The effects of wearing facemasks on oxygenation and ventilation at rest and during physical activity

Background Facemasks are recommended to reduce the spread of SARS-CoV-2, but concern about inadequate gas exchange is an often cited reason for non-compliance. Research question Among adult volunteers, do either cloth masks or surgical masks impair oxygenation or ventilation either at rest or during physical activity? Study design and methods With IRB approval and informed consent, we measured heart rate (HR), transcutaneous carbon dioxide (CO 2 ) tension and oxygen levels (SpO 2 ) at the conclusion of six 10-minute phases: sitting quietly and walking briskly without a mask, sitting quietly and walking briskly while wearing a cloth mask, and sitting quietly and walking briskly while wearing a surgical mask. Brisk walking required at least a 10bpm increase in heart rate. Occurrences of hypoxemia (decrease in SpO 2 of ≥3% from baseline to a value of ≤94%) and hypercarbia (increase in CO 2 tension of ≥5 mmHg from baseline to a value of ≥46 mmHg) in individual subjects were collected. Wilcoxon signed-rank was used for pairwise comparisons among values for the whole cohort (e.g. walking without a mask versus walking with a cloth mask). Results Among 50 adult volunteers (median age 33 years; 32% with a co-morbidity), there were no episodes of hypoxemia or hypercarbia (0%; 95% confidence interval 0–1.9%). In paired comparisons, there were no statistically significant differences in either CO 2 or SpO 2 between baseline measurements without a mask and those while wearing either kind of mask mask, both at rest and after walking briskly for ten minutes. Interpretation The risk of pathologic gas exchange impairment with cloth masks and surgical masks is near-zero in the general adult population.