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Because we cannot see the lower half of the face when someone is wearing a mask, our ability to understand people is reduced considerably.

As stated above, the face provides a universal language for communication, in particular, the communication of emotions. The author did not receive funding for this article. Moreover, a fraction of carbon dioxide previously exhaled is inhaled at each respiratory cycle. How individual face parts contribute to successful emotion recognition. Henrich J. Princeton University Press; Princeton NJ: 2016. Children and adolescents in theCoVid-19 pandemic: Schools and daycare centers are to be openedagain without restrictions. As the emotions of the viewer also follow his expressions, his or her emotions will be blunted as a result. Children are unlikely to be the main drivers of the COVID-19 pandemic - a systematic review. Scheller E., Bchel C., Gamer M. Diagnostic features of emotional expressions are processed preferentially. Fikenzer S., Uhe T., Lavall D., Rudolph U., Falz R., Busse M., Hepp P., Laufs U. In fact, the most basic form of communication between humans is by facial expressions. In addition, exposition training (such as in patients after trauma, patients with panic disorder, and patients with obsessive compulsive disorder, OCD) which implies the conscious provocation of anxiety, are hard to do with a face mask obstructing the perception of the patient's emotions. These closures of schools lasted for a few weeks only (as in Denmark) up to several months (in Italy and many other countries; [15]) and led to marked decreases in educational gains [75], hunger (because school meals were no longer served), increases in child abuse (because children were no longer observed by school staff), and, in general, the risk of scarring the life chances of a generation of young people2 In particular, compared to the surgical mask, the N95 mask led to higher humidity and skin temperatures inside the facemask, higher heart rate, and increased negative sensations, including feeling unfit, tight, itchy, [and] fatigued, as stated by the authors ([46], p. 501). Therefore, at the very least, all school professionals should be aware of the detrimental effects of face masks on face recognition and identification, communication, and social-emotional interaction. Effects of surgical and FFP2/N95 face masks on cardiopulmonary exercise capacity. As mask-wearing has become a normality in many societies, the magnitude with which covering our faces affects our social interactions and ability to recognize and identify other people becomes ever more clear. The general headmaster of the elementary and basic schools (up to grade 10) in Ulm told me that there was a lot of discussion as regards wearing face masks at schools, when the corona-pandemic was roaming through Germany by the middle of March 2020. In Germany, school authorities are rather reluctant to reopen schools after the summer break, but also face increasing criticism for not doing so. Face masks can prevent the spread of the virus SARS-CoV-2, in particular as this spread can occur from people with no symptoms. It is so difficult to give advice as to what haircut should be done when you cannot fully see the face of the customer. The virus can remain airborne for many hours in classrooms.

and transmitted securely. FOIA The authors presented single faces of two different individuals expressing Ekman's six basic emotions (as well as a seventh neutral face expression) behind a 68 grid of 48 white tiles that were sequentially (in random order) uncovered to 94 student subjects, with subjects instructed to stop the uncovering as soon as they recognize the emotion of the face and name it correctly. National Library of Medicine The effect of conventional and transparent surgical masks on speech understanding in individuals with and without hearing loss. During the time of school-closures (from about the middle of March into April and/or May 2020) it became clear that face masks covering mouth and nose in closed public spaces (public transportation, stores, restaurants etc.) Still Confused About Masks? I implemented the general use of face masks for all staff and patients on March 16th 2020, and it soon became clear that they interfere with practicing psychiatry: The decreased emotional observability made the job harder to do. An experimental study on the physical effects of wearing either a surgical or an N95/FFP-2 face mask was performed with 5 healthy male and 5 healthy female subjects, who performed intermittent exercise on a treadmill while wearing the protective facemasks in a climate chamber controlled at an air temperature of 25C and a relative humidity of 70%. Wearing a face mask makes the exhaled air go into the eyes. Gunnery S.D., Ruben M.A. So there is no question as to whether schools should open here this fall. If small children in China, South Korea, Japan, and Vietnam can be taught basic rules of hygiene such as handwashing and careful hygiene behavior, children and adolescents in Western societies should be capable of doing it just as well, including wearing face masks. The headmaster I talked to, in contrast, was quite positive about the possibility to do so in schools, even with young, and challenging, students. [Pandemie. government site. So why not use wearing face masks as a simple tool for social behavior training? Federal government websites often end in .gov or .mil. Face masks block emotional signaling between teacher and learner. We do know, for example, that viral particles in air will be more rapidly diluted outdoors, are sensitive to ambient temperature and relative humidity, and are inactivated by ultraviolet radiation in sunlight. Anonymus Physical distancing, face masks, and eye protection for prevention of covid-19. Accordingly, it has been shown, that emotions which are perceived in faces have an effect on the style, faces are processed in the first place: A face that is perceived to have a negative emotion is processed in a less holistic manner than a face displaying a positive emotion [17]. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV-2). An official website of the United States government. 4The reason for this misguiding advice became clear over time: There were too few masks.

Given that school closures already have come to an end, or will have to end eventually, the question of wearing face masks at schools during the next phase of the pandemic is heavily discussed, particularly, where new cases pop up in spots of waxing and waning infections, or in some states, in the form of additional waves of infection (as for example currently in Israel, Australia and Croatia). Positive emotions become less recognizable, and negative emotions are amplified. This matter should be discussed urgently, since it globally affects more than 1.5 billion students, teachers, and school staff directly, and, in addition, their families indirectly. Careers, Department of Psychiatry, University of Ulm, Leimgrubenweg 12-14, D-89075 Ulm, Germany. By now, the role of experience in the process of perceptual narrowing in face processing has demonstrated enhanced behavioral and neural responsiveness to (1) mother over stranger, (2) female over male, (3) own-race over other-race, and (4) native over non-native faces. Asadi S., Bouvier N., Wexler A.S., Ristenpart W.D. Physical distancing, face masks, and eye protection for prevention of Covid-19. A new coronavirus, SARS-CoV-2, has caused a global pandemic of the disease Covid-19, with as of July 31st almost 300.000 new cases within a single day, more than 17 million confirmed infections, and more than 670.000 deaths [16]. Bombari D., Schmid P.C., Schmid Mast M., Birri S., Mast F.W., Lobmaier J.S. PMC legacy view I also talked to my team about how to communicate with masks, as smiles no longer work. Face masks reduce airborne transmission of the SARS-CoV-2 virus. There is a remaining risk, and the many risks we face in life must always be balanced carefully. Accordingly, from their data, the authors estimated that as many as 230,000450,000 Covid-19 cases had been averted by May 22, 2020. This may also worsen the clinical condition of infected people if the enhanced breathing pushes the viral load down into their lungs, the authors add. As mask wearing by infected individuals reduces transmission risk, and because of the high proportion of asymptomatic infected individuals [68] and transmissions, by now there is a strong case for the effectiveness of widespread use of face masks in reducing the spread of COVID-19. New Scientist 3275, published online March 24th 2020 (. Pain medication (such as non-steroid analgesics) was used in only a few cases.

Mathematics anxiety: separating the math from the anxiety. That is, you get sick from contact with people who are apparently healthy. Emergence of enhanced attention to fearful faces between 5 and 7 months of age. Ekman P., Friesen W.V. There is additional epidemiological evidence for the effectiveness of wearing face masks regarding the spread of the new coronavirus: In Hongkong, 96% of the populations used face mask, and the incidence of new cases in March was 129 per million inhabitants, whereas in Spain, Italy, and Germany, where at the time no face masks were used, the incidence was 2983 (Italy), 2251 (Spain), and 1242 (Germany) per million [31]. The authors comment: Infectious aerosol particles can be released during breathing and speaking by asymptomatic infected individuals. In addition, there is learning. If applied to the use of face masks in school settings, these results suggest that happiness and disgust are less likely to be recognized, whereas fear and sadness may be recognized with a higher probability. The advantage of face-processing as compared to non-face stimuli declines during the second year of life [48]. This measure could contribute greatly to controlling the COVID-19 pandemic, with the benefit greatest in conjunction with other non-pharmaceutical interventions [such as physical distancing] that reduce community transmission ([26], p. 305). Within 30min after removal of the face mask, the pain resolved spontaneously. Lavezzo E., Franchin E., Ciavarella C. Suppression of a SARS-CoV-2 outbreak in the Italian municipality of V, Lawton G. (2020) You Could Be Spreading The Coronavirus Without Realising You've Got It. When strangers meet, who speak two different languages which they do not mutually understand, they can still interpret facial expressions such as smiles and frowns with ease and thereby communicate. I am in no position to rank the settings of psychotherapy, hairdressing or schools in terms of the importance of emotional connection, but these examples do make it clear that schools by no means are the only places where masks can cause difficulties. People without any symptoms may be infected and spread the SARS-CoV-2 virus. UNESCO (2020) Education: From Disruption to Recovery. Learn more Universal use of face masks for success against COVID-19: evidence and implications for prevention policies. Mendel L.L., Gardino J.A., Atcherson S.R. June 25, 2020 (doi: 10.1016/S2352-4642(20)30177-2; accessed 26th June 2020). or non-Duchhenne smiles, involve only the voluntary raising of the corners of the mouth in order to intentionally signal politeness. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. The 7This is why plastic surgeons have proposed to use botox, which can be injected around the orbicularis occuli muscle to prevent wrinkles around the eyes (no crow's feet and no frowning), as a means to prevent mask-induced false social signaling [57]. The human face as a dynamic tool for social communication. Wearing Face Masks Is The new Normal: Know These Tips and Tricks to Avoid Common Side Effects. No masking maximizes exposure, whereas universal masking results in the least exposure ([65], p. 1423, Science Magazine, with permission). Those phenomena increase breathing frequency and deepness, and they may worsen the burden of covid-19 if infected people wearing masks spread more contaminated air. In 2017 researchers from the University of Bielefeld published results from an experimental study of emotion recognition, which clearly demonstrated the importance of the eyes and mouth in the perception of emotions from faces. Eibl-Eibesfeld I. Mnchen; Piper: 1975. Once we direct our gaze to something, this something thereby can become the focus of shared attention, which is a basic mechanism of doing things and solving problems together. School Clusures Caused By Coronavirus (Covid-19) (. Hoehl S., Striano T. Neural processing of eye gaze and threat-related emotional facial expressions in infancy. Young People Are Infecting Older Family Members in Shared Homes. Finally, when it comes to weighing the pros and cons of face masks, general and specific medical and epidemiological considerations are an important part of the equation. COVID-19 Dashboard (2020) COVID-19 Dashboard By The Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU) (. Peltola M.J., Leppnen J.M., Mki S., Hietanen J.K. A recent meta-analysis of Duchenne versus Non-Duchenne smiles found that, overall, Duchenne smiles and people producing Duchenne smiles are rated more positively (i.e., authentic, genuine, real, attractive, trustworthy) than non-Duchenne smiles and people producing non-Duchenne smiles [35]. Responsible advisors wanted to make the most use what was available, and therefore gave masks and other protective equipment to hospitals, where there were in short supply and most dearly needed. So using a mask amounts to doing a favor to others and oneself. But second to the eyes are the regions of mouth and nose, when it comes to attending facial features. Libertus K., Landa R.J., Haworth J.L. Accessibility Fontana Press; London UK: 1872. One of which is simply talking about emotions. In sum, recognition of, and response to, the outward emotional displays of one's peers faces is a critical and necessary component of social interaction in schools. A hairdresser from another city sent me an email, once the lockdown was over such that he was able to restart his business: Yesterday I had two new customers, and I must say that I just had to ask them to go outside so we could remove our masks briefly. Bernstein L. . Nestor M.S., Fischer D., Arnold D. Masking our Emotions: botulinum toxin, facial expression and well-being in the age of COVID-19. Given that the real smile involves the upper and the lower half of the face, with the upper half providing the distinctive frowning that renders a smile a true smile, there is a lot of room for misunderstanding: Face masks block the smile and allow only the frowning to be communicated which may actually be worse than no smile at all! So the decreases in facial emotion communication can be compensated to some degree. Meselson M. Droplets and Aerosols in the Transmission of SARS-CoV-2. This regards schools just as well. Dimberg U., Thunberg M., Elmehed K. Unconscious facial reacions to emotional facial expressions. The Secret of Our Success. The louder someone speaks the more droplets and aerosols are produced. Other such tools of the mind have been widely proposed (music, sports, handcrafts martial arts) to increase attention, executive function, and cognitive control in 412 year olds [21],[22]. Bosch J. A psychotherapist wrote me an email, noting that socially complicated and challenging inpatients in psychotherapy are very difficult to treat, as dissociative states and tensions are much harder to detect early enough so that appropriate interventions can be performed. They start to respond to fearful faces but also respond to happy faces soon thereafter. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Measurements now show that intense coughs and sneezes that propel larger droplets more than 20 feet can also create thousands of aerosols that can travel even further. Since emotions are a major driver of group cohesion, the decreased emotionality, and decreased positive emotionality in particular, may interfere with smooth classroom action. Face to face with emotion: holistic face processing is modulated by emotional state. All of this happens primarily outside of conscious awareness, and hence, is hard to be consciously controlled or even corrected. The physical side effects of face masks have been mostly reported by medical professionals working in surgery and related surgical environments, and science professionals working in labs.

The issue of wearing face masks may serve as a prime example. When these emotional displays are inhibited by face masks, our ability to communicate effectively with one another is reduced and we are primarily left with mimicking negative (frown) emotions. Since they also have more daily contacts than older adults, they are the ones who definitely should wear masks in order to protect others, in particular, if they live with their parents and grandparents [9]. One of the richest and most powerful tools in human communication is the face, from which observers can quickly and easily make a number of inferences about identity, gender, sex, age, race, ethnicity, sexual orientation, physical health, attractiveness, emotional state, personality traits, pain or physical pleasure, deception, and even social status [38]. Just as in psychotherapy, where learning to talk about emotions (and not just having them) is an important mechanism of coping with emotional distress, students and teachers can learn this and the pandemic is a good reason to do so. However, covering the lower half of the face reduces the ability to communicate, interpret, and mimic the expressions of those with whom we interact. Wegrzyn M., Vogt M., Kireclioglu B., Schneider J., Kissler J. Mapping the emotional face. A natural experiment published on June 16th 2020 used the different timing (between April 8 and May 15) of state policies mandating public or community use of face masks or covers in 15 US states plus DC in mitigating covid-19 spread [52]. In contrast, dishonest smiles, which are also called fake smiles, Botox smiles, Pan Am smiles6 I already mentioned the possibility of interpreting only partially-revealed facial expressions wrongly, i.e., misconstruing frowning and the squinting of the eyes without a visible mouth as skepticism rather than true smiling.7 A face masks protects the person wearing it and the person with whom he or she talks. Received 2020 Aug 6; Accepted 2020 Aug 6. Solomon I.H., Normandin E., Bhattacharyya S., Mukerji S.S., Keller K., Ali A.S., Adams G., Hornick J.L., Padera R.F., Jr, Sabeti P. Neuropathological features of Covid-19. Elsevier Public Health Emergency Collection, http://www.uni-ulm.de/klinik/psychiatrie3/index.html, https://www.ucsf.edu/news/2020/06/417906/still-confused-about-masks-heres-science-behind-how-face-masks-prevent, https://theconversation.com/face-masks-what-the-spanish-flu-can-teach-us-about-making-them-compulsory-137648, https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6, https://www.newscientist.com/article/2238473-you-could-be-spreading-the-coronavirus-without-realising-youve-got, https://www.nature.com/articles/s41591-020-0843-2.pdf), https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00818?cookieSet=1, https://download.uni-mainz.de/presse/03_wiwi_corona_masken_paper_zusammenfassung.pdf, https://en.unesco.org/covid19/educationresponse. Was Die Krise Mit Uns Macht Und Was Wir Aus Ihr Machen. Shortly after the major of the German city of Jena (with about 110,000 inhabitants) implemented a face mask use order for the entire city on the 6th of April to fight the spread of the virus (three weeks before this was done for entire Germany), there were no new cases for 9 consecutive days. The Washington Post; 2020. In fact, the virus has been shown to remain airborne for many hours in a closed indoor space such as a classroom [49]. Szablewski C.M., Chang K.T., Brown M.M., Chu V.T., Yousaf A.R.

Johnson K.J., Waugh C.E., Fredrickson B.L. As regards the prevention of Covid-19, additional concerns of wearing face masks have been articulated, for example: In other words: Whereas face masks are intended to ease the burden of the pandemic they may at the same time make it worse under certain conditions. The school's specific situation must also inform any decision regarding face mask use. 2This quote is taken from Couzin-Frankel etal. Lazzarino A.I., Steptoe A., Hamer M., Michie S. Covid-19: important potential side effects of wearing face masks that we should bear in mind. [] Even in diagnostic interviews, face masks interfere with decisions regarding diagnosis and therapy (Bosch, personal communication [11]).

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