Wearing adequate personal protective equipment (PPE) (e.g FFP3 masks) is important in the front-line of the COVID-19 pandemic. However prolonged wearing of PPE is not comfortable and can have a physical impact on staff. From previous epidemics, such as the 2002-2003 SARS outbreak, we know that the tolerance of FFP3 mask wearing can vary. [1-4]

FFP3 masks also created a higher heat and humidity environment within the masks, leading to skin problems or reactions, and increased discomfort. [2,4]

A cross sectional study by Ong et al (2020), looked into risk factors for de novo PPE-associated headaches and the impact it had on healthcare staff in Singapore during the COVID-19 pandemic [5]. They found that a third of healthcare staff who had headaches associated with mask wearing had a pre-existing underlying headache diagnosis, and 91.3% with this pre-existing diagnosis found that their baseline control of symptoms had worsened as a result.

Previous studies have suggested that shorter periods of wearing N95/FFP3 masks or respirators can help improve tolerance and symptoms experienced [1-4]. However the limited resources of PPE (especially single-use), makes frequent breaks and changing of equipment difficult and not practical.

Anecdotes from doctors working in the front-line in the NHS, have reported limiting food and comfort breaks in order to stay in the masks for longer and conserve resources.

There we recognise that this will contribute to the psychological and physiological effect on our front-line staff.

References:

1. Lim EC, Seet RC, Lee KH, Wilder-Smith EP, Chuah BY, Ong BK. Headaches and the N95 face-mask amongst healthcare providers. Acta Neurol Scand. 2006;113(3):199–202. doi:10.1111/j.1600-0404.2005.00560.x

2. Roberge RJ. Are exhalation valves on N95 filtering facepiece respirators beneficial at low-moderate work rates: an overview. J Occup Environ Hyg. 2012;9(11):617–623. doi:10.1080/15459624.2012.715066

3.Roberge RJ, Coca A, Williams WJ, Palmiero AJ, Powell JB. Surgical mask placement over N95 filtering facepiece respirators: physiological effects on healthcare workers. Respirology. 2010;15(3):516–521. doi:10.1111/j.1440-1843.2010.01713.x

4.Johnson AT. Respirator masks protect health but impact performance: a review. J Biol Eng. 2016;10:4. Published 2016 Feb 9. doi:10.1186/s13036-016-0025-4

5.Jy Ong J, Bharatendu C, Goh Y, et al. Headaches Associated with Personal Protective Equipment - A Cross-sectional Study Amongst Frontline Healthcare Workers During COVID-19 (HAPPE Study) [published online ahead of print, 2020 Mar 30]. Headache. 2020;10.1111/head.13811. doi:10.1111/head.13811