The Use or Non-Use of Masks Within the Health Club Industry
Suggestions for Best Practices in the Acute and Long-term Situation
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A recent white paper by Minnesota exercise physiologist, Dan Zeman, piqued my interest regarding wearing masks in the health club setting. With many clubs opening, his report was interesting in that the thrust of his report stated that, when clubs open, they should be willing to let the coronavirus in as well. In discussing the coronavirus, the topic of wearing or not wearing masks became one of the seminal topics for public health vs. personal liberty. For our discussion here, I want to look at the use (or non-use) of masks within the health club setting in several areas.
I come from a unique perspective. My career started in personal training. I also worked in medical research, performing clinical exercise studies. In 1992, I started the Cancer Well-fit program, and now over 27 years later, thousands of survivors have trained in the club setting. During that time, no overt medical PPE has ever been worn by staff. Over the past 15 years, I have worked in environmental health and safety and injury prevention, and my skills in OSHA regulations and safety at the workplace has become part of my daily routine. This perspective has allowed me to discuss aspects of this issue on social media, and the recent conversation with exercise physiologist Dan Zeman (who posted his piece on LinkedIn on June 5, 2020), sparked yet more debate on the topic. Here are my thoughts.
The Use of Masks Within the Hospital Setting - Masks have been used in the operating room and intensive care wards for decades. The key is not spreading infections, mostly in open wounds. But, surgeons and nurses are quick to point out that masks, gloves and gowns are used only as needed (Desai, Klompas). There are few health professionals that wear masks in private rooms, or outside, as they have been practicing a social distance with patients for a long time. A report by Zhu in 2014 surveyed health care professionals who wore N95 masks for extended periods. Over 1/3 developed headaches and dizziness with extended use. Another report found that N95 masks offered a high protection against clinical respiratory illnesses and bacterial infections but not viral infections or influenza-like illnesses. Cloth masks offer almost no protection against influenza-like illness.
The Use of Specific Masks in the Social or Work Setting - Those who ski recognize the Balaclava brand of face and ear mask protection on the ski slopes. However, it should be remembered that this mask protects against frostbite, not infection. So, its designation as a guard against any type of coronavirus or bacteria should be stated. It is meant to be worn outside in cold weather and not any type of indoor exercise.
The Issue of Mask Use in COVID-19 - Until recently, the World Health Organization, the US Surgeon General, and the CDC did not recommend wearing a face mask or covering of any kind, unless a person was known to be infected with a virus. According to Blaylock, the current recommendations are not based on any research of this virus and have never been used to contain any other virus pandemic or epidemic in history. These recommendations from international associations are listed as follows:
- Annals of Internal Medicine: "In conclusion, both surgical and cotton masks seem to be ineffective in preventing the dissemination of SARS–CoV-2 from the coughs of patients with COVID-19 to the environment and external mask surface." (bit.ly/clubinsider93)
- WHO: "A medical mask is not required, as no evidence is available on its usefulness to protect non-sick persons." (bit.ly/clubinsider94)
- WHO: "However, there is currently no evidence that wearing a mask (whether medical or other types) by healthy persons in the wider community setting, including universal community masking, can prevent them from infection with respiratory viruses, including COVID-19." (bit.ly/clubinsider94)
Current Recommendation (after June 1, 2020) - So, why in the past few weeks have many county and city public health officers recommended (through mandates) wearing a mask while out in public? In my opinion, it is an attempt by public health departments to be doing something regarding the coronavirus issue. They see using a mask as a way for the public not to spread germs. From one perspective, it may make sense. Don't spread a virus by covering up. In reality, people were using whatever means of covering their faces they could to comply with public health recommendations, which bordered on the ridiculous when people wear crochet masks to the shopping center.
Science vs. Policy vs. Politics - It is interesting to see people wear knock-off versions of N95 masks, which have one way ventilators that allow air to filter through the material, and expired air flow through valves (true N95 masks must be fitted to the individual, and are used in the occupational and medical setting while handling materials that may cause bodily damage if inhaled). Persons are also walking into stores and restaurants using cotton masks and bandanas, neither of which can trap the small particulates that would come from a sneeze or expelled water droplets into the air. The main thrust is that business owners, restaurants and other public places want to been seen as, "doing the right thing," and many are mandated by city governments with the threat of closure if their staff and patrons do not wear masks while in their buildings.
The Use of Masks Within the Health Club Environment
It is not my place to tell any health club owner-operator not to mandate the use of masks for employees. Their goal is to maintain a clean environment and to limit contact of any potential virus from person to person. But, Management should know that the use of masks over time does present challenges in the following domains:
- Many reports are coming out citing that the use of masks doing routine work is causing difficulty in breathing. This may occur due to the change in O2 / CO2 breathing ratios over time. According to health journalist, Dr. Jennifer Margulis, masks do this and more.
- According to research by Zhaoshi et al, masks increase blood carbon dioxide, and the longer the wearing of masks, the higher the levels.
- Masks may cause brain fog (which I believe is exacerbated with exercise) due to insufficient oxygen during exercise.
- Masks may increase risk of infection. A recent report on the use of masks causing pulmonary pleurisy has just been published, and I feel that this will be the tip of the iceberg with employees who are wearing masks for eight or more hours a day are already complaining of sore throats and tight lungs and breathing problems.
We need only to take a look at research in exercise physiology (Astrand and Rodahl) to note that exercise has effects on the following mechanisms: the need of circulation in the removal of lactate from the system, reduction in gas transport and oxyhemoglobin, changes in bicarbonate ions in gas exchange and the limitations of the oxygen transport system. These are all affected by reducing ambient air coming into the lungs. This is why I would not recommend the use of masks while exercising, as the physical results of such would include dizziness, fainting, tightness in the chest, vomiting, higher than normal heart rate based on work load, changes in blood pressure and the aforementioned chemistries in the blood, all of which would make for an unpleasant exercise experience to say the least.
These symptoms would depend on the type of exercise (strength training vs. continual, intensity - light vs. heavy, and the current state of the individual - deconditioned vs. highly conditioned). A recent MSN report also discusses long-term issues while wearing masks, such as dyspnea, headaches, contact dermatitis, chronic respiratory issues and depressed immune systems. The immune system issue was discussed by Dave Nieman back in 1990 when he published on how intense endurance exercise had a suppressive effect on immune cell function. We could make a case for training with masks that may exacerbate this effect due to lower oxygen and higher carbon dioxide levels over time.
With this information in mind, the last thing that club owners would want to think about are the legal and constitutional issues relating for a forced medical procedure for healthy people. This has become a hot issue in the vaccine field nationwide, and the use of masks has been challenged already. Lawsuits in California for violation of 18 USC section 1804 of the United States Civil Rights law that states a person has the right to gather in certain places (public) and cannot be turned away due to specific condition (in this case, not wearing a mask while healthy). It should be noted that as of June 15, 2020, testing for antibodies or diagnostic testing, but neither test is accurate, and some estimates state that the positive predictive value (sensitivity and specificity) of the COVID-19 test is less than 50%. With so little information about the actual illness, and more healthcare professionals questioning headline stories, club owners should weigh the following:
- The actual risk of members (a self-selected population) actually infecting others in the health club setting (see report by Gao et al) is rare.
- The timing of the ending of the "curve" of any pandemic infection, based on the work of William Farr in the 1800s, which still applies today.
- The overall cleanliness of health clubs and their impact on keeping people at a higher level of sanitation (which includes hand washing pre and post workout)
- Enhanced use of HVAC systems that will filter air, move air, and in some cases, purify air. Even moving air has a big effect regarding fresh air. One of the big improvements in this was the introduction of products such as Big Ass Fans to the marketplace. They work very well.
In conclusion, the use of masks in the health club setting presents a challenge to owners and operators, from a staff and member standpoint. My takeaway here is, like any other virus, COVID-19 will have a finality, and when it does, it should allow health clubs to operate at a less stringent level but maintaining their elevated standards of cleanliness, customer support and wellness offerings.
To view the list of References for this article, please go to bit.ly/clubinsider95.