HomeMy Public PortalAbout2021.04.26 Letter Regarding Masks - Sarah Riese CIEUVIBM3
'Dear Mayor Bob Giles
APR 2 6 2021
My name is Sarah Riese and my husband along with our two children will be relocating to Idaho this coming
June from West Linn, Oregon. We have lived in Oregon all our lives(my husband age 48 and I am 49) and
never thought we would move but given the state of Oregon we have no choice as Oregon's Governor, Kate
Brown, has turned into a tyrannical dictator. She has signal handedly taken away all the rights from the people
that were fought for by our forefathers and protected by the United States Constitution and Bill of Rights all
under the scare tactic of protecting us.
I am an ICU nurse of 15 years and now a primary care nurse that goes to people's homes who are homebound to
provide care and so I understand that COVID-19 is a real virus and for a certain population it is a deadly virus.
However, for the majority of the people who are healthy this virus however will make you sick will not kill you.
How the government is implementing mandates punishable by jail and fines is inconceivable in what we
thought was the Land of the Free, Home of the Brave.
You-have-also participated-in-this_overreach_by-treating--the_citizens_of McCall-and-All_thosewho want to visit as_.
if they were your"subjects" that you can punish if they don't do what you want. I am speaking to the Mask
Mandate you have in place in your city. What I want to know is are you even willing to consider what you are
doing is 100%wrong and in fact doing more harm that good? A study conducted by Baruch Vainshelboim at
Stanford University looked at the Facemask in the COVID-19 ear and the effectiveness of the mask and what
potential harm could be happening. The conclusion of this paper was that the Facemask does more harm than
good:
Conclusion: The existing scientific evidences,challenge the safety and efficacy of wearing facemask as
preventive intervention for COVID-19. The data suggest that both medical and non-medical facemasks are
ineffective to block human-to-human transmission of viral and infectious disease such SARS-CoV-2 and
COVID-19, supporting against the usage of facemasks. Wearing facemasks has been demonstrated to have
substantial adverse physiological and psychological effects. These include hypoxia, hyper-capnia, shortness of
breath, increased acidity and toxicity, activation of fear and stress response, rise in stress hormones,
immunosuppression, fatigue, headaches, decline in cognitive performance, predisposition for viral and
infectious illnesses, chronic stress, anxiety and depression. Long-term consequences of wearing facemask can
cause health deteri-oration, developing and progression of chronic diseases and premature death. Governments,
policy makers and health organizations should utilize prosper and scientific evidence-based approach with
respect to wearing facemasks, when the latter is considered as preventive inter-vention for public health.
I have enclosed the full article and ask that you read it and hopefully you will see that mandating facemask is
not the right thing to do. Now, if there are individuals out there that still wish to wear the facemask then I
support that because that is their individual right to do so just like it should be might right to choose not to wear
one without fear of punishment.
Sincerely
Mrs Sarah Riese
4091 Ridge Ct
West Linn, OR 97068
SU3 5�_ 63
Medical Hypotheses 146(2021)110411
M a�
Contents lists available at ScienceDhect
N yc Medical Hypotheses
d ,
ELSEVIER journal homepage:www.elsevier.comfiocate/mehy -
Facemasks in the COVID-19 era: A health hypothesis
Baruch Vainshelboim
Cardiology DWLUOn,Veterans Affairs Palo Alto HeaUh Care Systan/Stanford University,Palo Alto,CA,United State
ARTICLE INFO ABSTRACT
Keywords: V Many countries across the globe utilized medical and non-medical facemasks as non-pharmaceutical intervention
Physiology for reducing the transmission and infectivity of coronavirus disease-2019(COVID-19).Although,scientific evi-
Psychology dence supporting facemasks' efficacy is lacking,adverse physiological, psychological and health effects are
Health established.Is has been hypothesized that facemasks have compromised safety and efficacy profile and should be
SARS-CoV-2 avoided from use.The current article comprehensively summarizes scientific evidences with respect to wearing
Safety
Efficacy facemasks in the COVID-19 era,providing prosper information for public health and decisions making.
Introduction scientific evidences with respect to safety and efficacy of wearing face-
masks, describing the physiological and psychological effects and the
Facemasks are part of non-pharmaceutical interventions providing potential long-term consequences on health.
some breathing barrier to the mouth and nose that have been utilized for
reducing the transmission of respiratory pathogens[11.Facemasks can Hypothesis
be medical and non-medical, where two types of the medical masks
primarily used by healthcare workers [1,21. The first type is National On January 30, 2020, the World Health Organization (WHO)
Institute for Occupational Safety and Health (NIOSH)-certified N95 announced a global public health emergency of severe acute respiratory
mask,a filtering face-piece respirator,and the second type is a surgical syndrome-coronavirus-2 (SARS-CoV-2) causing illness of coronavirus
mask[1].The designed and intended uses of N95 and surgical masks are disease-2019 (COVID-19) [3]. As of October 1, 2020, worldwide
different in the type of protection they potentially provide.The N95s are 34,166,633 cases were reported and 1,018,876 have died with virus
typically composed of electret filter media and seal tightly to the face of diagnosis.Interestingly,990i6 of the detected cases with SARS-CoV-2 are
the wearer,whereas surgical masks are generally loose fitting and may asymptomatic or have mild condition,which contradicts with the virus
or may not contain electret-filtering media. The N95s are designed to name(severe acute respiratory syndrome-coronavirus-2) [4].Although
reduce the wearer's inhalation exposure to infectious and harmful par- infection fatality rate(number of death cases divided by number of re-
ticles from the environment such as during extermination of insects.In ported cases) initially seems quite high 0.029 (2.9%) [41, this over-
contrast, surgical masks are designed to provide a_barrier protection estimation related to limited number of COVID-19 tests performed
against splash, spittle and other body fluids to spray from.the wearer which biases towards higher rates.Given the fact that asymptomatic or
(such as surgeon)to the sterile environment(patient during operation) minimally symptomatic cases is several times higher than the number of
for reducing the risk of contamination[l]. reported cases, the case fatality rate is considerably less than 1% [5].
The third type of facemasks are the non-medical cloth or fabric This was confirmed by the head of National Institute of Allergy and
masks. The non-medical facemasks are made from a variety of woven Infectious Diseases from US stating,"the overall clinical consequences of
and non-woven materials such as Polypropylene, Cotton, Polyester, .COVID-19 are similar to those of severe seasonal influenza"[5],having a
Cellulose,Gauze and Silk.Although non-medical cloth or fabric face- case fatality rate of approximately 0.1% [5-8]. In addition,data from
masks are neither a medical device nor personal protective equipment, hospitalized patients with COVID-19 and general public indicate that
some standards have been developed by the French Standardization the majority of deaths were among older and chronically ill individuals,
Association (AFNOR Group) to define a minimum performance for supporting the possibility that the virus may exacerbates existing con-
filtration and breathability capacity[2].The current article reviews the ditions but rarely causes death by itself[9,101. SARS-CoV-2 primarily
* Address:VA Palo Alto Health Care System,Cardiology 111C,3801 Miranda Ave,Palo Alto,CA 94304,United States.
E-mail address:ban:ch.v1981@gmail.com.
htt nS://doi.org/10.1016/j.iuehy.2020.110411
Received 4 October 2020;Received in revised foam 28 October 2020;Accepted 19 November 2020
Available online 22 November 2020
0306-9877/0 2020 Elsevier Ltd.All rights reserved.
0-- +a
B.VaULgidbolm Medical Hypotheses 146(2021)110411
affects respiratory system and can cause complications such as acute randomized controlled trial (RCT) of 246 participants [123 (500/0)
respiratory distress syndrome(ARDS), respiratory failure and death symptomatic)] who were allocated to either wearing or not wearing
[3,91.It is not clear however,what the scientific and clinical basis for surgical facemask,assessing viruses transmission including coronavirus
wearing facemasks as protective strategy,given the fact that facemasks [261.alie-results-of-thiszstudy--showed that amok-_sy-m top atic.in-
restrict breathing,causing hypoxemia and hypercapnia and increase the drviduals-(those-dvitli-fever,-cough;sore throat;runnynose-ect_,)-tliere
risk for respiratory complications,self-contamination and exacerbation was.-no-difference,between=wearingrandnot'wearing face&6k for
of existing chronic conditions[2,11-14]. cpronavirus-droplets transmission�ofparticies of r56lam Among
Of note,hyperoxia or oxygen supplementation (breathing air with ymptomatic_individuals,.there.-was-no dioplets-or aerosols cor viano rds
high partial 02 pressures that above the sea levels) has been well detected from-any_participant with or-withouttiie-mast�:suggesstng
established as therapeutic and curative practice for variety acute and asymptomatic individuals-do_not'transmit or-infect other-people-[26].
chronic conditions including respiratory complications [11,15].It fact, This was further supported by a study on infectivity where 445
the current standard of care practice for treating hospitalized patients asymptomatic individuals were exposed to asymptomatic SARS-CoV-2
with COVID-19 is breathing 100%oxygen [16-18]. Although several carrier (been positive for SARS-CoV-2) using close contact (shared
countries mandated wearing facemask in health care settings and public quarantine space)for a median of 4 to 5 days.The study found that none
areas, scientific evidences are lacking supporting their efficacy for of the 445 individuals was infected with SARS-CoV-2 confirmed by real-
reducing morbidity or mortality associated with infectious or viral dis- time reverse transcription polymerase[271.
eases[2,14,191.Therefore,it has been hypothesized:1)the practice of A meta-analysis among health care workers found that compared to
wearing facemasks has compromised safety and efficacy profile,2)Both no masks,surgical mask and N95 respirators were not effective against
medical and non-medical facemasks are ineffective to reduce human-to- transmission of viral infections or influenza-like illness based on six
human transmission and infectivity of SARS-CoV-2 and COVID-19,3) RCTs (28). Using separate analysis of 23 observational studies, this
Wearing facemasks has adverse physiological and psychological effects, meta-analysis found no protective effect of medical mask or N95,respi-
4) Long-term consequences of wearing facemasks on health are rators against SARS virus[28].A recent systematic review of 39 studies
detrimental. including 33,867.participants in community settings(self-report illness),
found no difference between N95 respirators versus surgical masks and
Evolution of hypothesis surgical mask versus no masks in the risk for developing influenza or
influenza-like illness,suggesting their ineffectiveness of blocking viral
Breathing Physiology transmissions in community settings[29].
Another meta-analysis of 44 non-RCT studies (n = 25,697 partici-
Breathing is one of the most important physiological functions to pants) examining the potential risk reduction of facemasks against
sustain life and health.Human body requires a continuous and adequate SARS,middle east respiratory syndrome(MERS)and COVID-19 trans-
oxygen (02) supply to all organs and cells for normal function and missions [301. The meta-analysis included four specific studies on
survival.Breathing is also an essential process for removing metabolic COVID-19 transmission (5,929 participants, primarily health-care
byproducts [carbon dioxide (CO2)] occurring during cell respiration workers used•N95 masks). Although the overall findings showed
[12,13].It is well established that acute significant deficit in 02(hyp- reduced risk of virus transmission with facemasks,the analysis had se-
oxemia)and increased levels of CO2(hypercapnia)even for few minutes vere limitations to draw conclusions.One of the four COVID-19 studies
can be severely harmful and lethal,while chronic hypoxemia and hy- had zero infected cases in both arms,and was excluded from meta-an-
percapnia cause health deterioration, exacerbation of existing condi- alytic calculation.Other two COVID-19 studies had unadjusted models,
tions, morbidity and ultimately mortality [11,20-22]. Emergency and were also excluded from the overall analysis. The meta-analytic
medicine demonstrates that 5-6 min of severe hypoxemia during cardiac results were based on only one COVID-19, one MERS and 8 SARS
arrest will cause brain death with extremely poor survival rates[20-23]. studies,resulting in high selection bias of the studies and contamination
On the other hand, chronic mild or moderate hypoxemia and hyper- of the results between different viruses.Based on four COVID-19 studies,
capnia such as from wearing facemasks resulting in shifting to higher the meta-analysis failed to demonstrate risk reduction of facemasks for
contribution of anaerobic energy metabolism,decrease in pH levels and COVID-19 transmission,where the authors reported that the results of
increase in cells and blood acidity, toxicity, oxidative stress, chronic meta-analysis have low certainty and are inconclusive[30].
inflammation, immunosuppression and health deterioration do eearly--publication—the--WRO--hated==that."facemasks are blot y
required_as_n_o evidenceis.available on°its_usefulness'to-protectnoii sick-
persons_[1 ].In the same publication,the-WHO_declaree ; at cTdth(e.
Efficacy of facemasks g. cotton or gauze)Znasks::are_not_recommended�u_nder.any cir`crf�m,
c:ggnce�" [14]. Conversely,in later publication the WHO stated that the
The physical properties of medical and non-medical facemasks sug- usage of fabric-made facemasks (Polypropylene, Cotton, Polyester,
gest that facemasks are ineffective to block viral particles due to their Cellulose, Gauze and Silk) is a general community practice for "pre-
difference in scales[16,17,20_.According.to_the current know edg-e, venting the infected wearer transmitting the virus to others and/or to
rus S' R� S CoV-2_has_a diameter of.-O0 nm to 140 r1m (nanometers offer protection to the healthy wearer against infection (prevention)"
(billionth of a meter)] [16,171, while medreal and noii medical face [2).The same publication further conflicted itself by stating that due to
masks thread diameter`ranges fronr55-pm-W440 gm[micrometers.(one the lower filtration, breathability and overall performance of fabric
millionth of a meter);which.is more than-1000•times•laig&r[251.Due:to� facemasks,the usage of woven fabric mask such as cloth,and/or non-
thezdifference=in=sizesr:lietween-SARS=C-ZW2-diEibeter=andzfacemasks:z woven fabrics,should only be considered for infected persons and not
thread-diameter(the:virus-is 100_0_times.smaller),SARS;CoVz2.can�easily= for prevention practice in asymptomatic individuals[2]•The Central for
-pass-through any-facemask [251. Injaddition;the-efficiencyyfiltration-= Disease Control and Prevention(CDC)made similar recommendation,
rat,e-of-facemaskszis-poor;--ranging==fromco.7%;in—no_n_-surgical,_eotton== stating that only symptomatic persons should consider wearing face-
gauze woven mask,to.26%in cotton=sweeter-material t2:LWith respecter mask, while for asymptomatic individuals this practice is not recom-
to:surgical_and-N95_.medical-facemasks;_theefficiencyfiltration`ratefallsa mended [311. Consistent with the CDC, clinical scientists from
to 15%,and-580.6;=respectively wlien eWif--ma l gap`between t'lie mask Departments of Infectious Diseases and Microbiology in Australia
and;t1ke.face:exists'E25] i counsel against facemasks usage for health-care workers,arguing that
Clinical scientific evidence challenges further the efficacy of face- there is no justification for such practice while normal caring relation-
masks to block human-to-human transmission or infectivity. A ship between patients and medical staff could be compromised [321.
2
B.yaiadefaun Medical Hypotheses 146(2021)110411
Moreover,the WHO repeatedly announced that"at present,there is no into the body,causing self-contamination.Breathing through facemasks
direct evidence(from studies on COVID-19) on the effectiveness face also increases temperature and humidity in the space between the
masking of healthy people in the community to prevent infection of mouth and the mask, resulting a release of toxic particles from the
respiratory viruses, including COVID-19"[2]. Despite these contro- mask's materials [1,2,19,26,35,36]. A systematic literature review
versies,the potential harms and risks of wearing facemasks were clearly estimated that aerosol contamination levels of facemasks including 13 to
acknowledged.These including self-contamination due to hand practice 202,549 different viruses Ell.Rebreathing contaminated air with high
or non-replaced when the mask is wet,soiled or damaged,development bacterial and toxic particle concentrations along with low Op and high
of facial skin lesions, irritant dermatitis or worsening acne and psy- COZ levels continuously challenge the body homeostasis,causing self-
chological discomfort Vulnerable populations such as people with toxicity and immunosuppression[1,2,19,26,35,36].
mental health disorders,developmental disabilities,hearing problems, A study on 39 patients with renal disease found that wearing N95
those living in hot and humid environments,children and patients with facemask during hemodialysis significantly reduced arterial partial ox-
respiratory conditions are at significant health risk for complications ygen pressure(from Pa02 101.7 to 92.7 mm Hg),increased respiratory
and harm[2]. rate(from 16.8 to 18.8 breaths/min),and increased the occurrence of
chest discomfort and respiratory distress [35]. Respiratory Protection
Physiological effects of wearing facemasks Standards from Occupational Safety and Health Administration, US
Department of Labor states that breathing air with 02 concentration
Wearing facemask mechanically restricts breathing:by_''increastng the below 19.5%is considered oxygen-deficiency,causing physiological and
. ��-- health adverse effects. These include increased breathing frequency,
r-I se istanee of air movement during-both•inhalation-andaexhalation pro- accelerated heartrate and cognitive impairments related to thinking and
c:!zess-(- 2,i3].Although,intermittent(several times a week)and repeti- coordination[361.A chronic state of mild hypoxia and hypercapnia has
tive(10=15 Brea It is for 2=4 sets)increase in respiration resistance may- —been shown as primarily mechanism for developing cognitive dysfunc-
be adaptive for strengthening respiratory muscles (33,34], prolonged tion based on animal studies and studies in patients with chronic
and continues effect of wearing facemask is maladaptive and could be obstructive pulmonary disease[44].
detrimental for health[11-131.In normal conditions at the sea level,air The adverse physiological effects were confirmed in a study of 53
contains 20.93%OZ and 0.03%COY providing partial pressures of 100 surgeons where surgical facemask were used during a major operation.
mmHg and 40 mmHg for these gases in the arterial blood,respectively. After 60 min of facemask wearing the oxygen saturation dropped by
These gas concentrations significantly altered when breathing occurs more than 1%and heart rate increased by approximately five beats/min
through facemask. A trapped air remaining between the mouth, nose
[45].Another study among 158 health-care workers using protective
and the facemask is rebreathed repeatedly in and out of the body,con-
taining low OZ and high COZ concentrations, causing hypoxemia and Personal equipment primarily N95 facemasks reported that 81%(128
workers) developed new headaches during their work shifts as these
hypercapnia [l 1-13,35,36] es vere hypoxemia-may- sal o-provoke-cac-' become mandatory due to COVID-19 outbreak.For those who used the
diopulmonaryandoneuroiagicai7complications::-and--is cconsidered.-an, N95 facemask greater than 4 h per day,the likelihood for developing a
important-clitucal-sign-in-cardtopulinonary-medicine--Il0'7-42]c low-ox- headache during the work shift was approximately four times higher
ygen4content in—tlie-arterial=$lood�can-cause-myocardial ischemia, [Odds ratio=3.91,95%Cl(1.35-11.31)p=0.0121,while 82.2%of the
ser ght_oraleft:yentricular=dysfunction;diiEBess? N95 wearers developed the headache already within <10 to 50 min
hypotension,syncope andp_uimonary hypertension E43].Chronic low- [46].
grade hypoxemia and hypercapnia as result of using facemask can r-With:respect:to_cloth:facemakkc,"-a,RCT using=four vaeeks_follow�up
cause exacerbation of existing cardiopulmonary, metabolic, vascular
and neurological conditions [37-421. Table 1 summarizes the physio- compared the_effecto£ciothffacema k=to medical'masks and to=no masks
logical, psychological effects of wearing facemask and their potential on the incidence of clinical respiratory illness;-iiifluenzal-Ia 07-pss and
laboratory=confirmed-respiratory-virus.infections-among_i 6O7�partici-
long-term consequences for health pants from -hospitals-[J;9],,T_h_e:r_esults_showed-that-there—were no
In addition to hypoxia and hypercapnia,breathing through facemask difference-between-wearing-cloth-masks;_medical.maslcs-and-no-masks,
residues bacterial and germs components on the inner and outside layer for-incidence-of-clinical-respiratory_illness.and laboratory-confirmed
of the facemask These toxic components are repeatedly rebreathed back res iaao virusFinfe lions. H` Ho Bever,-a lar a harmful effect with
� P ry 8 .�.- �
more:than 13itnes=lughe'r isk=[Relative Risk'=13:25 95� CI(1.74 to
Table I r100.91)was-obseryed_forinfluenzw-like>illness•among-those-,vho=-were
Physiological and Psychological Effects of Wearing Facemask and Their Poten- wearing_clothmasks-[l9].The.stud y._concludedArtt-cloth-masks`-Have
tial Health Consequences.
�signrficant.health and-safety-issues-including-moisture-retention;:reuse,
Physiological Effects Psychological Effect Health consequences poor filtration=and-increased=risk-for=infection;_proyiding-recommen-
• Hypoxemia . Activationof'fight . Increased datioq against the use of cloth masks[19].
• Hypercapnia or flight'stress predisposition for
• Shortness of breath response viral and infection
Psychological effects of wearing facemasks
• Increase lactate . Chronic Mess illnesses
concentration condition • Headaches
• Decline in pH levels . Fear . Anxiety Psyckologi2ally,-wearing-facemask=f indamentall}ehas:negative--eft
• Acidosis . Mood disturbances . Depression fects:--on=the-wearer-and-thr---uearby=person Basic human-to-human
• Toxicity . Insomnia . Hypertension connectivity through face expression is compromised and self-identity
• Inflammation . Fatigue . Cardiovascular
is somewhat eliminated [47-49]. These dehumanizing movements
• Self-contamination • Compromised disease
• Increase in stress hormones cognitive . Cancer partially delete the uniqueness and individuality of person who wearing
level(adrenaline, performance . Diabetes the facemask as well as the connected person [491.Social connections
noradrenaline and cortisol) . Alzheimer disease and relationships are basic human needs,which innately inherited in all
• increased muscle tension . Exacerbation of people,whereas reduced human-to-human connections are associated
• Immunosuppresslon existing conditions
and diseases with poor mental and physical health [50,511. Despite escalation in
• Accelerated aging technology and globalization that would presumably foster social con-
process nections,scientific findings show that people are becoming increasingly
. Health deterioration more socially isolated,and the prevalence of loneliness is increasing in
. Premature mortality last few decades[50,521.Poor social connections are closely related to
3
B.Vmnshetboim Medical Hypodwses 146(2021)110411
isolation and loneliness,considered significant health related risk fac- exacerbating the major health issues including hypertension, cardio-
tors[50-53]. vascular disease,diabetes,cancer,Alzheimer disease,rising anxiety and
A meta-analysis of 91 studies of about 400,000 people showed a 13% depression states,causes social isolation and loneliness and increasing
increased morality risk among people with low compare to high contact the risk for prematurely mortality[47,48,51,56,661.
frequency (53]. Another meta-analysis of 146 prospective studies
(308,849 participants)found that poor social relationships was associ- Coni lillsion ti-__ :<
ated with 50%increased mortality risk.People who were socially iso-
lated or fell lonely had 45% and 40% increased mortality risk, The existing scientific evidences challenge the safety and-efficacy of
respectively. These findings were consistent across ages, sex, initial waring`facemask as"preventiveintervention for`COVID 19 Tlie data
health status,cause of death and follow-up periods [521. Importantly, suggest that both medical and'non medical£acemasks'aze ineffective Yo�
the increased risk for mortality was found comparable to smoking and block human=Eo=human=transmission of viral and�nfecnous diseasesiicli
exceeding well-established risk factors such as obesity and physical SARS-CoV 2'and COVID;19,suppoihng agaznst theusage of`facemasks,
inactivity[521.An umbrella review of 40 systematic reviews including Wearing faceinasliS hasbeen demonstrated to havesubstanhal adverse
10 meta-analyses demonstrated that compromised social relationships phyAiological and psychological—effects.These Include hyp6id hyper
were associated with increased risk of all-cause mortality,depression, capnia;shortress of breath,increased acidity and.tomcity,'acuvahon'of'
anxiety suicide,cancer and overall physical illness[51]. fear and stress,response rise in stress}hormones mmunosuppression 7
As described earlier, wearing facemasks causing hypoxic and hy- fatigue;headac`h s decline in.cognihve performances predisposition f6i-
percapnic state that constantly challenges the normal homeostasis,and viral nd infectious illnesses, chronic stress, anxiety and..'depressiori;-
activates"fight or flight'stress response,an important survival mech- Long-term consequences'of-wearing facemask ctm-icause health"deteri
anism in the human body [11-13].The acute stress response includes oration developing and"progression of chronic diseases and premawrizij
activation of nervous,endocrine,cardiovascular,and the immune Sys- death:Governments'policy makers and,health organizations should
terns [47,54-56]. These include activation of the limbic part of the utilize`prosper and sctenttfic evidence based approach with-respect-toll
brain,release stress hormones(adrenalin,neuro-adrenalin and cortisol), we g facemasks e-when th latter isiconsidere'd,ds preventive-inter-
changes in blood flow distribution (vasodilation of peripheral blood 1ventitiu for public healtli — '=-
vessels and vasoconstriction of visceral blood vessels)and activation of ~` - s __.' ,
the immune system response (secretion of macrophages and natural CRediT authorship contribution statement
killer cells) [47,481.Encountering people who wearing facemasks acti-
vates innate stress-fear emotion,which is fundamental to all humans in Baruch vainshelboim:Conceptualization,Data curation,Writing-
danger or life threating situations,such as death or unknown, unpre- original draft.
dictable outcome. While acute stress response(seconds to minutes)is
adaptive reaction to challenges and part of the survival mechanism,
chronic and prolonged state of stress-fear is maladaptive and has Declaration of Competing Interest
detrimental effects on physical and mental health. The repeatedly or
continuously activated stress-fear response causes the body to operate The authors declare that they have no known competing financial
on survival mode, having sustain increase in blood pressure, pro- interests or personal relationships that could have appeared to influence
inflammatory state and immunosuppression[47,48]. the work reported in this paper.
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