Why some people can’t wear a face covering to stop the coronavirus

By Clare Wilson

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Do you get angry when you see someone without a face covering? They might have a good reason to avoid one, even if it isn’t obvious.

Despite claims to the contrary, face coverings don’t reduce the amount of oxygen in the blood or raise the level of carbon dioxide. So people with lung conditions such as asthma shouldn’t assume they don’t need to wear one. “For the vast majority of people with lung disease, wearing a mask is fine. It’s a mild irritation that they can put up with,” says Nick Hopkinson at the British Lung Foundation.

The exceptions are some people who experience occasional breathlessness due to conditions such as emphysema and pulmonary fibrosis. This can be due to genuinely low blood oxygen, but the conditions also make the lungs stiffer, requiring the chest muscles to work harder to pull in air. That sends a misleading signal to the brain that oxygen is in short supply, which creates the feeling of being short of breath, even if you aren’t.

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Face coverings can also trigger anxiety and panic attacks in those who are vulnerable, says UK mental health charity Mind. People with autism may have issues if they experience heightened touch or smell – so that a mask feels smothering – or if they struggle with the change to their routine. Individuals with learning disabilities may need to see their carer’s face for reassurance and to communicate.

In the UK, people are legally exempt from wearing a face covering if they are unable to use one because of disability or if it causes them severe distress. This is subjective, so we should accept the choice of individuals going unmasked, says Tim Nicholls at the UK’s National Autistic Society.

Those exempt can wear a badge explaining their medical reasons if they wish, but they aren’t obliged to do so. “We have to encourage people to wear a mask if they can, but be understanding if they can’t,” says Nicholls.

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