Front. Public Health, 05 April 2023
Sec. Environmental health and Exposome
Volume 11 – 2023 |

Physio-metabolic and clinical consequences of wearing face masks—Systematic review with meta-analysis and comprehensive evaluation

Kai Kisielinski1*, Oliver Hirsch2, Susanne Wagner3, Barbara Wojtasik4, Stefan Funken5, Bernd Klosterhalfen6, Soumen Kanti Manna7, Andreas Prescher8, Pritam Sukul9* and Andreas Sönnichsen10

Background: As face masks became mandatory in most countries during the COVID-19 pandemic, adverse effects require substantiated investigation.

Methods: A systematic review of 2,168 studies on adverse medical mask effects yielded 54 publications for synthesis and 37 studies for meta-analysis (on n = 8,641, m = 2,482, f = 6,159, age = 34.8 ± 12.5). The median trial duration was only 18 min (IQR = 50) for our comprehensive evaluation of mask induced physio-metabolic and clinical outcomes.

Results: We found significant effects in both medical surgical and N95 masks, with a greater impact of the second. These effects included decreased SpO2 (overall Standard Mean Difference, SMD = −0.24, 95% CI = −0.38 to −0.11, p < 0.001) and minute ventilation (SMD = −0.72, 95% CI = −0.99 to −0.46, p < 0.001), simultaneous increased in blood-CO2 (SMD = +0.64, 95% CI = 0.31–0.96, p < 0.001), heart rate (N95: SMD = +0.22, 95% CI = 0.03–0.41, p = 0.02), systolic blood pressure (surgical: SMD = +0.21, 95% CI = 0.03–0.39, p = 0.02), skin temperature (overall SMD = +0.80 95% CI = 0.23–1.38, p = 0.006) and humidity (SMD +2.24, 95% CI = 1.32–3.17, p < 0.001). Effects on exertion (overall SMD = +0.9, surgical = +0.63, N95 = +1.19), discomfort (SMD = +1.16), dyspnoea (SMD = +1.46), heat (SMD = +0.70), and humidity (SMD = +0.9) were significant in n = 373 with a robust relationship to mask wearing (p < 0.006 to p < 0.001). Pooled symptom prevalence (n = 8,128) was significant for: headache (62%, p < 0.001), acne (38%, p < 0.001), skin irritation (36%, p < 0.001), dyspnoea (33%, p < 0.001), heat (26%, p < 0.001), itching (26%, p < 0.001), voice disorder (23%, p < 0.03), and dizziness (5%, p = 0.01).

Discussion: Masks interfered with O2-uptake and CO2-release and compromised respiratory compensation. Though evaluated wearing durations are shorter than daily/prolonged use, outcomes independently validate mask-induced exhaustion-syndrome (MIES) and down-stream physio-metabolic disfunctions. MIES can have long-term clinical consequences, especially for vulnerable groups. So far, several mask related symptoms may have been misinterpreted as long COVID-19 symptoms. In any case, the possible MIES contrasts with the WHO definition of health.

Conclusion: Face mask side-effects must be assessed (risk-benefit) against the available evidence of their effectiveness against viral transmissions. In the absence of strong empirical evidence of effectiveness, mask wearing should not be mandated let alone enforced by law.

Systematic review registration:, identifier: PROSPERO 2021 CRD42021256694.



And yet, people are still donning these futile, toxic, oxygen depleters, infection propagators, and pollution causing face coverings that have set education back decadesYes, I’m passionate about this.

Sadly, an employee in a large hospital system in Michigan reports they’ve worn masks for almost three years. Recently, everyone got an email stating they are finally dropping masking but only for those who got the gene therapy injection and all recommended boosters despite the fact it is now widely known these injections don’t stop transmission or infection, severe illness, hospitalization, or death and are linked to more adverse reactions and death than any other “vaccine” in the history of VAERS.  But, truth be damned.  Keep pushing the face diaper narrative at all costs.

Seriously, ENOUGH of the lunacy!

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