There has been talk of the facial mask exemption during the COVID-19 pandemic that has been circulating on the internet for the past few weeks, but experts say very few people qualify, and the decision depends on each person’s doctor.
“People with underlying chronic lung disease, such as COPD or asthma, should be able to wear a non-N95 face covering without affecting their oxygen or carbon dioxide levels,” said Dr. Albert Rizzo, medical director of the American Lung Association, told ABC News, adding that “the masks have no ill effects, even in patients with chronic lung disease.”
When asked if people who have difficulty breathing with a face mask should be exempt, he said, “There are many different face covers or even shields that could be used instead, if one cannot tolerate the conventional face mask.”
Rizzo said that “exemption cases are very few and far between,” and that “people with supplemental oxygen or a compromised respiratory state who are short of breath even when walking could meet the criteria, which in that case, going out in public. it is a health risk for the person. “
The Centers for Disease Control and Prevention (CDC) explain that in some situations, such as people with intellectual and developmental disabilities, mental health conditions, or other sensory sensitivities like autism spectrum disorder, wearing a mask may create distress. .
“It could comprise rare cases of post-traumatic stress disorder (PTSD) in which past trauma involved covering the face; in such cases, wearing a mask may trigger possible setbacks, but this is more of an exception,” the doctor told ABC News. Divya Jose, a psychiatrist in New York City. .
“I see a lot of patients with mental health problems like anxiety, psychotic and mood disorders, and I have yet to see one come in without a mask,” he added. “None of my patients has ever felt that wearing a mask triggers any of their symptoms.”
As parts of the United States grapple with an increase in coronavirus cases, misleading posts and videos have been released on social media showing people claiming to be medically exempt from wearing a mask during the pandemic.
Certain “mask waiver cards” are also circulating, claiming to exempt the person in possession of the card from wearing a mask due to underlying health conditions.
A common mask exemption card, which has been proven to be false, says: “Wearing a face mask poses a mental and / or physical risk to me. Under the Americans with Disabilities Act (ADA), I am not required to disclose my condition for you “.
The Freedom to Breathe Agency (FTBA), the group that sells the cards online, is not a government organization, federal officials said, and these cards do not have the force of law.
Since several countries require that masks be worn in public, it is important to address the question: Are there really medical exemptions for facial linings?
The World Health Organization (WHO) and the CDC have issued statements advising people to cover their faces in public to decrease the spread of COVID-19. The WHO states that facial masks made of breathable material, used properly, will not lead to health problems.
The WHO also recognizes that the use of a face covering is not convenient and has some disadvantages. They list such disadvantages as self-contamination by touching the mask and then the eyes, contamination if the mask gets wet, and skin irritation or worsening acne when wearing the mask for long hours. However, none of the disadvantages are reasons for exemption.
They say that masks can be difficult to use for children, people with developmental problems, mental illness, older people with cognitive disabilities, chronic respiratory problems and facial trauma or recent surgery. Still, none of the conditions are listed as reasons for exemption.
Each country has implemented its own rules regarding masks. In the US, the CDC advised everyone over the age of 2 to wear a mask in public unless they are having trouble breathing or are unconscious, disabled or otherwise unable to remove the cloth cover without assistance.
Dr. Mona Degan, a primary care physician in Los Angeles who works with asthma patients, told ABC News: “I don’t see asthma as an impending factor, unless the person is in active acute respiratory distress, in which case leaving not recommended in public. “
Dr. Catherine Lord, a psychologist at the University of California, Los Angeles, told ABC News that for children with neurodevelopmental disorders such as autism spectrum disorder, wearing a mask “could be really difficult, as they often have strong reactions to different sensations. ”
“Children with autism could be gradually relieved at the idea of wearing a mask,” said José.
“Wearing a mask for 5 to 10 minutes indoors can help desensitize the person and ease any anxiety the patient may have,” added Rizzo. The CDC also recommends that all children over the age of 2 cover their faces when leaving the house.
Dr. Christine Thang, a pediatrician at the Mattel Children’s Hospital at the University of California, Los Angeles, told ABC News: “Children with autism may have difficulty understanding why they need to wear a mask and do not like the texture of the face. For children who may have difficulty understanding or tolerating their masks, I encourage families to consult their pediatrician for help. ”
“To protect everyone from COVID-19, children should wear their face covers when they are away from home,” he added.
Modifications to the traditional facial lining may also be a possible solution. “The masks come in different materials, accessories and sizes that can be more comfortable to wear,” said Dr. Roy Berenholtz, an anesthesiologist who has been on the front line of the pandemic. “There is absolutely no reason why someone should not wear a mask,” he added.
The American Lung Association stated that the decision to grant a mask exemption to a person must be that person’s doctor. The person’s concerns must be weighed against social needs to mitigate the spread of the virus. In some cases, the doctor’s reassurance regarding the safety of facial liners may be all that is needed.
At this time, professionals have not provided clear guidelines for determining the exemption. It is up to physicians to balance interest in public health and individual disability modifications by granting exemptions from masks.
The role of facial liners, along with social distancing, is stated by the American Lung Association to be a necessary public health priority to decrease the spread of COVID-19.
Yalda Safai, MD, MPH, is a New York City resident of psychiatry and a contributor to the ABC News Medical Unit.
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