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With Sikkim getting its first COVID-19 patient, now more than ever, face masks have become essential in the state. While the State government has been repeatedly issuing circulars and notifications appealing to people to wear these masks when out on in a public space, so much so that the Land Revenue and Disaster Management Department on May 10 declared a fine of Rs. 300 if anybody was found flouting the mandatory regulations. 

Additionally, on 10th May, the State Executive Committee implemented the Sikkim Public Health and Safety (COVID-19 Regulations, 2020 which declared the rules and penalties that would come into immediate force.

Under ‘Restrictions and Offences’, 3.1. it states: “It shall be compulsory tp wear face cover or mask in all public places and workplaces.”

We are nearing the summer season and with climate change, it has only gotten warmer – but with all efforts of cooling off otherwise, what of the face masks? 

Many have been complaining of how hot it is under the mask or how one gets breathless in a few minutes while donning it. There has been a rise in fatalities and health risks caused by the prolonged wear of these protective gear especially in athletes and those with pre-existing health conditions like Asthma. With reports of people’s lungs collapsing or lungs bursting or fainting due to prolonged use of the face protectant and having vehicular accidents, this is seen more commonly in runners. 

While the 3-ply surgical masks are only supposed to be worn for a couple of hours and must be replaced every few hours, the N95 masks which are made of a thicker material and mostly used by healthcare professionals during the pandemic are supposed to be replaced every 8 hours. With some people, there is a misconception that the surgical masks can be used until it completely breaks down or that the same N95 masks can be used for months. People must not touch their masks, have to change their single-use masks frequently or wash them regularly, dispose of them correctly and adopt other management measures, otherwise, their risks and those of others may increase. Also for the general public, there is no need for the N95 masks, which is a type of personal protective equipment (PPE) designed to protect health care workers and the patients they care for not for the public, which has been time and again stressed on by the State Health Department. 

The 3 ply surgery mask are increasingly painful, especially for the ears, because they hold the strings together. Yet the worst of the issues is that breathing becomes more difficult, especially for people with Chronic obstructive pulmonary disease (COPD)- a group of progressive lung diseases, the most common being chronic bronchitis, with face masks making it intolerable, since it reduces their intake of oxygen—or forcing them to breathe in their carbon dioxide. 

For normal people and runners, the risk of a burst lung is ever-present because a fraction of carbon dioxide previously exhaled is inhaled at each respiratory cycle. Those two phenomena increase breathing frequency and deepness, and hence they increase the amount of inhaled and exhaled air. Less oxygen and more carbon dioxide intake affect the health of any person. In America, one driver crashed his SUV into a pole in Lincoln Park, New Jersey, on April 23 and blamed his crash on his mask, telling the police he had fainted because he’d been wearing an N95 mask for too long.

Carbon dioxide is something we breathe in and out every day since it is a by-product of the body’s respiration system. So how bad can it be? Intake of a high level of carbon dioxide (CO²) can be life-threatening. It can cause headaches, seizures, double vision, suffocation due to displacement of air, hearing a noise, like a ringing or buzzing and carbon dioxide toxicity or hypercapnia. The level of carbon dioxide intake also depends on what time the mask is made of and how tight it is. 

They say that inhaling high levels of carbon dioxide (CO2) may be life-threatening. Hypercapnia (carbon dioxide toxicity) can also cause headache, vertigo, double vision, inability to concentrate, tinnitus (hearing a noise, like ringing or buzzing, that’s not caused by an outside source), seizures, or suffocation due to displacement of air. Experts believe wearing an N95 mask for a prolonged period may have alterations in their blood chemistry that could lead to changes in the level of consciousness if severe. With surgical masks and cloth masks, the risk of over intake of CO² is considerably lower and should be wearing these masks at all times in a public space, but the mask should cover the nose and mouth and still feel loose since it’s better than having one so tight that you feel you can’t breathe.

Dr Nikhel Topden Bhutia, a Medical Officer at the Rongpo check posts who screens returnees said, “A probable reason for the health risk reports besides prolonged wear of the mask could be that they are not changing the masks, or not using the proper material masks. To be clear, an N95 mask is unnecessary for a normal person, for us doctors it’s suffocating but it’s necessary for us because we are in the frontlines. For the general public, the 3 ply mask will suffice. Also, masks are supposed to be worn when on a public place while maintaining social distancing, there’s no keeping for it to be worn at home, which causes prolonged wear-causing us to breathe in the trapped CO² and dirt particles.” 

He recommends following protocols while wearing masks, especially for asthma patients. “The mask shouldn’t be too thin that it lets all particles enter and not too thick, that it causes obstructions in breathing.” He has advised runners and joggers to not wear masks when doing exercise, and that the most helpful would be to exercise at home or run on treadmills at home than to go outside for cardio. The best option he says is to eat light and not each too much fatty meat right now to avoid exercising outside.

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