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September 26, 2020 4 min read

Since humans have walked the Earth we have never found the need to cover our nose and mouth: the airways that regulate the delicate balance of oxygen/CO2 exchange, which keeps us alive. It may seem a bizarre decision to interfere with this natural process, which has been perfected over millions of years.


Despite the recent surge in usage, the concept of a face mask actually dates back to the 17th century. The rather terrifying costume of a “plague doctor”, designed by Charles de L’Orme in 1630, involved a long beak-shaped mask, which was stuffed with herbs and spices to supposedly protect the physician from miasma or “bad air”. This ancient theory was abandoned by the scientific community in 1880 with the discovery of germ theory. The first medical mask resembling those used today can be accredited to Polish doctor, Johann Mikulicz in 1897 and according to The Lancetit is estimated that by 1923,over two-thirds of surgeons in operating rooms in US and European hospitals woremasks.

While modern face masks have now been applied for more than a century, up until 2020 this was usually for short periods at a time, such as for dusting shelves, sawing timber or during a surgical operation. However, we have now entered unprecedented times, as longer-term use becomes “the new normal”. On Wednesday, Boris Johnson announced an extensive list of situations and places that face masks should be worn in. This includes all public transport, which could of course be hours at a time. All retail and hospitality workers are also advised to cover up at work. For full-time staff this essentially means they will be wearing a mask for a third of their day. Many other countries have even made masks compulsory while walking on the street, a step yet to be adopted by the UK.

While it is important to take measures to protect ourselves from external threats, such as bacteria and viruses, in doing so we must not forget one of the main principles of bioethics taught to medical students across the World: "Primum non nocere" (First, do no harm). The health related side effects of covering our breathing pathway long-term are currently unknown. However, there may be reasons to tread with caution. Concerns surround possible inhilation of plastics in disposable masks, chemicals in synthetic fabrics and pesticides used on non-organic cotton.

A study in Hindawi,one of the biggest peer-reviewed journals, identifies a carcinogenic link to polypropylene (a thermoplastic polymer, which is found in most “medical-grade” face masks), citing a “tumor-like reaction to the polypropylene material that resembled a giant cell tumor of soft tissue".

Washable fabric masks are of course an alternative option and are indeed now a popular choice for many. Yet similar cancer risks surround solvents and chemicals used in synthetic clothing materials. Meanwhile, the track-record of so-called “natural” materials like cotton is not much better. The charity Pesticide Action Network UK is calling for change to this industry, stating that “Nearly 1,000 people die every day from acute pesticide poisoning and many more suffer from chronic ill health, such as cancers and leukemia, neurological diseases and reproductive problems including infertility, miscarriage and birth defects”.

It is important to point out that all of the aforementioned concerns regard onlyenvironmental and skin exposure to these plastics and chemicals. While it is too early to understand the full cellular-level effects of directly covering the airways with these materials and therefore inhaling them into our lungs, there are already established health risks caused by abnormal breathing regulation alone.

A study published in the Oxford Academic Journals suggests that micro-plastics such as polypropylenein masks can actually reduce breathing efficiency, as the hydrophobic surface combines with water droplets in the breath, which “may be responsible for blocking the filtration media pores”. The effect of which cannot be understated:

As explained in The Britannica Science Encyclopedia, “If the quantity of inspired air entering the lungs is less than is needed to maintain normal exchange (a condition known as hypoventilation), the alveolar partial pressure of carbon dioxide rises and the partial pressure of oxygen falls almost reciprocally”. According to PubMed's publication, this “ventilation-perfusion (VA/Q) inequality is the underlying abnormality determining hypoxemia and hypercapnia in lung diseases”.

The recent decisions to step up face mask regulations are far from unanimous and are even considered controversial by some. The scientific debate will no doubt continue but Primum non nocere is medical doctrine. If you must wear a mask, whether by choice or by law, make sure you select the safest option possible. Choose natural, organic and breathable. If your mask does not tick all three of these then you may be doing more harm to your health than good.

Kate Middleton’s facecovering, costing £19.50 including delivery, scores an unexceptional brace. While not organic and with no active anti-bacterial properties, this pretty floral mask has proven popular with those prioritising fashion over health.

Meanwhile, a product that bags an impressive hat-trick on all these attributes is the Evolution of Cotton’ (EOC) face mask collection by Protexa, costing £14.99 with free 1st class postage.

The newly developed sustainable and ecologically sound EOC materials are coated with all natural nano-composites boasting strong anti-bacterial and infection preventative properties, making them vastly more effective at enhancing biosafety than any sustainable and reusable mask on the market.

Meanwhile, the internationally patented EOC textiles are 100% organic and contain no chemical dyes, pesticides or toxins. They’re also hypoallergenic with a pH of 5.5 that matches the body's optimal acidity range. Furthermore, this means they are highly eco-friendly, thus tackling the major issue of eco-waste created by PPE made from synthetic textiles.

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