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Are mask exemptions real?

Question:  I was picking up a few things at the Trader Joe’s and next thing I know, I’m in a fight with another customer who was not wearing a mask… with cases the way they are in Houston!  I asked him to put on a mask or leave the store.  He said he had bronchitis and was exempt.  That can’t be true, right?  He’s at a HIGHER risk!  Is there any such thing as a mask wearing exemption?

Answer: Dang, that sounds rough!  I haven’t had that type of interaction, but I have been reading about “exemptions” and your question prompted me to learn more.  Apparently, there are a number of fake “face mask exemption” cards being used, creating widespread skepticism (Figure 1).  Despite the deceit, there are actually some real “exemptions” to mask wearing, including “trouble breathing” (further detailed below). Each state’s face mask laws are also varied, further muddying the waters.  Texas exemptions include “Any person with a medical condition or disability that prevents wearing a face covering.” 

  • Per CDC, individuals who have mask wearing concerns due to ongoing respiratory conditions should talk with their health provider about risks/benefits of wearing a mask. 
  • Key respiratory medicine groups, including the American Lung Association and COPD Foundation, elaborate, “The decision to give this exemption should be at the discretion of the treating physician. However, the individual’s concerns should be weighed against societal needs to mitigate spread of the virus.”  
  • JAMA published an insightful article on this topic that provides even more detail and nuance, “Mask exemptions during the COVID-19 pandemic– A new frontier for clinicians.”  Authors state, “But for many individuals seeking exemption, the risk of participating in public spheres during a pandemic may be high. For those with underlying pulmonary disease, if masking cannot be tolerated, sheltering in place is a reasonable and safe medical recommendation.”  
  • Finally, a gentle reminder– generally shame is not effective for prompting desired behavior change (see Q&A of 7/2 and Q&A of 9/27).   

Excerpts from CDC’s Considerations for Mask Wearing 

Masks should not be worn by:

  • Children younger than 2 years old
  • Anyone who has trouble breathing
  • Anyone who is unconscious, incapacitated or otherwise unable to remove the mask without assistance
  • Wearing masks may be difficult for some people with sensory, cognitive, or behavioral issues. If they are unable to wear a mask properly or cannot tolerate a mask, they should not wear one, and adaptations and alternatives should be considered.

Most people with underlying medical conditions can and should wear masks.

  • If you have respiratory conditions and are concerned about wearing a mask safely, discuss with your healthcare provider the benefits and potential risks of wearing a mask.
  • If you have asthma, you can wear a mask. Discuss with your healthcare provider if you have any concerns about wearing a mask.

Figure 1. Fake Face Mask Exemption Card (from NBC)