.journalofhospitalinfection.com/article/0195-6701(91)90148-2/pdf

21 C DaZhou, P Sivathondan, et al. Unmasking the surgeons: the evidence base behind the use of facemasks in surgery. JR Soc Med. 2015 Jun; 108(6): 223-228.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480558/

22 L Brosseau, M Sietsema. Commentary: Masks for all for Covid-19 not based on sound data. U Minn Ctr Inf Dis Res Pol. 2020 Apr 1.

https://www.cidrap.umn.edu/news-perspective/2020/04/commentary-masks-all-covid-19-not-based-sound-data

23 N Leung, D Chu, et al. Respiratory virus shedding in exhaled breath and efficacy of face masks Nature Research. 2020 Mar 7. 26,676-680 (2020).

https://www.researchsquare.com/article/rs-16836/v1

24 S Rengasamy, B Eimer, et al. Simple respiratory protection – evaluation of the filtration performance of cloth masks and common fabric materials against 20-1000 nm size particles. Ann Occup Hyg. 2010 Oct; 54(7): 789-798.

https://academic.oup.com/annweh/article/54/7/789/202744

25 S Bae, M Kim, et al. Effectiveness of surgical and cotton masks in blocking SARS-CoV-2: A controlled comparison in 4 patients. Ann Int Med. 2020 Apr 6.

https://www.acpjournals.org/doi/10.7326/M20-1342

26 S Rengasamy, B Eimer, et al. Simple respiratory protection – evaluation of the filtration performance of cloth masks and common fabric materials against 20-1000 nm size particles. Ann Occup Hyg. 2010 Oct; 54(7): 789-798.

https://academic.oup.com/annweh/article/54/7/789/202744

27 C MacIntyre, H Seale, et al. A cluster randomized trial of cloth masks compared with medical masks in healthcare workers. BMJ Open. 2015; 5(4)

https://bmjopen.bmj.com/content/5/4/e006577.long​

28 W Kellogg. An experimental study of the efficacy of gauze face masks. Am J Pub Health. 1920. 34-42.

https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.10.1.34

29 M Klompas, C Morris, et al. Universal masking in hospitals in the Covid-19 era. N Eng J Med. 2020; 382 e63.

https://www.nejm.org/doi/full/10.1056/NEJMp2006372

30 E Person, C Lemercier et al. Effect of a surgical mask on six minute walking distance. Rev Mal Respir. 2018 Mar; 35(3):264-268.

https://pubmed.ncbi.nlm.nih.gov/29395560/

31 B Chandrasekaran, S Fernandes. Exercise with facemask; are we handling a devil’s sword – a physiological hypothesis. Med Hypothese. 2020 Jun 22. 144:110002.

https://pubmed.ncbi.nlm.nih.gov/32590322/

32 P Shuang Ye Tong, A Sugam Kale, et al. Respiratory consequences of N95-type mask usage in pregnant healthcare workers – A controlled clinical study. Antimicrob Resist Infect Control. 2015 Nov 16; 4:48.

https://pubmed.ncbi.nlm.nih.gov/26579222/

33 T Kao, K Huang, et al. The physiological impact of wearing an N95 mask during hemodialysis as a precaution against SARS in patients with end-stage renal disease. J Formos Med Assoc. 2004 Aug; 103(8):624-628.

https://pubmed.ncbi.nlm.nih.gov/15340662/

34 F Blachere, W Lindsley et al. Assessment of influenza virus exposure and recovery from contaminated surgical masks and N95 respirators. J Viro Methods. 2018 Oct; 260:98-106.

https://pubmed.ncbi.nlm.nih.gov/30029810/

35 A Rule, O Apau, et al. Healthcare personnel exposure in an emergency department during influenza season. PLoS One. 2018 Aug 31; 13(8): e0203223.

https://pubmed.ncbi.nlm.nih.gov/30169507/

36 F Blachere, W Lindsley et al. Assessment of influenza virus exposure and recovery from contaminated surgical masks and N95 respirators. J Viro Methods. 2018 Oct; 260:98-106.

https://pubmed.ncbi.nlm.nih.gov/30029810/

37 A Chughtai, S Stelzer-Braid, et al. Contamination by respiratory viruses on our surface of medical masks used by hospital healthcare workers. BMC Infect Dis. 2019 Jun 3; 19(1): 491.

https://pubmed.ncbi.nlm.nih.gov/31159777/​

38 L Zhiqing, C Yongyun, et al. J Orthop Translat. 2018 Jun 27; 14:57-62.

https://pubmed.ncbi.nlm.nih.gov/30035033/

39 C MacIntyre, H Seale, et al. A cluster randomized trial of cloth masks compared with medical masks in healthcare workers. BMJ Open. 2015; 5(4)

https://bmjopen.bmj.com/content/5/4/e006577

​40 A Beder, U Buyukkocak, et al. Preliminary report on surgical mask induced deoxygenation during major surgery. Neurocirugia. 2008; 19: 121-126.

http://scielo.isciii.es/pdf/neuro/v19n2/3.pdf

41 D Lukashev, B Klebanov, et al. Cutting edge: Hypoxia-inducible factor 1-alpha and its activation-inducible short isoform negatively regulate functions of CD4+ and CD8+ T lymphocytes. J Immunol. 2006 Oct 15; 177(8) 4962-4965.

https://www.jimmunol.org/content/177/8/4962

42 A Sant, A McMichael. Revealing the role of CD4+ T-cells in viral immunity. J Exper Med. 2012 Jun 30; 209(8):1391-1395.

https://europepmc.org/article/PMC/3420330

SOURCE 




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