An Increase in Respiratory Protection Device Injuries Associated with the COVID-19 Pandemic.

To the Editor: The COVID-19 pandemic abruptly changed many people's lives. While social distancing, quarantining, and personal protective equipment (PPE) have positively impacted the pandemic's progression, ancillary consequences have occurred. , Prior to the COVID-19 pandemic, the use of respiratory protection equipment was largely limited to health care and industrial settings. However, as PPE use by the general population increased, reports of dermatologic reactions have also increased. This study reports on the epidemiology of respiratory protection equipment-related injuries in the United States associated with the COVID-19 pandemic.

The data for this study was obtained from the National Electronic Injury Surveillance System (NEISS) for the period 2016 through 2020. The NEISS is a probability sample of approximately 100 hospitals and emergency rooms in the United States and is used to produce national estimates for emergency department treated consumer-product related injuries. Patient demographic and injury characteristics are abstracted from hospital medical record systems using standardized protocols. The injuries of interest in this study involved “Respiratory Protection Devices” (ie, NEISS Product Code 1618). Using this information, each injury was classified as due to rashes and/or allergic reactions, obscured vision, mask manufacturing, improper fit, or application issues.

From 2016 through 2019, approximately 200 face mask-related injuries were treated in the US emergency departments annually; 4976 persons were treated for such injuries in 2020, a 2400% increase. The injuries occurred across the lifespan, and most of those injured were women; White and Black patients were equally represented (Table I ). The most common injury diagnoses were dermatitis (28.3%) and laceration (10.1%), with the face (72.5%), head (8.2%) and finger (8.1%) representing the most commonly injured body parts among patients with such diagnoses. The majority of injuries were attributable to rashes and/or allergic reactions (38%), followed by poorly fitting masks (19%), obscured vision (14%) and application issues (10%). Injuries related to obscured vision included falls and motor vehicle collisions. In addition, there was a small (5%) but a meaningful number of injuries, all among children, attributable to consuming pieces of a mask or inserting dismantled pieces of a mask into body orifices (eg, nose, ear). Finally, injuries attributable to falls secondary to bending over to pick up a dropped mask (all elderly patients) and injuries associated with mask manufacturing were uncommon (3% and 2%, respectively).

Table I

Demographic characteristics of persons sustaining emergency department treated face mask-related injuries in the United States, 2020

	Number (N = 4976)	Percent
Age
<10	327	6.6
10-19	524	10.5
20-29	517	10.4
30-39	480	9.7
40-49	239	4.8
50-59	791	15.9
60-69	655	13.2
70-79	734	14.8
≥80	708	14.3
Sex
Male	1772	35.6
Female	3203	64.4
Race
White	2064	41.5
Black	2091	42.0
Other	821	16.5

There has been a dramatic increase in face mask-related injuries during the COVID-19 pandemic. This increase is mostly attributable to increased PPE utilization rather than changes in their inherent danger. The majority of injuries were due to contact dermatitis or skin abrasions. The latter was likely due to prolonged use; poorly fitting masks, leading to pain or shortness of breath, were also common. Of particular interest was the number of injuries attributable to obscured vision. The Centers for Disease Control and Prevention has published recommendations and resources to aid in the choice and proper fit of face masks. The current study results underscore the need for increased awareness of these resources to minimize the future occurrence of mask-related injuries.

Conflicts of interest

None disclosed.