It's easy to judge. But some people really can't wear a mask

Victoria's chief health officer Brett Sutton said recently there were good reasons why some people can't wear a mask:

"A number […] are legitimately not able to wear masks so please don't vilify individuals or don't make the assumption they are simply stubborn. There will be people with medical, behavioral, psychological reasons […] certainly don't make an assumption that they should be the subject of your ire."

He commented on the first day wearing a mask in public in Greater Melbourne and Mitchell Shire became mandatory, except for those without a valid reason.

It's easy to jump to conclusions

As wearing a mask in public becomes more common in Australia, either because it's mandatory where you live or because you choose to wear one, it might be tempting to assume people who don't wear masks are irresponsible, misguided or selfish.

You might also question why you need to wear a mask when others don't.

But some people find wearing a mask difficult or distressing. So, to reduce the risk of inflammatory or inappropriate comments being made, we need to understand some of the reasons why:

• autism—some people with autism spectrum disorders find covering the nose and mouth with fabric can cause sensory overload, feelings of panic, and extreme anxiety
• disability—some people with a disability can find wearing a mask difficult if they cannot remove one from their face without help. For example, someone with cerebral palsy may not be able to tie the strings or put the elastic loops of a face mask over the ears, due to limited mobility
• post-traumatic stress disorder, severe anxiety or claustrophobia—people with these conditions can find wearing a mask terrifying and may not be able to stay calm or function while wearing one
• hearing impairment—people who are deaf or hard of hearing, or those who care for or interact with someone who is hearing-impaired, rely on lipreading to communicate. So wearing a face mask can be a challenge
• facial deformities or physical trauma—may be incompatible with wearing a mask.

There are legitimate safety concerns

This is not a list of exemptions. Nor should we assume all people who fall into these categories can't wear masks.

In some situations, wearing a face covering may worsen a physical or mental health condition, lead to a medical emergency, or be a significant safety concern.

In the United States and United Kingdom there have been reports of people with disabilities being challenged, threatened with arrest, or excluded from retail and food outlets for not wearing a mask.

Conversely, there have been incidents in which anti-mask activists have feigned disability to avoid having to wear a mask in public. This could magnify skepticism and mistrust of people with legitimate, but potentially not obvious, reasons for not having to wear a mask.

While there are people who genuinely cannot wear masks, for others, it may just take extra time, resources, adaptions, alternatives and support to feel comfortable wearing one.

That might involve a bit of trial and error before finding a mask that fits well or is made from a comfortable fabric. Others may be able to wear a mask, but for only a short time.

There are online resources with useful tips and strategies to reduce the stress and challenges associated with using a mask or face shield. However, governments also need to ensure these resources are accessible to the people who need them, their family and carers.

How about breathing problems?

The Victorian government includes people with breathing problems on its list of valid medical exemptions for not wearing a mask in public.

But this is a grey area. We don't have evidence-based guidelines for judging these various medical exemptions. Each country is currently taking a slightly different approach in this area.

In any case, given the types of masks the public are wearing (cloth masks or surgical/face mask), some experts say it's unlikely these masks will cause problems.

For instance, the chief medical officer of the American Lung Association said recently: "People with underlying chronic lung disease, such as [chronic obstructive pulmonary disease] or asthma, should be able to wear a non-N95 facial covering without it affecting their oxygen or carbon dioxide levels."

The World Health Organization also says face masks of breathable material, worn properly, will not lead to oxygen deficiency or carbon dioxide intoxication.

For most of us, wearing a mask is new

While we all adjust to wearing masks in public, it is important we try to assume as little as possible about others based on whether they're wearing one.

Remember, the goal of the public wearing a mask when leaving the house is to reduce the risk of community transmission. If we can do that without vilifying people who genuinely can't wear masks, or need a bit of extra support to do so, we all benefit.