A study on inhaled CO2 with the use of nose and mouth cover devices and a mini-review.

(submitted to a scientific Journal)

November 30TH, 2020

Introduction. In Italy, from November 4, 2020, the obligation to wear a mask has been extended outdoors and, for students over 6 years old, to the entire period of stay at school. The symptoms complained of after prolonged use of masks, such as loss of concentration, headache, fatigue, difficulty in breathing, dizziness, could be caused, according to knowledge already known in physiology, by the high levels of carbon dioxide (CO2) (table 3). We therefore wanted to carry out some tests to detect the amount of CO2 that is inhaled in the microenvironment of the mask, in the hypothesis that the excess of this gas can justify, at least in part, the frequently complained disorders.

A study on “Air quality with the use of nose and mouth covering devices” was recently published by the Province of Bolzano 1. Since the conclusions of this study, as they were communicated to the general public (“masks are not harmful”), did not seem in line with what was reported by the same results of the Province, we also wanted to compare them with our data.

We therefore tried to understand how the mask works and the reason for the variations in results for the various types of devices. Finally, we carried out a research in the literature on other possible damages (increase in infections, psychological aspects, risk compensation, increased respiratory work, etc.) due to nose and mouth covering devices.

Method. We measured the re-inspired CO2 in 24 healthy individuals of various ages (mean 48, range 5-88 years), with the different types of masks, exclusively in the sitting position. The portable carbon dioxide analyzer G100, Geotech (www.geotechuk.com), equipped with an internal 100 cm3 / min pump, an infrared sensor with a measuring range of 0-20 in volume (per cent) and an accuracy of 1%. The tube was placed under the nose and the pump was activated at the beginning of the inhalation and turned off at the end. The same for the measurements during the exhalation.

Results. the results of the inspiratory CO2 measurements in sitting position are summarized here (for the purpose of comparison with the results of the province of Bolzano):

for the surgical mask: average CO2 value 7,292 ppm (range 5000 – 13,000) versus 3,350 ppm (range 950 – 5320) from the study of the province of Bolzano.

For FFP2-N95 masks: average CO2 value 11,000 ppm (range 7000 – 15,000) versus 3,850 ppm (range 1220 – 8080) from the study of the province of Bolzano.

For cloth masks / neck warmers: average CO2 value 11,500 ppm (range 5000 – 24,000) versus 4590 ppm (range 1480 – 10,280) from the study of the province of Bolzano.

Without mask: average CO2 value 3143 ppm (range 2000 – 5,000) versus 590 ppm (range 50 – 2250) of the study of the province of Bolzano.

The discrepancy between our results and those of the Bolzano Province study cannot be justified solely by the fact that the CO2 values ​​of the ambient air have been subtracted from the latter, nor by the presence of a different margin of error of the instruments of measurement. In fact, the measuring instrument used by the Province (Horiba_PG250) has an accuracy similar to that used by us (G100). Further studies are needed to better understand the causes of this discrepancy.

Our study confirms that masks with a large cavity (FFP2) are worse than tighter masks. The worse result with the cloth masks compared to the surgical masks is probably due to the lower permeability of the cloth masks. Talking or, worse, singing with the mask increases the amount of CO2 in the inhalation + exhalation.

In tables no. 4, 5 and 6 (and related graphs) show the values ​​of the measurements in the various subjects, in the different situations (only exhalation, only inhalation and mixed inhalation-exhalation), with the different types of masks.

Results of the mini-review. We have examined more than 40 studies on the usefulness of masks in preventing respiratory infections, finding no evidence of efficacy in extending their use to the entire population, outside healthcare facilities2-47. On the contrary, some studies highlight how, for example for cloth masks, moisture retention, reuse and poor filtration can even increase the risk of infection39. A study of thousands of individuals during pilgrimages to Mecca found more respiratory infections in the group that constantly wore masks46. Quite frequent appear dermatological forms such as “maskne” (mask acne). “Risk compensation” phenomena were also detected, caused by a false sense of security generated by the use of the mask48. Finally, it is necessary to note the increase in respiratory resistance and the consequent increase in the work of the respiratory muscles with the use of FFP236,49 masks. WHO currently recommends that people wear face masks only if they have respiratory symptoms or if they need to take care of someone with symptoms: individual states are left to possibly extend the indications.

Psychological effects. The mask is a symbol of danger which, by covering the face, prevents one from making the other known, and recognizing human expressions and emotions in the other. By thus limiting facial expressions, emotional contact is reduced with the consequence of making children – but this also affects adults – weak, anxious, insecure and even immunosuppressed since, the mental state represents a fundamental element to guarantee a good immune response.

From a psychological point of view, the health regulations provided by the Government that are imposed on healthy children are highly harmful and cause possible permanent mental disorders. Educating children to fear mutual closeness is highly detrimental to the development of their self-esteem. Furthermore, establishing a correlation between their behavior and the possible death of loved ones, which is difficult to demonstrate in practice, can profoundly damage their relationship with those around them.

Even in adults, the use of the mask suggests representations of disease, contagion, and death, and suggests that human proximity is a danger to life, causing psychological discomfort, and limiting the possibility of a real creative functioning of the brain. Psychologists are observing a drastic increase in anxiety disorders, social isolation, panic attacks, and cases of suicide50.

Conclusions. For people wearing a mask, each measured CO2 value (both in the present study and in that of the Province of Bolzano) is outside the acceptable values for indoor air quality in school buildings (table 2) 51 and it also exceeds the levels allowed in the workplace (5,000 ppm of CO2). The symptoms complained by patients after prolonged use of a mask are explained by the high levels of carbon dioxide37 and these levels are incompatible with optimal blood oxygenation. From the analysis of the literature there is no clear evidence to extend the use of masks to the entire population. Only in particular risk situations, as can occur in work environments, with the presence of toxic dust, or in infectious disease wards, or in the case of a person suffering from a respiratory infection (in the presence of other people) or by whom takes care of such a patient, then in these specific cases it is necessary to use a mask. In these situations, it would be important that the workers, properly trained, could have adequate periods, interspersed with work, in which they can breathe without a mask. It is concluded that the use of the mask is harmful to health and it is recommended to use it only for short periods.

Limitations. the instrument used detects CO2 only starting from 1,000 ppm. Therefore this did not allow accurate measurements of the amount of CO2 in the ambient air, where the tests were carried out. The measurements of this study, unlike that of the province of Bolzano (which took place in the summer months, in a well-ventilated environment), were carried out in October in an outpatient clinic with partially open windows, a situation that better reproduces the condition that a child lives within his class at the desk.

School and masks. With the latest DPCM of 4/11/2020, the obligation to wear the mask at school continuously for children over 6 years, applies to the whole national territory, regardless of the risk of transmission, on which the WHO recommends to base decisions 52. Imposing the mask on all schoolchildren for the entire period of stay at school, in the presumption of preventing an infection, does not appear justified at all. There are several reasons for not imposing the continued obligation of the mask on schoolchildren: [1] the Necessary Number of Treatments (NNT) to prevent an infection is quite high (the Norwegian Institute of Public Health has calculated that to prevent one infection per week , 200,000 individuals must use masks) 19; [2] COVID has a benign course in children in the vast majority of cases; [3] the evidence of a school-level transmission of COVID has not appeared important so far (children transmit much less than adults) 53 and finally [4] the lack of scientific evidence on the advantages of using masks in the community 2 -47.54.

The mask certainly has a symbolic value, to better understand with a visible means that there is an invisible enemy30.

However, although the symbolic value is important, it seems “unacceptable” to force our children to breathe intolerable amounts of CO2 under the mask for the entire duration of their stay at school and often during physical education.

Diffusibility of CO2. The high levels of CO2 re-inhaled without a mask (table 1), contradict the false idea that CO2 is easily diffusible. CO2 stagnation around the face takes some time to disperse because CO2 is 1.5 times heavier than air. This also accounts for its easy accumulation of CO2in closed environments. Therefore, the diffusibility of CO2 inside the rooms should not be confused with the easy diffusibility of CO2 through the alveolus membrane and the capillary wall.

Toxicity of carbon dioxide (CO2). Damage to health from CO2 is mostly studied in adults (animals and humans), under experimental conditions, only in the short to medium term. The rise in CO2 is followed by acidosis of the blood and tissues; it is well known that water + CO2 form carbonic acid with consequent lowering of the pH. The kidney takes a few days, with the increase in urinary excretion of acids and the reabsorption of bicarbonates, to compensate for acidosis and to bring the pH back to physiological values ​​(7.36–7.44). However, if the increase in CO2 is intermittent (as occurs with the use of masks), renal compensation does not occur and the acidosis is not fully compensated.55 What this entails in the long term in the child is not known. It is known for sure that children have two to three times higher oxygen requirements than adults. Furthermore, the mask increases the respiratory dead space in an inversely proportional way to age: in an adult the mask increases the respiratory dead space by 53% (which in the adult is normally 150 ml with 500 – 640 ml of current respiratory volume at rest), in an 8-year-old the increase is 78%, in a one-year-old child 122%. Since the CO2 concentration in dead spaces is 45,000 ppm, obviously this leads to a more marked increase in CO2 inhalation in children.56 The acidic blood environment induces several physiological alterations when doing exercises with the mask: 1) metabolic changes, 2) cardiorespiratory stress (increased pulse and pressure), 3) decreased renal function, 4) decreased immune response and 5) altered brain metabolism and mental health (decreased cerebral perfusion and inhibition of excitatory neurotransmitters) 27. Chronic elevation of CO2 in the body has also been linked to fetal malformations, damage to the reproductive system, lung and cardiovascular tissue inflammation and cancer.55 Last but not least, neurological damage is possible.55,57 Values of more than 5,000 ppm of CO2, as it has been recorded in this study with the use of masks, appear incompatible with optimal school learning, as many children will experience the symptoms listed in table 3.

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Consiglio Nazionale dell’Ordine degli Psicologi, La salute psicologica è un diritto! https://www.psy.it/la-salute-psicologica-e-un-diritto-cittadini-chiedono-azioni-concrete-a-protezione-della-loro-salute-psicologica.html