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Are there any valid medical reasons to not wear a mask?

are there medical reasons not to wear a mask
Photo via Nenad Stojkovic/Flickr (CC BY 2.0)

Despite the fact that wearing a face-covering has been scientifically proven to stop the spread and transmission of COVID-19—though some are admittedly more effective than others—people are still waging arguments about the question: Are there medical reasons not to wear a mask in public?

The internet is awash with viral videos of people refusing to wear masks in grocery stores and other retail establishments, with many claiming to have valid “medical exemptions” to get out of doing so. In reality, these claims are often dubious at best.

That also hasn’t stopped President Trump from going out of his way to avoid wearing a mask in public, even after he tested positive for COVID-19.

It doesn’t help that there are misinformation campaigns spreading misleading information about the alleged dangers and disadvantages of wearing masks. “Face Mask Exception Cards” have been circulating on social media for months, falsely citing both the Americans with Disabilities Act and the Department of Justice.

In fact, we need look no further than the Americans with Disabilities Act (ADA) to determine the validity of these so-called medical reasons for not wearing a mask.

The ADA is an anti-discrimination civil rights law intended to provide legal protections to Americans with disabilities—similar to the Civil Rights Act of 1964, which prohibits discrimination based on race, religion, sex, and national origin. The difference between the two laws is that the ADA requires disabled people to be “reasonably accommodated” by employers, public businesses, and government institutions. 

It’s these “reasonable accommodations” that can get tricky on a highly specific case-by-case basis. Both the ADA and the Department of Justice have made it clear that there are no medical reasons that absolve an individual from mask-wearing, however, without replacing it with a similar measure that would meet public health requirements.

“The ADA does not provide a blanket exemption to people with disabilities from complying with legitimate safety requirements necessary for safe operations,” the Department of Justice said in a June 30 statement.

Jessica Roberts, the director of the Health Law & Policy Institute at the University of Houston, told USA Today that a person must have a legally recognized disability to be covered by the protections of the ADA. “So, the individual would have to establish that she is a person with a disability under the law, which has specific legal standards and is not always an easy or straightforward thing to do,” Roberts explained.

The kicker, however, is that even if a person can identify their disability—and somehow prove that not wearing a mask without providing a similar precaution is a valid excuse—it still doesn’t necessarily protect them, according to ADA standards.

“The business could still turn that person away based on the direct threat [that they pose to others],” Roberts said.

“How the law is currently getting described is that everybody has protections under the ADA, and that is certainly not true,” said Jasmine Harris, a professor of law at the University of California-Davis. “For disability rights to be meaningful, individual assessment and analysis was made key to the law.”

In other words, each disabled person receives unique accommodations according to their individual needs, which contradicts much of the misinformation spreading online.

“Remember no shirt, no shoes, no service?” Harris added. “What was the legal basis for that? Yes, there may have been some bias against surfers in the state of California, but fundamentally it was about health.”

What are valid medical reasons to not wear a mask?

While keeping in mind that standards set by states, local governments, and private businesses vary, the CDC states that masks should not be worn by children under the age of 2; those who are unconscious, incapacitated, or otherwise unable to remove the mask without assistance; and finally, anyone who has trouble breathing.

The latter group is where things can get murky, as there are a number of possible underlying medical conditions that may make it difficult to breathe, such as asthma. Doctors still believe that most asthmatics can safely wear masks.

Even those suffering from chronic pulmonary diseases, such as chronic bronchitis and emphysema, don’t get a free pass from mask-wearing for medical reasons. On the contrary, people suffering from these conditions have even more reason to protect themselves by wearing a mask.

“Few guidelines exist regarding medical exemptions,” authors Dr. Mical Raz and attorney Doron Dorfman wrote in a June 10 JAMA Network article titled “Mask Exemptions During the Covid-19 Pandemic—A New Frontier for Clinicians.”

“An individual with a chronic pulmonary illness is at higher risk for severe disease [from COVID-19],” according to the article. “Conversely, if that same individual were infected, he or she would likely also be at higher risk for spreading viral illness because many pulmonary illnesses are associated with a chronic cough. There is a risk-benefit ratio that must be carefully considered.

“It is likely that chronic pulmonary disease in itself is a compelling reason for masking, rather than a category of exemption.”

People who suffer from facial deformities that make mask wearing difficult or impossible are a legitimate exemption from mask wearing requirements. 

Such is the case for Air Force veteran Israel Del Toro, who has been denied entry to several local Colorado Spring businesses because he isn’t able to wear a mask. While serving in Afghanistan in 2005, Del Toro’s humvee hit a roadside bomb, leaving 80% of his body burned.

“Not only can I not wear the ones around the ear because I don’t have ears, but due to my medical condition I can’t breathe [with one],” he told KKTV in June.

But given that the majority of people who do have valid medical reasons exempting them from wearing masks are also at higher or severe risk of disease, experts advise avoiding in-person interactions entirely. Instead, they advise opting for in-home deliveries to prevent exposure.

“In my experience, people with disabilities are not the ones rushing to stores looking for accommodations because they know they are the ones who are most likely to get COVID-19,” Dorfman, a professor of law at Syracuse University, told USA Today. “Often, disabled people will ask for other accommodations like curbside pickup or delivery for their groceries and other needs.”

The Northwest ADA Center, a part of the ADA National Network, agrees that businesses should be focused on accommodating those with disabilities, in the event that a customer’s disability is uniquely impacted due to face mask requirements.

“In limited circumstances, there could be a situation in which a customer cannot wear a face mask due to a legitimate health reason,” an article on the organization’s website states. “In this case, a business may not need to alter their face-mask required policy, but in any event, should attempt to accommodate that customer in an alternative manner that would continue to protect the store’s employees and other customers while also providing service to the customer.”

Read more on coronavirus face coverings:

Sources: CNBC, USA Today, JAMA Health Network, Northwest ADA Center, KKTV, CDC