What exempts you from wearing a mask? Experts explain the rare circumstances

Nowadays, it seems everyone is talking about face masks.

Currently, more than half of all states have some kind of public mask requirement in place due to the coronavirus pandemic, and starting Monday, a handful of major retailers will require customers to don masks while shopping.

Mask wear — and lack thereof — has caused a number of scuffles in the U.S.. Earlier this month, a woman in Oklahoma threw shoe boxes at a Skechers store worker who asked her to put on a mask per store policy.

A Starbucks worker in San Diego, California, received more than $100,000 in donations after he refused to serve a woman until she put on a mask. San Diego County has required face coverings in public since June.

Many of these mask mandates stipulate that young children and people with certain medical conditions are exempt from mask requirements, but don’t specify which conditions.

Last month, fake “mask exemption cards” bearing the U.S. Department of Justice seal circulated across the country claiming to exempt a cardholder from any mask requirements under the Americans with Disabilities Act, McClatchy News previously reported. The cards also brandished an emblem ascribed to the “Freedom to Breathe Agency,” which is not a government agency.

But doctors say medical conditions that would necessitate a mask exemption are rare.

What doctors say

“People who can’t wear a mask are a very rare segment of the population,” Raymond Casciari, a pulmonologist in California, told Prevention.

He said that people with neuromuscular conditions that could make it difficult to remove a mask could be exempt along with people who have COPD, according to the outlet.

Albert Rizzo, chief medical officer of the American Lung Association, sang a different tune, saying that surgical and cloth masks should have no detrimental effects, even to people with chronic lung illnesses, ABC News reported.

“People with underlying chronic lung disease, such as COPD or asthma, should be able to wear a non-N95 facial covering without it affecting their oxygen or carbon dioxide levels,” Rizzo told the outlet.

He added that people on oxygen or those who have compromised respiratory health that causes them to become short of breath while walking could be candidates for exemption, ABC News reported.

David Kaufman, a pulmonologist and ICU director in New York, said severe skin conditions, such as a bad burn that requires medical condition, could preclude a person from wearing a mask, according to Health.

“If you can wear a scarf to keep your face warm in the winter, you can wear a mask to prevent the spread of disease,” he said, according to the magazine.

What about mental health conditions?

Divya Jose, a psychiatrist in New York, said she could see where PTSD due to past trauma involving face masks could be cause for exemption, but that none of her patients with anxiety, psychotic or mood disorders “have felt that wearing a mask triggers any of their symptoms,” ABC News reported.

Robert Hudak, medical director of the Center for OCD and Related Disorders in Pennsylvania, said people with severe intellectual disabilities, such as those who are nonverbal, could be exempt, The Verge reported.

Some people have said their anxiety disorders are triggered by mask wear, but Hudak said he’s never seen it in patients or colleagues.

“I treat lots of doctors and nurses who have anxiety disorders, and who wear masks all the time, and literally no one has ever said ‘I feel afraid wearing a mask in the operating room,” he told The Verge. “Mask-wearing is not a trigger for panic attacks.”

For those whose medical conditions are so serious they may need to forgo wearing masks, doctors say it’s best to just stay home, according to Health.

“If you are truly that fragile, a COVID-19 infection could be a death sentence,” Jim Keany, an emergency medical physician, told the magazine.

What the CDC says

The Centers for Disease Control and Prevention recommends that people wear cloth face coverings in public to help prevent the spread of the coronavirus.

The agency advises that surgical masks and respirators be reserved for frontline workers. It also does not recommend face shields for everyday use or as a substitute for cloth face coverings.

The CDC’s only exemption from cloth mask wear is for children under the age of 2 “or anyone who has trouble breathing, is unconscious, incapacitated, or otherwise unable to remove the mask without assistance.”

For people with physical or mental conditions, the agency recommends mask adaptations or alternatives.

“In some situations, wearing a cloth face covering may exacerbate a physical or mental health condition, lead to a medical emergency, or introduce significant safety concerns,” the CDC said.

“Adaptations and alternatives should be considered whenever possible to increase the feasibility of wearing a cloth face covering or to reduce the risk of COVID-19 spreading if it is not possible to wear one,” according to the agency.

For instance, the CDC said people who are deaf or hard-of-hearing who should opt for clear face coverings.

Those with intellectual or developmental disabilities are encouraged to contact their doctor for guidance on whether to wear face coverings, according to the CDC.

People are advised not to wear face coverings when at the swimming pool or during any activity that could get the mask wet, the CDC said. Those doing strenuous exercise should remove masks if they have difficulty breathing.

This story was originally published July 20, 2020 at 8:00 AM with the headline "What exempts you from wearing a mask? Experts explain the rare circumstances."