Wearing Face Masks Is The new Normal: Know These Tips and Tricks to Avoid Common Side Effects. I already mentioned the possibility of interpreting only partially-revealed facial expressions wrongly, i.e., misconstruing frowning and the squinting of the eyes without a visible mouth as skepticism rather than true smiling.7 Therefore, face masks impair mainly our positive social interactions and our ability to understand, and empathize with, one another. Ludvigsson J.F. It may be considered as a prime example of a cultural norm that, if adhered by everybody, benefits the entire society considerably, with little cost to the individual. Second, the visual signal from the lips is completely obstructed. In a study of 158 health care workers during the Covid-19 pandemic, the most common side effect of prolonged face mask use was bilateral headache, reported by about 80% of the participants [58]. 
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As regards the problems of communication and emotional signaling, it should be noted that emotions can also be decoded from the body posture, a process quite similar to the decoding from faces [30], as well as from prosody (the melody of speech) and gesture. Teachers willing to learn and engage, will find workarounds even around the blocking by face masks. Dimberg U., Thunberg M., Elmehed K. Unconscious facial reacions to emotional facial expressions. As regards the prevention of Covid-19, additional concerns of wearing face masks have been articulated, for example: In other words: Whereas face masks are intended to ease the burden of the pandemic they may at the same time make it worse under certain conditions. In addition, oxytocin may be used to dampen down fearful signaling from the eyes and to amplify trust signals and thus work against the detrimental social effects of masks [40]. Lancet Child Adolesc. 
Enea V., Iancu S. Processing emotional body expressions: state-of-the-art. Because we cannot see the lower half of the face when someone is wearing a mask, our ability to understand people is reduced considerably. The Secret of Our Success. School Clusures Caused By Coronavirus (Covid-19) (. Wearing a face mask may give a false sense of security and may make people less compliant with other infection control measures. Received 2020 Aug 6; Accepted 2020 Aug 6.
4The reason for this misguiding advice became clear over time: There were too few masks. Since face masks are comparatively cheap and easy to use, they are among the most simple and straight forward means to curb SARS-Cov-2 and Covid-19 transmission (see also [53]). (2020) Community Use Of Face Masks And COVID-19: Evidence From A Natural Experiment Of State Mandates In The US. It may be for this reason, that many people do not like the wearing masks at all in the first place. June 10th, 2020. Face to face with emotion: holistic face processing is modulated by emotional state. In 2017 researchers from the University of Bielefeld published results from an experimental study of emotion recognition, which clearly demonstrated the importance of the eyes and mouth in the perception of emotions from faces. Megakaryocytes and platelet-fibrin thrombi characterize multi-organ thrombosis at autopsy in COVID-19: a case series. The author did not receive funding for this article. The development of attentional biases for faces in infancy: a developmental systems perspective.
Features of faces (such as the size and form of the nose, the color of the eyes etc.) We are forced to rely only on language and gesture, which limits the extent to which we can interpret nuance, with some input from interpreting eye movements, which are still visible above the mask. This had not been clear at the time when the pandemic started in most countries (February 2020), as institutions such as the World Health Organization (WHO), the US Centers of Disease Control and Prevention (CDC) and, for example, the German Robert-Koch-Institut (RKI), as well as many governments across the globe, did not recommend the use of face masks to fight Covid-19.4. Moreover, according to the embodied emotions hypothesis first proposed by William James more than one hundred years ago, not physically displaying emotions reduces their experience. government site. Brann D.H., Tsukahara T., Weinreb C., Lipovsek M., Van den Berge K. Non-neuronal expression of SARS-CoV-2 entry genes in the olfactory system suggests mechanisms underlying COVID-19-associated anosmia. There is additional epidemiological evidence for the effectiveness of wearing face masks regarding the spread of the new coronavirus: In Hongkong, 96% of the populations used face mask, and the incidence of new cases in March was 129 per million inhabitants, whereas in Spain, Italy, and Germany, where at the time no face masks were used, the incidence was 2983 (Italy), 2251 (Spain), and 1242 (Germany) per million [31]. Bosch J. The Overall, in both studies subjects preferred the surgical face mask. Scheller E., Bchel C., Gamer M. Diagnostic features of emotional expressions are processed preferentially. The virus can remain airborne for many hours in classrooms. People without any symptoms may be infected and spread the SARS-CoV-2 virus. Mitze T., Kosfeld R., Rode J., Wlde K. (2020) Compulsory Face Masks And Their Effects On The Corona Pandemic. From birth to about 8 months, babies look at their mother's mouth in order to pars the stream of sound into meaningful units (phonemes) in order to learn their mother tongue. Nestor M.S., Fischer D., Arnold D. Masking our Emotions: botulinum toxin, facial expression and well-being in the age of COVID-19. In fact, the virus has been shown to remain airborne for many hours in a closed indoor space such as a classroom [49]. We therefore attempt to verbally communicate in a more positive manner in order to counteract the lacking smiles (taken from [71], p. 184; translation by the author). This measure could contribute greatly to controlling the COVID-19 pandemic, with the benefit greatest in conjunction with other non-pharmaceutical interventions [such as physical distancing] that reduce community transmission ([26], p. 305). One of the richest and most powerful tools in human communication is the face, from which observers can quickly and easily make a number of inferences about identity, gender, sex, age, race, ethnicity, sexual orientation, physical health, attractiveness, emotional state, personality traits, pain or physical pleasure, deception, and even social status [38]. 8600 Rockville Pike Wearing face masks may cause glasses to fog and thereby cause anything from discomfort to accidents. Eikenberry S.E., Mancuso M., Iboi E., Phan T., Eikenberry K., Kuang Y., Kostelich E., Gumel A.B. Results showed that observers relied mostly on tiles that covered and revealed the mouth and eyes when they correctly named the emotion being displayed. At the same time, wearing masks may have physical side effects. COVID-19 Dashboard (2020) COVID-19 Dashboard By The Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU) (. In sum, recognition of, and response to, the outward emotional displays of one's peers faces is a critical and necessary component of social interaction in schools. GMS Hyg Infect Control 2020; 15: Doc11. Face masks impair verbal and non-verbal communication.
School openings across the globe suggest ways to keep the coronavirus at bay, despite outbreaks. Elsevier Public Health Emergency Collection, http://www.uni-ulm.de/klinik/psychiatrie3/index.html, https://www.ucsf.edu/news/2020/06/417906/still-confused-about-masks-heres-science-behind-how-face-masks-prevent, https://theconversation.com/face-masks-what-the-spanish-flu-can-teach-us-about-making-them-compulsory-137648, https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6, https://www.newscientist.com/article/2238473-you-could-be-spreading-the-coronavirus-without-realising-youve-got, https://www.nature.com/articles/s41591-020-0843-2.pdf), https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00818?cookieSet=1, https://download.uni-mainz.de/presse/03_wiwi_corona_masken_paper_zusammenfassung.pdf, https://en.unesco.org/covid19/educationresponse. If small children in China, South Korea, Japan, and Vietnam can be taught basic rules of hygiene such as handwashing and careful hygiene behavior, children and adolescents in Western societies should be capable of doing it just as well, including wearing face masks. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. Johnson K.J., Waugh C.E., Fredrickson B.L. Davies N.G., Klepac P., Liu Y., Prem K., Jit M., Eggo R.M. Physical distancing, face masks, and eye protection for prevention of Covid-19. But within seconds of absence, its importance is realized. The general headmaster of the elementary and basic schools (up to grade 10) in Ulm told me that there was a lot of discussion as regards wearing face masks at schools, when the corona-pandemic was roaming through Germany by the middle of March 2020. Asadi S., Bouvier N., Wexler A.S., Ristenpart W.D. Finally, a large comprehensive review and meta-analysis, published in the Lancet online on the 1st of June 2020, used data from 172 observational studies across 16 countries (among them 44 comparative studies in healthcare and non-healthcare settings [13]. This is why outdoor educational settings, wherever possible, should be highly recommended. Itchy rashes may be caused by irritant dermatitis, caused by the mask and/or the attached rubber strings rubbing the skin of nose and ears [63].
and their configuration are not only used to identify faces but also to infer the emotion expressed by them [10]. Smile to see the forest: facially expressed positive emotions broaden cognition. Spitzer M. Munich Publishing Group [Mnchner Verlagsgruppe (mvg)]; Munich, Germany: 2020. In a Chinese study from Wuhan, for example, it has been estimated that up to 79% of viral infections were caused by undiagnosed, presumably asymptomatic people [47]. Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans. Age-dependent effects in the transmission and control of COVID-19 epidemics. Darwin C. 3rd edition. Constants across cultures in the face and emotion. We do know, for example, that viral particles in air will be more rapidly diluted outdoors, are sensitive to ambient temperature and relative humidity, and are inactivated by ultraviolet radiation in sunlight. Darwin C. 3rd edition. People may feel that someone is being aggressive towards them, when there is no real intent of aggression (but in fact, a true smile), and may react accordingly potentially leading to all sorts of difficult, and even dangerous, situations. What This Crisis Is Doing To Us and What We Are Going to Make Out of it. Since emotions are a major driver of group cohesion, the decreased emotionality, and decreased positive emotionality in particular, may interfere with smooth classroom action. Wegrzyn M., Vogt M., Kireclioglu B., Schneider J., Kissler J. Mapping the emotional face.
Fontana Press; London UK: 1999. Fox S.E., Akmatbekov A., Harbert J.L., Li G., J Brown Q., Vander Heide R.S. In addition, emotions such as surprise or disgust that utilize the mouth may be mistaken for strongly negative emotions such anger or sadness. This may provide a breeding ground for bacteria. Initially regarded as some form of flu with symptoms such as fever and cough, it has been found to be much more severe, affecting not only the lungs but also the liver, heart, kidneys, and brain, with symptoms such as anosmia [12] and cognitive dysfunction due to defects of neuro-axonal integrity (even in mild to moderate cases; [1]). This decreases creativity further as well as increases anxiety of not being capable doing mathematics in a vicious circle independent of mathematical talent! When grown up, we tend to look close at the mouth of somebody under circumstances of impaired sound comprehensibility, such as noisy environments, low quality sound in movies and video calls. Duguid J.P. Pascalis O., Scott L.S., Kelly D.J., Shannon R.W., Nicholson E., Coleman M., Nelson C.A. Gunnery S.D., Ruben M.A. and transmitted securely. Masked education, Covid-19, Corona virus, Face masks, Emotions, School, Shutdown. These should be weighed against the alternatives, i.e., school closures (with the enormous burden on the children and their parents) and school re-openings without masks (with their increased risk of new infections). Emergence of enhanced attention to fearful faces between 5 and 7 months of age.
7This is why plastic surgeons have proposed to use botox, which can be injected around the orbicularis occuli muscle to prevent wrinkles around the eyes (no crow's feet and no frowning), as a means to prevent mask-induced false social signaling [57]. Walger P, Heininger U, Knuf M, et al. At the same time, emotional mimicry and thereby emotional contagion [59] is interrupted by the mask as well, i.e., the social phenomenon that we are involuntarily copying the facial expression of other people with whom we communicate. The authors summarize their perspective with a highly convincing drawing, which is reproduced in Fig. Accessibility
German pediatricians have voiced a similar opinion [76]. This regards schools just as well. When strangers meet, who speak two different languages which they do not mutually understand, they can still interpret facial expressions such as smiles and frowns with ease and thereby communicate. about navigating our updated article layout. Face masks block emotional signaling between teacher and learner. at around the time of the cusp of the pandemic. As mask-wearing has become a normality in many societies, the magnitude with which covering our faces affects our social interactions and ability to recognize and identify other people becomes ever more clear. Working paper from June 3rd 2020, University of Southern Denmark, University of Kassel, Technical University Darmstadt, Johannes Gutenberg University Mainz (. This finding, among others, led to the fact that N95 masks were never recommend for wearing by the general public, as they not only are more expensive, but also because of the discomfort they imply much less likely to be worn by everybody for extended periods. The ideas of what to do about schooling in times of a pandemic do not exist in a contextual vacuum. Esposito S., Principi N., Leung C.C., Migliori G.B. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV-2). Bernstein L. . Because speech transmission is impaired by mask-wearing, there is a risk of misunderstanding when face masks are used widely in schools. The effect of conventional and transparent surgical masks on speech understanding in individuals with and without hearing loss. In fact, if they are reared bilingually, they have to learn a larger number of phonemes and therefore start to look at their mother's mouth earlier and for longer than monolinguals [64]. Liu Y., Ning Z., Chen Y., Guo M., Liu Y., Gali N.K., Sun L., Duan Y., Cai J., Westerdahl D., Liu X., Xu K., Ho K.-.F., Kan H., Fu Q., Lan K. Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals. With this method, it was possible to discern which of the 48 parts of the face contributed to what extend to the observer's recognition of the facial expression being revealed. Those phenomena increase breathing frequency and deepness, and they may worsen the burden of covid-19 if infected people wearing masks spread more contaminated air. Before A recent meta-analysis of Duchenne versus Non-Duchenne smiles found that, overall, Duchenne smiles and people producing Duchenne smiles are rated more positively (i.e., authentic, genuine, real, attractive, trustworthy) than non-Duchenne smiles and people producing non-Duchenne smiles [35]. Charles Darwin [18], [19], the founding father of evolutionary theory, was the first to study the evolutionary origins of facial expression of emotions.
3Historically, this was also the case one hundred years ago, after the French bacteriologist Charles Nicolle discovered that the agent that caused influenza was much smaller than any known bacterium in October 1918, i.e. Jack R.E., Schyns P.G. Given that disgust is an emotion only rarely displayed in school settings, the net result of face masks may well be that the covering of the mouth, i.e., the organ of smiling, leads to diminished perceived happiness.
No data was collected for this opinion paper. PMC legacy view And face masks should be part of the decision-making process. June 25, 2020 (doi: 10.1016/S2352-4642(20)30177-2; accessed 26th June 2020). Upon speaking, the virus is released into the air, the louder the more. Ong J.J.Y., Bharatendu C., Goh Y., Tang J.Z.Y., Sooi K.X.X., Tan Y.L., Tan B.Y.Q., Teoh H.-.L., Ong S.T., Allen D.M., Sharma V.K. On top of this innate preference, the role of social experience in face processing and recognition becomes ever more salient, as research with infants has shown using such different measures as behavioral data, eye-tracking data, and neuroscience data mainly from event related potentials (ERP), functional magnetic resonance imaging (fMRI), and near infrared spectroscopy (NIRS). Grundri Der Vergleichenden Verhaltensforschung.
A recent study on the cardiovascular effects of face masks (surgical or N95/FFP-2) in young healthy male subjects on a bike-ergometer showed a 2 percent decrease in maximum power (not significant) for the surgical mask and a 5 percent decrease of maximal power (p<0,01) for the N95/FFP-2 mask [32]. Solomon I.H., Normandin E., Bhattacharyya S., Mukerji S.S., Keller K., Ali A.S., Adams G., Hornick J.L., Padera R.F., Jr, Sabeti P. Neuropathological features of Covid-19. Lyons I.M., Beilock S.L. The site is secure. Face masks may further cause perioral dermatitis with rashes and redness, i.e., an infection of the skin around the mouth because of saliva, sweat, and moist vapor between the mask and the skin.
It is a medical truism that everything that has effects also has side effects. The louder someone speaks the more droplets and aerosols are produced.
During the time of school-closures (from about the middle of March into April and/or May 2020) it became clear that face masks covering mouth and nose in closed public spaces (public transportation, stores, restaurants etc.) Was Die Krise Mit Uns Macht Und Was Wir Aus Ihr Machen. The coronavirus pandemic and aerosols: does COVID-19 transmit via expiratory particles? Ameres M., Brandstetter S., Tonchev A.A., Kabesch M., Leppert D., Kuhle J., Wellmann S. Association of neuronal injury blood marker neurofilament light chain with mild-to-moderate COVID-19. Other such tools of the mind have been widely proposed (music, sports, handcrafts martial arts) to increase attention, executive function, and cognitive control in 412 year olds [21],[22]. They start to respond to fearful faces but also respond to happy faces soon thereafter. Some teachers as well as other headmasters voiced concerns that they could not imagine teaching with face masks. How individual face parts contribute to successful emotion recognition. Since they also have more daily contacts than older adults, they are the ones who definitely should wear masks in order to protect others, in particular, if they live with their parents and grandparents [9]. If applied to the use of face masks in school settings, these results suggest that happiness and disgust are less likely to be recognized, whereas fear and sadness may be recognized with a higher probability. Accordingly, from their data, the authors estimated that as many as 230,000450,000 Covid-19 cases had been averted by May 22, 2020.
Therefore, at the very least, all school professionals should be aware of the detrimental effects of face masks on face recognition and identification, communication, and social-emotional interaction. In particular, compared to the surgical mask, the N95 mask led to higher humidity and skin temperatures inside the facemask, higher heart rate, and increased negative sensations, including feeling unfit, tight, itchy, [and] fatigued, as stated by the authors ([46], p. 501).
Once we direct our gaze to something, this something thereby can become the focus of shared attention, which is a basic mechanism of doing things and solving problems together. In their view, specific behaviors cause us to experience emotions (and not vice versa), as exemplified in the following statement: You are not crying because you are sad, but you are sad because you are crying. So why not use wearing face masks as a simple tool for social behavior training? Mimicking and sharing emotions: a re-examination of the link between facial mimicry and emotional contagion. It is known for more than 70 years that the act of speaking generates oral fluid droplets that vary widely in size, from clearly visible to invisibly small aerosols [24], [55]. In addition to the considerations already discussed, the following general remark should be considered: Face masks serve the additional benefit of reminding everybody who is present at school pupils, teachers, administrative and supporting staff of the lingering presence of the pandemic and of the appropriate behaviors that are highly important for keeping everybody safe. Wearing a face mask makes the exhaled air go into the eyes. A psychotherapist wrote me an email, noting that socially complicated and challenging inpatients in psychotherapy are very difficult to treat, as dissociative states and tensions are much harder to detect early enough so that appropriate interventions can be performed. For effective verbal communication, covering the mouth with cloth has two detrimental consequences: First, the auditory signal is impaired, as faces masks may dampen sound amplitude, and especially may absorb frequency bands used in speech. In their paper with the same Shakespearian title as this discussion, Eikenberry and coworkers close as follows: Our findings suggest that face mask use should be as nearly universal (i.e., nation-wide) as possible and implemented without delay, even if most masks are homemade and of relatively low quality. In addition, there is learning. Respiratory virus shedding in exhaled breath and efficacy of face masks. When these emotional displays are inhibited by face masks, our ability to communicate effectively with one another is reduced and we are primarily left with mimicking negative (frown) emotions. Gtzinger F., Santiago-Garca B., Noguera-Julin A., Lanaspa M., Lancella L., etal., on behalf of the ptbnet COVID-19 Study Group (2020) COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. Emotions play a large role in our social interactions, of which teaching and learning are among the culturally most relevant. They could have done better and tell people to make their own mask from cloth (and sell them, if they are good at sewing). Universal use of face masks for success against COVID-19: evidence and implications for prevention policies. To mask or not to mask: modeling the potential for face mask use by the general public to curtail the COVID-19 pandemic. An experimental study on the physical effects of wearing either a surgical or an N95/FFP-2 face mask was performed with 5 healthy male and 5 healthy female subjects, who performed intermittent exercise on a treadmill while wearing the protective facemasks in a climate chamber controlled at an air temperature of 25C and a relative humidity of 70%.
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