TRAVERSE CITY — Tens of thousands of parents have asked for the science and data behind Gov. Gretchen Whitmer's September executive order requiring athletes in organized sports to wear face masks.
Although the Michigan Supreme Court ruled Whitmer's orders were drawn from a 1945 law that didn't apply, the language of the sports mask mandate was adopted into an epidemic order from Michigan Department of Health and Human Services Director Robert Gordon two weeks ago. Michigan still requires athletes to wear masks while competing, a measure public health officials contend will limit the spread of COVID-19.
But the mask mandate prompted a national discussion on the safety of adding a barrier to an already strenuous activity, particularly after the state athletic association of Massachusetts has the same mandate in their state for soccer.
There are no records, at least according to email communications obtained through a Record-Eagle Freedom of Information Act request, of top state health officials communicating studies that supported wearing masks during exercise until four days after the Sept. 4 executive order was signed.
By then the order's wording had already caused confusion among coaches and athletic administrators statewide. Several youth sports organizations were left to decide for themselves the order's scope and reach heading into a busy Labor Day weekend.
On Sept. 8, Dr. Natasha Bagdasarian, a senior public health physician contracted by the MDHHS, emailed two studies to Dr. Joneigh Khaldun, Michigan’s chief medical executive. Those studies analyzed data related to wearing masks while exercising.
Whitmer’s first executive order was signed Sept. 4. It was reissued Sept. 9 (Executive Order No. 180) to clarify masks were necessary unless participants could consistently stay six feet apart, except for "occasional and fleeting moments."
MDHHS Spokesperson Bob Wheaton, when reached for comment via email, declined to conclude there was no data communicated prior to the order's signing. Bagdasarian, reached for comment through Wheaton, added "several" studies were reviewed and discussed leading up to the order.
"Discussions occurred during meetings and did not always involve the exchange of emails," Bagdasarian said.
Regardless of the timing behind the emails, the content of the studies widely differed from the image state officials painted of them in media contacts.
The first was the “Impact of the COVID-19 pandemic on sports and exercise” published in the Asia-Pacific Journal of Sports Medicine, the second was the “Effects of surgical and FFP2/N95 face masks on cardiopulmonary exercise capacity” published in Clinical Research in Cardiology — also the US National Library of Medicine, managed by the National Institute of Health.
The Asia-Pacific Journal study authored by Ashley Ying-Ying Wong and seven others measured the heart rate of 23 people while wearing a surgical mask and walking on a treadmill at four kilometers per hour for six minutes.
The researchers concluded that "exercise with a facemask definitely has a toll on the human body and it is advised to adjust the exercise intensity when masked."
The Clinical Research in Cardiology study had people ride a stationary bike while wearing N95 and surgical masks, measuring the output on the bike as a variable.
Dr. Sven Fikenzer, physician and sport scientist at the University of Leipzig in Germany, and seven others concluded, "Medical face masks have a marked negative impact on cardiopulmonary capacity that significantly impairs strenuous physical and occupational activities. In addition, medical masks significantly impair the quality of life of their wearer. These effects have to be considered versus the potential protective effects of face masks on viral transmissions."
Wong's study recruited 23 adults (10 male, 13 female) aged 21-60, with an average age of 35. Fikenzer's study recruited 12 male subjects 32-44 years old. Neither study observed children.
When interpreting the studies in her email to Khaldun, Bagdasarian said the studies used masks that are intended for health care workers. She thought negative effects could have been mitigated if athletes wore masks designed for exercising.
“It seems as though a mask could impact exercise parameters, but mask types used were surgical mask or N95,” Bagdasarian wrote in the email. “This could be mitigated with the use of thinner masks designed for exercise, and frequent rest breaks."
She later said neither study suggested that a mask was a reason it wasn’t possible for someone to compete with them.
That was the same view expressed by Khaldun at the state’s press conference later that week, and also Dr. Matt Jackson, Munson Hospital’s Medical Director of Sports Medicine when forwarded the studies for comment.
“One of the things they’re using is N95 masks and I don’t think anyone is recommending that for sports,” Jackson said. “They are using surgical masks — and that’s more of a question of being uncomfortable in kids and athletes.”
Jackson said now people are concerned with the work of breathing while competing in surgical masks. He pointed to altitude masks — widely used among runners before the pandemic — which are used to deliberately increase the work of breathing.
Jackson said nobody can argue the use of surgical masks in athletics is comfortable, but there’s a difference when discussing comfort and safety.
“When you have something in front of your face that can restrict some airflow, it may change your work of breathing,” Jackson said. “There's no evidence that changes the actual oxygenation of your body as an athlete.”
Many have also asked if science that observes adults is even applicable to children.
Sarah Carroll, the founder of the "Unmask MI Youth Sports" Facebook page, has sons ages 7 and 11 that play hockey in Traverse City. She was perplexed at how the studies the state picked observed adults and she thinks her children are now the state's science experiment.
"They observed adults on a treadmill, not playing an active contact sport," Carroll said. "To turn around and say, 'We know it's safe, there's no reason why children can't wear a mask while they play a sport' is pretty shocking."
Carroll also said if officials knew surgical masks could have hampered competition, they should have come out and said that when they had the opportunities to.
The same state officials say they have done so continuously.
Bagdasarian pointed to guidance from the department that says gaiters and face shields are permissible under Michigan's definition of a facial covering.
“It is important for student-athletes to choose a face covering that they can tolerate,” she said. “This could be a surgical mask, or this might mean choosing a face covering made from a thinner material, or adjusting the types of activity they are engaged in.”
Responding to the criticism that the two studies didn't recruit children, Bagdasarian acknowledged that there is a need for more robust COVID-19 studies that involve children.
For now, she said the department extrapolated data from the best studies available to them.
"We continue to urge athletes, regardless of age, to scale back the intensity of exercise if wearing a mask is challenging," Bagdasarian said.
Jackson said that such studies on children aren't widely available, but only because there would not have been a scientific question regarding them if the coronavirus pandemic had not been entering its seventh month.
He believes both the state and the Michigan High School Athletic Association’s broad definition of “face coverings” are broad because of that.
“We generally would not have been studying masks in kids had this not been a pandemic we’re in,” Jackson said.
Football spit shields
One week after Executive Order No. 176 was signed, Khaldun gave thumbs up to the MHSAA’s interpretation of a face shield affixed to the inside of the helmet — so long as it covers the nose and face of an athlete.
However her initial reaction to the press release was different in response to an inquiry from Zach Kolodin, Whitmer's counsel for public policy.
“The MHSAA has stated that clear plastic face shields satisfy the facial covering requirement,” wrote Kolodin in an email 20 minutes following the MHSAA’s news release. “I know we’ve said in the past that such shields are no substitute for masks.”
Khaldun replied: "An affixed helmet plastic shield? If it does not cover the mouth and nose then it is not appropriate."
Kolodin pointed to a paragraph in the release specifying the face shields must cover the nose and mouth. Khaldun said that that was fine, reiterating that it must cover the nose and mouth.
MHSAA Communications Director Geoff Kimmerly said the association's decisions on its definitions of compliant face coverings were made through interpretations of the executive orders with legal counsel.
"The interpretation that face shields met the standard was based on past executive orders on face shields," Kimmerly said.
Whitmer, a week later in an Associated Press report, confirmed that a face shield would be considered acceptable under the executive order when discussing how her orders would apply to the Big Ten's football restart.
Where are we now?
Jackson cited even more science in support of the state's mask mandate than the state disclosed in its FOIA response.
An article in the New England Journal of Medicine hypothesized that universal mask wearing may lead to less severe cases, concurrent with research funded by the NIH that found masks to reduce the amount of virus transmitted when both parties wear them.
"If we do see transmission: Do we protect the kids so that they don't get severely ill — they get mildly ill?" Jackson said. "That's an evolving question."
He said he gets asked constantly whether or not it's safe to compete with the wire surgical masks have above the nose — not having an answer because the masks are not designed for sports.
Jackson said he wishes student-athletes in the area had access to masks manufactured by Adidas designed for athletics, but those are in high demand by collegiate athletic departments with apparel deals and multi-million dollar budgets.
What's known he said is this: "Masks are the only other tool we have to limit the spread of the virus aside from being apart from each other."