(2020) Community Use Of Face Masks And COVID-19: Evidence From A Natural Experiment Of State Mandates In The US. Brann D.H., Tsukahara T., Weinreb C., Lipovsek M., Van den Berge K. Non-neuronal expression of SARS-CoV-2 entry genes in the olfactory system suggests mechanisms underlying COVID-19-associated anosmia. The protection of teachers, educators,carers and parents and the general hygiene rules do not conflict withthis. Constants across cultures in the face and emotion. Development of attention to faces during the first 3 years: influences of stimulus type. The advantage of face-processing as compared to non-face stimuli declines during the second year of life [48]. 
Darwin C. 3rd edition. 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. When infected people re-breathe air in the mask, their virus load increases. Health 2020, publ. Universal use of face masks for success against COVID-19: evidence and implications for prevention policies. Anonymus Physical distancing, face masks, and eye protection for prevention of covid-19. Given the fact that the very process of learning is facilitated by emotions (this is their main raison dtre), face masks are likely to cause some interference with pedagogy. Peltola M.J., Leppnen J.M., Mki S., Hietanen J.K.
Lyons I.M., Beilock S.L. 
In Germany, school authorities are rather reluctant to reopen schools after the summer break, but also face increasing criticism for not doing so. Physical distancing, face masks, and eye protection for prevention of Covid-19. 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. Mitze T., Kosfeld R., Rode J., Wlde K. (2020) Compulsory Face Masks And Their Effects On The Corona Pandemic. Face masks block emotional signaling between teacher and learner. Headaches associated with personal protective equipment a cross-sectional study among frontline healthcare workers during COVID-19. As the emotions of the viewer also follow his expressions, his or her emotions will be blunted as a result. Before 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. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. How individual face parts contribute to successful emotion recognition. In addition, teachers unions point to the increased risk of elderly teachers to contract a potentially lethal disease. Whereas some studies indicate that children are less likely to infect others [20], [50], some studies find children to be infectious [72]. Ludvigsson J.F. Bilingualism modulates infants selective attention to the mouth of a talking face. Itchy rashes may be caused by irritant dermatitis, caused by the mask and/or the attached rubber strings rubbing the skin of nose and ears [63]. Charles Darwin [18], [19], the founding father of evolutionary theory, was the first to study the evolutionary origins of facial expression of emotions. 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. All of this happens primarily outside of conscious awareness, and hence, is hard to be consciously controlled or even corrected. It helps pupils and teachers to modify their behavior in order to align with social communication and behavioral norms. National Library of Medicine The coronavirus pandemic and aerosols: does COVID-19 transmit via expiratory particles? Because of problems with understanding speech (see below), people may move closer together, without intention, and thereby increase infection risk. Meselson M. Droplets and Aerosols in the Transmission of SARS-CoV-2. Regardless of their size, they all can harbor infectious virus particles and spread viral diseases [2], [5], [6]. Of particular relevance for schools may be the experiences with face masks in hospitals, including psychiatric hospitals, such as the clinic which I am heading. 4The reason for this misguiding advice became clear over time: There were too few masks. Mendel L.L., Gardino J.A., Atcherson S.R. The authors summarize their perspective with a highly convincing drawing, which is reproduced in Fig. 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. 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.) 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. These reactions are typically outside of conscious awareness and occur within half a second [23].
and their configuration are not only used to identify faces but also to infer the emotion expressed by them [10]. In their paper with the same Shakespearian title as this discussion, Eikenberry and coworkers close as follows: Our findings suggest that face mask use should be as nearly universal (i.e., nation-wide) as possible and implemented without delay, even if most masks are homemade and of relatively low quality. Rivett L., Sridhar S., Sparkes D. Screening of healthcare workers for SARS-CoV-2 highlights the role of asymptomatic carriage in COVID-19 transmission. sharing sensitive information, make sure youre on a federal Accessibility Chu D.K., Akl E.A., Duda S., Solo K., Yaacoub S., Schnemann H.S., COVID-19 Systematic Urgent Review Group Effort (SURGE) study authors Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. In the Italian study, 42,5% of confirmed SARS-CoV-2 infections were asymptomatic, and in the British study, 60% had no or only very light symptoms. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The headmaster I talked to, in contrast, was quite positive about the possibility to do so in schools, even with young, and challenging, students.
Anfinrud P., Stadnytskyi V., Bax C.E., Bax A. Visualizing speech-generated oral fluid droplets with laser light scattering. 3Historically, this was also the case one hundred years ago, after the French bacteriologist Charles Nicolle discovered that the agent that caused influenza was much smaller than any known bacterium in October 1918, i.e. Not seeing the bottom half of the face makes it particularly difficult to recognize a mask-wearer's positive emotions pleasure, joy, happiness, amusement, sociability, and friendliness as they are basically communicated by a smiling mouth. This idea, in general, is one of the most important pro-social ideas, which have traditionally been promoted by mandatory schooling systems and the states implementing them. 
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. This is why in the present Covid-19 pandemic, it is not possible to have only those people wear masks who are infectious. Fontana Press; London UK: 1872. 
Bai N. University of California; San Francisco: 2020. Face to face with emotion: holistic face processing is modulated by emotional state. While most people may never have realized, this signal is used by human beings to aid speech understanding. The Expression of the Emotions in Man and Animals. Hiding the lower part of the face with a face mask markedly impairs face recognition and face identification. It is so difficult to give advice as to what haircut should be done when you cannot fully see the face of the customer. 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 The new PMC design is here! Lancet Child Adolesc. Liu Y., Ning Z., Chen Y., Guo M., Liu Y., Gali N.K., Sun L., Duan Y., Cai J., Westerdahl D., Liu X., Xu K., Ho K.-.F., Kan H., Fu Q., Lan K. Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals.
As stated above, the face provides a universal language for communication, in particular, the communication of emotions. Wearing masks is comparatively cheap and easy to implement and supervise. In addition, the verdict on children as regarding their role in infecting other people is not yet in. UNESCO (2020) Education: From Disruption to Recovery. In short, since it is clear that people may be infected and infectious even though they do not yet show any symptoms of Covid-19 which is a peculiar feature of the SARS-CoV-2 virus face masks can definitely mitigate the effects of this especially dangerous virus. Gunnery S.D., Ruben M.A. Johnson K.J., Waugh C.E., Fredrickson B.L. That is, you get sick from contact with people who are apparently healthy. Speech understanding using surgical masks: a problem in health care? Asadi S., Wexler A.S., Cappa C.D., Barreda S., Bouvier N.M., Ristenpart W.D. A true or genuine smile, also known as a Duchenne Face masks may further cause perioral dermatitis with rashes and redness, i.e., an infection of the skin around the mouth because of saliva, sweat, and moist vapor between the mask and the skin. In fact, the virus has been shown to remain airborne for many hours in a closed indoor space such as a classroom [49]. By now, schools plan for the fall on a global scale. Dimberg U., Thunberg M., Elmehed K. Unconscious facial reacions to emotional facial expressions. Fox S.E., Akmatbekov A., Harbert J.L., Li G., J Brown Q., Vander Heide R.S. Jack R.E., Schyns P.G. No data was collected for this opinion paper. This is because facial expressions are a simple universal language that we instinctively understand [25]. Features of faces (such as the size and form of the nose, the color of the eyes etc.) There is a remaining risk, and the many risks we face in life must always be balanced carefully. Prather K.A., Wang C.C., Schooley R.T. Reducing transmission of SARSCoV-2. Moreover, according to the embodied emotions hypothesis first proposed by William James more than one hundred years ago, not physically displaying emotions reduces their experience. As long as there is no vaccine and no specific treatment, the first pandemic of the 21st century is fought with methods from the 14th to the 19th centuries: Distancing, hand washing, and covering mouth and nose with a piece of cloth. Pons F., Bosch L., Lewkowicz D.J. 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. Children and adolescents in theCoVid-19 pandemic: Schools and daycare centers are to be openedagain without restrictions. The study found that the changes in the daily county-level COVID-19 growth rates between March 31, 2020 and May 22, 2020, was associated with a decline in the daily COVID-19 growth rate by 2% by two to three weeks after the mandatory face mask use. At the same time, wearing masks may have physical side effects. Perceptions of Duchenne and non-Duchenne smiles: a meta-analysis. Because the virus is still with us, this is all the more pressing for the following characteristics of the virus and its transmission [4], [8]: Given these pros and cons, it is not clear whether face masks should play a major role in educational settings in times of the current viral pandemic. HHS Vulnerability Disclosure, Help Upon the reopening of schools in April and May, this situation had changed [2], [26], [45], and by June 2020 there was no longer any doubt (see Fig. 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. Eikenberry S.E., Mancuso M., Iboi E., Phan T., Eikenberry K., Kuang Y., Kostelich E., Gumel A.B. At first blush, this may sound as a small effect, but three weeks of cumulated 2% decrease amounts to a decrease of over 40%. Compared with a surrogate Jena (a weighted mix of 4 German cities) as a control, this decline in new cases was 23% [56]. This may provide a breeding ground for bacteria. are an effective means of preventing the spread of the virus and thus, the worsening of the pandemic. 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. Even though in some cultures, a smile may also be taken as a sign of stupidity, shallowness, and even dishonesty, as a large cross-cultural study on social perception of smiling individuals has shown [41]. Fikenzer S., Uhe T., Lavall D., Rudolph U., Falz R., Busse M., Hepp P., Laufs U. 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). Duguid J.P. [15], p. 241], who cite an open letter published in June 2020, signed by more than 1500 members of the United Kingdom's Royal College of Paediatrics and Child Health (RCPCH). Atcherson S.R., Mendel L.L., Baltimore W.J., Patro C., Lee S., Pousson M., Spann M.J. Still Confused About Masks? We therefore attempt to verbally communicate in a more positive manner in order to counteract the lacking smiles (taken from [71], p. 184; translation by the author). Walger P, Heininger U, Knuf M, et al. 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. 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. Movements of the lips and the display of teeth are no longer perceptible by the observer, leaving only the top half of the face for detecting the mask-wearer's emotions. Learn more COVID-19 Dashboard (2020) COVID-19 Dashboard By The Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU) (. Of course, this is the case for the processing of other (non-face) content: Smiling broadens cognition and thereby increases creative thinking [39], whereas criticism causes anxiety and a reduction in creativity. Krys K., Vauclair C., Capaldi C.A., Lun V.M., Bond M.H., Domnguez-Espinosa A., Torres C., Lipp O.V., Manickam L.S., Xing C., Antalkov R., Pavlopoulos V., Teyssier J., Hur T., Hansen K., Szarota P., Ahmed R.A., Burtceva E., Chkhaidze A., Cenko E., Denoux P., Flp M., Hassan A., Igbokwe D.O., Ik ., Javangwe G., Malbran M., Maricchiolo F., Mikarsa H., Miles L.K., Nader M., Park J., Rizwan M., Salem R., Schwarz B., Shah I., Sun C.R., van Tilburg W., Wagner W., Wise R., Yu A.A. Be careful where you smile: culture shapes judgments of intelligence and honesty of smiling individuals. 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. Szablewski C.M., Chang K.T., Brown M.M., Chu V.T., Yousaf A.R. Moreover, a fraction of carbon dioxide previously exhaled is inhaled at each respiratory cycle. This discouraged the wearing of masks and caused a lot of discussion and distrust in the general public. Darwin C. 3rd edition. At the same time, emotional mimicry and thereby emotional contagion [59] is interrupted by the mask as well, i.e., the social phenomenon that we are involuntarily copying the facial expression of other people with whom we communicate. Pandemic. The issue of wearing face masks may serve as a prime example. However, covering the lower half of the face reduces the ability to communicate, interpret, and mimic the expressions of those with whom we interact. Results showed that observers relied mostly on tiles that covered and revealed the mouth and eyes when they correctly named the emotion being displayed. Effects of surgical and FFP2/N95 face masks on cardiopulmonary exercise capacity. Wmann L. Folgekosten ausbleibenden Lernens: was wir ber die Corona-bedingten Schulschlieungen aus der Forschung lernen knnen. The Expression of the Emotions in Man and Animals. 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. And since the perceiver of your face does not perceive the emotion because of the mask, both the sender and the receiver of the emotional communicative signal will be affected by the face mask. We know from our experience with sensory handicapped people, that they learn to compensate by sharpening their remaining senses. So there is no question as to whether schools should open here this fall. 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. There are two types of smiles, true smiles and dishonest smiles. The mouth region on a face conveys information that is crucial for smiling, i.e., a positive emotion, which can work as social glue and facilitates positive social cognition and action [69]. Fontana Press; London UK: 1999. Aerosol emission and superemission during human speech increase with voice loudness. People may feel that someone is being aggressive towards them, when there is no real intent of aggression (but in fact, a true smile), and may react accordingly potentially leading to all sorts of difficult, and even dangerous, situations. But by the age of seven months babies able to recognize angry or fearful faces [62], [37]. So using a mask amounts to doing a favor to others and oneself. The louder someone speaks the more droplets and aerosols are produced. So why not use wearing face masks as a simple tool for social behavior training? In a study of 158 health care workers during the Covid-19 pandemic, the most common side effect of prolonged face mask use was bilateral headache, reported by about 80% of the participants [58]. Federal government websites often end in .gov or .mil. The benefits and burdens of face masks in schools should be seriously considered and made obvious and clear to teachers and students. 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]. Emotional mimicry, contagion, and emotionality in general are reduced and (thereby) bonding between teachers and learners, group cohesion, and learning of which emotions are a major driver. Wearing a face mask may give a false sense of security and may make people less compliant with other infection control measures. It may be for this reason, that many people do not like the wearing masks at all in the first place. The 6It is named after Pan American World Airways (an airline that no longer exists), whose flight attendants were trained to always smile at their passengers. Bosch J. One of which is simply talking about emotions. Enea V., Iancu S. Processing emotional body expressions: state-of-the-art. 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. Diamond A., Lee K. Interventions shown to aid executive function development in children 4 to 12 years old. Henrich J. Princeton University Press; Princeton NJ: 2016. 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]. In two other studies, one from two surveys of 2812 and 2343 inhabitants of the small town of V near Padua in Italy, and another from 1032 healthcare workers (including frontline patient-facing staff such as doctors, nurses and physiotherapists) in the UK, similar findings have been reported [42]. Headaches occurred one to four times during a 30-day period of mask use and was rated as mild by the majority (72%) of respondents. In contrast, dishonest smiles, which are also called fake smiles, Botox smiles, Pan Am smiles6 Ameres M., Brandstetter S., Tonchev A.A., Kabesch M., Leppert D., Kuhle J., Wellmann S. Association of neuronal injury blood marker neurofilament light chain with mild-to-moderate COVID-19. Wearing a face mask makes the exhaled air go into the eyes. 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.
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