Surviving mask fatigue – Part I.

EVERY JAMAICAN citizen, resident, and visitor has a personal responsibility to curtail the spread of COVID-19. This is of the utmost importance as the active cases of COVID-19 and related deaths are at an all-time high. In August alone, reports have shown that COVID-19 cases have significantly tripled beyond the numbers that existed in February till July 2020.

The Jamaican Government and the Ministry of Health and Wellness have constantly been i mplementing and adjusting safety protocols, with hopes of eradicating this dreaded disease. It is unfortunate, however, that the guidelines and protocols that are put in place to protect us are still not being acknowledged or considered by the public to the degree that is required. One such noted disregard of the protocols is the ineffective wearing of masks, or the outright refusal to wear a mask, especially in public spaces. In a social poll we conducted between July and August 2020, it was discovered that more than 70 per cent of the respondents were not in favour of wearing a mask or stated that they could not tolerate wearing one for long periods. These assertions were due to the physiological effects they experienced while wearing masks.

Most common physical adverse effects reported were:

• Nasal congestion, sinusitis/ rhinosinusitis

• Shortness of breath

• Dry mouth

• Changes in mouth odour, halitosis

• Headaches

• Anxiety This noted conundrum of mask wearing has cast new attention on the once-dormant coined terminology of “mask fatigue”. In addition to the physiological effects of wearing a mask for long periods, the poll respondents also motioned that information relating to why these symptoms occurred and how to mitigate them was not readily available to the public, thus heightening the suspicions.

Individuals cited conflicting advice about COVID-19, alluding to the dearth of scientific knowledge centred around how the disease is actually spread and how to avoid becoming infected. Furthermore, conspiracy theories have been raised stating that prolonged mask wearing can cause illnesses that may prove more fatal than COVID-19.

The truth is that

COVID -19 is real and it can be deadly, and it is spread through droplets and, therefore, one way of reducing the chance of spread is the wearing of masks. We, therefore, should not neglect any information that supports the benefits of wearing a mask in situations where airborne or droplet contaminants are probable.

One major factor affecting the public is that we (Jamaicans) are not accustomed to wearing masks! In addition, the warmth and humidity of our tropical climate do not facilitate a claustrophobic environment of any kind, whether that of being trapped in an elevator, locked in a small room, or wearing a mask.

This article aims to provide some vital information as to why one may experience the stated adverse effects of prolonged mask use and provides recommendations to ease the ‘burden’ of mask wearing.

SOME EFFECTS EXPLAINED

Nasal congestion – Commonly known as stuffy nose, is said to be attributed to tight-fitting masks, which causes inadequate ventilation. The hot and humid environment found in the facial region covered by masks causes discomfort, increased temperature, and perspiration. The moist environment and pressure from the tight-fitting mask can cause inflammation of the lining of the nasal cavity. This may create an uncomfortable stuffed-up feeling, making the simple act of breathing difficult.

Sinusitis/rhinosinusitis: Nasal congestion caused by inflammation can lead to blockage of the sinus cavities. This provides an excellent medium for bacterial growth, resulting in inflammation of the sinuses (sinusitis). Another condition that can block the normal flow of the sinuses is the pressure of foreign objects such as a tight-fitting mask. Rhinitis (runny nose) can be caused by the reusing of masks that have already been exposed to environmental allergens or masks made from flaking materials. These environmental hazards may result in chronic inflammation of the nasal passages, leading to nasal congestion, hence sinusitis.

Shortness of breath: The prolonged wearing of masks facilitates the build-up of exhaled carbon dioxide (CO2) between the mask and face. Inhaling CO2 burdens breathing and forces a person to inhale little oxygen, increasing CO2 levels in the body. This can cause a person to experience symptoms such as chest discomfort, rapid breathing, and rapid heart rate, resulting in difficulty breathing, hence shortness of breath. If the person is also having nasal congestion or sinusitis, obstruction of the nasal passages may also contribute to difficult breathing.

Dry Mouth: Chronic nasal congestion or compression around the nasal area from a snug mask may force the individual to breathe through the mouth, thus producing dryness of the oral mucosa and associated problems, including persistent dry mouth.

Changes in mouth odour/halitosis:

This may result because the mouth constitutes an aggregate of natural bacteria. Wearing a mask creates an environment where oxygen is limited, and the temperature and moisture inside the mask increase. This gives room for the bacteria to proliferate and multiply. Since bacteria are living organisms, they excrete and produce certain gases and acids that cause foul-smelling odours in the mouth.

Headaches: Can be related to other adverse effects such as inhaling more than the required amount of CO2 or tight mask straps, which places pressure on superficial facial and cervical nerves (nerves in the face and neck). Also, constant nasal congestion and/or sinusitis can cause a build-up of pressure in the nasal and/or facial sinuses, resulting in headaches.

Anxiety: Individuals wearing a mask may complain that it feels claustrophobic. It is too tight around my face. It is hot. It is hard to breathe. Researchers have concluded that the area of the face covered by a protective mask happens to be very thermosensitive. An increase of temperature in the facial skin covered by the mask substantially affects thermal sensations of the whole body, making one feel hot, irritable, and anxious.

In Part II of this series, we will examine how you can prevent mask fatigue.

Carlene Simpson is assistant lecturer at The UWI School of Nursing, Loraine Hyde-Allison is supervisory family nurse practitioner at SERHA, and Shirlene Marshall-Davis is the logistics manager (infection prevention control nurse) at the Emergency Disaster Management and Special Services Branch at the Ministry of Health and Wellness. Send feedback to columns@gleanerjm.com.