Getting Used to Working in Masks

Young woman putting on a disposable surgical face mask

Getting Used to Working in Masks

By Cal Cates and Kerry Jordan

Some of us are having a hard time adjusting to the mask lifestyle, and massage therapists (and many others) are worrying about hypoxia, hypercapnia, and hypoxemia. 

Research shows that it is seriously unlikely you are at risk of developing any of these conditions from the kind of mask-wearing that you should be doing in your duties as a massage therapist.

“We don’t have ERs full of people who wore a mask and became sick because they were wearing a mask,” said William Schaffner, MD, an infectious diseases specialist at Vanderbilt University Medical Center. CO2 (carbon dioxide) and oxygen deprivation are not the big issue with masks. “The big issue with masks,” Schaffner says, “is that people aren’t wearing them.”1

Let’s review a point on which it seems most people agree. First, the coronavirus is primarily transmitted person to person via respiratory droplets. The best way to limit and even stop the spread is to do what we can to decrease droplets transmitted between people.

Basic physics tells us that wearing a mask decreases the amount of spit that leaves your face and moves into the air when you breathe, talk, cough, or sneeze. Even before COVID-19, when you coughed or sneezed, chances are good that you coughed or sneezed into your elbow or at least into your hand. It’s commonsense and it’s just polite to not blow your droplets on those around you, whether you think you have a disease or not.

This brings us to a key point. If you are going back to work as a massage therapist, you must make decisions based on the assumption that you and your clients are infected. This is not because we think going back to work will result in infection. It’s because assumption of infection is a standard way to take the best possible precautions to prevent the spread of disease. 

According to multiple sources, ranging from the World Health Organization (WHO) to the Centers for Disease Control and Prevention (CDC) to the American Lung Association, all of the data support mask-wearing as a key public health measure to decrease viral spread. The numbers vary, but we can’t ignore the wild card of “asymptomatic transmission” either. Some say it’s as high as 45 percent and others “rare,” but there are no expert voices saying that asymptomatic transmission is not worth our consideration. No amount of temperature-taking, screening questions, nor preparation will control for these variables.

There are lots of suggestions out there about what kind of mask massage therapists should wear while providing care. The gold standard N-95 mask is 95 percent effective at keeping the wearer free of inhaling viral particles, but there’s really no reason massage therapists should be wearing them. In addition to the need for a legitimate “fit test” and actual practice wearing and working in these masks for them to be effective (despite their availability on the open market), they are still best reserved for front-line workers in high-risk settings.

If you’re considering (or even already own and are using) KN-95 masks, you should know that they can range in effectiveness from filtering between 80 and 90 percent of particles to as low as 28 percent. In addition, during the first week in May, more than 65 of the 80 authorized manufacturers of KN-95 masks in China were banned from importing them to the US due to poor quality.

A majority of massage therapists work in what the US Occupational Safety and Health Administration (OSHA) calls “medium-risk” environments. Surgical masks are perfectly adequate for our work.

Surgical masks are not the same as the masks you buy at Home Depot or other places intended to create a simple barrier for large particles like dust. When you buy your masks, you should look for surgical masks intended for “medical use.” The US Food and Drug Administration (FDA) provides good guidance about characteristics for which you should look when buying. Be sure to look specifically at their answer to the question “I am interested in manufacturing surgical masks for COVID-19. What do I need to do?” If you have already purchased surgical masks and are wondering, you can test them.

Cloth face coverings are often a bit less effective, but still much, much better than no mask at all. The American Lung Association reminds us that “even a 50 percent reduction in viral transmission is statistically important.” The WHO is clear: “While wearing a medical mask, make sure it fits properly and that it is tight enough to contain droplets, but also to allow you to breathe normally. Do not reuse a disposable mask and always change it as soon as it gets damp.” Pretty simple.

The American Lung Association goes on to explain that surgical masks are designed to be breathed through and there is no evidence that low oxygen levels occur as a matter of course. There is some evidence that prolonged (many hours with no break) use of N-95 masks in people with preexisting lung disease could cause some buildup of carbon dioxide levels in the body, but even these are often sub-clinical levels.

Health experts say the solution isn’t forgoing masks altogether, but wearing ones better suited to the individual. Doctors say various conditions don’t excuse people from wearing masks, but rather emphasize the importance of wearing one correctly. It is recommended that people with pre-existing health conditions who have mask-wearing concerns discuss this with their health-care providers. In addition, it’s important to note that there is absolutely no scientific evidence that wearing a mask or physical distancing weakens the immune system.2

If you have a pre-existing, diagnosable lung/pulmonary condition, it’s not advisable that you work in an environment that will put you in close proximity with other humans while COVID-19 is active in your community. This lands some massage therapists in a tough spot if you can’t wear a mask and keep it on for the duration of the client encounter. A doctor’s note or other form of exemption from mask-wearing does not make it safe for you or your clients to not wear a mask. The medical exemption is intended to “protect” you from legal charges, not from disease.

Countless expert sources discuss the options for people with trauma histories, asthma, and other pulmonary conditions and also the very real panic and claustrophobia that many people experience when they are not accustomed to wearing masks. It’s not the mask that makes it hard for many people. It’s their fear that the mask will make it hard. When we’re afraid, we breathe shallow, quick breaths. When a mask makes us feel we are in an artificially enclosed space, the fear intensifies and our ability to make use of oxygen decreases. We need practice and we won’t get practice if we keep taking off our masks.

Podcast Resources About Mask Use


1. Stacey Burling, “Some People Think Face Masks Are Dangerous. Can That Be True?” Philadelphia Inquirer, June 23, 2020; accessed July 2020,

2. David Hill, MD, “From the Frontlines: The Truth About Masks and COVID-19” American Lung Association, June 18, 2020; accessed July 2020,

author bio

Cal Cates and Kerry Jordan are honored to work with Healwell (which is a big team of many people) providing massage therapy and education in hospitals around the Washington, DC metro area and around the world. Together, they have more than 35 years of experience in massage therapy with a focus on serving adults and children living with medically complex conditions, both in and out of the hospital.



The article wasn't clear about wether we should be asking clients to wear masks.  Should they do so during the entire massage?  Only while supine.? Just when they want to?


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