Table 2.
Eligible studies grouped in twelve thematic categories
| Category | Number reports | Author/year | Study design | Language | Sample (n) and measures | Results | |
|---|---|---|---|---|---|---|---|
| Children | 3 | Goh DYT et al. 2016 [7] | Two-period crossover randomized study | English |
106 children (7–14 years old) Physiological parameters: ETCO2, FICO2, RR, SpO2, HR, mask fit test, comfort assessment by visual analogue scale (VAS) without mask, with mask and with mask + microfan at rest and on mild exercise |
Mask without MF: increased the ETCO2 and FICO2 at rest and on mild exertion Mask with MF: FICO2 levels comparably closer to baseline levels without the mask for both activities Mask, with or without the MF: well fitting, comfortable and safe for use in children, at rest and on mild exertion |
|
| Lubrano R et al. 2021 [8] | Cohort study | English | 47 healthy children (aged A:4–24 months, B: 24–144 months). Parameters: ETCO2, SaO2, PR, RR, or signs of respiratory distress during two 30-min session with and without mask. In group B 12-min walking-test wearing the mask | In group A there is no significant differences with and without mask. In group B after 12-min walking-test with mask there are a significant change in PR and RR but always within normal ranges | |||
| Schwarz S et al. 2021 [9] | Survey | German |
20.353 respondents (parents, teachers, physicians) at survey of side effects of FMs worn by children and adolescents (Age: 0–17) |
67.7% of parents reported their children had side effects: headache, concentration difficulties, sleepiness, fatigue, skin worsening, nosebleed, anxiety disorders, rejection or anxiety of school, increased sweating, injuries behind ears, cracked lips, vision disorders and nightmares. Age 7–12 group, 60,4% had greater irritability, 49,3% were unhappy, 44% refused school, 25,3% developed new fears | |||
| Chronic lung diseases | 7 | Schönhofer B et al. 1995 [13] | Case control study | German | 29 cases vs 23 controls Pimax (cmH2O), P0,1 (cmH2O), P0,1/Pimax (cmH2O) | Cases: after 2 h with mask increased PaCO2, P0,1, P0,1/Pimax, HCO3 and reduced Pimax | |
| Bansal S et al. 2010 [11] | Case control study; dual cartridge half face mask vs N95 | English | 73 cases with mild respiratory disease vs 24 healthy controls; minute ventilation/high, inspiratory time, duty circle, heart rate, tidal volume / high, respiratory rate, expiratory time, time to reach, peak inspiratory/expiratory flow, mead inspiratory flow, peak inspiratory/expiratory flow | Respirator type affects physiologic measures; respiratory timing parameters are more affected that ventilator volumes; asthma has greater respirator-disease interaction than COPD and rhynopathy | |||
| Harber P et al. 2010 [12] | Case control study; dual cartridge half face mask vs N95 | English | 77 cases with mild respiratory disease vs 27 healthy controls; subjective response to respirator during tasks in a simulated work environment. Subjective response to respirator for multiple domains includes 12 specific symptoms and assessment of respirator- related duration decrement | More adverse subjective responses with half face mask than N95, especially in women. Asthma significantly increased the adverse effect of the HFM for six of the scales and showed a borderline significant effect for another. Conversely, the presence of COPD or rhinitis tended to decrease the differences between using an HFM versus an N95 device for many of the subjective rating variables | |||
| Kyung SY Kim Y et al. 2020 [10] | Observational study | English | 97 subjects with COPD; blood pressure, heart rate (HR), breathing rate (BR), SPO2, ETCO2 at baseline, during 6- minute walking test without a mask, 10 min rest with a mask and 6 mwt with the mask | BR, SPO2 and ETCO2 significantly higher after N95 use at rest; HR, BF and ETCO2 higher after 6MWT with a mask than after 6 MWT without a mask, SPO2 significantly lower after 6MWT with a mask | |||
| Ciocan C et al. 2020 [15] | Case-Series study | English | 10 participants, 3 with asthma and 3 smokers. Subject were tested three times: basal condition without mask, with mask and after 4 h of use of mask. In all times they performed Respiratory Functional Test (RFT) and Arterial Blood Gases Test (ABG). Parameters VC, FVC, FEV1, FEV1/FVC, TD, MVV, PaO2, PaCO2, SaO2 | PaCO2 showed a slight increase in well- controlled asthmatic patients, probably due to minimal increase in dead space | |||
| Samannan R. et al. 2021 [14] | Clinical observation study | English | 30 participants (15 healthy subjects; 15 with severe COPD). Parameters: ETCO2, SaO2 during 6-min walking test (6MWT) with surgical mask | Patients with severe COPD did not present any physiological changes in gas exchange measurements after 6MWT using surgical masks | |||
| Faria N. et al. 2021 [16] | Retrospective self- controlled study | English |
286 COPD patients with severe acute exacerbation (sAECOPD) They compared the incidence of sAECOPD events in 2020 with 2016, 2017, 2018 and 2019 |
Over the course of 2020 there was a statistically significant decrease of 73.4% in sAECOPD events comparing with previous years’ average | |||
| Ear-nose-throat diseases | 7 |
A. Hearing impairment Mendel LL et al 2008 [17] |
Case control study | English | 31 adults (1 talker, 15 listeners with normal hearing and 15 with hearing impairment | Surgical mask did not negatively affect speech uncerstanding. Noise has a deleterious effect on speech perception | |
| Langrish et al. 2012 [22] | Open randomized crossover trial | English | 98 patients with coronary heart disease walked on a predefined route once with and once without N95; symptoms, exercise, personal air pollution exposure, blood pressure, heart rate, and 12-lead electrocardiography were monitored throughout the 24- hr study period | Face mask well tolerated, its use was associated with decreased self-reported symptoms and reduced maximal ST segment depression (– 142 vs. – 156 μV, P = 0.046) over the 24-h period; mean ambulatory arterial blood pressure and heart rate more stable in the subjects who used masks | |||
| Atcherson SR et al. 2017 [20] | Case control study | English | 31 adults participated in this study: 1 talker, 10 listeners with normal hearing, 10 listeners with moderate sensorineural hearing loss, and 10 listeners with severe- profound hearing loss. Transparent surgical masks vs conventional paper mask | Listeners with normal hearing performed consistently well across all conditions. Both groups of listeners with hearing impairment benefitted from visual input from the transparent mask, mainly the severe-to- profound group | |||
| Trecca EMC et al. 2020 [21] | Case series | English | 59 patients with mild to profound hearing impairment referred from the Emergency Department for urgent ORL consultations; difficulties to communicate with HCWs in relation to their hearing impairment as none, mild, moderate, and severe and face mask use; causes of experienced difficulties | Eight (13.6%) subjects did not have difficulties, 15 (25.4%) presented mild difficulties, 22 (37.3%) moderate and 14 (23.7%) severe; the main cause of speech understanding about face masks was the sound attenuation for 26 (44.1%) subjects and the impossibility of lip reading for 33 (55.9%) | |||
| Chodosh J et al. 2020 [18] | Editorial | English | The challenging for people with hearing loss is reported in this study and they focused on how masks undermine speech communication for patients with hearing loss in medical care settings | They proposed solutions to overcome the difficulties with this patient: speak slowly, raise the volume voice, face masks with clear windows, low tech aids: white boards, yellow pads, app on smartphone or tablets, microphone directly connected to the headphones | |||
| Ten Hulzen RD et al. 2020 [19] | Review | English | The negative impact of universal masking and social distancing is analyzed in both health care and community settings for individuals with hearing loss | Each type of mask decreased the higher frequencies of speaker’s voice from 3 to 4 dB in medical mask, to nearly 12 dB in N95 mask. Physical distancing decreased the sound by 6–12 dB. Helpful strategies are: reduce background noise, ask how the individual prefers to communicate; speak louder | |||
| Vos TG et al. 2021 [23] | Prospective cohort study | English | 23 patients with cochlear implant (CI) for at least 6 months listened a female talker recorded sentences with: no mask, N95 mask, N95mask + face shield. They measured the speech recognition | CI Patient experienced a lower speech recognition whit N95 mask + face shield rather than only the N95 mask, because the plastic barrier attenuated the high- frequencies essential for the speech recognition | |||
| 3 |
B. Allergic and rhinopathic Dror AA et al. 2020 [24] |
Survey | English | 301 nurses with allergic rhinitis (233 with intermittent rhinitis and 68 with persistent) | Nurses who used N95 masks and surgical masks, reported a decrease of symptomatology compared with no mask. Standard surgical masks filter particles larger than 3 µm whereas N95 respirators can filter particles as small as 0.04 µm, so they can block the allergy triggers | ||
| Kishore Dayal a et al. 2020 [25] | Retrospective Observational Study | English | Patients with signs and symptoms of allergic rhinitis post pandemic (March– July2020) were compared to preceding three months (Jan 2020-March2020) | The number of patients of allergic rhinitis have shown a decreasing trend by nearly quartered as compared to immediately preceding three months | |||
| Klimek L et al. 2020 [26] | Experimental study | English | 46 healthy subjects came to the clinic for suspected new form of irritant rhinitis caused by FFP (filtering facepiece mask) | Patients referred symptoms like sneezing, itching, nasal blockage, and/or watery nasal discharge after wearing their FFP for > 2 h. Endoscopic signs of irritation and edema were found, they decreased after 3 days without mask | |||
| Heart diseases | 2 | Langrish JP et al. 2020 [22] | Open randomized crossover trial | English | 98 patients with coronary heart disease walked on a predefined route once with and once without N95; symptoms, exercise, personal air pollution exposure, blood pressure, heart rate, and 12- lead electrocardiography were monitored throughout the 24- hr study period | Face mask well tolerated, its use was associated with decreased self-reported symptoms and reduced maximal ST segment depression (– 142 vs. – 156 μV, P = 0.046) over the 24-h period; mean ambulatory arterial blood pressure and heart rate more stable in the subjects who used masks | |
| Fikenzer S et al. 2020 [27] | Prospective cross-over study | English | 12 healthy males were monitored exercising with no mask, surgical and N95/FFP2 masks. Parameters: Pmax, CO, SV, HR, VO2max VE FVC, FEV1, PEF, TIFF | FFP2/N95 marked negative impact on exercise parameters Pmax and VO2max/kg; reduced pulmonary parameters at rest and at maximum load.; they are very uncomfortable due to subjective breathing resistance | |||
| Haemodialysis | 1 | Kao TW et. al 2004 [28] | Observational study | English | 39 ESRD patients, each patient wore a new N95 mask (3 M Model 8210) during HD (4 h); vital signs, clinical symptoms and arterial blood gas measured before and at the end of HD | Wearing an N95 mask for 4 h during HD significantly reduced PaO2 and increased respiratory adverse effects in ESRD patients | |
| Eye disease | 5 | Moshifar M et al. 2020 [30] | Comment | English | People who wear FMs regularly, both patients and HCWs | They described an increased airflow that can accelerates the evaporation of the tear film and when continuous for hours or days, may result in ocular surface irritation or inflammation. Discomfort from dry eyes may also increase eye rubbing and face touching behaviours, with attendant fomite transmission | |
| El-Nimri NW et al. 2020 [33] | Case-series | English | 6 patients with the diagnosis of ocular hypertension, glaucoma suspect, or glaucoma underwent SAP while wearing surgical FM | Fogging may reduce visual field (VF) test reliability and induce artifacts that mimic glaucomatous defects | |||
| Young SL et al. 2020 [32] | Case report | English | A 32-year-old female underwent SAP while wearing a surgical FM | There was a marked reduction in sensitivity inferiorly of VF in both eyes. Patient repositioned her FM. VF were repeated and found to be normal. Poorly fitting FMs represent a new cause of VF artifact which may mimic pathologic field defects | |||
| Boccardo L. 2021 [29] | Survey | English | 3605 respondents among general people about mask- associated dry eye (MADE) | 26.9% reported exacerbation of symptoms when wearing a mask, thus 18.3% of all participants experienced MADE. The prevalence was higher in woman and in those who wore glasses and contact lens | |||
| Bayram N et al. 2021 [31] | Experimental study | English | 127 glaucoma patients: 101 wearing surgical mask; 26 cloth masks. (Age range: 34–84 years old). They underwent standard automated perimeter (SAP) | 20.5% of patients had FMs-related problems. 18.1% low SAP reliability significantly higher in cloth FMs than surgical FMs (47.8 vs. 9.9%), inferior visual field defects were present 2.4%. After taping the upper edge of masks, false- positive errors were significant improvements and after the reposition of masks, the visual field defects disappeared in the repeated SAP | |||
| Neurodegenerative disease | 2 | Gil R et al. 2020 [34] | Review | English | Challenge that patients with Alzheimer’s Disease (AD) and their caregivers have had to face during the pandemic due to amnesia and symptoms related to AD | AD patients can have sensorial deficits and perception troubles, including visual difficulties and the inability to recognize faces and emotions. FMs and physical distancing can make it more difficult to recognize emotional expressions and can provoke distress | |
| Kobayashi R et al. 2021 [35] | Observational study | English | 55 patients with AD were interviewed to examine recognition of the COVID-19 pandemic and the status of face mask wearing in patients with AD | 38.2% of AD patients knew about COVID- 19, 74.5% didn’t’ wear properly masks by themselves, 12.7% didn’t wear properly masks even with caregiver’s help | |||
| Exercise | 3 | Fikenzer S et al. 2020 [27] | Prospective cross-over study | English | 12 healthy males were monitored exercising with no mask, surgical and N95/FFP2 masks. Parameters: Pmax, CO, SV, HR, VO2max VE FVC, FEV1, PEF, TIFF | FFP2/N95 marked negative impact on exercise parameters Pmax and VO2max/kg; reduced pulmonary parameters at rest and at maximum load.; they are very uncomfortable due to subjective breathing resistance | |
| Chandrasekaran B et al. 2020 [37] | Review | English | Evidence-based hypotheses of health risk while exercising with N95 respirator | Exercising with tight face masks induces hypoxia, reduces renal functions, increases the heart rate and blood pressure | |||
| Epstein D et al. 2021 [36] | Multiple cross-over trial | English |
16 healthy male volunteers who participated in vigorous- intensity activity for 75 min or moderate-intensity activity for 150 min/week. Bbefore and after the test, were measured parameters: HR, SO2, RR, EtCO2, BP During the test was measured rate level of perceived exertion (RPE) |
Exercising with N95 mask was associated with a significant increase in end-tidal carbon dioxide (EtCO2) levels | |||
| Skin diseases and adverse reactions | 7 |
Veraldi S et al. 2020 [38] |
Letter to editor | English |
43 patients with seborrheic dermatitis (SD) using face mask for 6–10 h/day (Age range 23–48 years) |
46.5% of sample had worsening of SD. Worsening includes: increased erythema and desquamation 70% had worst itching |
|
|
Zuo Y et al. 2020 [39] |
Cross‐ sectional survey | English | 404 respondents to the questionnaire where they had to document skin, eye, and respiratory tract symptoms and suspected etiologic factors related to the use of masks | 49.0% reported mask‐related skin reactions, 85.4% facial skin problems, 17.1% respiratory tract problems, 6.2% eye symptoms. Of 129 participants, 44.2% had exacerbation, including 43.6% acne patients, 37.5% with seborrheic dermatitis, and all acne rosacea | |||
| Szepietowski JC et al. 2020 [40] | Survey | English | 2307 respondents survey about prevalence, intensity and clinical characteristics of itch related to the use of face masks | 60.4% reported using face masks during the previous week, and, of these, 19.6% reported having itch. People who reported skin had higher risk of itch development. Responders who wore masks for longer periods more frequently itch | |||
|
Han C et al. 2020 [41] |
Letter to editor | English | Two dozen of patients with diagnosis of flare of acne between April and May 2020. The most reported symptoms were itching sensation and excessive seborrhea | Higher T°C increases sebum excretion (sebum excretion increases by 10% for each 1 °C rise). Patients could be tempted to touch their face, removing of mask for itch and annoying pimples, which could increase the risk of COVID‐19 transmission | |||
|
Park S et al. 2020 [42] |
Observational study | English | 21 healthy subjects were enrolled and skin temperature, redness, hydration, elasticity sebum secretion, trans- epidermal water loss, were measured. Three measurements were taken 1) before wearing the mask, 2) after wearing the mask for 1 h, and 3) after wearing the mask for 6 h | Skin temperature, redness, hydration, and sebum secretion were changed significantly after 1 and 6 h of wearing a mask. Skin changes showed significant differences between the mask-wearing area and the non–mask-wearing area | |||
| Techasatian L et al. 2020 [44] | Prospective Survey | English | 833 respondents a survey which investigated face mask- related adverse skin reactions | Most common skin reaction were acne 39.9%, rashes 18.4% and itching 15.6%). Surgical masks were significantly more associated with skin reactions than cloth masks. Also, people who wearing masks 4- 8 h/day or ˃8 h/day had higher risk of skin reactions | |||
| Han HS et al. 2021 [43] | Cross- sectional study | English | 20 HCWs included. Skin parameters were measured: skin hydration, temperature transepidermal water loss (TEWL), erythema, sebum secretion, pH, in the mask- covered and uncovered areas of the face 4–8 h after wearing RPE and 14 h after not wearing respiratory protective equipment (RPE) | Skin hydration, temperature, TEWL, erythema, pH, increased in the RPE covered areas after wearing RPE for 4–8 h. In the RPE-uncovered areas, skin hydration decreased and TEWL, erythema, and pH showed minimal changes over time | |||
| Psychiatric disorders | 8 | Wu S et al. 2011 [49] |
Case control study; elastomeric half-face maskwith dual- cartridges (HFM)vs N95 filtering facepiece during work |
English | 12 volunteers with normal or mildly impaired respiratory conditions performed a series of simulated work tasks using the HFM and N95 on different days. The State-Trait Anxiety Inventory (STAI) measured state anxiety (SA) before and during respirator use | Work with HFM was associated with an increase in anxiety (2.92 units, p < 0.01), whereas work with the N95 had no observed effect | |
| Uvais NA, 2020 [46] | Cross- sectional study | English | 168 psychiatric patients attending the psychiatric department answered the questionnaire about the correct use of face mask. | The most common psychiatric diagnosis was depressive disorder (44%), psychotic illness (17.3%), panic disorder (12.5%), adjustment disorder (10.7%). 99.4% of the sample wore a mask, but 17.4% wore it not properly | |||
| Sivaraman M et al. 2020 [50] | Experimental study | English | 6 children with diagnosis of Autistic Spectrum Disorder (ASD) with a history of challenging behavior associated with mask wearing were recruited from different parts of the world. They had to follow 15 steps to learn to tolerate the mask | By the end of the intervention, all participants wore a face mask for a period of 10 min without exhibiting challenging behavior. Mask wearing did not affect the % of oxyhemoglobin saturation of participants | |||
| Soh KC et al. 2021 [47] | Letter to editor | English | The challenge of face mask with PTSD patients in inpatient unit in Australia | Mask-wearing hid the verbal/nonverbal communication, making difficult to establish a trusting relationship with patients. Moreover, a person, with past trauma whilst having her mouth covered, had great difficulties to cover her mouth with mask | |||
| Battista RA et al 2021 [48] | Observational study | English | 381 participants complain about side effects including psychiatric symptoms | More than 35% of respondents reported worsening of mood tone while nearly 10% complained about personal protective equipment (PPE) related panic attacks | |||
| Jung H et al. 2021 [45] | Survey | English | 261 psychiatric patients responded to a questionnaire about mask-wearing behaviour | 37.4% wore a mask in hospital and they were more aware of the recommendation to prevent COVID-19 infection than people who did not wear a mask | |||
| Halbur M et al. 2021 [51] | Experimental study | English | 12 children with ASD with a history of challenging behaviour associated with face covering (face masks and face shields) wearing. They had to follow 15 steps for each face covering | The duration of tolerance of facial coverings did not exceed 15 min | |||
| Schwarz S, et al. 2021 [9] | Survey | German |
20.353 respondents (parents, teachers, physicians) at survey of side effects of FMs worn by children and adolescents (Age: 0–17) |
67.7% of parents reported their children had side effects: headache, concentration difficulties, sleepiness, fatigue, skin worsening, nosebleed, anxiety disorders, rejection or anxiety of school, increased sweating, injuries behind ears, cracked lips, vision disorders and nightmares. Age 7–12 group, 60.4% had greater irritability, 49.3% were unhappy, 44% refused school, 25.3% developed new fears | |||
| Contraindications and side effects | 16 | Lim EC et al. 2006 [53] | Survey | English | 212 healthcare workers responded, risk factors associated with development of headaches associated to N95 (frequency, headache subtypes and duration of face- mask wear) and impact of headaches (sick days, headache frequency and use of abortive/preventive headache medications) | 37.3% reported face-mask-associated headaches: 32.9% headache frequency exceeding 6 times/month; 7.6% had taken sick leave (mean 2 days) 59.5% required abortive analgesics, 2.1% preventive medications for headaches. Pre-existing headaches and continuous use (> 4 h) were associated with development of headaches | |
| Baig AS et.al 2010 [63] | Survey | English | 559 surveys distributed, 159 respondents | Features required by respondents: comfort, less interference with breathing, diminished heat build-up, disposable, and permission of facial hair. Multivariate analyses suggest that emergency department staff had 12.3 greater odds of wanting a new respirator (P = 0.031) as compared with their referent group. Males were more likely to indicate that the N95 respirator was comfortable to wear versus females (P = 0.003) | |||
| MacIntyre CR et al. 2011 [60] | Cluster randomized trial | English | 1441 participants s aged ≥ 18 years from the emergency departments and respiratory wards of 15 hospitals wearing masks or respirators during the entire work shift for 4 weeks; clinical respiratory illness (CRI), influenza-like illness (ILI), laboratory-confirmed respiratory virus infection and influenza; Adherence to wearing the masks or respirators was monitored by these diary cards and returned to researchers on a weekly basis. Exit interviews with participants were conducted after the 4 weeks to gain further insights into adherence and other issues around the use of masks/respirators including adverse effects. A convenience no-mask/respirator group of 481 health workers from nine hospitals was compared | The rates of all outcomes were higher in the convenience no‐mask group than in the masks groups. By adjusted intention‐to‐ treat analysis, N95 respirators but not medical masks had significantly lower rates of infection compared to no masks. Among reported problems associated with using the masks or respirators N95 generates more trouble in communicating with patients than medical mask (8% vs 3%) | |||
| Thomas F. et al. 2011 [62] | Randomized controlled study | English | A flight crewmember and a layperson sitting in a Bell 407 crew compartment and a dispatcher sitting in a communication centre record 20 randomized aviation terms transmitted over the radio by a helicopter emergency medical services (HEMS) pilot wearing a surgical facemask and six different N95s with and without the aircraft engine operating | With the aircraft engine off, all terms (100% accuracy) were correctly identified, regardless of the absence or presence of the surgical facemask or N95 studied. With the aircraft engine on, the surgical facemask (3 M-1826) and two N95 respirators (3 M- 1860, Safe Life Corp-150) maintained 100% accuracy. Remaining N95 accuracy was as follows: 3 M-8511 and Kimberly- Clark PFR95 (98%), Inoyel-3212 (97%), and 3 M-1870 (93%) | |||
| Honarbakhsh M. et. al 2017 [59] | Cross sectional study | English | Problems and obstacles in using N95 respirators were identified and ranked by experts, using Fuzzy Delphi and Fuzzy Analytic Hierarchy Process (FAHP). Additionally, HCWs were asked to give their opinions about obstacles in using N95 respirators to form an opinion | 4 factors—including heat around the face, inaccessibility to respirators, difficulty breathing, and trouble in communication— achieved the highest average score according to the HCWs’ opinions | |||
| Or PP et. al 2018 [64] | Randomized study | English | 84 nursing students, divided randomly into 4 groups, with 21 in each group. Personal Respirator Sampling Test (PRST) and usability questionnaire to record their evaluations of the six perceptions of comfort of wearing N95 respirators | Respirators resulted comfortable at warm temperatures of 20–24 °C. Tightness in the respirators and discomfort on their ear lobes were the main obstacles to face masks use | |||
| Ong JJY et. al 2020 [54] | Cross sectional study | English | 158 healthcare workers completed a self-administered questionnaire | Most healthcare workers develop de novo PPE-associated headaches or exacerbation of their pre-existing headache disorders | |||
| Ramirez-Moreno JM et al. 2020 [55] | Cross- sectional study | English | 306 healthcare workers completed a self-administered questionnaire | 51.6% presented. “De novo” headache and 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 | |||
| Kalra S et al. 2020 [52] | Commentary | English | They coined new term “Mask fatigue” and proposed solution to prevent it. Mask fatigue is defined as the lack of energy that accompanies, and/or follows prolonged wearing of a mask. may be considered as a disorder if it interfered with daily life | Prevent mask fatigue: suggested: choosing right mask (size, type), drinking, and eating before wearing mask, taking voice rest and talk less, not strenuous exercises, removing mask for a few minutes at a safe place, avoiding prolonged (> 6 h) use of same mask. Washing face with soap and lukewarm water followed by cold water splashes on eye, apply an emollient if needed, relax, deep breathing exercises, respiratory muscle training, aerobic exercise of 30 min at least 5 days a week, weight management | |||
| Farronato et al. 2020 [56] | Scoping Review | English | 256 Italian dentists completed a self-administered questionnaire | Prolonged use of respirators was associated with headaches (47.5%), severe exertion and discomfort (50.8%), moderate concentration problems (54.3%), moderate breathing difficulties (63.5%), and consequently, an impaired work ability (85.5%) | |||
| Scheid JL et al. 2020 [58] | Commentary | English | Physiological effects of wearing masks for prolonged periods of time, including mask wearing among those who engaged in exercise training, and concerns for individuals with pre-existing chronic diseases |
Healthy individuals, wearing masks, even for an extended period, did not produce any clinically relevant changes in circulating O2 or CO2 concentrations, and did not seem to impact tidal volume or respiratory rate However, wearing a mask does produce a small increase in breathing resistance caused by the mask material filtering particles and aerosols in the air and any moisture that is trapped in the mask material |
|||
| Bothra A et al. 2020 [65] | Letter | English | 14 patients both healthcare workers and general population visited between 1st April- 30th April | 35.7% patients were diagnosed to have Irritant Contact Dermatitis, 28.5% patients were diagnosed with Allergic Contact Dermatitis, 21.4% patients developed sweat dermatitis, 1 patient pressure urticarial, 1 patient had exacerbation of pre-existing dermatoses. Pre-existing dermatoses were present in 50% including atopic dermatitis, seborrheic dermatitis and chronic urticaria. The most common symptoms reported were itching and dryness, whereas the most common signs seen were erythema, scaling and papules | |||
| Battista RA et al. 2021 [48] | Observational study | English | 381 participants complained about side effects including psychiatric symptoms | More than 35% of respondents reported worsening of mood tone while nearly 10% complained about Personal protective equipment (PPE) related panic attacks | |||
| Cheok GJW et al. 2021 [57] | Cross- sectional survey | English | 402 respondents of lay people completed a questionnaire | 67.2% wore disposable surgical masks. 72% felt mask-wearing was necessary to control COVID-19 transmission. 78.4% reported discomfort: dermatological issues, sweating, difficulty breathing especially panic prone individuals | |||
| Czypionka T et al. 2021 [61] | Review | English | Mask-wearing among general population were analysed in various aspects | All kind of masks caused discomforts and difficulties in communications especially with young children, older person, and people with hearing impairment, but the benefits seem to outweigh the harm | |||
| İpek S et al. 2021 [66] | Experimental study | English | 34 healthcare workers wore surgical mask one day and a N95 mask on the next day, both for 1–4 h. After removing the mask, capillary blood gases were taken, and a questionnaire was given | With N95 mask: 59% headache, 27% palpitation, 80% respiratory distress, 47% feeling of dizziness, drowsiness, 11% nausea, 53% face sweating, 59% suffocation, 50% attention deficit disorder, 62% concentration problems, 62% fatigue, 9% feeling of death. With surgical mask 15% headache, 24% respiratory distress, 6% feeling of dizziness, drowsiness, 27% face sweating, 6% suffocation, 15% attention deficit disorder, 18% concentration problems, 15% fatigue, 3% feeling of death. The symptoms were worse with N95 masks | |||
| Mask re-use | 3 | Scalvenzi M et al. 2020 [68] | Survey | English | 2562 patients of a dermatological clinic in Italy completed a questionnaire | 98.2%, regularly use masks, 1.8% not use any masks; 42.3% use mask 1–3 h/day, 23.8% use PPE 3–5 h/day, 18.3% use PPE less 1 h/day, 34.2% use of surgical mask before changing it for 3–4 h, 30.7% 1 day, 25.8% 2–5 days,6.5% 1 week, 2.8% more than 11 weeks. Use of FFP2 before changing it for about 12 h in 21.6%,1 day in 20.8%, 2–5 days in 28%, 1 week in 21.4%, more than 1 week in 8.3%. Use of FFP3 before changing it for about 12 h in 18.3%, 1 day in 18.7%, 2–5 days in 26.5%,1 week in 23%, more than 1 week in 13.5% | |
| Duong MC et al. 2021 [67] | Cross- sectional Study | English | 728 university students from Vietnam answered a self- developed questionnaire | 43% of respondents re-use the mask, 28.8% wash the mask after each use and 64.4% after every day of use, 5.5% after some days of use but less than a week, and 1.3% after every week of use | |||
| Cho Kwan R et al. 2021 [69] | Survey | English | 355 respondents an online survey about the correlation between depressive symptoms, health beliefs regarding COVID-19, and face mask use and reuse | There was a correlation between depressive symptoms and health beliefs, because depressive symptoms were more evident among older people who reused face masks, had a stronger belief in disease severity, and did not have adequate cues to preventive measures | |||