• Karen McPhail, RN, MSN

Mask Exemption - Why this is Very, Very rare!


I am contacted weekly by a variety of individuals asking for a mask exemption letter or mechanism to get a mask exemption. I listen and then go on to educate these individuals further on mask use and about the very, very few that may under very special conditions be exempt from mask use. As result of these request, my blog today will clarify this frequently asked question!


To start, it is again very rare for anyone to need a mask exemption!


In what is now the "new normal" we all need to be mindful and considerate and embrace some lifestyle style changes which include masking. As a clinician I find it stressful and very frustrating when we have Covid-19 cases on the rise across the country and know that masks, hand washing, and social distancing do in fact help to decrease transmission, that some individuals are trying to side step the rules for convenience and putting themselves and others at risk. When someone does not follow the advisory rules and they get covid they put friends, family, strangers, and health care providers at risk through this choice. But, if you do not believe me lets hear from a pulmonary expert...


Dr. Albert Rizzo, MD, Chief Medical Officer for the American Lung Association and a Pulmonary (Lung) specialist at Christiana Care Health System in Newark, DE, explains that it is very rare for someone to need an exemption. Dr. Rizzo states that: "one rare example of someone who cannot wear a mask might be a person with an advanced lung condition so severe, they need extra oxygen. These are the extreme patients where any change in oxygen and carbon dioxide could make a difference." He continues, "but that's also the population that shouldn't be going out in the first place."


When closely examining not only clinical practice, patients, and research even those with reactive airway disease and COPD can usually breath normally through a mask. Surgeons work for hours in operating rooms without issues wearing a mask the entire time. If your surgeon asked if they could opt out of wearing a mask for your surgery I doubt you would say OK... or feel that he has the legal right to not wear one. So, that being said, the average individual who is routinely going out and about is not the one who should be requesting a mask exemption or thinking that a mask exemption is prudent or appropriate.


I have heard individuals say that a cloth mask gives them headaches, saying that they think it is most likely due to carbon dioxide build up - this is not possible or probable. Now, individuals who are incapacitated due to severe mental health issues should be considered on a case by case basis in terms of mask use and exclusion. However, I will say that even my severe dementia patients in congregate care settings with positive redirection and cueing have been able to wear a mask without issues. I often recommend having a few different styles and colors to try and allow them to participate and drive the process as much as possible in a safe way. Have potentially a looser fitting mask at least initially so that they do not feel pinched or restricted. Often times it is all in the approach...


So if you are someone at home thinking that a mask is not needed, inconvenient, or a hassle think of yourself and others and think twice before trying to ask for a mask exemption as your request is probably going to be declined.



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