Effects of wearing face masks during COVID-19 Pandemic: A Cross-sectional Study

Abstract

COVID-19 Pandemic made it mandatory to change the way we live. Along with other COVID Appropriate Behavior, wearing a mask has become the 'new-normal' lifestyle. This cross-sectional study aims at having an insight on the effects of wearing a mask in a general population, including all professions and involving global citizenry. A questionnaire of 27 inquiries was circulated via online platform 'Google Forms' all across the globe. No age bar, no professional predisposition, no boundaries of country were in place for obtaining the data. Received 1380 responses across the world (691 male and 689 female participants), data analyzed for various health affections due to use of masks. The period of study was from January 2021 to April 2021 (4 months). It was observed that maximum people complained about suffocation and fogging of spectacles (52%). Followed by Pain behind the ears (39%) and marks left on the nose due to mask (21%). Rash on face and itching and headache was observed in approximately 10%. Dryness of mouth and nose was observed in 9%. After mask use, 78% (120) participants confirmed that their allergy/asthma symptoms have been reduced. Acceptance of masks as a new normal by general population based on Likert Scale (1-5) comfort level. Around 80% people were comfortable using mask and accepted it as new normal life style where as 20% were couldn't adjust with usage of mask.

Full text

International Journal of Medical Science in Clinical Research and Review
Online ISSN: 2581-8945
Available Online at http://www.ijmscrr.in Volume 05|Issue 05 (September-October)|2022|Page: 751-759
IJMSCRR: September-October 2022 http://doi.org/10.5281/zenodo.7133379 Page | 751
Original Research Paper
Effects of wearing face masks during COVID- 19 Pandemic: A Cross-sectional
Study
Authors:
1Dr. Shreeya Kulkarni, 2Dr. Rushika Patel, 3Dr. Chaitanya Bharadwaj, 4Dr. Ojas Kulkarni*, 5Dr. Aishwarya
Kulkarni
1,2,3,4Dr Vasantrao Pawar Medical College Hospital and Research Centre Nashik Maharashtra
5Amrita Dental University, Kochi
Corresponding Author: Dr. Ojas Kulkarni*
Article Received: 17-08-2022 Revised: 08-09-2022 Accepted: 29-09-2022
ABSTRACT
COVID-19 Pandemic made it mandatory to change the way we live. Along with other COVID Appropriate Behavior,
wearing a mask has become the ‘new-normal’ lifestyle. This cross-sectional study aims at having an insight on the effects
of wearing a mask in a general population, including all professions and involving global citizenry. A questionnaire of 27
inquiries was circulated via online platform ‘Google Forms’ all across the globe. No age bar, no professional
predisposition, no boundaries of country were in place for obtaining the data. Received 1380 responses across the world
(691 male and 689 female participants), data analyzed for various health affections due to use of masks. The period of
study was from January 2021 to April 2021 (4 months). It was observed that maximum people complained about
suffocation and fogging of spectacles (52%). Followed by Pain behind the ears (39%) and marks left on the nose due to
mask (21%). Rash on face and itching and headache was observed in approximately 10%. Dryness of mouth and nose was
observed in 9%. After mask use, 78% (120) participants confirmed that their allergy/asthma symptoms have been reduced.
Acceptance of masks as a new normal by general population based on Likert Scale (1 – 5) comfort level. Around 80%
people were comfortable using mask and accepted it as new normal life style where as 20% were couldn’t adjust with
usage of mask.
Keywords COVID-19 Pandemic, Face Masks, N-95 Masks, Mask Habits, Suffocation, Dryness of mouth.
INTRODUCTION:
The concept and use of the surgical mask was first
introduced in the nineteenth century in Germany.
(Roberge, Kim, & Benson, 2012) World Health
Organization (WHO) termed the SARS-CoV-2 as
COVID-19 on February 11, 2020. A month later on 12
March, 2020 COVID-19 is declared as a pandemic.
(Krajewska, Krajewski, Zub, & Zatoński, 2020) Novel
COVID-19 Virus pandemic in 2020 has emerged as
major health emergency, needing an urgent change in
various healthcare policies and treatment protocols
(Krajewska et al., 2020). The use of face mask, frequent
hand sanitization and social distancing were
recommended to prevent aerosol transmission and hence
to curb to further spread of disease. So, wearing a face
mask has become a new additive in the life-style of
whole population. There are certain discomforts
observed due to continuous usage of mask for particular
period of time like suffocation, fogging of spectacles,
rashes on face, itching, scars on nose, etc. (Gupta,
Singh, & Gupta, 2020) However, there are certain good
effects in patients of allergy and asthma as well, that
there is reduction in the symptoms and dosages of
medications required. The regular use of mask may
cause respiratory discomfort and inconvenience that may
hinder its usage. It was observed that 52% non-HCW
also accepted the mask use. (Gupta et al., 2020)
This study is hence designed for surveying various
issues associated with mask compliance and highlights
various pros and cons, acceptance of use of mask in
general population from various geographical locations.
AIM & OBJECTIVES:
1. To study the common effects of wearing masks in
general population during COVID-19 pandemic.
2. To study acceptability of wearing mask as new normal
in general population during COVID-19 pandemic.

IJMSCRR: September-October 2022 Page | 752
METHODOLOGY:
This is cross-sectional study. A questionnaire in form of
Google Form was created for circulation among various
professionals and general population across the globe via
various contacts of resourceful people. This survey
started after approval of Institutional Ethics Committee
(IEC). The Google form was designed which comprises
of 27 questions ranging from short answer, multiple
choice questions, linear scale and checkboxes etc. Out of
these, 23 were mandatory responses and remaining 4
were optional. The design of the questions is such that
data can be extracted regarding the types of mask,
duration of usage, profession of the person, various
discomfort encountered during mask usage, presence of
co-morbidity, whether affected by COVID-19. The
inputs regarding concomitant existence of allergy and
asthma is also inquired and their regression of symptoms
with masks usage. The evaluation of acceptability of
mask usage is also assessed by a linear scale/ Likert
scale. The Likert scale constituted from 1 (not
comfortable) to 5 (very comfortable).
Statistical analysis
Pearson Chi-square test was applied for various analysis
and finding significance between type of mask and
symptom. Gender predisposition in reduction of
allergy/asthma symptoms after using mask and ultimate
acceptance of mask usage.
RESULTS:
In this survey from January 2021 to April 2021 (4
months) we received 1380 responses (n = 1380) Gender
distribution: Male: Female (691:689) i.e. 50% (Figure
1)
Figure 1: Gender distribution of study
population.
In Country-wise distribution- India: Other countries
(1301:79); 94% from India and 6% from other countries
like USA, UK, Dubai, Australia, Germany, Bahrain,
France etc. In India, State-wise distribution: Maximum
participation was recorded from Maharashtra State, India
(1049) i.e. 76% Considering Age distribution: The age
ranges from 10 years to 76 years. Maximum participants
were from age 40-60 years, comprising 54% (745)
followed by age group 20-40, comprising 36% (503).
Above 60-year-old participants were 6.6% (91) and the
least number was age group <20, which was 3% (41).
(Figure 2)
Figure 2: Age-wise distribution of study population.
Considering the Occupation distribution: Maximum
participants were Health care workers 35% (482),
followed by Businessmen. College students were 13%
(176). Least number were retired people 2.2% (30)
(Figure 3)
MALE
50%
FEMALE
50%
Gender Distribution
MALE FEMALE
Less than 20 20-40 40-60 Above 60
Percent 3.0 36.4 54.0 6.6
Number 41 503 745 91
41
503
745
91
3.0
36.4
54.0
6.6
0
100
200
300
400
500
600
700
800
900
Age-wise distribution
Number Percent

IJMSCRR: September-October 2022 Page | 753
Figure 3: Occupational distribution of study population.
125 participants were confirmed cases of COVID-19 (by
RT-PCR) and 1255 were not suffering from COVID-19,
in the period of cross sectional study that is from January
to April (II wave of COVID-19) Regarding regularity in
use of mask- 1235 participants chose regular use of
mask while in public, 68 participants often used the
mask while 5 participants who chose not to wear the
mask at all. Type of Mask used- Highest use was
recorded for cloth masks from 768 participants, followed
by N95 Mask by 654 participants, and a surgical mask/3
ply mask by 293 participants. Use of Mask with Bands-
Of the two types, which are behind the ear and around
the head, 584 preferred behind the ear (of which 54%
(316) were Females) and 303 around the head (of which
Females 39% i.e. 119) respectively. (Figure 4)
Figure 4: Mask Band Types compared with gender.
Hand sanitizing awareness before/after touching the
masks- 49% participants had general hand sanitizing
habit regarding mask use, 36% occasionally sanitized the
hands, lastly 15% did not follow hand hygiene measures
at all. Duration of wearing masks (in hours)- The data
was categorized between HCW (Health Care Workers)
and non-HCW, and was analyzed for the duration of
hours. It was observed that out of the total 482 HCW,
females constituted 233 and males 249. Maximum
number (181) that is 38% of HCW used mask for more
than 7 hours, followed by (158) 33% had continuous
mask use for 5 to 7 hours. (Figure 5)
482
280
210 176
109 100
30
0
100
200
300
400
500
600
Number
Occupational Distribution
Health care worker Job Business
Student Others Home maker
Retired
0100 200 300 400 500 600 700 800 900 1000
Female
Male
Grand Total
Mask Band Types compared with gender
Grand Total Bands behind the ears Bands around the head

IJMSCRR: September-October 2022 Page | 754
Figure 5: Duration of wearing face masks in HCW
Comparing this data with Non-HCW, it was observed
that 39% used mask for less than 1 hour, and only 10% of non-HCW used the mask continuously for more than
7 hours. (Figure 6)
Figure 6: Duration of wearing face masks in non-HCW
Effects of wearing face masks- The questionnaire asked
for the commonly experienced effects of wearing masks
viz. Suffocation, dryness of mouth, rash on face, mark
on nose, fogging of spectacles, itching, pain behind the
ears, headache, throat irritation, voice problems and
irritability. It was observed that maximum people
complained about suffocation and fogging of spectacles
(52%). Followed by Pain behind the ears (39%) and
marks left on the nose due to mask (21%). On the
contrary, around 17% people had no issues wearing
mask. The least complains were for the effect of throat
irritation (7%). Rash on face and itching and headache
was observed in approximately 10%. Dryness of mouth
and nose was observed in 9%.
5
21
55
80
72
4
15
43
78
109
9
36
98
158
181
L ES S T H AN 1
H O U R
1 T O 3 HO UR S 3 T O 5 HO UR S 5 T O 7 HO UR S M OR E T HA N 7
H O U R S
DURATI ON OF WEARING FACE MASKS
IN HCW
Female Male HCW Total
199
77
56
100
24
153
98
58
70
63
352
175
114
170
87
L ES S T H AN 1
H O U R
1 T O 3 H O UR S 3 T O 5 H O UR S 5 T O 7 H O UR S M OR E T HA N 7
H O U R S
DURATION OF WEA RI NG FACE MASK
IN NON-HCW
Female Male Non- HCW Total

IJMSCRR: September-October 2022 Page | 755
Figure 7: Effects of wearing mask.
Out of 534 people having pain behind the ears, 50%
were using mask with band behind the ears which is
significant. But out of 136 people complaining of
headache, 25% were using mask with band around head
which is not significant. (Figure 7) Number of people
coming across at work place: 390 people had
considerably less exposure at work place (0-5 people per
day), 216 people had exposure to 6-10 people per day,
and 774 people were exposed to more than 10 people per
day at work place. Out of these 774, 400 were HCW.
General survey on Asthma/Allergy in the sample size of
1380: Among 1380 participants, 154 people had
symptoms/diagnosed of asthma, whereas 1226 people
did not suffer from it. Of these 154, 39 people use nasal
spray, 55 use per oral medications, 50 use inhalers, and
10 people were not on any active interventions. After
mask use, 78% (120) participants confirmed that their
allergy/asthma symptoms have been reduced likely due
to reduced exposure to the allergen. Acceptance of
masks as a new normal by general population based on
Likert Scale (1 – 5) comfort level: In this Likert Scale, 1
indicated not comfortable and 5 indicates very
comfortable, inferring to be good mask acceptance.
Maximum response was received for grade 4
constituting 484 people (35%) and only 80 people (6%)
chose grade 1 and were least comfortable using mask.
20% people were very comfortable using the mask and
showed highest acceptance for mask as the new normal.
(Figure 8)
Figure 8: Mask Acceptance grade in percent.
719
712
534
289
232
222
185
136
134
123
119
98
0100 200 300 400 500 600 700 800
Suffocation
Fogging of sepcs
Pain behind the…
Mark on Nose
No problem with…
Irritability
Voice problem
Itching
Headache
Rash on Face
Dryness of Mouth
Throat irritation
Effects of wearing mask
68
31
35
20
0
5
10
15
20
25
30
35
40
1
Mask acceptance grade in percent
Grade 1 Grade 2 Grade 3 Grade 4 Grade 5

IJMSCRR: September-October 2022 Page | 756
DISCUSSION:
On 30th January 2020, the WHO declared the outbreak
of COVID-19 to be a Public Health Emergency.
(Sohrabi et al., 2020) W.H.O. termed the SARS-CoV-2
as COVID-19 on February 11, 2020. A month later on
12, March 2020 COVID-19 is declared as Pandemic.
About 88 million people were infected with COVID-19
infection worldwide and this disease cause about 1.9
million deaths across the globe (Tsang et al., 2021). The
use of face mask, frequent sanitization of hands and
social distancing were recommended to prevent aerosol
transmission and hence to curb to further spread of
disease (Krajewska et al., 2020). So, wearing a face
mask has become a new additive in the life-style of
whole population. There are certain discomforts
observed due to continuous usage of mask for particular
period of time like suffocation, fogging of spectacles,
rashes on face, itching, scars on nose, etc. There are
certain good effects in patients of allergy and asthma that
there is reduction in the symptoms and dosages of
medications required. This study is hence designed for
surveying general population from various geographical
boundaries. It includes people of all age groups and
various occupations including healthcare workers,
policemen, students, businessmen and other
professionals (Feng et al., 2020). The objective of this
study was to do global survey about common effects of
wearing mask. In our study, maximum responders were
from India and rest from USA, UK, Dubai, Australia,
Germany, Bahrain, France. This includes maximum
people from working age group that i.e. 40-60 years
(54%), followed by 36% from 20 to 40 years.
Incidentally gender distribution is absolutely equal. The
HCW were 35% who gave significant contribution in
this study regarding type of mask, duration of mask,
sanitization habits associated with mask etc. P. K.
Purushothaman et.al gives study of 250 HCW with
outcome which suggests that continuous usage of
facemasks can lead to a wide spectrum of nasal
discomfort and complaints pertaining to the facial skin
and oral cavity due to its pro- longed usage
(Purushothaman, Priyangha, & Vaidhyswaran, 2020). In
this study, it was observed that out of the total 482
HCW, females constituted 233 and males 249.
Maximum number (181) that is 38% of HCW used mask
for more than 7 hours, followed by (158) 33% had
continuous mask use for 5 to 7 hours. Comparing this
data with Non-HCW, it was observed that 39% used
mask for less than 1 hour, and only 10% of non-HCW
used the mask continuously for more than 7 hours.
(Wang, Pan, Tang, Ji, & Shi, 2020) In this study 9%
participants were confirmed cases of COVID-19 (by RT-
PCR) and remaining 1255 were not suffering from
COVID-19, in the period of cross sectional study that is
from January to April (II wave of COVID-19). Since it
was mandatory to follow COVID appropriate behavior,
mask use was a norm. (T. Li, Liu, Li, Qian, & Dai,
2020). 1235 participants chose to use mask regularly
while in public, 68 participants often used the mask
while 5 participants who chose not to wear the mask at
all.(T. Li et al., 2020) Highest use was recorded for cloth
masks from 768 participants, followed by N95 Mask by
654 participants, and a surgical mask/3 ply mask by 293
participants. People use multiple types of masks or
combination of masks. Of the two types, which are
behind the ear and around the head, 584 preferred behind
the ear and 303 around the head, in which 54%-316 were
females in the prior and 39%-119 were females in the
later, respectively. It is observed that females preferred
mask with bands behind the ear over wearing masks
around the head. Multiple modifications of using behind
the ear masks for proper fitting and comfort are possible
in a study conducted by Phillip W. Clapp et al. (Clapp et
al., 2021). Out of 369 people having earache, 267 were
using mask with band behind the ears. The correlation
was significant according to Table 1.
Table 1: Distribution of type of mask and presence of earache
Out of Effect - Pain behind the ear
Yes
No
Total
Band behind ear
267
(46%)
317
(54%)
584
Band behind head
102
(34%)
201
(66%)
303
Total
369
(42%)
518
(58%)
887

IJMSCRR: September-October 2022 Page | 757
Pearson Chi-square value-11.93; P value < 0.001;
Highly significant. There is significant association of
earache with type of mask used. Out of 106 people
having headache, 34 were using mask with band behind
the ears. The correlation was not significant according to
Table 2.
Table 2: Distribution of type of mask and presence of headache
Pearson Chi-square value-0.223; P value = 0.628; Not
significant. There is no significant association of
headache with type of mask used. According to Gokhan
Tanisali et al. cloth masks may be effective, depending
on the quality of the cloth. Valve N95 masks exclusively
protect the user. The fit of a mask is an important factor
to minimize the contaminated region. (Tanisali et al.,
2021) The study in detail of various disadvantages listed
by our participants revealed that suffocation and fogging
on spectacles was complained by 52%, pain behind the
ears by 39% and mark on the nose by 21%. In study
conducted for HCW by Manish Gupta et al, maximum
complaints are similar to our study i.e. Fogging of specs
and suffocation. (Gupta et al., 2020)
Itching and rash was seen in 10% people due to
sweating. In a study by Jacek C. SZEPIETOWSKI from
Poland , 20% of young people wearing face masks
reported itch (Szepietowski, Matusiak, Szepietowska,
Krajewski, & Białynicki-Birula, 2020). Excessive
sweating underneath the mask can cause various
dermatological effects. In a study by A.B. DuBois et al,
heat flux diminishes when face is covered with porous
mask which causes increase in temperature of skin under
the mask. (DuBois, Harb, & Fox, 1990). A study from
Thailand observed affection of skin underneath in
around 50% of study population. (Techasatian et al.,
2020). In our study rash on face was seen in 9 % people.
Adverse skin reactions of using N95 mask was studied
by Kaihui Hu et al, with around 30 % skin effects. (Hu et
al., 2020) Mark on nose in 68% whereas in our study, it
is 21%. In a small study on 150 participants in Turkey,
65% people had trouble of itching underneath. (İnan
Doğan & Kaya, 2021) A new type of headache has
developed among healthcare workers. Both an
aggravation in pre-existing headaches and the emergence
of de-novo headaches has been shown to increase with
mask use, regardless of mask use duration. This was
according to another study from Turkey in 375 HCW.
(Toksoy, Demirbaş, Bozkurt, Acar, & Börü, 2021) In
this study, out of the 1380 participants 32% worked from
home and almost more than twice that is 64% worked on
site or outside home who were mostly HCW. (Galanti,
Guidetti, Mazzei, Zappalà, & Toscano, 2021) 154 people
were already suffering from allergic symptoms and were
taking some sort of treatment for it. Out of that 120
people (66 females and 54 males) i.e. 80 % showed
significant reduction in allergies due to mask usage,
Table 3. It could be because face masks reduce atopic
allergic responses. Similar results are observed in study
by Amiel A. Dror,et al. (Dror et al., 2020)
Allergy symptoms reduction
Female
Male
Total
REDUCED
66
(55%)
54
(45%)
120
NOT REDUCED/REMAIN
SAME
22
(65%)
12
(35%)
34
Total
88
(57%)
66
(43%)
154
Table 3: Gender wise reduction in allergy symptoms
Out of HEADCHE SYMPTOMS
Yes
no
Total
Band around head
34
(11%)
269
(89%)
303
Band behind ears
72
(12%)
512
(88%)
584
Total Headache
106
(12%)
781
(88%)
887

IJMSCRR: September-October 2022 Page | 758
Pearson Chi-square value 1.019; P value = 0.313; Not
significant. There is no significant association of allergic
symptoms and gender. Acceptance of masks as a new
normal by general population was analyzed based on
Likert Scale (1 – 5) comfort level. 14% people were
uncomfortable using mask, 35% were neutral regarding
mask, and 55% accepted the change of wearing mask, as
a new normal habit. According to this study, there is no
significant association of acceptance level with gender
Table 4.
Row Labels
Female
Male
Grand
Total
Not accepted
97
(50%)
97
(50%)
194
Accepted
369
(49%)
387
(51%)
756
Grand Total
466
(49%)
484
(51%)
950
Table 4: Acceptance level with gender
Pearson Chi-square value 0.088; P value = 0.767; Not
significant. There is no significant association of
acceptance level and gender. Another objective of this
study was acceptance of mask as new normal. Similar
study from Brazil showed similar results and
acceptability though due to anxiety in most of them.
(Cotrin et al., 2020). A systematic review and meta-
analysis concludes that wearing a mask could reduce the
risk of COVID-19 infection.(Y. Li et al., 2021)
CONCLUSION:
Face masks have become a new advent and the simplest
barrier in prevention of aerosol generated disease like
COVID-19. Even though they were in use before the
pandemic by HCW, the use of mask in general public
has now become a new normal to help curb the spread of
COVID. In spite of general discomfort of mask usage in
HCW and non-HCW, acceptability of wearing mask in
general population across the globe appears to be
satisfactory. In guidelines set forth by the WHO
regarding following the ‘COVID appropriate behaviour’,
regular mask use appears as an easy-to-follow preventive
measure.
Funding This research received no specific grant from
any funding agency.
Compliance with Ethical Standards Compliance
according to ethical standards is present, as per
Institutional Ethical Committee (IEC). IEC approval
received.
Informed Consent Informed consent was obtained from
all participants included in the study, in the description
of the Google form questionnaire.
Conflict of Interest The author/(s) declared no potential
conflicts of interest with respect to the research,
authorship, and/or publication of this article.
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