{"id":75249,"date":"2021-07-23T21:11:22","date_gmt":"2021-07-24T01:11:22","guid":{"rendered":"http:\/\/stateofthenation.co\/?p=75249"},"modified":"2021-07-23T21:13:12","modified_gmt":"2021-07-24T01:13:12","slug":"scientific-research-paper-the-existing-scientific-evidences-challenge-the-safety-and-efficacy-of-wearing-facemask-as-preventive-intervention-for-covid-19","status":"publish","type":"post","link":"https:\/\/stateofthenation.co\/?p=75249","title":{"rendered":"SCIENTIFIC RESEARCH PAPER: <b>&#8220;The existing scientific evidences challenge the safety and efficacy of wearing facemask as preventive intervention for COVID-19.&#8221;<\/b>"},"content":{"rendered":"<p><!--more--><\/p>\n<div class=\"pmc-page-banner whole_rhythm\">\n<div><img decoding=\"async\" class=\"aligncenter\" src=\"https:\/\/www.ncbi.nlm.nih.gov\/corehtml\/pmc\/pmcgifs\/logo-pheelsevier.png\" alt=\"Logo of pheelsevier\" usemap=\"#logo-imagemap\" \/><\/p>\n<map id=\"logo-imagemap\" name=\"logo-imagemap\">\n<area title=\"Link to Publisher's site\" alt=\"Link to Publisher's site\" coords=\"0,0,499,74\" shape=\"default\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/about\/covid-19\/\" target=\"_blank\" rel=\"noopener noreferrer\" \/><\/map>\n<\/div>\n<\/div>\n<div class=\"\">\n<div id=\"mc\" class=\" article lit-style content pmc-wm slang-all page-box\">\n<div id=\"ui-ncbiinpagenav-1\" class=\"jig-ncbiinpagenav\" data-jigconfig=\"smoothScroll: false, allHeadingLevels: ['h2'], headingExclude: ':hidden,.nomenu'\">\n<div class=\"fm-sec half_rhythm no_top_margin\">\n<div class=\"fm-flexbox\">\n<div class=\"fm-citation\">\n<div class=\"citation-default\">\n<div class=\"part1\"><span role=\"menubar\"><a role=\"menuitem\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#\" aria-expanded=\"false\" aria-haspopup=\"true\">Med Hypotheses.<\/a><\/span>\u00a02021 Jan; 146: 110411.<\/div>\n<div class=\"part2\"><span class=\"fm-vol-iss-date\">Published online 2020 Nov 22.\u00a0<\/span><span class=\"doi\">doi:\u00a0<a href=\"https:\/\/dx.doi.org\/10.1016%2Fj.mehy.2020.110411\" target=\"_blank\" rel=\"noopener noreferrer\">10.1016\/j.mehy.2020.110411<\/a><\/span><\/div>\n<\/div>\n<\/div>\n<div class=\"fm-ids\">\n<div class=\"fm-citation-pmcid\"><span class=\"fm-citation-ids-label\">PMCID:\u00a0<\/span>PMC7680614<\/div>\n<div class=\"fm-citation-pmid\">PMID:\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/33303303\">33303303<\/a><\/div>\n<\/div>\n<\/div>\n<p class=\"pmc-alert-box retraction-alert\"><span class=\"notice\">This article has been retracted.<\/span><br \/>\nRetraction in:\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8114149\/\">Med Hypotheses. 2021 July; 152: 110601<\/a>\u00a0\u00a0\u00a0\u00a0See also:\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/about\/guidelines\/#retract\">PMC Retraction Policy<\/a><\/p>\n<h1 class=\"content-title\">Facemasks in the COVID-19 era: A health hypothesis<\/h1>\n<div class=\"half_rhythm\">\n<div class=\"contrib-group fm-author\"><a id=\"au005\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Vainshelboim%20B%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=33303303\">Baruch Vainshelboim<\/a><sup>\u204e<\/sup><\/div>\n<\/div>\n<div class=\"fm-panel half_rhythm\">\n<div class=\"togglers fm-copyright-license\"><a class=\"pmctoggle\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#\">Author information<\/a>\u00a0<a class=\"pmctoggle\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#\">Article notes<\/a>\u00a0<a class=\"pmctoggle\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#\">Copyright and License information<\/a>\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/about\/disclaimer\/\">Disclaimer<\/a><\/div>\n<\/div>\n<div id=\"pmclinksbox\" class=\"links-box whole_rhythm\">\n<div class=\"fm-panel\">\n<div><strong>This article has been retracted.\u00a0<\/strong>See\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8114149\/\">Med Hypotheses. 2021 July; 152: 110601<\/a>.<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"sec\"><\/div>\n<div id=\"ab005\" class=\"tsec sec\" lang=\"en\">\n<div class=\"goto jig-ncbiinpagenav-goto-container\"><span role=\"menubar\"><a class=\"tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading\" title=\"Go to other sections in this page\" role=\"menuitem\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#\" aria-expanded=\"false\" aria-haspopup=\"true\">Go to:<\/a><\/span><\/div>\n<h2 id=\"ab005title\" class=\"head no_bottom_margin ui-helper-clearfix\">Abstract<\/h2>\n<div>\n<p id=\"__p1\" class=\"p p-first-last\">Many countries across the globe utilized medical and non-medical facemasks as non-pharmaceutical intervention for reducing the transmission and infectivity of coronavirus disease-2019 (COVID-19). Although, scientific evidence supporting facemasks\u2019 efficacy is lacking, adverse physiological, psychological and health effects are established. Is has been hypothesized that facemasks have compromised safety and efficacy profile and should be avoided from use. The current article comprehensively summarizes scientific evidences with respect to wearing facemasks in the COVID-19 era, providing prosper information for public health and decisions making.<\/p>\n<\/div>\n<div class=\"sec\"><strong class=\"kwd-title\">Keywords:\u00a0<\/strong><span class=\"kwd-text\">Physiology, Psychology, Health, SARS-CoV-2, Safety, Efficacy<\/span><\/div>\n<\/div>\n<div id=\"s0005\" class=\"tsec sec\">\n<div class=\"goto jig-ncbiinpagenav-goto-container\"><a class=\"tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading\" title=\"Go to other sections in this page\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#\" aria-expanded=\"false\" aria-haspopup=\"true\">Go to:<\/a><\/div>\n<h2 id=\"s0005title\" class=\"head no_bottom_margin ui-helper-clearfix\">Introduction<\/h2>\n<p id=\"p0165\" class=\"p p-first\">Facemasks are part of non-pharmaceutical interventions providing some breathing barrier to the mouth and nose that have been utilized for reducing the transmission of respiratory pathogens\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0005\" aria-expanded=\"false\" aria-haspopup=\"true\">[1]<\/a><\/sup>. Facemasks can be medical and non-medical, where two types of the medical masks primarily used by healthcare workers\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0005\" aria-expanded=\"false\" aria-haspopup=\"true\">[1]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0010\" aria-expanded=\"false\" aria-haspopup=\"true\">[2]<\/a><\/sup>. The first type is National Institute for Occupational Safety and Health (NIOSH)-certified N95 mask, a filtering face-piece respirator, and the second type is a surgical mask\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0005\" aria-expanded=\"false\" aria-haspopup=\"true\">[1]<\/a><\/sup>. The designed and intended uses of N95 and surgical masks are different in the type of protection they potentially provide. The N95s are typically composed of electret filter media and seal tightly to the face of the wearer, whereas surgical masks are generally loose fitting and may or may not contain electret-filtering media. The N95s are designed to reduce the wearer\u2019s inhalation exposure to infectious and harmful particles from the environment such as during extermination of insects. In contrast, surgical masks are designed to provide a barrier protection against splash, spittle and other body fluids to spray from the wearer (such as surgeon) to the sterile environment (patient during operation) for reducing the risk of contamination\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0005\" aria-expanded=\"false\" aria-haspopup=\"true\">[1]<\/a><\/sup>.<\/p>\n<p id=\"p0170\" class=\"p p-last\">The third type of facemasks are the non-medical cloth or fabric masks. The non-medical facemasks are made from a variety of woven and non-woven materials such as Polypropylene, Cotton, Polyester, Cellulose, Gauze and Silk. Although non-medical cloth or fabric facemasks are neither a medical device nor personal protective equipment, some standards have been developed by the French Standardization Association (AFNOR Group) to define a minimum performance for filtration and breathability capacity\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0010\" aria-expanded=\"false\" aria-haspopup=\"true\">[2]<\/a><\/sup>. The current article reviews the scientific evidences with respect to safety and efficacy of wearing facemasks, describing the physiological and psychological effects and the potential long-term consequences on health.<\/p>\n<\/div>\n<div id=\"s0010\" class=\"tsec sec\">\n<div class=\"goto jig-ncbiinpagenav-goto-container\"><a class=\"tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading\" title=\"Go to other sections in this page\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#\" aria-expanded=\"false\" aria-haspopup=\"true\">Go to:<\/a><\/div>\n<h2 id=\"s0010title\" class=\"head no_bottom_margin ui-helper-clearfix\">Hypothesis<\/h2>\n<p id=\"p0175\" class=\"p p-first\">On January 30, 2020, the World Health Organization (WHO) announced a global public health emergency of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) causing illness of coronavirus disease-2019 (COVID-19)\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0015\" aria-expanded=\"false\" aria-haspopup=\"true\">[3]<\/a><\/sup>. As of October 1, 2020, worldwide 34,166,633 cases were reported and 1,018,876 have died with virus diagnosis. Interestingly, 99% of the detected cases with SARS-CoV-2 are asymptomatic or have mild condition, which contradicts with the virus name (<em>severe<\/em>\u00a0acute respiratory syndrome-coronavirus-2)\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0020\" aria-expanded=\"false\" aria-haspopup=\"true\">[4]<\/a><\/sup>. Although infection fatality rate (number of death cases divided by number of reported cases) initially seems quite high 0.029 (2.9%)\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0020\" aria-expanded=\"false\" aria-haspopup=\"true\">[4]<\/a><\/sup>, this overestimation related to limited number of COVID-19 tests performed which biases towards higher rates. Given the fact that asymptomatic or minimally symptomatic cases is several times higher than the number of reported cases, the case fatality rate is considerably less than 1%\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0025\" aria-expanded=\"false\" aria-haspopup=\"true\">[5]<\/a><\/sup>. This was confirmed by the head of National Institute of Allergy and Infectious Diseases from US stating, \u201cthe overall clinical consequences of COVID-19 are similar to those of severe seasonal influenza\u201d\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0025\" aria-expanded=\"false\" aria-haspopup=\"true\">[5]<\/a><\/sup>, having a case fatality rate of approximately 0.1%\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0025\" aria-expanded=\"false\" aria-haspopup=\"true\">[5]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0030\" aria-expanded=\"false\" aria-haspopup=\"true\">[6]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0035\" aria-expanded=\"false\" aria-haspopup=\"true\">[7]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0040\" aria-expanded=\"false\" aria-haspopup=\"true\">[8]<\/a><\/sup>. In addition, data from hospitalized patients with COVID-19 and general public indicate that the majority of deaths were among older and chronically ill individuals, supporting the possibility that the virus may exacerbates existing conditions but rarely causes death by itself\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0045\" aria-expanded=\"false\" aria-haspopup=\"true\">[9]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0050\" aria-expanded=\"false\" aria-haspopup=\"true\">[10]<\/a><\/sup>. SARS-CoV-2 primarily affects respiratory system and can cause complications such as acute respiratory distress syndrome (ARDS), respiratory failure and death\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0015\" aria-expanded=\"false\" aria-haspopup=\"true\">[3]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0045\" aria-expanded=\"false\" aria-haspopup=\"true\">[9]<\/a><\/sup>. It is not clear however, what the scientific and clinical basis for wearing facemasks as protective strategy, given the fact that facemasks restrict breathing, causing hypoxemia and hypercapnia and increase the risk for respiratory complications, self-contamination and exacerbation of existing chronic conditions\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0010\" aria-expanded=\"false\" aria-haspopup=\"true\">[2]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0055\" aria-expanded=\"false\" aria-haspopup=\"true\">[11]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0060\" aria-expanded=\"false\" aria-haspopup=\"true\">[12]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0065\" aria-expanded=\"false\" aria-haspopup=\"true\">[13]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0070\" aria-expanded=\"false\" aria-haspopup=\"true\">[14]<\/a><\/sup>.<\/p>\n<p id=\"p0180\" class=\"p p-last\">Of note, hyperoxia or oxygen supplementation (breathing air with high partial O<sub>2<\/sub>\u00a0pressures that above the sea levels) has been well established as therapeutic and curative practice for variety acute and chronic conditions including respiratory complications\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0055\" aria-expanded=\"false\" aria-haspopup=\"true\">[11]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0075\" aria-expanded=\"false\" aria-haspopup=\"true\">[15]<\/a><\/sup>. It fact, the current standard of care practice for treating hospitalized patients with COVID-19 is breathing 100% oxygen\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0080\" aria-expanded=\"false\" aria-haspopup=\"true\">[16]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0085\" aria-expanded=\"false\" aria-haspopup=\"true\">[17]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0090\" aria-expanded=\"false\" aria-haspopup=\"true\">[18]<\/a><\/sup>. Although several countries mandated wearing facemask in health care settings and public areas, scientific evidences are lacking supporting their efficacy for reducing morbidity or mortality associated with infectious or viral diseases\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0010\" aria-expanded=\"false\" aria-haspopup=\"true\">[2]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0070\" aria-expanded=\"false\" aria-haspopup=\"true\">[14]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0095\" aria-expanded=\"false\" aria-haspopup=\"true\">[19]<\/a><\/sup>. Therefore, it has been hypothesized: 1) the practice of wearing facemasks has compromised safety and efficacy profile, 2) Both medical and non-medical facemasks are ineffective to reduce human-to-human transmission and infectivity of SARS-CoV-2 and COVID-19, 3) Wearing facemasks has adverse physiological and psychological effects, 4) Long-term consequences of wearing facemasks on health are detrimental.<\/p>\n<\/div>\n<div id=\"s0015\" class=\"tsec sec\">\n<div class=\"goto jig-ncbiinpagenav-goto-container\"><a class=\"tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading\" title=\"Go to other sections in this page\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#\" aria-expanded=\"false\" aria-haspopup=\"true\">Go to:<\/a><\/div>\n<h2 id=\"s0015title\" class=\"head no_bottom_margin ui-helper-clearfix\">Evolution of hypothesis<\/h2>\n<div id=\"s0020\" class=\"sec sec-first\">\n<h3 id=\"s0020title\">Breathing Physiology<\/h3>\n<p id=\"p0185\" class=\"p p-first-last\">Breathing is one of the most important physiological functions to sustain life and health. Human body requires a continuous and adequate oxygen (O<sub>2<\/sub>) supply to all organs and cells for normal function and survival. Breathing is also an essential process for removing metabolic byproducts [carbon dioxide (CO<sub>2<\/sub>)] occurring during cell respiration\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0060\" aria-expanded=\"false\" aria-haspopup=\"true\">[12]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0065\" aria-expanded=\"false\" aria-haspopup=\"true\">[13]<\/a><\/sup>. It is well established that acute significant deficit in O<sub>2<\/sub>\u00a0(hypoxemia) and increased levels of CO<sub>2<\/sub>\u00a0(hypercapnia) even for few minutes can be severely harmful and lethal, while chronic hypoxemia and hypercapnia cause health deterioration, exacerbation of existing conditions, morbidity and ultimately mortality\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0055\" aria-expanded=\"false\" aria-haspopup=\"true\">[11]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0100\" aria-expanded=\"false\" aria-haspopup=\"true\">[20]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0105\" aria-expanded=\"false\" aria-haspopup=\"true\">[21]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0110\" aria-expanded=\"false\" aria-haspopup=\"true\">[22]<\/a><\/sup>. Emergency medicine demonstrates that 5\u20136\u00a0min of severe hypoxemia during cardiac arrest will cause brain death with extremely poor survival rates\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0100\" aria-expanded=\"false\" aria-haspopup=\"true\">[20]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0105\" aria-expanded=\"false\" aria-haspopup=\"true\">[21]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0110\" aria-expanded=\"false\" aria-haspopup=\"true\">[22]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0115\" aria-expanded=\"false\" aria-haspopup=\"true\">[23]<\/a><\/sup>. On the other hand, chronic mild or moderate hypoxemia and hypercapnia such as from wearing facemasks resulting in shifting to higher contribution of anaerobic energy metabolism, decrease in pH levels and increase in cells and blood acidity, toxicity, oxidative stress, chronic inflammation, immunosuppression and health deterioration\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0120\" aria-expanded=\"false\" aria-haspopup=\"true\">[24]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0055\" aria-expanded=\"false\" aria-haspopup=\"true\">[11]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0060\" aria-expanded=\"false\" aria-haspopup=\"true\">[12]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0065\" aria-expanded=\"false\" aria-haspopup=\"true\">[13]<\/a><\/sup>.<\/p>\n<\/div>\n<div id=\"s0025\" class=\"sec\">\n<h3 id=\"s0025title\">Efficacy of facemasks<\/h3>\n<p id=\"p0190\" class=\"p p-first\">The physical properties of medical and non-medical facemasks suggest that facemasks are ineffective to block viral particles due to their difference in scales\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0080\" aria-expanded=\"false\" aria-haspopup=\"true\">[16]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0085\" aria-expanded=\"false\" aria-haspopup=\"true\">[17]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0125\" aria-expanded=\"false\" aria-haspopup=\"true\">[25]<\/a><\/sup>. According to the current knowledge, the virus SARS-CoV-2 has a diameter of 60\u00a0nm to 140\u00a0nm [nanometers (billionth of a\u00a0meter)]\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0080\" aria-expanded=\"false\" aria-haspopup=\"true\">[16]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0085\" aria-expanded=\"false\" aria-haspopup=\"true\">[17]<\/a><\/sup>, while medical and non-medical facemasks\u2019 thread diameter ranges from 55\u00a0\u00b5m to 440\u00a0\u00b5m [micrometers (one millionth of a\u00a0meter), which is more than 1000 times larger\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0125\" aria-expanded=\"false\" aria-haspopup=\"true\">[25]<\/a><\/sup>. Due to the difference in sizes between SARS-CoV-2 diameter and facemasks thread diameter (the virus is 1000 times smaller), SARS-CoV-2 can easily pass through any facemask\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0125\" aria-expanded=\"false\" aria-haspopup=\"true\">[25]<\/a><\/sup>. In addition, the efficiency filtration rate of facemasks is poor, ranging from 0.7% in non-surgical, cotton-gauze woven mask to 26% in cotton sweeter material\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0010\" aria-expanded=\"false\" aria-haspopup=\"true\">[2]<\/a><\/sup>. With respect to surgical and N95 medical facemasks, the efficiency filtration rate falls to 15% and 58%, respectively when even small gap between the mask and the face exists\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0125\" aria-expanded=\"false\" aria-haspopup=\"true\">[25]<\/a><\/sup>.<\/p>\n<p id=\"p0195\">Clinical scientific evidence challenges further the efficacy of facemasks to block human-to-human transmission or infectivity. A randomized controlled trial (RCT) of 246 participants [123 (50%) symptomatic)] who were allocated to either wearing or not wearing surgical facemask, assessing viruses transmission including coronavirus\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0130\" aria-expanded=\"false\" aria-haspopup=\"true\">[26]<\/a><\/sup>. The results of this study showed that among symptomatic individuals (those with fever, cough, sore throat, runny nose ect\u2026) there was no difference between wearing and not wearing facemask for coronavirus droplets transmission of particles of &gt;5\u00a0\u00b5m. Among asymptomatic individuals, there was no droplets or aerosols coronavirus detected from any participant with or without the mask, suggesting that asymptomatic individuals do not transmit or infect other people\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0130\" aria-expanded=\"false\" aria-haspopup=\"true\">[26]<\/a><\/sup>. This was further supported by a study on infectivity where 445 asymptomatic individuals were exposed to asymptomatic SARS-CoV-2 carrier (been positive for SARS-CoV-2) using close contact (shared quarantine space) for a median of 4 to 5\u00a0days. The study found that none of the 445 individuals was infected with SARS-CoV-2 confirmed by real-time reverse transcription polymerase\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0135\" aria-expanded=\"false\" aria-haspopup=\"true\">[27]<\/a><\/sup>.<\/p>\n<p id=\"p0200\">A\u00a0<em>meta<\/em>-analysis among health care workers found that compared to no masks, surgical mask and N95 respirators were not effective against transmission of viral infections or influenza-like illness based on six RCTs\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0140\" aria-expanded=\"false\" aria-haspopup=\"true\">[28]<\/a><\/sup>. Using separate analysis of 23 observational studies, this\u00a0<em>meta<\/em>-analysis found no protective effect of medical mask or N95 respirators against SARS virus\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0140\" aria-expanded=\"false\" aria-haspopup=\"true\">[28]<\/a><\/sup>. A recent systematic review of 39 studies including 33,867 participants in community settings (self-report illness), found no difference between N95 respirators versus surgical masks and surgical mask versus no masks in the risk for developing influenza or influenza-like illness, suggesting their ineffectiveness of blocking viral transmissions in community settings\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0145\" aria-expanded=\"false\" aria-haspopup=\"true\">[29]<\/a><\/sup>.<\/p>\n<p id=\"p0205\">Another\u00a0<em>meta<\/em>-analysis of 44 non-RCT studies (n\u00a0=\u00a025,697 participants) examining the potential risk reduction of facemasks against SARS, middle east respiratory syndrome (MERS) and COVID-19 transmissions\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0150\" aria-expanded=\"false\" aria-haspopup=\"true\">[30]<\/a><\/sup>. The\u00a0<em>meta<\/em>-analysis included four specific studies on COVID-19 transmission (5,929 participants, primarily health-care workers used N95 masks). Although the overall findings showed reduced risk of virus transmission with facemasks, the analysis had severe limitations to draw conclusions. One of the four COVID-19 studies had zero infected cases in both arms, and was excluded from\u00a0<em>meta<\/em>-analytic calculation. Other two COVID-19 studies had unadjusted models, and were also excluded from the overall analysis. The\u00a0<em>meta<\/em>-analytic results were based on only one COVID-19, one MERS and 8 SARS studies, resulting in high selection bias of the studies and contamination of the results between different viruses. Based on four COVID-19 studies, the\u00a0<em>meta<\/em>-analysis failed to demonstrate risk reduction of facemasks for COVID-19 transmission, where the authors reported that the results of\u00a0<em>meta<\/em>-analysis have low certainty and are inconclusive\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0150\" aria-expanded=\"false\" aria-haspopup=\"true\">[30]<\/a><\/sup>.<\/p>\n<p id=\"p0210\" class=\"p p-last\">In early publication the WHO stated that \u201cfacemasks are not required, as no evidence is available on its usefulness to protect non-sick persons\u201d\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0070\" aria-expanded=\"false\" aria-haspopup=\"true\">[14]<\/a><\/sup>. In the same publication, the WHO declared that \u201ccloth (e.g. cotton or gauze) masks are not recommended under any circumstance\u201d\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0070\" aria-expanded=\"false\" aria-haspopup=\"true\">[14]<\/a><\/sup>. Conversely, in later publication the WHO stated that the usage of fabric-made facemasks (Polypropylene, Cotton, Polyester, Cellulose, Gauze and Silk) is a general community practice for \u201cpreventing the infected wearer transmitting the virus to others and\/or to offer protection to the healthy wearer against infection (prevention)\u201d\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0010\" aria-expanded=\"false\" aria-haspopup=\"true\">[2]<\/a><\/sup>. The same publication further conflicted itself by stating that due to the lower filtration, breathability and overall performance of fabric facemasks, the usage of woven fabric mask such as cloth, and\/or non-woven fabrics, should only be considered for infected persons and not for prevention practice in asymptomatic individuals\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0010\" aria-expanded=\"false\" aria-haspopup=\"true\">[2]<\/a><\/sup>. The Central for Disease Control and Prevention (CDC) made similar recommendation, stating that only symptomatic persons should consider wearing facemask, while for asymptomatic individuals this practice is not recommended\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0155\" aria-expanded=\"false\" aria-haspopup=\"true\">[31]<\/a><\/sup>. Consistent with the CDC, clinical scientists from Departments of Infectious Diseases and Microbiology in Australia counsel against facemasks usage for health-care workers, arguing that there is no justification for such practice while normal caring relationship between patients and medical staff could be compromised\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0160\" aria-expanded=\"false\" aria-haspopup=\"true\">[32]<\/a><\/sup>. Moreover, the WHO repeatedly announced that \u201cat present, there is no direct evidence (from studies on COVID-19) on the effectiveness face masking of healthy people in the community to prevent infection of respiratory viruses, including COVID-19\u201d<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0010\" aria-expanded=\"false\" aria-haspopup=\"true\">[2]<\/a><\/sup>. Despite these controversies, the potential harms and risks of wearing facemasks were clearly acknowledged. These including self-contamination due to hand practice or non-replaced when the mask is wet, soiled or damaged, development of facial skin lesions, irritant dermatitis or worsening acne and psychological discomfort. Vulnerable populations such as people with mental health disorders, developmental disabilities, hearing problems, those living in hot and humid environments, children and patients with respiratory conditions are at significant health risk for complications and harm\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0010\" aria-expanded=\"false\" aria-haspopup=\"true\">[2]<\/a><\/sup>.<\/p>\n<\/div>\n<div id=\"s0030\" class=\"sec\">\n<h3 id=\"s0030title\">Physiological effects of wearing facemasks<\/h3>\n<p id=\"p0215\" class=\"p p-first\">Wearing facemask mechanically restricts breathing by increasing the resistance of air movement during both inhalation and exhalation process\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0060\" aria-expanded=\"false\" aria-haspopup=\"true\">[12]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0065\" aria-expanded=\"false\" aria-haspopup=\"true\">[13]<\/a><\/sup>. Although, intermittent (several times a week) and repetitive (10\u201315 breaths for 2\u20134 sets) increase in respiration resistance may be adaptive for strengthening respiratory muscles\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0165\" aria-expanded=\"false\" aria-haspopup=\"true\">[33]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0170\" aria-expanded=\"false\" aria-haspopup=\"true\">[34]<\/a><\/sup>, prolonged and continues effect of wearing facemask is maladaptive and could be detrimental for health\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0055\" aria-expanded=\"false\" aria-haspopup=\"true\">[11]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0060\" aria-expanded=\"false\" aria-haspopup=\"true\">[12]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0065\" aria-expanded=\"false\" aria-haspopup=\"true\">[13]<\/a><\/sup>. In normal conditions at the sea level, air contains 20.93% O<sub>2<\/sub>\u00a0and 0.03% CO<sub>2<\/sub>, providing partial pressures of 100\u00a0mmHg and 40\u00a0mmHg for these gases in the arterial blood, respectively. These gas concentrations significantly altered when breathing occurs through facemask. A trapped air remaining between the mouth, nose and the facemask is rebreathed repeatedly in and out of the body, containing low O<sub>2<\/sub>\u00a0and high CO<sub>2<\/sub>\u00a0concentrations, causing hypoxemia and hypercapnia\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0175\" aria-expanded=\"false\" aria-haspopup=\"true\">[35]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0180\" aria-expanded=\"false\" aria-haspopup=\"true\">[36]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0055\" aria-expanded=\"false\" aria-haspopup=\"true\">[11]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0060\" aria-expanded=\"false\" aria-haspopup=\"true\">[12]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0065\" aria-expanded=\"false\" aria-haspopup=\"true\">[13]<\/a><\/sup>. Severe hypoxemia may also provoke cardiopulmonary and neurological complications and is considered an important clinical sign in cardiopulmonary medicine\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0185\" aria-expanded=\"false\" aria-haspopup=\"true\">[37]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0190\" aria-expanded=\"false\" aria-haspopup=\"true\">[38]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0195\" aria-expanded=\"false\" aria-haspopup=\"true\">[39]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0200\" aria-expanded=\"false\" aria-haspopup=\"true\">[40]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0205\" aria-expanded=\"false\" aria-haspopup=\"true\">[41]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0210\" aria-expanded=\"false\" aria-haspopup=\"true\">[42]<\/a><\/sup>. Low oxygen content in the arterial blood can cause myocardial ischemia, serious arrhythmias, right or left ventricular dysfunction, dizziness, hypotension, syncope and pulmonary hypertension\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0215\" aria-expanded=\"false\" aria-haspopup=\"true\">[43]<\/a><\/sup>. Chronic low-grade hypoxemia and hypercapnia as result of using facemask can cause exacerbation of existing cardiopulmonary, metabolic, vascular and neurological conditions\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0185\" aria-expanded=\"false\" aria-haspopup=\"true\">[37]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0190\" aria-expanded=\"false\" aria-haspopup=\"true\">[38]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0195\" aria-expanded=\"false\" aria-haspopup=\"true\">[39]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0200\" aria-expanded=\"false\" aria-haspopup=\"true\">[40]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0205\" aria-expanded=\"false\" aria-haspopup=\"true\">[41]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0210\" aria-expanded=\"false\" aria-haspopup=\"true\">[42]<\/a><\/sup>.\u00a0<a class=\"fig-table-link figpopup\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/table\/t0005\/\" target=\"table\" rel=\"noopener\">Table 1<\/a>\u00a0summarizes the physiological, psychological effects of wearing facemask and their potential long-term consequences for health.<\/p>\n<div id=\"t0005\" class=\"table-wrap anchored whole_rhythm\">\n<h3>Table 1<\/h3>\n<div class=\"caption\">\n<p id=\"__p2\">Physiological and Psychological Effects of Wearing Facemask and Their Potential Health Consequences.<\/p>\n<\/div>\n<div class=\"xtable\" data-largeobj=\"\" data-largeobj-link-rid=\"largeobj_idm139788360001984\">\n<table class=\"rendered small default_table\" frame=\"hsides\" rules=\"groups\">\n<thead>\n<tr>\n<th colspan=\"1\" rowspan=\"1\">Physiological Effects<\/th>\n<th colspan=\"1\" rowspan=\"1\">Psychological Effect<\/th>\n<th colspan=\"1\" rowspan=\"1\">Health Consequences<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td colspan=\"1\" rowspan=\"1\">\n<ul id=\"l0005\" class=\"first-line-outdent\">\n<li id=\"o0005\">\u2022 Hypoxemia<\/li>\n<li id=\"o0010\">\u2022 Hypercapnia<\/li>\n<li id=\"o0015\">\u2022 Shortness of breath<\/li>\n<li id=\"o0020\">\u2022 Increase lactate concentration<\/li>\n<li id=\"o0025\">\u2022 Decline in pH levels<\/li>\n<li id=\"o0030\">\u2022 Acidosis<\/li>\n<li id=\"o0035\">\u2022 Toxicity<\/li>\n<li id=\"o0040\">\u2022 Inflammation<\/li>\n<li id=\"o0045\">\u2022 Self-contamination<\/li>\n<li id=\"o0050\">\u2022 Increase in stress hormones level (adrenaline, noradrenaline and cortisol)<\/li>\n<li id=\"o0055\">\u2022 Increased muscle tension<\/li>\n<li id=\"o0060\">\u2022 Immunosuppression<\/li>\n<\/ul>\n<\/td>\n<td colspan=\"1\" rowspan=\"1\">\n<ul id=\"l0010\" class=\"first-line-outdent\">\n<li id=\"o0065\">\u2022 Activation of \u201cfight or flight\u201d stress response<\/li>\n<li id=\"o0070\">\u2022 Chronic stress condition<\/li>\n<li id=\"o0075\">\u2022 Fear<\/li>\n<li id=\"o0080\">\u2022 Mood disturbances<\/li>\n<li id=\"o0085\">\u2022 Insomnia<\/li>\n<li id=\"o0090\">\u2022 Fatigue<\/li>\n<li id=\"o0095\">\u2022 Compromised cognitive performance<\/li>\n<\/ul>\n<\/td>\n<td colspan=\"1\" rowspan=\"1\">\n<ul id=\"l0015\" class=\"first-line-outdent\">\n<li id=\"o0100\">\u2022 Increased predisposition for viral and infection illnesses<\/li>\n<li id=\"o0105\">\u2022 Headaches<\/li>\n<li id=\"o0110\">\u2022 Anxiety<\/li>\n<li id=\"o0115\">\u2022 Depression<\/li>\n<li id=\"o0120\">\u2022 Hypertension<\/li>\n<li id=\"o0125\">\u2022 Cardiovascular disease<\/li>\n<li id=\"o0130\">\u2022 Cancer<\/li>\n<li id=\"o0135\">\u2022 Diabetes<\/li>\n<li id=\"o0140\">\u2022 Alzheimer disease<\/li>\n<li id=\"o0145\">\u2022 Exacerbation of existing conditions and diseases<\/li>\n<li id=\"o0150\">\u2022 Accelerated aging process<\/li>\n<li id=\"o0155\">\u2022 Health deterioration<\/li>\n<li id=\"o0160\">\u2022 Premature mortality<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<p id=\"p0220\">In addition to hypoxia and hypercapnia, breathing through facemask residues bacterial and germs components on the inner and outside layer of the facemask. These toxic components are repeatedly rebreathed back into the body, causing self-contamination. Breathing through facemasks also increases temperature and humidity in the space between the mouth and the mask, resulting a release of toxic particles from the mask\u2019s materials\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0005\" aria-expanded=\"false\" aria-haspopup=\"true\">[1]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0010\" aria-expanded=\"false\" aria-haspopup=\"true\">[2]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0095\" aria-expanded=\"false\" aria-haspopup=\"true\">[19]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0130\" aria-expanded=\"false\" aria-haspopup=\"true\">[26]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0175\" aria-expanded=\"false\" aria-haspopup=\"true\">[35]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0180\" aria-expanded=\"false\" aria-haspopup=\"true\">[36]<\/a><\/sup>. A systematic literature review estimated that aerosol contamination levels of facemasks including 13 to 202,549 different viruses\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0005\" aria-expanded=\"false\" aria-haspopup=\"true\">[1]<\/a><\/sup>. Rebreathing contaminated air with high bacterial and toxic particle concentrations along with low O<sub>2<\/sub>\u00a0and high CO<sub>2<\/sub>\u00a0levels continuously challenge the body homeostasis, causing self-toxicity and immunosuppression\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0005\" aria-expanded=\"false\" aria-haspopup=\"true\">[1]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0010\" aria-expanded=\"false\" aria-haspopup=\"true\">[2]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0095\" aria-expanded=\"false\" aria-haspopup=\"true\">[19]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0130\" aria-expanded=\"false\" aria-haspopup=\"true\">[26]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0175\" aria-expanded=\"false\" aria-haspopup=\"true\">[35]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0180\" aria-expanded=\"false\" aria-haspopup=\"true\">[36]<\/a><\/sup>.<\/p>\n<p id=\"p0225\">A study on 39 patients with renal disease found that wearing N95 facemask during hemodialysis significantly reduced arterial partial oxygen pressure (from PaO<sub>2<\/sub>\u00a0101.7 to 92.7\u00a0mm Hg), increased respiratory rate (from 16.8 to 18.8 breaths\/min), and increased the occurrence of chest discomfort and respiratory distress\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0175\" aria-expanded=\"false\" aria-haspopup=\"true\">[35]<\/a><\/sup>. Respiratory Protection Standards from Occupational Safety and Health Administration, US Department of Labor states that breathing air with O<sub>2<\/sub>\u00a0concentration below 19.5% is considered oxygen-deficiency, causing physiological and health adverse effects. These include increased breathing frequency, accelerated heartrate and cognitive impairments related to thinking and coordination\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0180\" aria-expanded=\"false\" aria-haspopup=\"true\">[36]<\/a><\/sup>. A chronic state of mild hypoxia and hypercapnia has been shown as primarily mechanism for developing cognitive dysfunction based on animal studies and studies in patients with chronic obstructive pulmonary disease\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0220\" aria-expanded=\"false\" aria-haspopup=\"true\">[44]<\/a><\/sup>.<\/p>\n<p id=\"p0230\">The adverse physiological effects were confirmed in a study of 53 surgeons where surgical facemask were used during a major operation. After 60\u00a0min of facemask wearing the oxygen saturation dropped by more than 1% and heart rate increased by approximately five beats\/min\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0225\" aria-expanded=\"false\" aria-haspopup=\"true\">[45]<\/a><\/sup>. Another study among 158 health-care workers using protective personal equipment primarily N95 facemasks reported that 81% (128 workers) developed new headaches during their work shifts as these become mandatory due to COVID-19 outbreak. For those who used the N95 facemask\u00a0greater than\u00a04\u00a0h per day, the likelihood for developing a headache during the work shift was approximately four times higher [Odds ratio\u00a0=\u00a03.91, 95% CI (1.35\u201311.31) p\u00a0=\u00a00.012], while 82.2% of the N95 wearers developed the headache already within \u226410 to 50\u00a0min\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0230\" aria-expanded=\"false\" aria-haspopup=\"true\">[46]<\/a><\/sup>.<\/p>\n<p id=\"p0235\" class=\"p p-last\">With respect to cloth facemask, a RCT using four weeks follow up compared the effect of cloth facemask to medical masks and to no masks on the incidence of clinical respiratory illness, influenza-like illness and laboratory-confirmed respiratory virus infections among 1607 participants from 14 hospitals\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0095\" aria-expanded=\"false\" aria-haspopup=\"true\">[19]<\/a><\/sup>. The results showed that there were no difference between wearing cloth masks, medical masks and no masks for incidence of clinical respiratory illness and laboratory-confirmed respiratory virus infections. However, a large harmful effect with more than 13 times higher risk [Relative Risk\u00a0=\u00a013.25 95% CI (1.74 to 100.97) was observed for influenza-like illness among those who were wearing cloth masks\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0095\" aria-expanded=\"false\" aria-haspopup=\"true\">[19]<\/a><\/sup>. The study concluded that cloth masks have significant health and safety issues including moisture retention, reuse, poor filtration and increased risk for infection, providing recommendation against the use of cloth masks\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0095\" aria-expanded=\"false\" aria-haspopup=\"true\">[19]<\/a><\/sup>.<\/p>\n<\/div>\n<div id=\"s0035\" class=\"sec\">\n<h3 id=\"s0035title\">Psychological effects of wearing facemasks<\/h3>\n<p id=\"p0240\" class=\"p p-first\">Psychologically, wearing facemask fundamentally has negative effects on the wearer and the nearby person. Basic human-to-human connectivity through face expression is compromised and self-identity is somewhat eliminated\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0235\" aria-expanded=\"false\" aria-haspopup=\"true\">[47]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0240\" aria-expanded=\"false\" aria-haspopup=\"true\">[48]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0245\" aria-expanded=\"false\" aria-haspopup=\"true\">[49]<\/a><\/sup>. These dehumanizing movements partially delete the uniqueness and individuality of person who wearing the facemask as well as the connected person\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0245\" aria-expanded=\"false\" aria-haspopup=\"true\">[49]<\/a><\/sup>. Social connections and relationships are basic human needs, which innately inherited in all people, whereas reduced human-to-human connections are associated with poor mental and physical health\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0250\" aria-expanded=\"false\" aria-haspopup=\"true\">[50]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0255\" aria-expanded=\"false\" aria-haspopup=\"true\">[51]<\/a><\/sup>. Despite escalation in technology and globalization that would presumably foster social connections, scientific findings show that people are becoming increasingly more socially isolated, and the prevalence of loneliness is increasing in last few decades\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0250\" aria-expanded=\"false\" aria-haspopup=\"true\">[50]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0260\" aria-expanded=\"false\" aria-haspopup=\"true\">[52]<\/a><\/sup>. Poor social connections are closely related to isolation and loneliness, considered significant health related risk factors\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0250\" aria-expanded=\"false\" aria-haspopup=\"true\">[50]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0255\" aria-expanded=\"false\" aria-haspopup=\"true\">[51]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0260\" aria-expanded=\"false\" aria-haspopup=\"true\">[52]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0265\" aria-expanded=\"false\" aria-haspopup=\"true\">[53]<\/a><\/sup>.<\/p>\n<p id=\"p0245\">A\u00a0<em>meta<\/em>-analysis of 91 studies of about 400,000 people showed a 13% increased morality risk among people with low compare to high contact frequency\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0265\" aria-expanded=\"false\" aria-haspopup=\"true\">[53]<\/a><\/sup>. Another\u00a0<em>meta<\/em>-analysis of 148 prospective studies (308,849 participants) found that poor social relationships was associated with 50% increased mortality risk. People who were socially isolated or fell lonely had 45% and 40% increased mortality risk, respectively. These findings were consistent across ages, sex, initial health status, cause of death and follow-up periods\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0260\" aria-expanded=\"false\" aria-haspopup=\"true\">[52]<\/a><\/sup>. Importantly, the increased risk for mortality was found comparable to smoking and exceeding well-established risk factors such as obesity and physical inactivity\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0260\" aria-expanded=\"false\" aria-haspopup=\"true\">[52]<\/a><\/sup>. An umbrella review of 40 systematic reviews including 10\u00a0<em>meta<\/em>-analyses demonstrated that compromised social relationships were associated with increased risk of all-cause mortality, depression, anxiety suicide, cancer and overall physical illness\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0255\" aria-expanded=\"false\" aria-haspopup=\"true\">[51]<\/a><\/sup>.<\/p>\n<p id=\"p0250\" class=\"p p-last\">As described earlier, wearing facemasks causing hypoxic and hypercapnic state that constantly challenges the normal homeostasis, and activates \u201cfight or flight\u201d stress response, an important survival mechanism in the human body\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0055\" aria-expanded=\"false\" aria-haspopup=\"true\">[11]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0060\" aria-expanded=\"false\" aria-haspopup=\"true\">[12]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0065\" aria-expanded=\"false\" aria-haspopup=\"true\">[13]<\/a><\/sup>. The acute stress response includes activation of nervous, endocrine, cardiovascular, and the immune systems\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0235\" aria-expanded=\"false\" aria-haspopup=\"true\">[47]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0270\" aria-expanded=\"false\" aria-haspopup=\"true\">[54]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0275\" aria-expanded=\"false\" aria-haspopup=\"true\">[55]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0280\" aria-expanded=\"false\" aria-haspopup=\"true\">[56]<\/a><\/sup>. These include activation of the limbic part of the brain, release stress hormones (adrenalin, neuro-adrenalin and cortisol), changes in blood flow distribution (vasodilation of peripheral blood vessels and vasoconstriction of visceral blood vessels) and activation of the immune system response (secretion of macrophages and natural killer cells)\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0235\" aria-expanded=\"false\" aria-haspopup=\"true\">[47]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0240\" aria-expanded=\"false\" aria-haspopup=\"true\">[48]<\/a><\/sup>. Encountering people who wearing facemasks activates innate stress-fear emotion, which is fundamental to all humans in danger or life threating situations, such as death or unknown, unpredictable outcome. While acute stress response (seconds to minutes) is adaptive reaction to challenges and part of the survival mechanism, chronic and prolonged state of stress-fear is maladaptive and has detrimental effects on physical and mental health. The repeatedly or continuously activated stress-fear response causes the body to operate on survival mode, having sustain increase in blood pressure, pro-inflammatory state and immunosuppression\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0235\" aria-expanded=\"false\" aria-haspopup=\"true\">[47]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0240\" aria-expanded=\"false\" aria-haspopup=\"true\">[48]<\/a><\/sup>.<\/p>\n<\/div>\n<div id=\"s0040\" class=\"sec sec-last\">\n<h3 id=\"s0040title\">Long-Term health consequences of wearing facemasks<\/h3>\n<p id=\"p0255\" class=\"p p-first\">Long-term practice of wearing facemasks has strong potential for devastating health consequences. Prolonged hypoxic-hypercapnic state compromises normal physiological and psychological balance, deteriorating health and promotes the developing and progression of existing chronic diseases\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0115\" aria-expanded=\"false\" aria-haspopup=\"true\">[23]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0190\" aria-expanded=\"false\" aria-haspopup=\"true\">[38]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0195\" aria-expanded=\"false\" aria-haspopup=\"true\">[39]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0215\" aria-expanded=\"false\" aria-haspopup=\"true\">[43]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0235\" aria-expanded=\"false\" aria-haspopup=\"true\">[47]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0240\" aria-expanded=\"false\" aria-haspopup=\"true\">[48]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0285\" aria-expanded=\"false\" aria-haspopup=\"true\">[57]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0055\" aria-expanded=\"false\" aria-haspopup=\"true\">[11]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0060\" aria-expanded=\"false\" aria-haspopup=\"true\">[12]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0065\" aria-expanded=\"false\" aria-haspopup=\"true\">[13]<\/a><\/sup>. For instance, ischemic heart disease caused by hypoxic damage to the myocardium is the most common form of cardiovascular disease and is a number one cause of death worldwide (44% of all non-communicable diseases) with 17.9 million deaths occurred in 2016\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0285\" aria-expanded=\"false\" aria-haspopup=\"true\">[57]<\/a><\/sup>. Hypoxia also playing an important role in cancer burden\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0290\" aria-expanded=\"false\" aria-haspopup=\"true\">[58]<\/a><\/sup>. Cellular hypoxia has strong mechanistic feature in promoting cancer initiation, progression, metastasis, predicting clinical outcomes and usually presents a poorer survival in patients with cancer. Most solid tumors present some degree of hypoxia, which is independent predictor of more aggressive disease, resistance to cancer therapies and poorer clinical outcomes\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0295\" aria-expanded=\"false\" aria-haspopup=\"true\">[59]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0300\" aria-expanded=\"false\" aria-haspopup=\"true\">[60]<\/a><\/sup>. Worth note, cancer is one of the leading causes of death worldwide, with an estimate of more than 18 million new diagnosed cases and 9.6 million cancer-related deaths occurred in 2018\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0305\" aria-expanded=\"false\" aria-haspopup=\"true\">[61]<\/a><\/sup>.<\/p>\n<p id=\"p0260\" class=\"p p-last\">With respect to mental health, global estimates showing that COVID-19 will cause a catastrophe due to collateral psychological damage such as quarantine, lockdowns, unemployment, economic collapse, social isolation, violence and suicides\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0310\" aria-expanded=\"false\" aria-haspopup=\"true\">[62]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0315\" aria-expanded=\"false\" aria-haspopup=\"true\">[63]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0320\" aria-expanded=\"false\" aria-haspopup=\"true\">[64]<\/a><\/sup>. Chronic stress along with hypoxic and hypercapnic conditions knocks the body out of balance, and can cause headaches, fatigue, stomach issues, muscle tension, mood disturbances, insomnia and accelerated aging\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0235\" aria-expanded=\"false\" aria-haspopup=\"true\">[47]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0240\" aria-expanded=\"false\" aria-haspopup=\"true\">[48]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0325\" aria-expanded=\"false\" aria-haspopup=\"true\">[65]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0330\" aria-expanded=\"false\" aria-haspopup=\"true\">[66]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0335\" aria-expanded=\"false\" aria-haspopup=\"true\">[67]<\/a><\/sup>. This state suppressing the immune system to protect the body from viruses and bacteria, decreasing cognitive function, promoting the developing and exacerbating the major health issues including hypertension, cardiovascular disease, diabetes, cancer, Alzheimer disease, rising anxiety and depression states, causes social isolation and loneliness and increasing the risk for prematurely mortality\u00a0<sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0235\" aria-expanded=\"false\" aria-haspopup=\"true\">[47]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0240\" aria-expanded=\"false\" aria-haspopup=\"true\">[48]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0255\" aria-expanded=\"false\" aria-haspopup=\"true\">[51]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0280\" aria-expanded=\"false\" aria-haspopup=\"true\">[56]<\/a><\/sup><sup>,\u00a0<\/sup><sup><a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#b0330\" aria-expanded=\"false\" aria-haspopup=\"true\">[66]<\/a><\/sup>.<\/p>\n<\/div>\n<\/div>\n<div id=\"s0045\" class=\"tsec sec\">\n<div class=\"goto jig-ncbiinpagenav-goto-container\"><a class=\"tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading\" title=\"Go to other sections in this page\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#\" aria-expanded=\"false\" aria-haspopup=\"true\">Go to:<\/a><\/div>\n<h2 id=\"s0045title\" class=\"head no_bottom_margin ui-helper-clearfix\">Conclusion<\/h2>\n<p id=\"p0265\" class=\"p p-first-last\">The existing scientific evidences challenge the safety and efficacy of wearing facemask as preventive intervention for COVID-19. The data suggest that both medical and non-medical facemasks are ineffective to block human-to-human transmission of viral and infectious disease such SARS-CoV-2 and COVID-19, supporting against the usage of facemasks. Wearing facemasks has been demonstrated to have substantial adverse physiological and psychological effects. These include hypoxia, hypercapnia, shortness of breath, increased acidity and toxicity, activation of fear and stress response, rise in stress hormones, immunosuppression, fatigue, headaches, decline in cognitive performance, predisposition for viral and infectious illnesses, chronic stress, anxiety and depression. Long-term consequences of wearing facemask can cause health deterioration, developing and progression of chronic diseases and premature death. Governments, policy makers and health organizations should utilize prosper and scientific evidence-based approach with respect to wearing facemasks, when the latter is considered as preventive intervention for public health.<\/p>\n<\/div>\n<div id=\"s0050\" class=\"tsec sec\">\n<div class=\"goto jig-ncbiinpagenav-goto-container\"><a class=\"tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading\" title=\"Go to other sections in this page\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#\" aria-expanded=\"false\" aria-haspopup=\"true\">Go to:<\/a><\/div>\n<h2 id=\"s0050title\" class=\"head no_bottom_margin ui-helper-clearfix\">CRediT authorship contribution statement<\/h2>\n<p id=\"p0270\" class=\"p p-first-last\"><strong>Baruch Vainshelboim:<\/strong>\u00a0Conceptualization, Data curation, Writing &#8211; original draft.<\/p>\n<\/div>\n<div id=\"__sec1\" class=\"tsec sec\">\n<div class=\"goto jig-ncbiinpagenav-goto-container\"><a class=\"tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading\" title=\"Go to other sections in this page\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#\" aria-expanded=\"false\" aria-haspopup=\"true\">Go to:<\/a><\/div>\n<h2 id=\"__sec1title\" class=\"head no_bottom_margin ui-helper-clearfix\">Declaration of Competing Interest<\/h2>\n<p id=\"p0275\" class=\"p p-first-last\">The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.<\/p>\n<\/div>\n<div id=\"bi005\" class=\"tsec sec\">\n<div class=\"goto jig-ncbiinpagenav-goto-container\"><a class=\"tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading\" title=\"Go to other sections in this page\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7680614\/#\" aria-expanded=\"false\" aria-haspopup=\"true\">Go to:<\/a><\/div>\n<h2 id=\"bi005title\" class=\"head no_bottom_margin ui-helper-clearfix\">References<\/h2>\n<div id=\"reference-list\" class=\"ref-list-sec sec\">\n<div id=\"b0005\" class=\"ref-cit-blk half_rhythm\">1.\u00a0<span id=\"h0005\" class=\"element-citation\">Fisher E.M., Noti J.D., Lindsley W.G., Blachere F.M., Shaffer R.E. 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