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What should we tell patients who say that masks cause problems such as lack of oxygen or too much carbon dioxide?

Prolonged wearing of face masks by healthy individuals have not been shown to cause increase in carbon dioxide or lack of oxygen according to information provided by both Vanderbilt University Medical Center and the American Society of Anesthesiologists. However, wearing a face mask may help prevent people with COVID-19 from spreading the virus to others and are most likely to reduce the spread of COVID-19 when they are widely used by people in public settings. Certain medical conditions, such as chronic lung disease, may make breathing with a face mask more difficult, but this is not a result of CO2 retention.

Curi recommends that physicians patiently explain to patients who express concerns or refuse to wear a mask that it is recommended that everyone wear mask when unable to social distance. Practice staff may also remind patients that it is the practice’s policy that everyone who enters the medical office should be masked. The only exception CDC provides is children under 2 or anyone who has trouble breathing, is unconscious, incapacitated, or otherwise unable to remove the mask without assistance.

We recommend that practices have extra face coverings available for patients who arrive without a mask/face covering. If the patient still refuses, depending on the urgency of the visit, it may be safer to reschedule the appointment as a telehealth visit. For patients who need to be seen and continue to refuse to comply or have some medical reason they cannot tolerate a mask, staff should reschedule for an appointment later in the day, such as last visit. Curi recommends you screen these patients and don’t allow them in your practice until a room is ready. When seeing patients who are not wearing a face mask, we also recommend that staff who will be in close contact with the unmasked patient wear face shields along with their mask for added protection.

To minimize unpleasant conversations at your facility, you may wish to address mask policy requirements during pre-visit screening, and ensure that all practice physicians are aware when patients are refusing to wear a mask. To avoid allegations of discrimination, make sure policies are in writing, including any exceptions, and that staff are trained and policies are consistently followed for all patients, staff, and physicians.

CDC guidance to assist with talking to patients can be found at this link: https://www.cdc.gov/coronavirus/2019-ncov/php/contact-tracing/case-investigator-guide.html

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All Curi recommendations are based on current CDC criteria at the time of publication. CDC guidance for SARS-CoV-2 infection may, or may not, be adopted by state and local health departments to respond to rapidly changing local circumstances. Providers should always check with their local health department to see if the CDC’s guidance on any given topic has been modified (particularly if more restrictive) from the CDC’s recommended guidelines. Follow this link https://www.cdc.gov/publichealthgateway/healthdirectories/index.html for contact information to your state/local health department. If local recommendations vary from those of the CDC, and you are unsure what recommendations to follow, then it is safer to follow the more restrictive guidelines/recommendations.