DOES WEARING A COVID-19 FACEMASK INCREASE THE RISK OF INJURY?
COVID-19 facemasks, while limiting the spread of the virus, also limited the peripheral vision of the wearer. On or about March 19, 2020, there was a nearly national COVID-19 lockdown. A facemask was widely required for appearing in public.
There is recognition in the medical literature that COVID-19 related mouth-nose masks restrict the visual field, even in persons with normal vision. While the governmental requirement to wear facemasks has relaxed, there remains the possibility of future waves of virus and future requirements of facemask use when in public. Some persons continue to wear a mask in pubic for protection. Many health care facilities continue to require the use of facemasks to enter their premises. Therefore, it is important to understand the effect of facemasks on vision and prevent or reduce the hazards created by them.
Do facemasks affect healthy vision? Is there a defined standard of facemask? Do facemasks vary by size and shape? Do different types of facemasks affect the visual field? Does the position of the facemask on the face matter? Is a nose clip on a facemask important? What part of the visual field is affected by the wearing of a facemask? Is the lower peripheral field of vision important for detecting and avoiding nearby hazards? Does wearing a facemask obscure what otherwise might be considered an open and obvious hazard? Should one wear a facemask while driving? These are some of the issues raised and answered in the medical literature.
In Navigating Through a COVID-19 World: Avoiding Obstacles. Klatt and Anson, J. Neurol Phys Ther. 2021, Jan: 45, this University of Pittsburgh-related article states that:
The lower visual field is particularly important for obstacle avoidance and grocery shopping; individuals may don their mask before getting out of the car. Thus, seeing the curb or potholes may be more challenging because of the mask while navigating across the parking lot into the store…. some masks block the lower visual field more than others…
Their research found that some masks impair the lower visual field more than others but did not identify an “optimal” face covering. They tested a bandana, a homemade facemask and a N95 face mask. Their conclusion was the N95 mask wearer lost approximately an additional 3 feet of vision to observe obstacles the wearer approached.
In Face masks, vision, and risk of falls, Kal, Young, Elmers, British Medical Journal, 2020; 371 :m4133 find that:
“…face masks invariably block parts of the lower peripheral visual field…visual information from the lower peripheral field is important for detecting and avoiding nearby hazards, and for placing our steps safely. Wearing a face mask reduces the wearer’s opportunity to use this important sensor information during walking and may therefore increase the chance of tripping or falling.”
In Facemasks block lower visual field in Youth Ice Hockey; Critelli, Deminis, et. al., Frontiers in Sports and Active Living, December 2021.22, discuss:
Wearing a facemask significantly restricts the lower field of view in youth hockey players significantly reducing the player’s ability to visualize the puck.
In Mouth-nose masks impair the visual field of health eyes, Weber, Hohberger, et. al. PLOS ONE, May 2021, found that visual field function was significantly impaired in the inferior-nasal sector when wearing a mouth-nose mask. The article focused on the different types of masks used, the presence or absence of a nose clip and whether the nose clip was correctly used. Home-made masks do not usually have a nose clip. Failure to use a nose clip, or using one in the wrong way, were found to adversely affect the visual field. The face mask is identified as an additional visual field artifact in the lower peripheral field. Other visual artifacts include ocular diseases such as glaucoma.
Many ocular and neurological diseases impair visual field. Their visual field will be even more restricted, if these patients do wear a mask in the wrong way or wear a mask that cannot be worn closely to the nose. An enhanced visual field loss can result in a higher risk of falling. Incidents like falling might increase morbidity and mortality especially in elderly person…A study with young and healthy participants showed an increasing number of pedestrian collisions after constricting the participant’s visual field. Using compensatory mechanisms (e.g. eye movements) reduced these pedestrian collisions, yet the number of collisions was still significantly increased compared to without restriction of visual field.
The article warns against the increased risk of falling and also advises against wearing a face mask while driving:
Therefore, wearing a mask while driving a car might be a reason for preventable accidents, even if the driver is young and healthy and uses compensatory mechanisms.
Brick and mortar stores, among others, remained open during the face-mask requirement period as essential businesses, but, pursuant to the mask mandate, permitted access to only those persons wearing a mouth–nose mask cover.
The medical literature indicates that wearing the COVID-19 facemask restricts the peripheral vision of the customer and causes increased falls and injuries to shoppers and other pedestrians.
Because approximately 60% of in-store purchases are thought to be unplanned, current brick and mortar store interiors are designed to attract the attention of shoppers in order to generate sales. Overstocked products, various displays, end caps and other attractions are designed to capture the customer’s attention. Shoppers in a crowded store do not travel in lanes, but seem to zigzag through the aisles requiring one’s attention to avoid collisions. A shopper’s vision is understandably divided. Walking with one’s lower peripheral vision blocked by the COVID-19 face mask in this environment can obscure a waiting hazard.
Would wearing a face mask be an effective answer to the open and obvious defense used against injured victims? In the modern brick and mortar store, the owners or management of the premises should expect that a customer will not discover or realize the danger of hazards on the walkway, or will fail to protect themselves against it. This is especially true when the victim is wearing a facemask.
“Tripping Hazards Absent” is an entry found on every Store Safety Checklist. The National Safety Council Data Sheet I_495-Reaf 86 states that:
- Tripping hazards constitute one kind of unsafe condition that causes falls. Examples are merchandise left in aisles, extension cords lying across paths of travel, display, platforms, or merchandise racks protruding into traffic lanes…
It is submitted that the prevalence of facemask wearing requires a higher degree of vigilance to eliminate tripping hazards by management of brick and mortar establishments open to the public.
In conclusion, the current medical literature indicates that wearing the COVID-19 facemask can lead to more falling and tripping accidents while on foot and more motor vehicle accidents when the driver is wearing a facemask. This is due to the unexpected loss of the lower peripheral vision of the wearer.
As the wearing of facemasks may become a more common occurrence, especially for the more vulnerable parts of the population, as with any of the medical literature, FRIN (further research is needed) regarding this particular visual artifact.