This article is by Amy Hornblas, of Williston. She is a health educator associated with vtmasksurvey.com.

Over the past three years an entire infrastructure of mask policies has been built across various community settings in response to Covid. Mask requirements have, and continue to be, imposed on people of all ages and abilities, without any of the basic protections offered to employees who wear an N95-style respirator at work.

One would hope that the end of the Federal Emergency on May 11th would also mean an end to, or at the very least an evaluation of, the numerous emergency use-approved products, such as masks, that were introduced without proper scrutiny. However, that is not likely. According to the U.S. Department of Health and Human Services, the Food and Drug Administration’s Emergency Use Approval for “COVID-19 products (including tests, vaccines, and treatments) will not be affected” by the ending of the Federal Emergency.

Mask requirements are not going away on their own. However, there are protections in place for who are people expected to wear masks, and very good reasons for them. In the rush to implement mask policies, the harms of masks and the need for protections has been ignored at all levels. Now that the urgency is over, it is time to consider them at last.

Do Students Deserve Protections?

School mask requirements continue to this day, and may pop up at any time at a school in your
community under the guise of special education protection laws. Using guidance from the federal
government, at least one school in Vermont has continued to require students to wear face masks
again this year. This is despite the fact that, upon request, both the school’s supervisory union and the Agency of Education confirmed they do not possesses any evidence masks are safe for children. What responsibility does a school have to their students when requiring them to wear an unregulated and untested mask in order to attend school?

September 17, 2020: “Hi – I have a kiddo with ezema – he has been reacting to wearing a mask for the 2 full days he is in school (high school student), Mom is currently at the ER with him right now as his eye is swollen shut and he has hives all over his face.” (Source: Emails obtained by a Freedom of Information Request for mask-related correspondences to and from a supervisory union in Vermont)

Within a month of school re-opening in 2020 for half-time instruction, one high school student was seen in the emergency room with a severe skin reaction to wearing a mask at school. Skin irritation is a common side effect of wearing respiratory protection over the face for prolonged periods, especially for people with a predisposition.

Upon learning of an injury caused by a newly-adopted school health policy, one would expect school personnel would concentrate on the well-being of the student, and take steps to prevent others from being similarly harmed due to pre-existing skin conditions, or irritants in the masks themselves. According to the email, the emergency room suggested the student wear a neck gaitor to school instead of a mask, since “he wears one in baseball without reaction.” However, the school nurses decided one gaitor would not suffice, and required him to wear two neck gaitors when he returned to school.

Perhaps the nurses’ clinical decision to require the student to double-up their gaitors was based upon a Washington Post article sent to them by the superintendent a few weeks previously. The article did not address safety concerns, and concluded that wearing a neck gaitor may be worse than wearing no mask at all.

It does not appear that option the option of wearing no mask at all, at least long enough to heal, was considered.

Evidence of Harm to Employees

“The kitchen staff does admit that occasionally masks are removed from the nose area to allow the wearer to breath with less difficulty.” (FOIA Released Email between School Administrators, September 11, 2020)

Students weren’t the only ones experiencing difficulties with the masks as soon as school began in the fall of 2020. In the same school district cited above, administrators were made aware that staff working in the school kitchen had difficulty breathing with the masks over their noses.

In early September, one would expect that it was especially hot in the school kitchens across Vermont. Face masks are known to increase body temperature, and this is a serious issue for employers to consider. Guidance from the Occupational Safety and Health Administration (OSHA) provides specific recommendations for the supervision of face mask use in hot environments in response to Covid:

“Employers with workers in a setting where face coverings may increase the risk of heat-related illness indoors… may wish to consult with an occupational safety and health professional to help determine the appropriate face covering/respirator use for their setting.”

Perhaps the heat was exacerbating the issue, the employees had underlying health conditions (perhaps even unknown to them), or they were simply having difficulty breathing as a result of wearing a mask. Whatever the reason, it does not appear the complaint was addressed in that kitchen, nor was there a discussion about assessing the situation in other kitchens in the district. This complaint was also met with a similar requirement for those who complained to “double-up” by wearing both a face mask and a shield, further restricting the airflow to the mask.

An Employer’s Responsibility to Assess the Hazard

Any time the respiratory system is inhibited by placing a filter over the face, there will be health hazards to consider. This is the basis of the original respiratory protection handbook for supervisors published by OSHA and Los Alamos Scientific Laboratory. Protecting the respiratory system from the hazards of restricted breathing and covering the face is the top concern when wearing a respirator. Any time an employee wears a respirator at work, for any reason, the employer is responsible to provide proper supervision.

According to Occupational Safety and Health Administration (OSHA) standards, even if a respirator, such as an approved n-95 or dust mask, is used voluntarily by an employee while at work, the employer is responsible for determining that such respirator use will not in itself create a hazard. They are also required to provide their employees with a form documenting the fact that there are hazards to consider, and how to properly care for the equipment. (1910.134(c)(2)(i))

Are there any employers in Vermont who are aware of, let alone following, this “voluntary use” standard today? If they would follow this one requirement, and conduct a simple hazard assessment, as recommended by OSHA, that step in and of itself would greatly improve the employers’ understanding of the hazards so that they could better ensure their worker’s health and safety when developing policies.

However, some employers and public establishments are going a step further, actually requiring employees, as well as patients, customers, and other guests, to wear a variety of “face masks” for entry. The Vermont Department of Health and OSHA have not developed their own guidance, but are are currently still referring to CDC guidance on face masks, and this is the guidance referred to by the schools, medical facilities, and other public establishments with mask requirements.

The CDC has explicit instructions on its Types of Masks webpage. It explains that respirators provide better protection than other types of masks because they are tight-fitting, which is of course, essential when it comes to blocking the inhalation of particles. However, they also warn that tight-fitting respirators should NOT be worn (their capitals), first and foremost, “if it is hard to breathe while wearing them.”

By following the CDC’s advice and allowing people the option of wearing an EUA “face mask” with no known safety or effectiveness, instead of a tight-fitting respirator with some proven effects at filtering the incoming air (if worn properly), employers are avoiding the majority of the OSHA respiratory protection standards. OSHA standards require a medical screening for employees required to wear respirators, as well as fit testing and training. Employers are also required to assess the need, and address complaints, on a continual basis.

These OSHA respiratory protection standards provide a framework designed to guide employers through the hazard assessment, mitigation, and implementation process that takes into account a worker’s safety and the steps necessary to make sure the device is actually providing the protection it is meant to. Is totally ignoring these steps the responsible thing to do?

The Need for Safety Regulations

“Using a respirator may place a physiological burden on employees that varies with the type of respirator worn, the job and workplace conditions in which the respirator is used, and the medical status of the employee.” – OSHA Standard 1910.134(e)

An employer following the OSHA standards which apply to required respirator use first needs to determine that a hazard is present in sufficient quantity to be harmful.

Secondly, before asking their employees to take on the burden of wearing a respiratory protection device, they are required to try all other environmental strategies.

Third, they must provide protective equipment that is fit for the exposure limit:

“While it was not a violation to require a face covering in some relevant short-term settings pre-COVID, it is an OSHA violation when non-mitigating apparatuses are being required and touted as personal protection… It is dangerous to put employees in non-mitigating kit when they have been told to consider themselves safe and protecting others.” – Megan Mansell, Accommodating Chaos, pages 21-22

Masks Protect Who?

If employers had followed the regulations concerning respirators, they would have realized that neither “face masks” nor respirators are able to protect a person from releasing Covid particles into the air. The latest and best scientific research continues to confirm what we already knew before the pandemic: Wearing a mask, including an n-95, has never been proven to protect others from respiratory viruses.

One needs to look no further than the American Society for Testing Materials, the regulatory agency the The CDC relies upon to set the standards and test the effectiveness of protective equipment.

ASTM confirms that all face coverings, including NIOSH-approved N-95’s, have no known effectiveness in regards to protecting others:

“There are currently no established methods for measuring outward leakage from a barrier face covering, medical mask, or respirator. Nothing in this standard addresses or implies a quantitative assessment of outward leakage and no claims can be made about the degree to which a barrier face covering reduces emission of human-generated particles.”

Respirators, such as N-95’s, may have some effectiveness when it comes to protecting the wearer in medical settings, but only if worn properly, for short periods of time, by trained professionals in sterile environments.

Vaccine or Mask Policies

The infrastructure of mask requirements in response to Covid is increasingly being tied to vaccine status. Schools in Vermont were encouraged to base mask requirements on vaccine rates when returning to school in the fall of 2021. Students were told their schools could drop the mask mandates once their Covid vaccination rates reached 80%.

OSHA has created updated standards which describe Vaccine or Mask policies which are to be used specifically in health care facilities and settings. Staff are required to stay up to date on their vaccines, or face mask and/or testing requirements in order to keep their jobs.

Vaccine or Mask policies are not new. In some medical facilities in Vermont and elsewhere, there were policies in place prior to 2020 which required staff to wear masks if they did not receive the annual flu vaccine.

Employers in sectors other than healthcare are also being encouraged by OSHA’s new guidance to consider similar vaccine-related policies. There is even an enforcement arm under construction for this expansion into non-medical settings.

“What they are attempting to do, still, in a round-about way, is create a permanent Covid-19 standard. That means permanent testing, permanent quaranteen, permanent distancing, permanent face masks, permanent vaccines. Think about that.

“…the Supreme Court has had to step in and rule against OSHA because they are going so rogue, they are literally trying to create a permanent Covid-19 standard- permanent- on all businesses in the United States, which would affect all employees in the United States.” (Tammy Clark, America’s Frontline Industrial Hygienists & Multidisciplinary Support Summit)

Responsible Supervision

Most employers would like to provide proper supervision, but they don’t know how. They have been put in an impossible position: asked to require masks, even if they have no proven effectiveness, while making sure that a device which restricts breathing, and has no long-term safety data, is not causing a hazard in and of itself.

The task is daunting, since supervision of respiratory protection is a highly-developed field, with layers of workplace protections woven through the standards and recommendations. There is a web of safety standards in place in order to protect worker safety, as well as employer liability. A logical place to begin would be by examining and applying as many protections as possible, rather than trying to avoid them.

To Learn More

Specialists in the field are coming to Vermont to fully inform the public of the hazards and effectiveness of masks, as well as the legal protections which are in place specifically to protect us and how to use them to protect ourselves and others.

The Vermont Emergency Forum to Assess the Respiratory Hazards of Masks will be held in Burlington on Friday, May 12th, 2023. This all-day event will begin the process of assessing and addressing the harms of masks, as well as the infrastructure of Vaccine or Mask requirements that has been built over the past three years and government plans to continue these policies beyond the Covid emergency. Registration and other information about The Vermont Emergency Forum to Assess the Respiratory Hazards of Masks can be found at: vtmasksurvey.com