With face coverings as common as nametags and uniforms among workers in essential businesses during the coronavirus pandemic, experts are raising concerns over whether such protective measures are risk-free.

While government safety officials recommend employees wear masks at work to stem the spread of COVID-19, employers should educate workers on how to use face covering safely, experts say.

Wearing masks continuously for hours can lead to anxiety, headaches, increased heart rate, dizziness and fatigue, said Mark Carbone, Cocoa Beach, Florida-based CEO of PN Medical, which provides respiratory training and services in the workers compensation sector.

“Our clinical research department started noticing it in grocery stores,” he said of workers’ tendency to pull masks off to catch their breath. PN Medical is conducting research on the issue, he said. 

Nina Bausek, PN Medical’s chief scientist, who is based in Vienna, Austria, said the “biggest issue” with regard to mask-wearing over long periods of time is “we have observed it is changing your breathing.”  

“Either you are going into hyperventilation or you are restricting your breathing,” she said. “Most people will breathe more rapidly or more shallow” when wearing a face covering for extended periods of time. Another concern is that people  retain more carbon dioxide while covering their mouth and nose, she said, adding the physiological side effect is fatigue.

“When people take off their mask it appears they are trying to catch their breath,” Ms. Bausek said. “It adds to your fatigue because you are not getting enough oxygen.”

Respiratory distress and heat stress while wearing a face covering are emerging concerns, said Cory Worden, Houston-based administrator of the health care practice specialty for the American Society of Safety Professionals. The solution is to wear appropriate masks and to ensure they are “breathable,” she said.

“If you have your face covered, some people may feel they can’t breathe,” she said. “With that breaks are important.” She said ASSP is stressing that workers should take breaks when necessary but ensure that they do so safely. This means knowing how to remove a mask, ensuring it does not become contaminated, and maintaining social distancing while taking a break.

The California Department of Industrial Relations, in issuing its annual summer notice to employers on heat illness prevention on Tuesday, addressed the topic of face coverings and outdoor work: “Employers should be aware that wearing face coverings can make it more difficult to breathe and harder for a worker to cool off, so additional breaks may be needed to prevent overheating. Workers should have face coverings at all times, but they should be removed in outdoor high heat conditions to help prevent overheating as long as physical distancing can be maintained.”

Will Smith, chief commercial officer for Jacksonville, Florida-based medical services provider One Call, said there are concerns that workers compensation claims for respiratory issues could become an issue. One Call has partnered with PN Medical to help inform employer clients on preventive measures. The companies are providing training materials to help employers guide their employees on mask wearing and breathing techniques.

“Wearing masks eight to 10 hours a day when most of us have never had to do that is going to call for some education,” he said. “We are thinking in terms of preventing injury.”

“The bottom line is you have this change in breathing patterns,” Mr. Carbone said. “We are not trying to trash the mask. We don’t want to trash the mask; you have to wear it. … You need a protocol” for safe breathing. 

Several comp insurers are catching on to the idea that providing face coverings must come with a dose of education on proper mask wearing, which many in the industry said is a practice that is not going away anytime soon. The Centers for Disease Control and Prevention, whose guidance ties into that provided by the U.S. Occupational Safety and Health Administration, is calling on mask-wearing indefinitely as a way to curb the spread of the virus.

Julie Bolton, Houston-based vice president of casualty risk engineering for Zurich North America, said “proactive training” on masks and other personal protective equipment is on the rise and will likely evolve. “You can’t just give somebody PPE; you have to do the training,” she said. “The big thing with masks is ensuring that employees understand how to wear them, how to put them on, and how to take them off.”

“There is a fair amount of confusion out there” concerning personal protective equipment, said Dave Anderson, Hartford, Connecticut-based technical director of the risk control industrial hygiene specialist group at Travelers Cos. Inc. “There’s a lot of guidance … and different levels of training” in the workforce.

“Communication is vital to not confusing people,” said Scott Humphrey, Hartford, Connecticut-based second vice president of risk control at Travelers, which is accustomed to providing training on respiratory protections in industries that typically call for personal protective equipment, such as health care and welding. COVID-19 protections are no different, he said. “You definitely don’t hand someone a face covering without telling them how to use it.”