*4.4. The Importance of COVID-19 Safety Measures*

There is broad public health support for wearing face masks and face coverings in the community in order to fight against COVID-19 successfully. However, many people with secondary chronic diseases have questioned if it is safe for them to wear a mask. According to our study, 174 patients (34.8%) reported it is difficult for them to wear masks. It was observed mostly in patients with asthma (*p* < 0.001, Figure 3A, Table S3) and COPD (*p* = 0.008, Table S3). This finding is explainable due to possible occurring symptoms of these diseases, including difficulty breathing (shortness of breath) and wheezing. The physical barrier of the mask makes it harder to take in air; it also traps some carbon dioxide during exhaling, leading to breathing warmer and moister air [55]. However, it should be noted that according to the American Academy of Allergy, Asthma & Immunology (AAAAI), there is no evidence that wearing a face mask can worsen lung diseases [56]. Furthermore, we determined a subgroup of vaccine-hesitant individuals who both reported difficulties in wearing facemasks and refused the vaccination because of potential side effects (*p* < 0.001, Figure 3B, Table S3). This correlation was also observed in other studies. For instance, Latkin et al. examined the prevalence of COVID-19 vaccine hesitancy and factors associated with vaccine intentions in the US. From a total of 1056 respondents who completed a national panel survey, about half (53.6%) reported intending to be vaccinated, 16.7% did not intend, and 29.7% were unsure. Authors determined that compared to those who reported positive vaccine intentions, respondents with negative vaccine intentions were significantly less likely to report that they engaged in the COVID-19 prevention behaviors of wearing masks (OR = 0.53, 95% [CI 0.37–0.76]) and social distancing (OR = 0.22, 95% CI [0.12–0.42]) [57]. These results suggest that although COVID-19 vaccines are becoming more available, the continued communication and implementation of COVID-19 safety measures (e.g., face masks, personal hygiene, and social distancing) are still instrumental to effective pandemic control and containment [58]. These statements are currently even more necessary because masking can help to reduce the spread of new variants of SARS-CoV-2 while vaccines are rolling out [59].
