Safe Face Mask Wearing

Firsthand observations and information reported for more than 6 months in more than one country in the context of face masks, lockdown, curfews, stay at home, self-isolation and quarantine: 

Please see WHO recommendations regarding mask wearing and safe mask wearing.  

A. Many (or most in some European countries) individuals wear masks in ways that increase risk for COVID-19, rather than decrease risk, such as wearing masks under noses, on chins, on arms or hands. We sometimes or often observe that most individuals, at least 75%, in our surroundings engage in this behaviour, and that not many individuals, more or less 10%, wear masks to cover noses.

B. Many or most individuals regularly touch mouths with unwashed on unclean hands, often underneath masks, which increases risk for COVID-19 markedly.  

Research indicates that most adults touch their faces more or less 16-23 times per hour, often without registering this behaviour.  In the context of youth, elevated emotion eg anxiety, mental health problems, learning problems and/or neurodevelopmental problems, these behaviours usually increase markedly. Please see earlier references to children and schools.

C. Most individuals, not living in poverty, report that they never replace masks even though they fall on wet floors, which increases risk markedly.  

Most individuals report that they have worn the same mask for at least 3-6 months.  Many report that they have extra masks, but will rather “save them for emergencies”.  

D. Not one person has admitted to cleaning his or her hands before and after using a mask, as per WHO guidelines, December 2020, which increases risk markedly.  

It is also important to consider where the mask is ‘kept’ if not worn; wearing or keeping masks on arms or wrists are not good practice.

Most doctors will agree that if a recommendation or behaviour cannot be engaged in safety, it could increase risk significantly, rather than decrease risk.  

E. Many individuals report that they drink alcohol, take over the counter or prescription medication (for other purposes) or illicit drugs to “cope” with lockdown, curfews, quarantine and mask wearing; many report these behaviours on a daily basis.  Many individuals in this context never used alcohol or illicit drugs before the pandemic.

Many individuals do not know that a medical certificate can be requested to avoid mask wearing.

It is important to seek advice and assistance without delay in these contexts – GPs will have helpful information, and in an emergency, contact emergency numbers. Many organisations will keep concerns confidential. Please see Helpful Links at http://www.cinaps.co.uk for more information.

F. Many individuals report, during quarantine at home, that they could not access necessary healthcare, medication or food to maintain health.

G. Many report markedly increased social risk in their homes or immediate environment due to indiscriminate mandatory initiatives such as relating to mask wearing, curfew, lockdown and quarantine.  Concerns include general violence, domestic violence, child abuse, alcohol abuse and illicit substance abuse.  

It is important to seek advice and assistance without delay in these contexts – GPs will have helpful information, and in an emergency, contact emergency numbers. Many organisations will keep concerns confidential. Please see Helpful Links at http://www.cinaps.co.uk for more information.

H. Many report “breaking rules” regarding safety and health to comply with curfew rules, such as driving too fast.

I. Many individuals, with and without a relevant mental health history, report significant mental health symptoms or morbidity due to indiscriminate mandatory mask wearing initiatives, stay at home, curfew, lockdown and quarantine. 

It is relevant to note that many individuals report that their concerns are not related to COVID-19, but due to initiatives depriving liberty and autonomy.  

It is important to seek advice and assistance without delay in these contexts – GPs will have helpful information, and in an emergency, contact emergency numbers. If you are not sure if it is an emergency, get immediate advice. Many organisations will keep concerns confidential. Please see Helpful Links at http://www.cinaps.co.uk for more information.

J. Many individuals report significant general health symptoms due to indiscriminate mandatory initiatives such as relating to mask wearing, curfews, lockdown, stay at home and quarantine.  We have referred to these concerns in Deprivation of Liberty. Medical doctors often report that they fall into this group.  

It is important to seek advice and assistance without delay in these contexts – GPs will have helpful information, and in an emergency, contact emergency numbers.

K. Many individuals report that they are not engaging in protective behaviours such as washing hands before eating, covering faces when sneezing or coughing, or remaining home if sick or if symptoms and contacting health professionals, and comment on indiscriminate restrictive initiatives maintaining lethargy and nihilism (no hope for the future or that things will change).  

L. Many individuals report that they are not engaging in medical or mental health appointments to avoid face masks and due to stay at home messages, lockdown or quarantine.  

M. Many individuals report that they will not seek medical assistance or buy medication needed for themselves, their children or family due to mandatory mask wearing initiatives, or due to curfew, during lockdown, quarantine or stay at home messages.  Some report that messages such as ‘pretend you have the virus’ and ‘anyone can make you sick’ cause confusion and “fear”, “it is safest to stay at home”, as reported by a family. 

It is important to prioritise general health and mental health, along with a safe and calm environment in this time.

Most individuals report that their concerns, as above, are not secondary to the risk of the virus, but due to restrictive initiatives; indiscriminate mandatory face masks, travel related quarantine, curfews, lockdown and stay at home messages for individuals without symptoms and not at high risk for severe COVID-19.

Most families report that the “most helpful thing” is to know that they are not alone in presenting with these thoughts, feelings, behaviours or mental health or general health presentations, that many experience the same concerns. This is our reason for sharing these thoughts today.

We have shared observations and concerns with relevant organisations, updating observations since our initial correspondence in March 2020. Many organisations share these concerns.

Finally, it is always important to prioritise general health and mental health, along with a safe, calm and positive environment, but it is especially important in this time. Please see previous comments on evidence-based protective factors and the immune system.

Simple measures often affect outcome in very significant ways. We provide an example – take a daily or weekly walk – one parent or carer with one child – where the rule is to only talk about positive and fun topics – if this is difficult in the beginning – focus on what you see around you that you like. This one to one time with every combination of child and parent or carer provides opportunities to share enjoyment, relax, bond, learn and develop. The walk does not have to be long, 10 minutes might be sufficient, but take the time to experience life and the precious moments if you can. We often recommend this simple strategy to families, often with good outcomes.