Wearing a Mask During Indoor Exercise Can Be Fatal

Published at The Brownstone Institute 10 June 2022

A recent article from the Technical University of Munich published in PNAS  reached national  newspapers  in  several   countries  worldwide. The team showed that aerosol emissions increase exponentially with intense physical exertion, indicating that indoor sporting activities result in higher risk of infectious diseases as COVID. The authors suggested the use of face masks, social distancing and ventilation to prevent viral infections during (vigorous) indoor exercise. 

However, the study as presented in the newspaper article does not yet prove a higher risk for viral infections by aerosols emitted by healthy persons during indoor sports. The recommendation wearing face masks during vigorous exercise has not been argued to be safe and effective.

Current available information supports a potential risk of long-term from frequent wearing face masks while there is very low to no beneficial effect in preventing the transmission of a virus. Moreover, based on historical information, the transmission of a respiratory virus by persons without symptoms is questioned. 

The way the article is presented in the newspapers may result in even stricter protocols during indoor sports while a possible increased risk for death wearing masks during vigorous exercise cannot be ruled out. 

In the  study  well-trained athletes show significantly higher aerosol emissions than untrained persons due to their higher minute ventilation which indirectly means a higher risk for infection. The authors state that SARS-CoV-2 virus and other respiratory viruses are transmitted via respiratory particles while breathing or speaking. Transmission of these viruses will depend in part on the rate with which these particles are emitted.

Based on their results and  gyms  being a potential risk for  super-spreading events , the authors recommend special protective measures in indoor sports. In cases of high community infection rates with a low vaccination rate testing, using plastic shields, proper distance, high-quality ventilation systems and wearing masks by fit and young athletes during high-impact training in indoor gyms is recommended. At low workloads only distancing and ventilation systems would be needed.

Another study that was recently published in  Communication Medicine  found that aerosol mass emission during vigorous exercise is not different from speaking at a conversational level. Though speaking generates larger particles and exercise generates smaller particles. Face masks could be used with very vigorous exercise as larger particles are produced with increasing intensity of training. Social distancing is suggested as a preventative measure for COVID-19 for non-exercise-based social interaction and most low-impact exercises as the aerosol particles emitted are too small and could penetrate through the mask. During the experiment five healthy and fit young people of the 25 participants (both sexes) could not complete the very vigorous exercise testing period due to exhaustion.

Using cell phone data of 98 million US people, researchers found the indoor public places  most responsible  for the spread of COVID-19, showing that restaurants and gyms were the places at most risk for super-spreading events. In Chicago, 10% of the places people visited accounted for 85% of the infections, with higher infections in lower income neighborhoods.

Super-spreading events  are characterized by venues when one positive-tested person is traced to many other people testing positive. Several super-spreading events have been in the news where a group of people were tested positive for the SARS-CoV-2 virus after indoor exercising. Remarkably, in most cases the identified index person was either mildly symptomatic or had not yet developed symptoms.

A potential role of  airborne transmission  of the virus by aerosols (droplets < 5 um) in indoor venues is now broadly acknowledged. The smaller lighter aerosols can linger and accumulate in the air and travel long distances on air currents. Previously the dominant view was that respiratory viruses are transmitted by larger droplets that fall on surfaces within about 2 meters or are transferred by people’s hands. Catching the virus from  surfaces  – although plausible – seems to be rare.

Researchers presume  super-spreading events might become larger and more frequent as more transmissible SARS-CoV-2 variants are becoming more prevalent. Smaller, more densely occupied venues could be at greater risk when visited for longer periods and being poorly ventilated.

More than two years into the pandemic, there are  many questions  about an asymptomatic SARS-CoV-2 infection left. Interesting to notice is that in China, at the start of the pandemic, infected individuals weren’t immediately causing exponential local outbreaks. Similarly, many health care workers treating patients at a time that personal equipment was not routinely used remained seronegative. Also living closely together in one house will not assure one will get a positive PCR test and/or symptoms.

It became complex when doctors found  disease symptoms  in asymptomatic people. One example is from Wuhan early in the pandemic, which showed that about one-third of persons with asymptomatic infections had lung changes that were visible on computed tomography scans indicating end organ damage. Another example is the US FAIR Health study that found 19% of cases of Long COVID have resulted from asymptomatic infections. However, symptoms like  Long Covid  or  a loss of smell  could have other origins as well.

To determine the extent to which people without symptoms  testing  positive with either the  PCR test ,  rapid antigen test  or  antibody test  contribute to the COVID-19 pandemic remains a challenge. Especially since the term asymptomatic can be used in various ways. Strictly the definition would be a laboratory confirmed SARS-CoV-2 infection as determined by PCR or serology but with no symptoms related to COVID-19 for the duration of the infection.

The  highly sensitive PCR test  may result in high numbers of  false positive s and false negatives when asymptomatic people are tested. The PCR test can detect the presence of a piece of RNA of the SARS-CoV-2 virus. However, the RNA alone may remain detectable for months after a previous infection resulting in  a positive test. Unfortunately, materials and methods of published articles and reports do not always present the number and type of gene probes and  Ct values  used in PCR tests and could therefore lead to different data among various studies.

Furthermore, it is unknown whether tests used are correctly validated  against viral infectivity  in culture; e.g. detecting a virus that might be able to transmit to another person and cause infection. In many countries a variety of PCR tests have been used with  Ct values > 30  with a risk for high percentages of false positives. Depending on the gene probes used, cross-reactivity with other  (corona)viruses  may occur. Rapid antigen tests have been validated across PCR tests and are therefore prone to high numbers of false positives and false negatives for people without symptoms as well.

Other problems have been in the news, like contamination at sampling and  laboratory sites  where large quantities of tests were handled, shortness in materials using only one gene probe for PCR testing, inexperienced personnel and  unreliable tests  adding up to a possible low quality of diagnosis used, based on which data have been analyzed and presented.

Researchers propose that 20-40% of global infections are asymptomatic .  These data are mostly based on diagnostic tests without analysis  of symptoms  by a medical doctor. A qualification between symptomatic or asymptomatic can be questioned and is in many cases  not notified.  

The discussion continues, as it is  very hard  to detect aerosols outside the laboratory and show that they contain and  transmit the virus  to another person and  cause COVID-19  symptoms.

SARS-CoV-2 virus is one of the most extensively studied immune targets that led to reappraisal of former textbooks. Up to now, a possible cause of symptoms by long-term wearing of masks, frequent use of disinfectant and testing which has never been seen in history before, has not been evaluated.

Harvard Medical School , the  Mayo Clinic  , the  Cleveland Clinic ,  Bangkok hospital  and several medical doctors and  researchers  in the  UK  recommend wearing masks during sports. While face masks may not be comfortable, they can protect against COVID-19 and won’t interfere with your efforts to stay fit during the pandemic, so they say.

The  CDC  urges gym goers to wear masks while working out at fitness centers even during high-intensity exercise, but it’s okay for people who are fully vaccinated to exercise indoors without a mask. However, the  WHO  does not recommend  wearing a mask  during sports. A serious warning was given by  Cambridge news  and other  news outlets  when two Chinese children died while running while wearing a mask.

Results of the poorly studied impact of covering mouth and nose with face masks or other respiratory devices on the physiological and perceptual responses during exercise have been controversial. The small cohorts of participants of those studies were mostly selected persons with athletic abilities, as those with cardio-pulmonary and other disorders were not included.

As a   25% rise  in emergency cardiovascular events among under 40 population in Israel during vaccine rollout and the third COVID-19 wave is noticed, safety and effectiveness for wearing masks (during sports) is an important topic .

Up to now more than  150 studies  do not allow the conclusion that without any doubt the wearing of masks can protect against infection and prevent transmission of a virus. A report of the  ECDC  concludes there is no real evidence in favor of face masks. Furthermore, the number of peer-reviewed publications suggesting the potential harms by frequent and long-term wearing masks, which have been neglected earlier, are piling up.

A recent  study  (not peer-reviewed yet) showed the increase of CO2 while wearing a mask. The CO2 content reached levels above the set risk level of 5,000 ppm (acceptable threshold for workers) for 40.2% of the people wearing medical masks and for 99.0% of the people wearing a FFP2 mask. A  special article  COVID-19 and masks in sports also found an enhancing effect on pCO2 in case of intense physical exercise.

The use of masks in  athletes  causes hypoxic and hypercapnic breathing as evidenced by increased effort during exercise. Another  study  found that wearing a face mask during exercise intensity mostly affects perceptual responses, causing an increase in the rate of perceived breathlessness and overall exertion with limited influence on pulse oxygen, blood lactate, and heart rate responses.

Participants wearing masks  reported marked discomfort , such as feeling hot, humid, and breathing resistance and claustrophobia with higher exercise intensity. While other researchers could  not measure   significant detectable   differences , these signs need to be taken seriously.

Both oxygen and carbon dioxide are the primary gaseous substrate and product respectively, of oxidative metabolism. Variations in the levels of these  gases  outside the physiological range can lead to pathological conditions including respiratory and heart problems, permanent injury, immune suppression, increased aging, and altered gene expression for fertility and death.  Carbon dioxide poisoning  is recognized as an often-forgotten cause of  intoxication  in the emergency department.

A change in these gases, albeit small, may influence a disbalance in the microbial flora, resulting in a weakened immune system that may be noticed by  mask acne  and  mask mouth  with an increased risk for infectious diseases and chronic diseases.

Authors from a study published in  Frontiers in Physiology  raised particular concern for individuals exercising in a hot and humid environment, which can break down the mask and lose the ability to block outgoing viruses and germs, and experience a hot facial temperature and difficulties with breathing.

The results from an observational study published in  Medicine  strongly suggest that mask mandates caused 50% more deaths compared to no mask mandates. It is theorized that hyper-condensed droplets caught by masks are reinhaled and introduced deeper into the respiratory tract could be responsible for the increased mortality rate ( The Foegen effect ).

Also, a  peer-reviewed study  published in April 2022 on mask usage across Europe noted a moderate positive correlation between mask usage and deaths in Western Europe.

A recent review concluded a potential risk for developing  MIES (Mask Induced Exhaustion Syndrome)  by long-term wearing of masks.

The safety of masks used by the general public cannot be guaranteed.  Toxic compounds  like nanoparticles ( graphene oxide , titanium dioxide, Silver, Zinc oxide) and microplastics have been found. Masks delivered by governments have been retracted from the market in The Netherlands, Canada, Germany and Belgium. Recent studies demonstrated the presence of microplastics and nanoparticles in  blood ,  deep lung tissue  and the  liver. Microplastics and nanoparticles deplete the body, by forming bio corona, from essential nutrients, proteins and cells which the body needs to function properly. A recent review assessed the potential  carcinogenicity  of increased exposure to microplastics and nanoparticles in humans.

At this moment there is no proof that long-term wearing of masks during normal life is safe and effective. With a lack of evidence of the transmission of an infectious virus by an asymptomatic person and the effectiveness of wearing masks, mask mandates should be  banned immediately. There is a serious indication for irreversible harm which might increase when people have been vaccinated and might be more sensitive to oxidative stress.

For many years it is known that individuals with a  regular exercise  habit report fewer symptoms associated with upper respiratory illnesses. Data from  epidemiological studies  suggest that regular exercise can protect the host organism from infections like COVID-19 such as influenza virus, rhinovirus, varicella zoster and herpes simplex virus. The remarkable low prevalence of COVID-19 in a Sub-Saharan Africa region is thought to be related to  moving more and sitting less

Instead of focusing on the level of aerosol production and arguing for mask wearing, testing without symptoms, and social distancing, it would be much more beneficial to support exercise in a ventilated environment (with the right humidity and temperature) and healthy living. This would be a better way to manage successfully the next seasonal outbreak of respiratory diseases and prevent a  tsunami of chronic diseases  and  suicides.

Journalists of prominent newspapers/channels could play a supportive role in rebuilding trust in health by delivering honest and balanced science-based information to the public based on critical analyses.

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