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December-B 2020, Volume 70, Issue 12

Primary Care Diabetes

Mask fatigue

Sanjay Kalra  ( Department of Endocrinology, Bharti Hospital, Karnal, India. )
Sandeep Chaudhary  ( Department of Endocrinology, NMC Hospital, Dubai, United Arab Emirates )
Viny Kantroo  ( Department of Pulmonology, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi, India )
Jatin Ahuja  ( Department of Infectious Diseases, Dr Ahuja’s ID Clinic, New Delhi, India. )


Extended wearing of mask, which has become a part of routine life, has led to the emergence of ‘mask fatigue’. Mask fatigue is defined as the lack of energy that accompanies, and/or follows prolonged wearing of a mask. This communication describes the various aspects of mask fatigue, and shares pragmatic tips on its reduction. This discussion is relevant to all health care professionals and to general public to some extent, in the present scenario.

Keywords: COVID 19, hypoxia, mask, N 95, fatigue, CO2 retention




COVID-19 is here to stay.1 With this new pandemic, we have had to modify our lifestyles, focusing on community and personal hygiene. One integral tenet of hygiene is the necessity of wearing masks. All adults and adolescents are now expected to wear masks in public places. As health care professionals, we are duty bound to encourage the public to follow these norms, and other aspects of COVID 19 prevention. It is also incumbent upon us to practice what we preach, and hence wear masks in work places and crowded areas. Health care professionals are more prone to this type of fatigue due to nature of extended hours of work, talking needed to assess and manage the patients and especially use of filtering face piece (FFP) respirators.


The mask as a helper or a hazard?


A mask acts as a protection against the professional hazards of contracting airborne or droplet infection. Paradoxically, however, it is considered as an impediment to professional work as well.2-4 This is because of the newly emerging condition, mask fatigue.


Mask fatigue


The phrase ‘mask fatigue’ can be used in multiple contexts. Getting tired of using masks, and becoming tired due to the use of masks, both can be described as mask fatigue. We define mask fatigue as the lack of energy that accompanies, and/or is a consequence of extended use of a mask. The mere lack of compliance or reluctance to wear a mask, or easy fatigability, does not qualify as a disorder. Mask fatigue may be considered as a disorder if it interferes with physical, mental, psychological, or social functioning in healthy adults.

Table-1 describes the various etiopathophysiologic and clinical aspects of mask fatigue. There is published evidence which shows that extended wearing of mask impairs functioning of health care professionals.2-5 Health care physicians relate anecdotes which highlight the difficulty associated with wearing masks, and with ensuring that patients and their carers wear masks as well. The situation is compounded by differing guidelines and varying information on the need to wear masks.6


Mask fitness


Table-27 shares a few pragmatic tips to help minimize mask fatigue in health care workers. Simple rules if followed, can help minimize the fatigue. The most important tip to prevent this fatigue is to act early. The right choice of mask type depending upon area of work, fit, material, the correct way of donning it, and a graded approach to work while wearing it, help prevent mask fatigue. Primary prevention of mask fatigue also includes inculcating the right attitude to wear a mask, i.e., to consider these new norms as friend rather than as a foe.




Masks have become an essential part of our lifestyle, and our routine. As health care workers, it is our job to encourage and promote compliance to wearing a mask among the public, and practice it ourselves, especially in the wake of rising evidence of airborne route of transmission for COVID-19.8 Understanding the concept of mask fatigue, and ways to limit it, will help us in being vigilant in taking appropriate measures to prevent it.




1. Salahuddin N. The COVID-19 pandemic. J Pak Med Assoc. 2020;70: S4-6.

2. Rosner E. Adverse effects of prolonged mask use among health care professionals during COVID-19. J Infect Dis Epidemiol 2020; 6:130

3. Li Y, Tokura H, Guo YP, Wong AS, Wong T, Chung J, et al. Effects of wearing N95 and surgical facemasks on heart rate, thermal stress and subjective sensations. Int Arch Occup Environ Health. 2005;78:501-9.

4. Smith CL, Whitelaw JL, Davies B. Carbon dioxide rebreathing in respiratory protective devices: influence of speech and work rate in fullface masks, Ergonomics, 2013; 56:5, 781-790

5. Tian Y, Tu X, Zhou X, Yu J, Luo S, Ma L, et al. Wearing a N95 mask increases rescuer's fatigue and decreases chest compression quality in simulated cardiopulmonary resuscitation. Am. J. Emerg. Med.. 2020 May 27. pii/S0735675720304241

6. Rab S, Javaid M, Haleem A, Vaishya R. Face masks are new normal after COVID-19 pandemic. Diabetes Metab Syndr: 2020;14:1617-9.

7. Roberge RJ, Coca A, Williams WJ, Powell JB, Palmiero AJ. Physiological impact of the N95 filtering facepiece respirator on healthcare workers. Respir Care. 2010;55:569-77.

8. Center for Disease Control and prevention, How COVID-19 Spreads. how-covid-spreads.html, accessed 6th Oct 2020.


Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: