CAREMEDICS FAMILY HEALTH ORGANIZATION STATEMENT ON MASK EXEMPTIONS

AUGUST 21, 2020

We, the physicians of CAREMEDICS FHO, believe in providing the best care to our community and patients. In light of the new universal masking recommendations set out by Ottawa Public Health, and multiple phone calls from concerned patients regarding universal masking, we have evaluated the current available evidence. To date, the current evidence for masking during COVID 19 outweighs any theoretical risks.

As such, we fully advocate for universal masking, in addition to maintaining a 2 m physical distance at all times and diligent frequent handwashing (or the use of an alcohol based hand sanitizer). Inappropriate medical exemptions have the potential to inadvertently hasten the

spread of COVID19 in our community.

However, there are exceptional circumstances, which do warrant consideration of a mask exemption. 

These include:

• children less than 2 years of age

• children less than 5 years of age (cognitively or developmentally) who refuse to wear aface covering and cannot be persuaded to

• people with PTSD who are triggered by a face covering

• extreme agoraphobia/asphyxia phobia (which is longstanding predating COVID 19)

• people with cognitive impairment, intellectual deficiency or autism spectrum disorder for who wearing a face covering will cause severe distress or disorganization

• people unable to apply or remove a face covering without help

• people, especially children, with severe sensory processing disorders

• patients with facial deformities that are incompatible with mask wearing

• people with accommodations under the Ontario Human Rights Code or the Accessibility for Ontarians with a Disabilities Act (that would pertain to wearing a face covering i.e

immobilization in a wheelchair would not qualify)

If you believe, based upon the above criteria, that you warrant an exemption, or if you want to discuss your concerns with your physician, please call the clinic for a virtual appointment.

We strongly advise people who are exempt from wearing a face covering to avoid all indoor public spaces.

Please Note:

• ASTHMA is NOT a contraindication to mask wearing

• COPD (including chronic bronchitis and emphysema) is NOT a contraindication to

mask wearing

• Discomfort caused by the mask is not an exemption.

• Acne caused by the mask is not an exemption.

• Patients wearing oxygen can wear a mask over top of their nasal cannula. It does not impair their ability to continue to wear their oxygen, nor lower their oxygen levels.

Masks with exhalation valves should NOT be used because they allow infectious respiratory droplets to spread outside the mask and thus do not protect others from COVID-19 and do not

limit the spread of the virus. As such, patients presenting to our clinic with masks with exhalation valves will not be permitted in without changing their mask to a face covering without exhalation valves.

Patients With Respiratory Illnesses Such as Asthma and COPD:

“There is NO evidence that wearing a face mask will exacerbate an underlying lung condition.” The Canadian Thoracic Society (the professional society that provides asthma and COPD guidelines for physicians and patients)

Individuals with chronic pulmonary illnesses such as asthma and COPD are at higher risk for severe disease from COVID-19. Having a chronic breathing problem is a compelling reason to

wear a mask, rather than be exempt from wearing one. As such, we will not be providing exemptions to patients with chronic lung disease.

Face Masks and the Feelings of Anxiety or Difficulty Breathing with a Facemask:

Wearing a face mask may create feelings of anxiety and panic (including shortness of breath, which is a symptom of anxiety). If you cannot tolerate wearing a facemask due to these symptoms, it is advised that you:

• try different mask formats and materials to find one you feel is more tolerable

• try using the mask for short periods of time around home, slowly increasing the

duration of wear at home until you can tolerate its use

• see any counsellor for support, tips, advice, desensitization, Cognitive Behavioural Therapy

• if all else fails, avoid public indoor spaces and any circumstances in which physical distancing is not possible.

**Thank you for your understanding, your patience and your compassion**

References:

1. Canadian Thoracic Society recommendations regarding the use of face masks by thepublic during the SARS-CoV-2 (COVID-19) pandemic June 2, 2020 2. Lung Association: Non-Medical Face Masks and COVID-19 www.lung.ca/covid19 3. Joint Statement on Importance of Patients with Chronic Lung Disease Wearing Facial Coverings During COVID 19 Pandemic (this is a joint statement by the American College

of Chest Physicians, the American Lung Association, the American Thoracic Society and the COPD Foundation) July 17, 2020