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Respiratory Therapist Speaks Out 

About Masks 

by Betsy Thomason, BA, RRT © 2021

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Finally, thanks to covid, everyone has heard of respiratory therapists and our life-saving work managing folks connected to mechanical ventilation. We’ve been trained, over and over again, in the proper use of masks. This knowledge and experience leads me to question mask mandates. 


What I know about masks: 

There are two types of masks, surgical and N95. The most common and affordable are surgical masks, worn by people on the street. N95 masks are more rigid and form fitting with a pliable metal bracket across the bridge of the nose to create a tight seal. It is meant for short term use only, in the room of a patient with a contagious disease, such as active tuberculosis or active covid. 


During my respiratory training, it was drummed into students that surgical masks do not prevent the spread of germs; they simply prevent large particles, say from a sneeze, from entering a sterile surgical field. Only N95 masks block microbes and are touted to protect against 95% of contagious germs. I was trained to achieve a secure N95 fit. Annual training included a spritz of scented aerosol in your face. If you could smell it with the mask snugly in place, it was not tight enough. After fit testing, subsequent N95 use required the user’s memory of the feeling of proper tightness. Subsequently, it’s the professional’s responsibility to know when to wear a surgical mask and when to wear an N95 mask. So you can understand my reluctance to wear a covid-mandated surgical mask. Why aren’t people on the street using N95 masks? The answers: They are too expensive, are in short supply, and are not designed for continual use. 


My conflict with the mask mandate:

Frankly, as I review the research (1.) from the US Centers for Disease Control and Prevention (CDC), I am conflicted by wording that states that surgical masks are effective because they block the covid virus which is encapsulated in water droplets. Air generally contains moisture. If the moisture is trapped on the inside of the mask along with the encapsulated “bug,” why then is there no condensation running down one’s face? Does a mask block moist air from both entering and exiting? Why, then, is it possible for masked folks to develop covid? Could there be other reasons to explain covid’s ability to sneak past one’s immune system? 


The CDC (2.) also claims that surgical masks leave plenty of room for CO2 to escape on exhalation — no need to worry about CO2 toxicity, manifested as headaches or sleepiness. One study utilized a tiny sample size — 12 people. The conclusion: more study is required. In the mean time, the CDC is reporting “no problem.” Is this acceptable science? In a You Tube video, Gregory Schmidt, MD, an intensive care specialist at the University of Iowa, claims there is absolutely no problem clearing CO2 from a face mask. He demonstrates this using one young adult, standing still, using a pulse oximeter to measure blood oxygen and a capnograph to measure exhaled CO2. Does a study of one person qualify as acceptable, reportable science? Is the viewer supposed to believe this without a question, because a doctor says so? 


Here are my questions and concerns about mask use: What are the long-term effects of constant mask use, for example, at work? What about the “average” American who, these days, might be obese, or have hypertension, or diabetes, or be highly stressed? These conditions themselves are toxic. Add to this the fact that most folks ignore breathing altogether. While the normal respiratory rate is 12-20 breaths/minute, my observations indicate that the majority of people breathe more frequently, often as much as 30 times per minute, which is one breathing cycle — outbreath and inbreath — every 2 seconds. I question that there is actually enough time for the CO2 to “wash out” of the mask before the next unfocused, shallow inhale. What’s most likely happening is that some of the old air, full of CO2, is being rebreathed, over and over again. 


Kids and masks: 

Why are children, starting at the age of 2, required to wear masks? These youngsters have even higher normal breathing rates. Two-year-old children typically breathe 25 to 35 times per minute. 


This raises the same concerns about the ability to clear CO2 from the mask. Added to this physiological concern are psychological ramifications — kids who refuse to don a mask or kids who are afraid of people wearing masks. If you’re a masked four-year-old, your face has been covered for half of your lifetime and you’ve only known people who are masked, including your essential caregivers, mom and dad. How is this impacting the growth, development, and understanding of these new world citizens? 


What is the real issue?

America is sick. Our health status ranks number 10 among the financially richest nations, yet our national healthcare budget exceeds that of the average nation. In 2019 –- just one year — the CDC says (3.) that 659,041 folks died of heart disease, 599,041 of cancer, 173,040 of accidents, 156,979 of chronic lung disease, 150,005 from stroke. Since covid’s onset in 2019 — over two years ago — 723,8800 US citizens have died. (4.) Which conditions are more pernicious? 


How can you keep your immune system healthy and prevent disease? Start with a commitment. Go for a walk every day. Decrease or eliminate the use of drugs, alcohol, and other mind-body numbing substances. Fall in love with a glass of water. Learn the BreatheOutDynamic system — drug-free management of anxiety, fear, pain, and stress. Reinvent yourself. You are the only one who can create and maintain your own health. Then share your story with a friend. 

About the author:

Betsy Thomason, a Vermont resident, began writing in the 1970s as a stringer for a community newspaper in northern New Jersey. Her articles have also appeared in specialty magazines for small business, respiratory therapists, and the outdoors. She is the author of Just Breathe Out — Using Your Breath to Create a New, Healthier You (North Loop Books, 2016).


Contact info:

Betsy Thomason, 2766 #1 Windham Hill Road, West Townshend VT 05359






1) Science Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2

Updated May 7, 2021  


Author Thomason is unable to locate website link for information below:

Summary of Recent Changes

Last updated May 7, 2021

From CDC website—Adverse Health Effects of Mask Wearing:

Research supports that mask wearing has no significant adverse health effects for wearers.  Studies of healthy hospital workers, older adults, and adults with COPD reported no change in oxygen or carbon dioxide levels while wearing a cloth or surgical mask either during rest or physical activity.57-59 Among 12 healthy non-smoking adults, there was minimal impact on respiration when wearing a mask compared with not wearing a mask; however, the authors noted that while some respiratory discomfort may have been present, mask use was safe even during exercise.60 The safety of mask use during exercise has been confirmed in other studies of healthy adults.61-63 Additionally, no oxygen desaturation or respiratory distress was observed amongchildren less than 2 years of age when masked during normal play.64 While some studies have found an increase in reports of dyspnea65 (difficulty breathing) when wearing face masks, no physiologic differences were identified between periods of rest or exercise while masked or non-masked.63



Carbon dioxide increases with face masks but remains below short-term NIOSH limits

Michelle S. M. Rhee, Carin D. Lindquist, Matthew T. Silvestrini, Amanda C. Chan, Jonathan J. Y. Ong & Vijay K. Sharma 

BMC Infectious Diseases



Background and purpose

COVID-19 pandemic led to wide-spread use of face-masks, respirators and other personal protective equipment (PPE) by healthcare workers. Various symptoms attributed to the use of PPE are believed to be, at least in part, due to elevated carbon-dioxide (CO2) levels. We evaluated concentrations of CO2 under various PPE.


In a prospective observational study on healthy volunteers, CO2 levels were measured during regular breathing while donning 1) no mask, 2) JustAir® powered air purifying respirator (PAPR), 3) KN95 respirator, and 4) valved-respirator. Serial CO2 measurements were taken with a nasal cannula at a frequency of 1-Hz for 15-min for each PPE configuration to evaluate whether National Institute for Occupational Safety and Health (NIOSH) limits were breached.


The study included 11 healthy volunteers, median age 32 years (range 16–54) and 6 (55%) men. Percent mean (SD) changes in CO2 values for no mask, JustAir® PAPR, KN95 respirator and valve respirator were 0.26 (0.12), 0.59 (0.097), 2.6 (0.14) and 2.4 (0.59), respectively. Use of face masks (KN95 and valved-respirator) resulted in significant increases in CO2 concentrations, which exceeded the 8-h NIOSH exposure threshold limit value-weighted average (TLV-TWA). However, the increases in CO2 concentrations did not breach short-term (15-min) limits. Importantly, these levels were considerably lower than the long-term (8-h) NIOSH limits during donning JustAir® PAPR. There was a statistically significant difference between all pairs (p < 0.0001, except KN95 and valved-respirator (p = 0.25). However, whether increase in CO2 levels are clinically significant remains debatable.


Although, significant increase in CO2 concentrations are noted with routinely used face-masks, the levels still remain within the NIOSH limits for short-term use. Therefore, there should not be a concern in their regular day-to-day use for healthcare providers. The clinical implications of elevated CO2 levels with long-term use of face masks needs further studies. Use of PAPR prevents relative hypercapnoea. However, whether PAPR should be advocated for healthcare workers requiring PPE for extended hours needs to evaluated in further studies.


3) Source: Mortality in the United States, 2019, data table for figure 2

Leading Causes of Death

Data are for the U.S.

Number of deaths for leading causes of death

•           Heart disease: 659,041

•           Cancer: 599,601

•           Accidents (unintentional injuries): 173,040

•           Chronic lower respiratory diseases: 156,979

•           Stroke (cerebrovascular diseases): 150,005

•           Alzheimer’s disease: 121,499

•           Diabetes: 87,647

•           Nephritis, nephrotic syndrome, and nephrosis: 51,565

•           Influenza and pneumonia: 49,783

•           Intentional self-harm (suicide): 47,511


4) Source: National Center for Health Statistics

Provisional Death Counts for Coronavirus Disease 2019 (COVID-19)

Deaths Attributed to COVID-19 on Death Certificates

Data as of 10/20/202Deaths through week ending 10/16/2021


In at least 90% of these deaths, COVID-19 was listed as the underlying cause of death. For the remaining deaths, COVID-19 was listed as a contributing cause of death.

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