By Linda Johnston, MD


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The clarion call for local, state and national mask mandates is being fueled by two main mantras: the unquestioned “Masks work” and the unanswered “Why not? What harm could they do?” Every decision should take into account both benefits and risks. In the arena of general population mask wearing the purported benefits are dubious at best and certainly not supported by clear scientific evidence. That dispute is being played out among various scientists and politicians in the public square. As far as the risks of chronic mask wearing are involved, hardly a peep is heard and what peeping there is denies the possibility of any adverse effects whatsoever. As with so many aspects of recent events, the truth is quite different from what is professed.

As anyone will tell you, wearing masks is uncomfortable at best and down-right intolerable for many. Common sense and widespread experience indicate something is not really normal about long periods of breathing through fabric. This unpleasant shared experience is not to be discounted. It is indicative of some serious problems with chronic mask use in the general population. Whereas the questions of mask effectiveness have received some attention, there has not been any appreciable dialogue about what are the health costs for chronic mask wearing. Let’s discuss that.

We should start by talking about oxygen. Getting oxygen into our bodies is the main goal of breathing. Getting rid of the waste product, carbon dioxide, is the other goal. The air we breathe is composed of 21% oxygen and 0.04% carbon dioxide. We keep the oxygen and discard carbon dioxide. Our exhaled air has about 16% oxygen and 4% carbon dioxide, a 100-fold increase.

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Those amounts are not the same when breathing through a mask. Carbon dioxide rich and oxygen poor air accumulates behind the mask. When inhaling, this waste air mixes with what fresh air can makes its way in through the obstructive fabric. Not only does breathing through a mask require more energy to inhale, the inspired air also contains less oxygen and more carbon dioxide.

This is supported by many studies of mask wearing, done when the issue was purely medical and not political.  Wearing medical face masks has been the norm in medical, surgical and hospital settings for years. Hence, the issues of safety and changes in breathing and oxygenation have been well studied. Overall, proper mask wearing increases inhaled carbon dioxide to about 2 – 3% (from 0.04%), reduces inhaled oxygen to about 16% and increases the physical labor of breathing.

Since even scant elevation of carbon dioxide blood levels is severely detrimental to the body, causing serious metabolic symptoms, it takes great effort in maintaining the levels within a very narrow range. With mask wearing, the rebreathed carbon dioxide exhaust creates a transitory acidosis demanding that the body increase respiratory and heart rates to bring that back to normal. Symptoms include headaches, sweating, visual changes, trouble breathing,  fatigue, irritability as well as reduced cognitive functioning and alertness.

In 2009, the Environmental Protection Agency (EPA) declared that carbon dioxide was a pollutant and presented a “danger” to human health and welfare and therefore must be regulated by the EPA regardless of Congressional action. In EPA parlance, the CO2 level in the air we breathe is about 400 parts per million (ppm). Regulation is required for any increase that exceeds 5000 ppm or roughly an increase of 12 times regular levels.

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The levels of carbon dioxide in mask-trapped air that is rebreathed reach levels of  40,000 ppm. That is many times higher than the speculated increases that spawned the EPA’s alarm. Where is the EPA now when mask mandates are subjecting people to dangerously high levels of carbon dioxide in the air they are forced to breathe?

Additionally, oxygen intake is reduced from a normal ambient air of 21% to about 16%, which amounts to about 24% decrease. Symptoms of lightheadedness, dizziness, drowsiness, muscle weakness, shortness of breath especially with slight exertion, nausea and even vomiting are common.

If you want to know what chronically breathing low oxygen feels like, just recall your last plane flight of at least one hour. The oxygen level in airplanes is routinely kept at 15%, This is the same level as is found at an elevation of 8000 ft, or 1.5 miles or like sitting on top of Mount Everest. I am sure it is a nice view from up there, but how well do you think you will feel breathing that scanty oxygen-poor air for some hours? At 15% oxygen, most passengers’ blood levels of oxygen drop about 4 percentage points. Is it any wonder passengers fall asleep easily and routinely feel poorly during and right after a flight. It is not just jet lag, it is oxygen lag. Now add a mask, as required by all airlines. How are you going to feel after that flight?

Other factors to consider such as increased temperature and humidity behind the mask, distorted general thermal controls and reduced respiration rate (hypoventilation) are well known and have been the subject of research in the past. Problems encountered with mask wearing in excess of one hour have resulted in headaches, nervous system changes including reduced cognition, altered judgment, decreased situational awareness, difficulty coordinating sensory or cognitive abilities and motor activity, increased stress responses, increased difficulty breathing, diminished heart contractibility and reduced toleration of even lighter workloads. Isn’t that just the kind of state you want for yourself, family, your employees or your various service providers, especially those making critical decisions?

As bad as it is for adults trying to live and work in a hypoxemic environment, for children it might be worse. Growth of their body, brain and emotions requires adequate nutrition, including proper oxygen. It has been well documented that there is virtually no risk from COVID-19 for children and young adults. Therefore for children wearing masks is all risk and no benefit. They are being oxygen deprived, exposed to dangerous carbon dioxide levels for no reason, and for very young children, we have yet to determine the long-term effects of interfering with their cognitive development by preventing them from the seeing facial expressions of others. How could this possibly make sense?

This discussion is not to say that wearing a mask these days does not have its place. The point is that every decision must take into account both benefits and risk. The current attitude of “Why not wear a mask? There is no harm in it” is both incorrect and potentially dangerous. In the months and years to come, as the results of mask mandates on peoples’ health start to appear it will be too late to rethink the hasty, cavalier and unscientific mask-wearing frenzy.

Linda Johnston, MD

Aug 14, 2020

This article was written and disseminated via email. It is reprinted here, with assumed permission.