While the wearing of the mask will become mandatory in all closed public places in Quebec on Saturday, some invoke – sincerely or fraudulently – medical reasons for opting out of the new measure. But what health conditions are really incompatible with wearing a mask?
“There are few situations that are recognized as being problematic for wearing a mask or a face covering,” says Dr. Chantal Sauvageau, medical consultant at the National Institute of Public Health of Quebec (INSPQ).
The measure that takes effect on Saturday excludes children under 12 and those who are unable to remove their mask without the help of another person. This includes people living with physical or intellectual disabilities, illustrates Dr. Sauvageau.
“On the other hand, even for people who have lung problems such as asthma or emphysema, it is recommended to wear a mask,” she adds.
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When announcing the imposition of the wearing of masks in closed public places, the National Director of Public Health of Quebec, Dr Horacio Arruda, briefly mentioned “heart or respiratory problems” that could make wearing the mask optional for people of a “certain age”.
Joined by email by HuffPost Quebec for details, a spokesperson for the ministry of health indicated that there was not yet an exhaustive list of medical conditions justifying the exemption from wearing a mask.
Marie-Louise Harvey, however, indicated that people who suffer from “serious cardio-respiratory health problems” that cause shortness of breath “with little effort” will be among those exempt.
The Canadian Thoracic Society (CTS) recently claimed that there is “no evidence that wearing a face mask or cover causes a flare-up (exacerbation) of an underlying lung condition”. She even considers that wearing a mask constitutes “additional protection” for people with an underlying lung disease.
In its official recommendation on the wearing of a mask by the public, the Société nonetheless concedes that “breathing through a mask requires more effort”, which can cause “an impression of running out of breath”. Specialists believe that people who fail to find strategies to tolerate the mask in collaboration with a health care professional should refrain from visiting places where physical distancing is not possible as much as possible.
Sauvageau also recalls that most people who suffer from serious respiratory problems generally already avoid closed public places, since they are at risk of serious complications if they contract COVID-19.
Find the right mask
Not all masks are created equal and finding the right one could solve many problems, says Dr. Sauvageau.
The type of material the face cover is made of and how it fits can make a big difference in the breathing comfort of the person wearing it. “Sometimes you have to try more than one,” she says.
People suffering from pulmonary vulnerability should also prefer a procedural mask or a homemade mask that has filtration characteristics similar to those of a medical grade mask. The mask will help protect them from COVID-19, in addition to protecting others from their own respiratory droplets.
The Robert-Sauvé Research Institute for Occupational Health and Safety has published the results of its spraying, filtration and breathability tests for several materials used to design removable masks and filters.
Legitimate concerns
Even if the wearing of the mask does not represent a danger for the vast majority of the population, that does not mean that all the people who invoke a medical exemption do so with malice.
Some people with anxiety, for example, report symptoms exacerbated by wearing a mask, going as far as a panic attack.
“We must not sweep this out of the hand,” says Dr. Sauvageau. “But you have to get help to identify a good mask that you will be able to tolerate for short moments when you have no choice but to wear one.”
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She adds that people who are really having trouble breathing with a mask may want to see a healthcare professional.
“If you really feel uncomfortable wearing a mask to the point where you are not able to breathe well, it is not supposed,” she says. “You can consult to make sure there isn’t a condition that deserves treatment.”
Significant feelings of anxiety caused by wearing a face covering, for example, should prompt a discussion with a health care professional about our mental health.
Dr. Sauvageau also gives the example of a colleague whose patient reported significant difficulty in breathing with a mask. “He finally had an unstable angina problem which was treated and after that he was able to wear the mask without difficulty.”
People who report that their medical condition prevents them from wearing a mask will not have to present evidence to be exempt.
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A certain vagueness persists however around the way in which these declarations should be treated by the traders, who have the duty to enforce the rule.
If the spokesperson of the MSSS Marie-Louise Harvey affirms that “it is not for the merchants to determine if the exemption is legitimate or not”, she adds that the signs of medical conditions justifying the exemption are “physical”.
The ministry therefore requests the cooperation of the population to enforce “this important obligation”.
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