RETRACTED: Physio-metabolic and clinical consequences of wearing face masks—Systematic review with meta-analysis and comprehensive evaluation

Abstract

BackgroundAs face masks became mandatory in most countries during the COVID-19 pandemic, adverse effects require substantiated investigation.MethodsA systematic review of 2,168 studies on adverse medical mask effects yielded 54 publications for synthesis and 37 studies for meta-analysis (on n = 8,641, m = 2,482, f = 6,159, age = 34.8 ± 12.5). The median trial duration was only 18 min (IQR = 50) for our comprehensive evaluation of mask induced physio-metabolic and clinical outcomes.ResultsWe found significant effects in both medical surgical and N95 masks, with a greater impact of the second. These effects included decreased SpO2 (overall Standard Mean Difference, SMD = −0.24, 95% CI = −0.38 to −0.11, p < 0.001) and minute ventilation (SMD = −0.72, 95% CI = −0.99 to −0.46, p < 0.001), simultaneous increased in blood-CO2 (SMD = +0.64, 95% CI = 0.31–0.96, p < 0.001), heart rate (N95: SMD = +0.22, 95% CI = 0.03–0.41, p = 0.02), systolic blood pressure (surgical: SMD = +0.21, 95% CI = 0.03–0.39, p = 0.02), skin temperature (overall SMD = +0.80 95% CI = 0.23–1.38, p = 0.006) and humidity (SMD +2.24, 95% CI = 1.32–3.17, p < 0.001). Effects on exertion (overall SMD = +0.9, surgical = +0.63, N95 = +1.19), discomfort (SMD = +1.16), dyspnoea (SMD = +1.46), heat (SMD = +0.70), and humidity (SMD = +0.9) were significant in n = 373 with a robust relationship to mask wearing (p < 0.006 to p < 0.001). Pooled symptom prevalence (n = 8,128) was significant for: headache (62%, p < 0.001), acne (38%, p < 0.001), skin irritation (36%, p < 0.001), dyspnoea (33%, p < 0.001), heat (26%, p < 0.001), itching (26%, p < 0.001), voice disorder (23%, p < 0.03), and dizziness (5%, p = 0.01).DiscussionMasks interfered with O2-uptake and CO2-release and compromised respiratory compensation. Though evaluated wearing durations are shorter than daily/prolonged use, outcomes independently validate mask-induced exhaustion-syndrome (MIES) and down-stream physio-metabolic disfunctions. MIES can have long-term clinical consequences, especially for vulnerable groups. So far, several mask related symptoms may have been misinterpreted as long COVID-19 symptoms. In any case, the possible MIES contrasts with the WHO definition of health.ConclusionFace mask side-effects must be assessed (risk-benefit) against the available evidence of their effectiveness against viral transmissions. In the absence of strong empirical evidence of effectiveness, mask wearing should not be mandated let alone enforced by law.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021256694, identifier: PROSPERO 2021 CRD42021256694.

Wearing Face Masks as a Potential Source for Inhalation and Oral Uptake of Inanimate Toxins: a Scoping Review

“…An exposure to a mixture of VOC as shown for face masks according to our results (TVOC, Table 2) [24,25,56,71,72] may be an important trigger of the so-called Sick Building Syndrome (SBS) [155]. SBS-like symptoms have been linked to mask use in recent comprehensive reviews on adverse face mask effects [26,62,63]. Possibly, some of the symptoms immediately occurring while wearing a mask may be caused by toxic chemicals released by the face mask.…”

“…Of the original 1003 results, 24 studies (2.4%) were finally included (Figure 1). This is not an unusually low rate in reviews [62,63]. Moreover, our selection was strictly based on the inclusion and exclusion criteria and the quality assessment applied.…”

“…This phenomenon could lead to further toxic compounds with a new kind of threat to human health. One has to consider that the mask dead space does not only have a higher temperature, but is more humid [26,63], which facilitates many chemical reactions. It should not go unmentioned, that there is an additional possibility of amplifying toxic effects, resulting from the mixture of toxins.…”

“…Despite a broad narrative during the SARS-CoV-2 pandemic supporting the efficacy of face masks against virus transmission [62,63] there is only weak evidence for the effectiveness against respiratory viral infections even from the highest evidence-based institutions [193]. Regarding our results of multiple toxic substances released by face masks that can be ingested and inhaled (Tables 1, 2 and 3), the introduction of mask mandates by law for the general population in many countries during the SARS-CoV-2-pandemic 2020-2023 appears questionable from an empirical and scientific perspective.…”

Revisiting the rationale of mandatory masking

“…This has been shown to cause elevated transcutaneous carbon dioxide values and lower oxygen availability [45,51], which can lead to short-term confusion, disorientation, impaired cognitive abilities, and drowsiness, symptoms that have been collectively referred to as maskinduced exhaustion syndrome (MIES) by Kisielinski et al [45]. More recently, Kisielinski et al reported a systematic review with meta-analysis demonstrating that masks interfere with O 2 -uptake and CO 2 -release and providing evidence that masks lead to adverse physio-metabolic and clinical outcomes, thereby validating MIES, especially for vulnerable groups, such as children, pregnant women, the elderly, and people suffering from illnesses [52]. With regards to issues of CO 2 release, it has been reported that mask wearing rapidly leads to children inhaling CO 2 at concentrations above the accepted safe levels [53], the long term implications of which to children's health are unknown.…”