Fact or Fiction? Masking and CO2 Dangers

As the COVID-19 pandemic unfolds, experts are urging the use of protective masks.  While experts weigh in, misinformation is running rampant on social media.  So, will carbon dioxide become trapped and build in your body? Read on for the final verdict. Nurses General Nursing Article

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As the COVID-19 pandemic unfolds, health experts continue to urge the public to wear face masks for protection. Sound advice, right? Well.. if you spend any time on social media it’s likely you’ve read warnings about the dangers of wearing a mask for long periods of time. Specifically, the risk of carbon dioxide (CO2) becoming trapped under your mask, causing unsafe levels to build up in the body (hypercapnia). So, let’s take a closer look to see if wearing a mask can lead to someone passing out or worse.

A Possible Catalyst

One April incident added fuel to the “masking causing carbon dioxide poisoning” theory. On April 25, 2020, a New Jersey woman crashed her car into a power pole and was taken to a nearby hospital. The local police department posted to facebook that the woman had been wearing an N95 mask for several hours and passed out. The department believed wearing the N95 mask contributed to the crash by causing a buildup of carbon dioxide and resulting in the driver fainting.

The facebook post was shared thousands of times and received hundreds of comments. The story was also reported on major news outlets.

The Basics

Let’s first review the characteristics of protective masks as we look for the truth. There are two main types of masks used in healthcare, N95 respirators and surgical masks.

Surgical

These masks are fluid resistant, fit loosely and protect you from large droplets, splashes or sprays of body or hazardous fluids. They also protect others from your own respiratory and body secretions. However, there are limits to protection surgical masks provide, including:

  • Does not provide reliable protection from small airborne particles
  • Are not considered respiratory protection
  • Leakage occurs around the edge of the mask when you inhale
  • Designed for single use

N95 Respirators

The N95 respirator is tight-fitting and requires a fit test to make you have a good seal around the mask. It protects you against small particle aerosols and large droplets. In fact, it filters out at least 95% of small and large airborne particles. If properly fitted, minimal leakage occurs around the edges when you inhale. N95 masks also have limitations, including:

  • Ideally, N95 masks should be discarded after each patient encounter
  • Is ineffective if a good seal is not maintained
  • Breathing can become difficult

The Verdict

A CDC representative told Reuters that CO2 will build up in face masks over time, however, the level of CO2 trapped is tolerable for most of us. Protective masks are designed to trap droplets, which are much larger than CO2 particles. Therefore, CO2 will escape through or around the edges of surgical, cloth and even N95 masks. If CO2 levels do rise high enough to cause symptoms, we would most likely remove the mask.

Healthcare workers, who wear masks for extended periods of time, could potentially experience symptoms of elevated CO2 levels (I.e. headaches and dizziness).

Caveat: Preexisting Conditions

People with respiratory conditions (such as COPD) that cause hypercapnia may experience breathing difficulties. Therefore, the CDC does not recommend face masks for anyone having breathing difficulties or other conditions that will increase the risk of hypercapnia.

Have you experienced any other “myths” or “truths” related to masking during the pandemic?

References

Driver in crash may have passed out from wearing N95 mask too long: Police

Killer COVID-19 Masks? The Truth About Trapped Carbon Dioxide

6 hours ago, LovingLife123 said:

True story. I promise.

That’s what they told you happened but I highly doubt that’s the way it went down. The way you heard it sounds better in the retelling. Otherwise every person in that ED is incompetent.

23 minutes ago, Wuzzie said:

That’s what they told you happened but I highly doubt that’s the way it went down. The way you heard it sounds better in the retelling. Otherwise every person in that ED is incompetent.

That’s the story I was told. I trust these people as they are not ones to exaggerate or make things up. I know the difference. In al my years of nursing, I’ve seen more than my fair share of incompetence.

But my point stands. Wearing an N-95 for long periods of time can interfere with adequate oxygenation while a surgical mask will not. How did you miss that point?

9 minutes ago, LovingLife123 said:

Wearing an N-95 for long periods of time can interfere with adequate oxygenation while a surgical mask will not. How did you miss that point?

Cite your source please.

Specializes in Critical Care.
5 hours ago, Wuzzie said:

Cite your source please.

Come on, you know they can't cite something that doesn't exist...

Specializes in oncology.
On 7/1/2020 at 11:00 PM, LovingLife123 said:

When one of the guys who is in his 60’s went to the hospital for SOB they immediately put him on a monitor and saw his O2 was very low. Intubation was talked about. Then they realized he had an N-95 on which he wore everywhere in public. Mask was removed and his sats came up.

No one looked at his lips? Did they even look at his face?

These experts from the University of Illinois at Chicago did a pretty good job of rounding up data on the effectiveness of masks.

https://www.cidrap.umn.edu/news-perspective/2020/04/commentary-masks-all-covid-19-not-based-sound-data

Thoughts? It seems that unless the whole world puts on N-95 masks it’s an exercise in futility. The general populace will never cooperate with that.

Specializes in oncology.
49 minutes ago, damiorifice said:

These experts from the University of Illinois at Chicago did a pretty good job of rounding up data on the effectiveness of masks.

The article cited was published April 1, 2020. The major study the authors drew their conclusions from was from 2015. I encourage all to read it (footnote 38). Because of issues in their study, the authors have published a further note of guidance when using their results to determine the value of masks. They state:

It is important to note that some subjects in the control arm wore surgical masks, which could explain why cloth masks performed poorly compared to the control group. We also did an analysis of all mask wearers, and the higher infection rate in cloth mask group persisted. The cloth masks may have been worse in our study because they were not washed well enough – they may become damp and contaminated. The cloth masks used in our study were products manufactured locally, and fabrics can vary in quality. This and other limitations were also discussed.

I would encourage seeking out better research on this subject before making a mask versus no mask decision.

On 7/3/2020 at 12:24 AM, 42pines said:

Masks certainly do not cause any issue.

Two words: "tidal volume"

Summed up best by another, whose words I'll quote here:

"I think that these videos are irrelevant in evaluating the hazards of respirator use , as summed up in a single physiologic variable: tidal volume.

Tidal volume (the volume of air entering the body through the nose and mouth with a single breath) is greater than the volume of air inside the mask, so after sucking in that 17% O2 air, you promptly begin sucking in 21% O2 air - all in any one breath. I’ve briefly reviewed about half a dozen articles on respirator physiology with air-purifying respirators. A respirator DOES increase dead space - the volume of air inside the “respiratory column” from the alveoli to the “outside,” Spontaneous respiratory rate and minute volume DO change with use of a respirator and none of the articles reported PaO2 - oxygen in arterial blood - but they DO report that, in terms of exercise tolerance (over periods significantly more than the 30 seconds measured on the video) adults - including those with mild to moderate obstructive or restrictive lung disease - did fine while wearing air-purifying respirators…as confirmed by at least 50 years of monitored use of industrial air-purifymg respirators. Masks? Oh, please...

There are only 3 contradictions to use of air-purifying respirators (ie risks of the respirator itself, in a properly administered program), for someone who can do the physical tasks of the job without a respirator: claustrophobia (which can often be overcome with proper training), poor fit and type I allergy to respirator components (fit and allergy problems can often be overcome with proper respirator selection).

J Brustein< MD, MSIH, FACOEM

Posted on occ-env-med-l

+1

you don’t need any “studies“ to know that your lung capacity is far below the volume of air trapped between your body and the mask.

anyone medically incapable of wearing a mask belongs in a hospital, not a big box store.

On 7/1/2020 at 1:56 PM, Pcmama said:

I saw a nurse on Instagram that did capnography with 3 masks on with minimal impact. It was an interesting video.

Just because it showed good readings for him does not mean it will for everyone. Pulse ox is by no means a full picture either. Also, who is he to tell me I have no reason to not "where" a mask? Creepy authoritarian stuff there.
Specializes in oncology.

I guess I would like to hear the reason(s) why some individuals want research to prove the mask prevents spreading of the virus before they will wear one. I would like some concrete reason besides the old chestnut it interferes with "personal liberty" "you are being a sheep" etc. I am really asking this sincerely. It seems to me we can infer the mask will obstruct virus material from leaving one person's airspace and entering someone else on the basis of it's construction and proper application. It follows logic and seems to be a reasonable precautionary action. It does follow that different weaves of fabric may do a better job than others. But research showing that wearing a cloth mask can actually put you more at risk for acquiring Covid is getting press.

https://www.bmj.com/content/369/bmj.m1411

For example women have been instructed to wipe front to back after using the toilet for as long as I can remember. There is no research to my knowledge to show this prevents UTIs. But am I fighting this accepted piece of hygiene care and insisting until I see a formal research conclusion that this is true, I am going to wipe back to front or side to side?

Quote

Since the start of the covid-19 pandemic the authors have been asked whether healthcare workers should wear no mask rather than a cloth mask

It's a good question, here is my opinion..

The question is why now? Why now have we decided to wear masks to prevent a "virus" that has a survival rate of 99%? Why haven't we worn them all of the time? Especially considering that there are far more effective killers out there...

Cardiac disease takes a life every 40 - 90 seconds. I know that's not a transmittable disease, but you catch my drift.

If the masks are so effective, then why have lock-downs?

I understand why it seems logical and a small-ask to many, but when we see how we have absolutely no reason to trust media, information, corrupt health officials, and corrupt government "leaders" (this issue is way beyond Trump) as well as how much they have shifted the goalpost on what's in, what's out... it's hard to argue with those who have a difficult time complying. Not to mention, many in the healthcare industry just regurgitate what is told to them for fear of retribution - institutional inbreeding.

I personally think it's a big overreach for a town/governor/president to require masks, once again considering that a very small percentage of the population is actually at risk. Many see it as a sort of litmus test, or dry-run, on how much they can control you without citizen backlash. Our rights are never taken away - they are given away.

The large majority of people are ignorant of virology, epidemiology, pathology, etc.. and they are at the behest of un-elected, bureaucratic "officials," suddenly coming on the scene and demanding orders. Subsequently, these people are controlled by fear, which manifests in many forms such as public shaming, police citations, service denial, social media bans, etc.. We see that the deaths are sometimes pinned on those who do not wear masks, which is just disgusting and wrong.

It definitely requires more research, but I firmly believe that this whole situation is a massive global maneuver to shift power and usher in more control over citizens, regardless of whether the virus is real/not real, deadly/non-deadly.

Never let a good crisis go to waste.

Specializes in oncology.
1 hour ago, malogna said:

The question is why now?

Actually it is not "why now". Those who choose to reject basic steps and science to protect themselves/children/grandparents or others have complained previously with the old " its my body" or it's another "power shift" will find that their objections have been heard before. Their method of oppositional defiance is not effectively clearing the virus from the US.. Nor was it effective in the past century..there were disruptions for those who felt "it was their duty to take a stand". Please take a seat and look at these: Your ancestors will have faced this before. Think about the realization the Spanish Flu or influenza epidemic of 1918 killed between 50 and 100 million people. And tell me "What you would do to help?"

1 hour ago, malogna said:

I personally think it's a big overreach for a town/governor/president to require masks,

Gosh darn, it may have helped the last time

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