Catching our breath: After months of wearing masks, most have adjusted

Jerryann Fooks, a cashier at the Save A Lot store in Seaford, rings up Alberta Shockley. Ms. Fooks wears a mask at both of her jobs — in grocery retail and at a nursing home in Delmar. (Delaware State News/Glenn Rolfe)

Love them or hate them, agree or disagree on their protective value — facial coverings are here to stay for the foreseeable future as a precautionary public health norm.

Masks, designed to help lessen the spread of COVID-19, are welcomed by some, deemed an annoyance and nuisance by others and present a discomforting challenge to many, particularly those who must wear them for extended periods.

“I work at an elementary school where I have to mask up all day every day,” said Evelyne Adams, employed at Woodbridge Early Childhood Education Center. “It has prevented me from not only COVID, but also from the common flu and other viruses. By this time last year, I had already been sick four times with upper respiratory infections. Haven’t been sick once this year!”

Wearing a mask may affect how an individual breathes, resulting in shallow breaths or even held breaths.

However, said Thomas Jones, director of critical care for TidalHealth Peninsula Regional in Salisbury, Maryland, “they are a necessary pain.”

Seaford resident Mary Boone works in the produce department at Save A Lot in Seaford. She finds herself frequently seeking a breath of fresh air.

“I definitely had to go through multiple different kinds of masks that I was OK with wearing at work with hauling 20- to 40-pound boxes back and forth,” said Ms. Boone. “And even then, when you really get moving, you just can’t pull enough air in and have to get some fresh air — without the mask!”

Breathe properly
while wearing masks

Reported “side effects” of wearing a mask, particularly for extended periods, can include anxiousness, dizziness, lightheadedness and headaches.

“It’s just all of the hard work of breathing in and out. You are still having to breathe in and out,” said Mr. Jones. “It is harder to draw breath in, and it is harder to exhale breath through that mask. That is what you are feeling. You just need to pace yourself. I notice when I climb a lot of stairs with a mask on, I am more winded than I am when I don’t have a mask on. It impedes the good inhale/exhale that you are used to feeling. You are certainly getting enough oxygen. That is not the issue. But it does impede your normal work of breathing.”

The key, Mr. Jones said, is to pace yourself. “Don’t think you can do what you physically are used to doing without a mask on,” he said.

When masked, there is a recommended, proper way to breathe: in through the nose and exhale through the mouth.

“That,” said Mr. Jones, “is the optimal way of breathing. You have more hairs in your nose, to filter out particulates in the air. That is what it is designed to do. Breathe in through your nose, and you have maximum filtration in the air going in, and then, you have maximum air exchange going out.”

Odds are carbon dioxide is not a major cause of side effects.

According to the Centers for Disease Control and Prevention, wearing a cloth mask does not raise carbon dioxide levels. Because a cloth mask does not provide an airtight fit across the face, the CO2 completely escapes into the air through and around the sides of the cloth mask when you breathe out or talk. CO2 is small enough to easily pass through any cloth mask material, while the virus that causes COVID-19 is much larger, so it cannot pass as easily through a properly designed and properly worn cloth mask.

“Now, if you are wearing a mask that does not provide adequate ways for you to move air in and out, yeah, carbon dioxide can become trapped,” said Mr. Jones. “But that is pretty rare. Most of the masks that we are wearing right now are either what are called surgical masks, which is an artificial filtered material (or) the N95, or there are all kinds of varieties of cloth masks out there.”

Health workers can
struggle with PPE

Health care workers and first responders often work long, physically and mentally exhausting shifts. During these extended hours, many health care workers are also required to wear personal protective equipment, which may include N95 filtering facepiece respirators, elastomeric half-mask respirators or powered air-supplied respirators, according to the CDC.

Particular features of PPE can impose a burden on those workers’ normal bodily functions, which can be exacerbated by long work hours without adequate breaks for eating, hydration and personal care, the CDC said.

Delmar resident Jerryann Fooks pulls double duty as a mask-wearer. She wears a cloth mask as a part-time cashier at Save A Lot. At a nursing home in Delmar, where she works full time, she must wear PPE — a shield and a mask, sometimes the N95.

“You can’t wear the fancy kind of masks. You have to wear the blue ones or the N95 with a shield,” Ms. Fooks said. “The only discomfort — of course, I wear glasses — is it can fog up your glasses. And it can make you hot. But other (than) that, I don’t have any other issues with it.

“I’m breathing fine, but when I want to get some air, a lot of times I like to go outside,” she added. “It’s all according to what mask. Now, the N95, it can be a little more problem breathing … a little more challenging.”

While more protective, the N95 can come with an irritating price to those who wear them.

Mr. Jones explained.

“You can get skin breakdown, especially from the dreaded N95. It usually happens across the bridge of your nose, sometimes your upper cheeks, because there is a hard wire in the upper portion of the mask to help you push down and conform it to your face,” he said. “Usually, the N95 is designed to be tightfitting because the N95, what that means is the size of particles that it will filter out. It will literally filter out things down to a virus-sized particle. Any little gap in the mask anywhere around the face is a place where virus can enter. So you form that hard metal bar to the bridge of your nose and to your upper cheeks to seal the one spot that tends to not get adequately sealed. That pressure can certainly lead to skin breakdown, pressure injuries of the bridge of your nose and the upper cheek.”

Again, there’s a simple solution: Take an occasional break if possible.

“You can try to take a break, once an hour or so,” Mr. Jones said. “Get somewhere where you can relieve some of that pressure on your face just a little bit. I myself have personally worn one for about six straight hours without ever taking it off, and you are pretty miserable. You definitely don’t want to go that long without a break.”

Communication barrier
“You have to remember to enunciate and speak clearly (while wearing a mask). Speak up because folks can’t hear you as easily through it,” said Mr. Jones. “Certainly, the more protective the mask, the harder it is to hear through it. You take an N95 and throw a face shield over that … it’s like, ‘What?’”

Restaurant worker Johanna Farmer Benton of Seaford agreed.

“I work at a restaurant, and the mask makes it harder to communicate with guests. It also makes breathing a little strained,” she said.

“Actually, I don’t mind wearing them,” said Dover resident Paula Ballard, manager at Save A Lot in Seaford. “My whole problem with the masking is the people who come in our store and want to give us a hard time about wearing them. That’s what I can’t stand.

“To me, that just makes it harder for essential workers to do their job more efficiently and properly without having to stop and fight with people to make sure they are wearing masks (and) wearing them properly, not just tying a scarf around their face,” said Ms. Ballard. “From a management standpoint, it is making our jobs more difficult for people who don’t want to abide by CDC guidelines and Gov. (John) Carney’s order, and that makes it very difficult. I feel if everybody could just suck it up and do what they are supposed to do, we wouldn’t have as many outbreaks.”

Tina Washington works part time at The Home Depot, sometimes for six-hour shifts. She has experienced no real discomfort as a masked employee, just concern about how others wear them.

“I am comfortable, as I am in contact for short periods with customers, (but there are) others who don’t always wear masks properly,” said Ms. Washington.

Wear it properly
“For me, the key is not that you wear your mask,” said Mr. Jones. “It is wearing the damn mask right.”

Noting the three main portals of entry for any virus are the nose, mouth and eyes, Mr. Jones pointed to a study undertaken this past summer by The University of North Carolina at Chapel Hill that contends your “nose is prime real estate for coronavirus.”

The study indicates that the virus firmly establishes itself initially inside the nose. Then, in some cases, people breathe the coronavirus into their lungs, which may lead to more serious complications, including potentially fatal COVID-19 pneumonia.

“The study tries to show that wearing the mask with your nose out is actually worse than you not wearing a mask because you’re breathing in and out solely through your nose. And the coronavirus, the little spikes on the surface of it, have an affinity for the ACE receptors of your cells in your nose, your throat and your lungs,” said Mr. Jones. “And where do you have more receptor sites in your body in a normal healthy person? In your nose! So if the virus attaches in your nose and if you have the virus, and you’re coughing, sneezing, breathing, just talking, particulates are flying out of your nose that may very well be infected with the virus and infect those around you.

“When we cough, when we laugh, when we sneeze, obviously, particulate fly out of our nose and our mouth. The particulates that come out of your mouth are usually denser and heavier and fall relatively quickly just a few feet from the body,” Mr. Jones continued. “The stuff that comes out of your nose tends to be finer as far as the droplet size, and many times is microscopic. Those are the ones that can go a long way.”

Mr. Jones said the hope is that the virus stays in the nose and throat.

“If most folks that become infected with the coronavirus, if they become infected in their nose, hopefully, that is where it is contained. Your body catches it there. Worst-case scenario, you become infected in your nose and throat, and hopefully, that is where it is contained, and it stayed there. If, for whatever reason, the virus makes it beyond, all the way to the ACE receptor sites in your lungs, that is where you develop the pneumonia … significant disease or death,” he said.

Breathing retraining
Children’s Minnesota, a nationally ranked nonprofit, acute-care hospital system based in St. Paul and Minneapolis, offers insight for those feeling more tired after wearing a mask.

According to the Children’s Minnesota website, this happens because:
• Breathing through a mask is a workout and, often, you are using your smallest of breathing muscles to do a really big job. Coupled with mouth breathing, it expends a lot of energy to breathe.
• When wearing a mask, most people breathe with their upper chest muscles and with their mouths open. This is a very inefficient way of breathing that can also cause increased stress and anxiety.

While wearing a mask, take a moment to feel how you breathe. Which moves, your belly or your upper chest? Are you breathing with your nose or mouth? Place your hands on your stomach or lower rib cage, slowly take a breath through your nose and feel your stomach and rib cage push outward and exhale though your mouth. With practice, it’s retraining your breathing muscles and a way to become a more efficient breather while wearing a mask.

Editor’s note: Staff writer Glenn Rolfe also is a part-time employee of Save A Lot.

Helpful Coronavirus links

Delaware Division of Health Coronavirus Page
CDC: About the Coronavirus Disease 2019
CDC: What to do if You Are Sick
Johns Hopkins Coronavirus Resource Center
AP News Coronavirus Coverage
Reopening Delaware: Resources for Businesses
Delaware Phase 2 guidance

Have a question, tip, or resources about the coronavirus pandemic? Submit it to our newsroom and we’ll do what we can to provide answers.