{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T19:06:20Z","timestamp":1784833580217,"version":"3.55.0"},"reference-count":194,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T00:00:00Z","timestamp":1680652800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>As face masks became mandatory in most countries during the COVID-19 pandemic, adverse effects require substantiated investigation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A systematic review of 2,168 studies on adverse medical mask effects yielded 54 publications for synthesis and 37 studies for meta-analysis (on\n                      <jats:italic>n<\/jats:italic>\n                      = 8,641,\n                      <jats:italic>m<\/jats:italic>\n                      = 2,482,\n                      <jats:italic>f<\/jats:italic>\n                      = 6,159, age = 34.8 \u00b1 12.5). The median trial duration was only 18 min (IQR = 50) for our comprehensive evaluation of mask induced physio-metabolic and clinical outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We found significant effects in both medical surgical and N95 masks, with a greater impact of the second. These effects included decreased SpO\n                      <jats:sub>2<\/jats:sub>\n                      (overall Standard Mean Difference, SMD = \u22120.24, 95% CI = \u22120.38 to \u22120.11,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001) and minute ventilation (SMD = \u22120.72, 95% CI = \u22120.99 to \u22120.46,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001), simultaneous increased in blood-CO\n                      <jats:sub>2<\/jats:sub>\n                      (SMD = +0.64, 95% CI = 0.31\u20130.96,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001), heart rate (N95: SMD = +0.22, 95% CI = 0.03\u20130.41,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.02), systolic blood pressure (surgical: SMD = +0.21, 95% CI = 0.03\u20130.39,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.02), skin temperature (overall SMD = +0.80 95% CI = 0.23\u20131.38,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.006) and humidity (SMD +2.24, 95% CI = 1.32\u20133.17,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). Effects on exertion (overall SMD = +0.9, surgical = +0.63, N95 = +1.19), discomfort (SMD = +1.16), dyspnoea (SMD = +1.46), heat (SMD = +0.70), and humidity (SMD = +0.9) were significant in\n                      <jats:italic>n<\/jats:italic>\n                      = 373 with a robust relationship to mask wearing (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.006 to\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). Pooled symptom prevalence (\n                      <jats:italic>n<\/jats:italic>\n                      = 8,128) was significant for: headache (62%,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001), acne (38%,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001), skin irritation (36%,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001), dyspnoea (33%,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001), heat (26%,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001), itching (26%,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001), voice disorder (23%,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.03), and dizziness (5%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>\n                      Masks interfered with O\n                      <jats:sub>2<\/jats:sub>\n                      -uptake and CO\n                      <jats:sub>2<\/jats:sub>\n                      -release and compromised respiratory compensation. Though evaluated wearing durations are shorter than daily\/prolonged use, outcomes independently validate mask-induced exhaustion-syndrome (MIES) and down-stream physio-metabolic disfunctions. MIES can have long-term clinical consequences, especially for vulnerable groups. So far, several mask related symptoms may have been misinterpreted as long COVID-19 symptoms. In any case, the possible MIES contrasts with the WHO definition of health.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Face mask side-effects must be assessed (risk-benefit) against the available evidence of their effectiveness against viral transmissions. In the absence of strong empirical evidence of effectiveness, mask wearing should not be mandated let alone enforced by law.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD42021256694<\/jats:ext-link>\n                      , identifier: PROSPERO 2021 CRD42021256694.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2023.1125150","type":"journal-article","created":{"date-parts":[[2023,4,6]],"date-time":"2023-04-06T06:09:20Z","timestamp":1680761360000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["RETRACTED: Physio-metabolic and clinical consequences of wearing face masks\u2014Systematic review with meta-analysis and comprehensive 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