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The Mask-Induced Exhaustion Syndrome

at 04.12.2021
“Is a mask that Covers the mouth and nose free from undesirable side effects in everyday use and free of potential hazards?” asks a team of German physicians from different specialties in an extensive meta-analysis on the side effects of wearing a mask. In the abstract, the German scientists assert that, although many countries introduced the requirement to wear masks in public spaces for containing SARS-CoV-2, up until now, there has been no comprehensive investigation as to the adverse health effects masks can cause. Their answer is that yes, wearing the mask for hours every day, in the long run, has more than 20 serious side effects.

Based on the evaluated literature, the researchers [1] found that wearing a mask can produce adverse effects relevant to different disciplines of medicine. It is a psychological and physical deterioration, manifested by multiple symptoms, called generically Mask-Induced Exhaustion Syndrome (MIES). The main causes of these symptoms are obvious changes in respiratory physiology in mask wearers.

Broadly speaking, Mask-Induced Exhaustion Syndrome (MIES) can occur in both sick and healthy people, with typical changes and symptoms, such as: "increase in breathing dead space volume [2], increase in breathing resistance [3], increase in blood carbon dioxide [4], decrease in blood oxygen saturation [5], increase in heart rate [6], increase in blood pressure, decrease in cardiopulmonary capacity [7], increase in respiratory rate [8], shortness of breath and difficulty breathing [9], headache, dizziness [10], feeling hot and clammy, decreased ability to concentrate, decreased ability to think, drowsiness, decrease in empathy perception [11], impaired skin barrier function with itching, acne, skin lesions and irritation [12], overall perceived fatigue and exhaustion”.

Wearing masks does not cause immediate clinical deviations from the norm of physiological parameters, but according to the scientific literature, a long-term pathological consequence with clinical relevance is to be expected owing to a longer-lasting effect with a subliminal impact and significant shift in the pathological direction. Changes that do not exceed normal values, but are persistently recurring, such as an increase in blood carbon dioxide, an increase in heart rate, or an increase in respiratory rate, should generate in the long-term run high blood pressure, arteriosclerosis, and coronary heart disease and of neurological diseases.

There is a pathogenic damage principle with a chronic low-dose exposure with long-term effect, which leads to disease or disease-relevant conditions and has already been extensively studied and described in many areas of environmental medicine. Extended mask-wearing would have the potential, according to the facts and correlations we have found, to cause a chronic sympathetic stress response induced by blood gas modifications and controlled by brain centers. This in turn induces and triggers immune suppression and metabolic syndrome with cardiovascular and neurological diseases.

In addition to the potential long-term effects of wearing a mask, experts also mention short-term side effects, directly proportional to the duration of wearing the mask: carbon dioxide retention, drowsiness, headache, feeling of exhaustion, skin irritation (redness, itching), and microbiological contamination (germ colonization) [13].

Overall, the exact frequency of the described symptom constellation MIES in the mask-using populace remains unclear and cannot be estimated due to insufficient data. Theoretically, the main mask-induced effects of the drop in blood gas oxygen and increase in carbon dioxide extend to the cellular level with induction of the transcription factor HIF (hypoxia-induced factor) and increased inflammatory and cancer-promoting effects and can, thus, also have a negative influence on pre-existing clinical pictures.

The list of the main side effects caused by wearing a long-term protective mask is as follows:

Internal diseases Psychiatric illness Neurological Diseases
COPD
Sleep Apnea Syndrome
advanced renal Failure
Obesity
Cardiopulmonary Dysfunction
Asthma
Claustrophobia
Panic Disorder
Personality Disorders
Dementia
Schizophrenia
helpless Patients
fixed and sedated Patients
Migraines and Headache Sufferers
Patients with intracranial Masses
Epilepsy
Pediatric Diseases ENT Diseases Dermatological Diseases
Asthma Vocal Cord Disorders Acne
Respiratory Diseases Rhinitis and obstructive Diseases Atopic
Cardiopulmonary Diseases

Neuromuscular Diseases

Epilepsy

Occupational Health Restrictions Gynecological restrictions
moderate/heavy physical Work Pregnant Women

Furthermore, the German physicians point out that wearing a mask is not recommended for people who exercise and for pregnant women.

For all these reasons, the paper points out that, first of all, medical doctors should protect the health of their patients, having as the base of their actions the guiding principle of the 1948 Geneva Declaration, as revised in 2017. According to this, every doctor vows to put the health and dignity of his patient first and, even under threat, not to use his medical knowledge to violate human rights and civil liberties. 




[1] Kisielinski K, Giboni P, Prescher A, Klosterhalfen B, Graessel D, Funken S, Kempski O, Hirsch O. Is a Mask That Covers the Mouth and Nose Free from Undesirable Side Effects in Everyday Use and Free of Potential Hazards? International Journal of Environmental Research and Public Health. 2021; 18(8):4344. https://doi.org/10.3390/ijerph18084344
[2] Roberge, R.J.; Kim, J.-H.; Powell, J.B. N95 Respirator Use during Advanced Pregnancy. Am. J. Infect. Control 2014, 42, 1097–1100. Epstein, D.; Korytny, A.; Isenberg, Y.; Marcusohn, E.; Zukermann, R.; Bishop, B.; Minha, S.; Raz, A.; Miller, A. Return to Training in the COVID-19 Era: The Physiological Effects of Face Masks during Exercise. Scand. J. Med. Sci. Sports 2020.
[3] 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 Capacity. Clin. Res. Cardiol. 2020, 109, 1522–1530. Li, Y.; Tokura, H.; Guo, Y.P.;Wong, A.S.W.;Wong, T.; Chung, J.; Newton, E. Effects ofWearing N95 and Surgical Facemasks on Heart Rate, Thermal Stress and Subjective Sensations. Int. Arch. Occup. Environ. Health 2005, 78, 501–509. Roberge, R.; Bayer, E.; Powell, J.; Coca, A.; Roberge, M.; Benson, S. Effect of Exhaled Moisture on Breathing Resistance of N95 Filtering Facepiece Respirators. Ann. Occup. Hyg. 2010, 54, 671–677.
[4] Butz, U. Rückatmung von Kohlendioxid bei Verwendung von Operationsmasken als hygienischer Mundschutz an medizinischem Fachpersonal. Ph.D. Thesis, Fakultät für Medizin der Technischen Universität München, Munich, Germany, 2005. Roberge, R.J.; Kim, J.-H.; Benson, S.M. Absence of Consequential Changes in Physiological, Thermal and Subjective Responses fromWearing a Surgical Mask. Respir. Physiol. Neurobiol. 2012, 181, 29–35.
[5] Pifarré, F.; Zabala, D.D.; Grazioli, G.; de Yzaguirre i Maura, I. COVID 19 and Mask in Sports. Apunt. Sports Med. 2020. Rebmann, T.; Carrico, R.; Wang, J. Physiologic and Other Effects and Compliance with Long-Term Respirator Use among Medical Intensive Care Unit Nurses. Am. J. Infect. Control 2013, 41, 1218–1223. Georgi, C.; Haase-Fielitz, A.; Meretz, D.; Gäsert, L.; Butter, C. Einfluss gängiger Gesichtsmasken auf physiologische Parameter und Belastungsempfinden unter arbeitstypischer körperlicher Anstrengung. Deutsches Ärzteblatt 2020, 674–675.
[6] Roberge, R.J.; Kim, J.-H.; Benson, S.M. Absence of Consequential Changes in Physiological, Thermal and Subjective Responses fromWearing a Surgical Mask. Respir. Physiol. Neurobiol. 2012, 181, 29–35. Rebmann, T.; Carrico, R.; Wang, J. Physiologic and Other Effects and Compliance with Long-Term Respirator Use among Medical Intensive Care Unit Nurses. Am. J. Infect. Control 2013, 41, 1218–1223. Kyung, S.Y.; Kim, Y.; Hwang, H.; Park, J.-W.; Jeong, S.H. Risks of N95 Face Mask Use in Subjects with COPD. Respir. Care 2020, 65, 658–664.
[7] 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 Capacity. Clin. Res. Cardiol. 2020, 109, 1522–1530.
[8] Roberge, R.J.; Kim, J.-H.; Benson, S.M. Absence of Consequential Changes in Physiological, Thermal and Subjective Responses fromWearing a Surgical Mask. Respir. Physiol. Neurobiol. 2012, 181, 29–35. Georgi, C.; Haase-Fielitz, A.; Meretz, D.; Gäsert, L.; Butter, C. Einfluss gängiger Gesichtsmasken auf physiologische Parameter und Belastungsempfinden unter arbeitstypischer körperlicher Anstrengung. Deutsches Ärzteblatt 2020, 674–675. Kyung, S.Y.; Kim, Y.; Hwang, H.; Park, J.-W.; Jeong, S.H. Risks of N95 Face Mask Use in Subjects with COPD. Respir. Care 2020, 65, 658–664.
[9] Roberge, R.J.; Kim, J.-H.; Benson, S.M. Absence of Consequential Changes in Physiological, Thermal and Subjective Responses fromWearing a Surgical Mask. Respir. Physiol. Neurobiol. 2012, 181, 29–35. Rebmann, T.; Carrico, R.; Wang, J. Physiologic and Other Effects and Compliance with Long-Term Respirator Use among Medical Intensive Care Unit Nurses. Am. J. Infect. Control 2013, 41, 1218–1223. Georgi, C.; Haase-Fielitz, A.; Meretz, D.; Gäsert, L.; Butter, C. Einfluss gängiger Gesichtsmasken auf physiologische Parameter und Belastungsempfinden unter arbeitstypischer körperlicher Anstrengung. Deutsches Ärzteblatt 2020, 674–675.
[10] Kyung, S.Y.; Kim, Y.; Hwang, H.; Park, J.-W.; Jeong, S.H. Risks of N95 Face Mask Use in Subjects with COPD. Respir. Care 2020, 65, 658–664. Liu, C.; Li, G.; He, Y.; Zhang, Z.; Ding, Y. Effects of Wearing Masks on Human Health and Comfort during the COVID-19 Pandemic. IOP Conf. Ser. Earth Environ. Sci. 2020, 531, 012034.
[11] Wong, C.K.M.; Yip, B.H.K.; Mercer, S.; Griffiths, S.; Kung, K.;Wong, M.C.; Chor, J.;Wong, S.Y. Effect of Facemasks on Empathy and Relational Continuity: A Randomised Controlled Trial in Primary Care. BMC Fam. Pract. 2013, 14, 200.
[12] Rosner, E. Adverse Effects of Prolonged Mask Use among Healthcare Professionals during COVID-19. J. Infect. Dis. Epidemiol. 2020. Foo, C.C.I.; Goon, A.T.J.; Leow, Y.; Goh, C. Adverse Skin Reactions to Personal Protective Equipment against Severe Acute Respiratory Syndrome–a Descriptive Study in Singapore. Contact Dermat. 2006, 55, 291–294. Hua, W.; Zuo, Y.; Wan, R.; Xiong, L.; Tang, J.; Zou, L.; Shu, X.; Li, L. Short-Term Skin Reactions Following Use of N95 Respirators and Medical Masks. Contact Dermat. 2020, 83, 115–121.
[13] Rebmann, T.; Carrico, R.; Wang, J. Physiologic and Other Effects and Compliance with Long-Term Respirator Use among Medical Intensive Care Unit Nurses. Am. J. Infect. Control 2013, 41, 1218–1223. Roberge, R.J.; Kim, J.-H.; Powell, J.B. N95 Respirator Use during Advanced Pregnancy. Am. J. Infect. Control 2014, 42, 1097–1100. Rosner, E. Adverse Effects of Prolonged Mask Use among Healthcare Professionals during COVID-19. J. Infect. Dis. Epidemiol. 2020. Ong, J.J.Y.; Bharatendu, C.; Goh, Y.; Tang, J.Z.Y.; Sooi, K.W.X.; Tan, Y.L.; Tan, B.Y.Q.; Teoh, H.-L.; Ong, S.T.; Allen, D.M.; et al. Headaches AssociatedWith Personal Protective Equipment-A Cross-Sectional Study among Frontline HealthcareWorkers During COVID-19. Headache 2020, 60, 864–877.

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