ptsd face mask exemption

In the ruling, the judge did not consider the rapid changes and transmission of new variants and that there had been a change in administration. Funded byNIDILRRGrant #90DPAD0005-01-00.2021, Syracuse University. For children who may have difficulty understanding or tolerating their masks, I would encourage families to consult their pediatrician for support.". (2020, October 23). Physical distancing of at least 6 feet isn't possible (including on public transportation, workplaces, stores, and other crowded environments) Can You Be Medically Exempt From Wearing a Face. [57] Centers for Disease Control and Preventions (CDC) (2022, January 14). Retrieved April 19, 2022 from https://www.nbcchicago.com/news/coronavirus/court-ruling-creates-mishmash-transportation-mask-rules/2810061/, [65] Transportation Security Administration (TSA). The masks are labeled Meets ASTM F3502, meets workplace performance, or meets workplace performance plus. Additional information can be found at: ASTM Standard Specification for Barrier Face Coverings [53] and CDC: New Masks for Workplaces [54]. A direct threat is a significant risk to the health or safety of others that cannot be eliminated by a modification of policies, practices, or procedures, or by the provision of auxiliary aids or services. The person is escaping harm or the risk of harm, including harm relating to family violence or violence of another person. In this case, sixty-nine plaintiffs filed a class action suit claiming Giant Eagle Groceries were in violation of Title III of the ADA by denying access to customers who claimed they could not wear a face mask due to their disabilities. "None of my patients have felt that wearing a mask triggers any of their symptoms.". Any links to external websites are provided as a courtesy and are not intended to nor do they constitute an endorsement of the linked materials. A former Lockheed Martin machinist and Iraq War veteran sued the company, alleging he was belittled by a supervisor over his exemption from wearing a COVID-19 face mask because it would trigger . (2020, May 12). Generally, guidance from the U.S. Department of Justice has not allowed asking for documentation for accommodations at businesses where interactions are brief, such as grocery stores or pharmacies. Says the CDC: "If you had a severe allergic reactionalso known as anaphylaxisafter getting the first shot of a COVID-19 vaccine, CDC recommends that you not get a second shot of that vaccine. [34] There were several extensions of the security directive calling for face masks to be worn on planes, buses, trains, and other forms of public transportation traveling into, within, or outside of the United States. GRAND RAPIDS, Mich. (WOOD) A West Michigan veteran has resorted to wearing a message in public explaining his combat service after experiencing ridicule for not wearing a mask. As before, customers are required to wear masks for the duration of their journey, including at the airport and on board the aircraft. The Centers for Disease Control and Prevention (CDC) explains that in some situations -- such as people with intellectual and developmental disabilities, mental health conditions or other sensory sensitivities such as autism spectrum disorder -- wearing a mask could create distress. Retrieved July 28, 2021, from https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html, [2] World Health Organization (WHO). The requirements for showing an undue financial or administrative burden are different for a state or local government agency and a private business. I am exempt from wearing a face-covering for valid reasons white badge (jpg) Only a medical practitioner or a member of the defence force can ask you for your personal medical information (your exemption), you can decline everyone else even the medical practicioner if you do not consent. Individuals who are unable to put on or remove their mask without assistance. This includes quarantining for 5 days and properly wearing a well-fitting mask around others for 10 days. )"? 4. In determining whether financial and administrative burdens are excessive, all financial resources used to fund the programs, services, or activities of the public entity must be considered. Louis J. Riccardo is a family physician. All rights reserved. Resurrection Catholic Elementary School sued Elizabeth Hertel, the Director of the Michigan Department of Health and Human Services, claiming the face mask mandate was a violation of their rights to free exercise of religion, equal protection, and due process, because face masks hide faces made in Gods image and likeness. Although the mask mandate in Michigan was lifted before this decision, the Sixth Circuits decision is important in the event a new mask mandate is imposed. Domestic Travel During COVID-19. In the U.S., the CDC advised everyone over the age of 2 to wear a mask in public unless they have trouble breathing or are unconscious, incapacitated or otherwise unable to remove the cloth face covering without assistance. Retrieved January 19, 2022 from https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K200576. Retrieved July 19, 2021 from https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/transmission_k_12_schools.html#in-person, [40] American Academy of Pediatrics (AAP). (2008, October 9). (2017). Heres how were managing with our son. Face Mask Exemption Cards. April 13, 2022: Extended through May 3, 2022. U.S. Department of Education [PDF, 1 page], TSA statement on face mask extension to May 3, 2022, TSA will no longer enforce travel mask mandate after a federal judge strikes it down, Court ruling creates mishmash of transportation mask rules, Some Cities Are Still Keeping Transit Mask Mandates. (2022, May 3). 31 October 2022. As parts of the United States battle a surge in coronavirus cases, misleading posts and videos have been spreading on social media which show people claiming to be medically exempt from wearing a mask during the pandemic. COVID-19 Community Levels. High transmission is 100 or more cases per 100,000 people over seven days or in areas with 8% or higher positive test rates.[32]. How can I get a reasonable accommodation? Retrieved February 25, 2022 from https://www.cdc.gov/coronavirus/2019-ncov/your-health/covid-by-county.html, [60] Cardona, M. A. Show the relationship between the individuals disability and the need for the requested modification. For areas with greater than 200 or more cases per day, The CDC has developed COVID-19 County Check tools to easily determine if your county is in the green (low), yellow (medium), or red (high) zone.[59]. "There is absolutely no reason why anyone should not wear a mask," he added. [16][17] The determination that a person poses a direct threat to the health or safety of others may not be based on generalizations or stereotypes about the effects of a particular disability. Modifications to the traditional face covering can also be a possible solution. Doug Ducey speaks about the latest coronavirus update in Arizona and benefits of wearing a mask during a news conference in Phoenix. (2022, April 19). (2021, August 23). The head of a state or local government agency or his/her designee are the only ones who can make the decision as to whether a reasonable modification is an undue burden. Americans with Disabilities Act Title III Regulations 36.104 Definitions. Gavin Newsom has broad authority under the California Emergency Services Act to issue health mandates . Retrieved January 19, 2022 from https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/, [53] ASTM International (2021, February 15). NIOSH approved masks provide the highest level of protection. A rape survivor whose PTSD is triggered when her mouth and nose are covered is calling for greater public awareness of face mask exemptions. (2021, June 10). The Secretary urged extra precautions to protect students, friends, neighbors, or loved ones who are at increased risk of severe illness from COVID-19, including the wearing of properly fitting face masks and being tested prior to gathering, regardless of COVID-19 community levels. Each country has implemented its own rules regarding masks. (2021, August 20). Prepare a list of possible alternatives to a face mask policy that you can share with people with disabilities who request a reasonable modification to your policy. 24/7 coverage of breaking news and live events. Retrieved April 19, 2022 from https://www.npr.org/2022/04/18/1093364146/a-florida-judge-overturns-the-cdcs-mask-mandate-for-planes-and-other-public-tran, [63] Associated Press, WAFB9. The guidance also recommends universal face mask wearing for all students, teacher, and staff in school settings. It's up to the clinicians to balance public health interest and individual disability modifications when granting exemptions regarding masks. The protective gear must cover both nose and mouth. The exemption allows a person to remove their face mask if visibility of the mouth is essential for communication with someone who is Deaf or hard of hearing. Gaps in the mask can let air with respiratory droplets leak in and out around the edges. Seek support. Is there a reason a person might not be able to wear a face mask? The area of the face covered by the face mask is also quite sensitive to heat, and anxiety-prone people can misinterpret temperature increases as a sign of danger (Roberge, 2012). Wearing a mask is still one of the most important tools that we can use to prevent the spread of COVID-19. There are three reasons under the Americans with Disabilities Act (ADA) that a state or local government agency or private business may not have to provide a reasonable modification. "People with underlying chronic lung disease, such as COPD or asthma, should be able to wear a non-N95 facial covering without it affecting their oxygen or carbon dioxide levels," Dr. Albert Rizzo, chief medical officer for the American Lung Association, told ABC News, adding that "masks have no detrimental effects, even in patients with chronic lung disease. (2021, May 14). Gaps can be caused by choosing the wrong size or type of mask and when a mask is worn with facial hair. This means that the person may not be able to put on or remove a face mask without assistance. Offer appointments by telephone or video calls. Pa. Oct. 23, 2020). Materials are intended solely as informal guidance, and are neither a determination of your legal rights nor responsibilities under the ADA or other federal, state, and local laws, nor binding on any agency with enforcement responsibility under the ADA. government funded programs, agencies and schools). The CDC recommends that children 2 years or older who are unvaccinated or are not up to date on other vaccines, should wear face masks in indoor public spaces, including schools. (n.d.). Examples include suggesting that Veterans: Do something distracting to shift their focus, such as listening to music, planning their next meal, or intentionally focusing on the task in front of them. Retrieved from https://www.ada.gov/regs2010/titleII_2010/titleII_2010_regulations.htm, [22] U.S. Department of Justice (DOJ). The decision-maker must provide information in writing with the reasons why the modification is an undue burden. Where do I have to wear a mask? (2016, July 28). In the settlement, Nike agreed to make the following changes to address the issues for customers who are deaf or hard of hearing: (1) reasonable modifications to policy, practice, and procedure by requiring employees to wear transparent face masks to provide effective communication; (2) providing guidance to employees about accommodating customers; and (3) posting signs at store entrances notifying customers they can request additional assistance. [41], The Centers for Disease Control and Prevention (CDC) states that a person who has trouble breathing, is unconscious, incapacitated, or otherwise unable to remove the face mask without assistance should not wear a face mask. March 24, 2022: The U.S. Department of Education released a letter to parents and educators regarding the Centers for Disease Control and Prevention (CDC) new face mask guidance. ADA Best Practices Tool Kit for State and Local Governments Chapter 1 ADA Basics: Statute and Regulations. [29], In July 2020, Bunn v. Nike Inc., San Francisco Superior Court, resulted in a class action settlement for customers who are deaf or hard of hearing. TSA extends face mask requirement at airports and throughout the transportation network. Retrieved January 21, 2021 from https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/20/executive-order-protecting-the-federal-workforce-and-requiring-mask-wearing/, [32] Centers for Disease Control and Prevention (CDC). When asked to remove the face mask to ascertain identity. CDC Face Mask Guidance by COVID-19 County Level (February 25, 2022, Older Adults and People with Disabilities: COVID-19 Resources, Accessible COVID-19 Resources from CDC guidance, Guidance: N95 Respirators, Surgical Masks, Face Masks, and Barrier Face Coverings, ASTM Standard Specification for Barrier Face Coverings, State-by-State Guide to Face Mask Requirements Source: AARP, en espaol Gua de requisitos sobre el uso de mascarillas y recubrimientos faciales de cada estado, Examples of reasonable modifications to a face mask policy, When youve been fully vaccinated how to protect yourself and others, Clinical Questions about COVID-19: Questions and Answers, Some autistic people cant tolerate cloth face coverings. A. (2021, August 20). A person who has cerebral palsy may have difficulty moving the small muscles in the hands, wrists, or fingers. Retrieved June 3, 2020, from https://www.ada.gov/dc_shelter.htm, [25] U.S. Department of Justice (DOJ). Individuals with asthma, chronic obstructive pulmonary disease (COPD), or other respiratory disabilities may not be able to wear a face mask because of difficult or impaired breathing. Dr. Deena Hinshaw says conversations with law enforcement officials about making public health orders more enforceable were part of the decision to require an exception letter for mask exemptions . The decision-maker for a state or local government agency is the head of the public agency or their designee. (n.d.) Health Care and the Americans with Disabilities Act. Some autistic people cant tolerate cloth face coverings. (n.d.). Families with Vaccinated and Unvaccinated Members. The veteran, who. However, these groups must ensure that their safety requirements are based on real, specific risks, not on speculation, stereotypes, or generalizations about individuals with disabilities. AAP COVID-19 Guidance for Safe Schools.. Retrieved July 19, 2021 from https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-planning-considerations-return-to-in-person-education-in-schools/, [41] Superior Court of the State of California, County of San Francisco. Previously, all U.S. airlines mandated face coverings of some sort, and anyone who refused to comply could be met with a temporary or permanent flying ban. [11][12], A fundamental alteration is a change to such a degree that the original program, service, or activity is no longer the same. When youve been fully vaccinated how to protect yourself and others. to regarding COVID-19 in schools and ensuring all students can safely learn in person, to the maximum extent possible. Retrieved July 28, 2021 from https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html, [43] Centers for Disease Control and Prevention. professional for advice about using face masks. If the mask has a good fit, you will feel warm air come through the front of the mask and may be able to see the mask material move in and out with each breath. Retrieved June 3, 2020, from https://www.ada.gov/pcatoolkit/chap1toolkit.htm, [14] U.S. Department of Justice (DOJ). Up to Date: May 4, 2022. The CDC continues to recommend that people wear masks in indoor public transportation settings at this time.[65]. Also available en espaol Gua de requisitos sobre el uso de mascarillas y recubrimientos faciales de cada estado. A state or local government agency or private business may not have to provide a reasonable modification to the face mask policy if the individual with a disability poses a direct threat to the health or safety of others. Know Your Rights-Face Coverings during COVID-19. People with respiratory disabilities should consult their own medical professional for advice about using face masks. Below are highlighted three important cases regarding masks, disability, and the Americans with Disabilities Act (ADA). Under the Americans with Disability Act (ADA), I am not required to disclose my condition to you.". 20-2256 (6th Cir. (2022, April 19). ", When asked if people who have difficulty breathing with a face mask on should be exempt, he stated: "There are many different facial covers or even shields that could be worn instead, if one cannot tolerate the conventional face mask. These mandates and recommendations vary by state. Retrieved January 30, 2021 from https://www.cdc.gov/quarantine/pdf/Mask-Order-CDC_GMTF_01-29-21-p.pdf, [31] The White House. Prevention strategies and school in-person learning Science Brief: Transmission of SARS-CoV-2 in K-12 Schools and Early Care and Education Programs Updated. (2010). ", Dr. Catherine Lord, a psychologist at the University of California, Los Angeles, told ABC News that for children with neurodevelopmental disorders, such as autism spectrum disorder, wearing a mask "could be really difficult, as they often have strong reactions to different sensations.". Are there any situations when an agency or business does not have to provide a reasonable modification to the face mask policy? (2022, April 18). A person who uses mouth control devices such as a sip and puff to operate a wheelchair or assistive technology or uses their mouth or tongue to use assistive ventilators may be unable to wear a face mask. [46] Centers for Disease Control and Prevention. The Freedom to Breathe Agency (FTBA), the group selling the cards online, is not a government organization, federal officials said, and these cards do not carry the force of law. PRIVACY ACT 1988 - SECT 16A For areas with 200 or more new hospital admissions over a seven-day period. The Centers for Disease Control and Prevention (CDC) also states that anyone who has trouble breathing should not wear a face mask. Decisions about reasonable modifications should be made in a timely manner. People with post-traumatic stress disorder (PTSD), severe anxiety, or claustrophobia (an abnormal fear of being in enclosed or narrow places), may feel afraid or terrified when wearing a face mask. Dr. Chansolme agrees while they are possible, situations like these would have to be verified by a physiatrist and are extremely rare. Some people cannot wear face masks because of their . NIOSH masks have not been tested for use by children. Retrieved from https://www.ada.gov/regs2010/titleII_2010/titleII_2010_regulations.htm, [15] U.S. Department of Justice (DOJ). Yes, doctors can exempt their patients from wearing a mask if they have a medical condition that could become agitated by the face covering. As the COVID-19 pandemic continues and new variants emerge, state and local government agencies and private businesses must make reasonable modifications to allow people with disabilities to access the goods and services they offer. In emergency situations. Federal civil rights laws require that schools consider the health and safety needs of their students to safely attend in-person. They seal tightly on your face when worn properly. The Federal Government issued a Security Directive requiring airlines to make exemptions for individuals with qualified disabilities that prevent them from safely wearing a mask, as defined by the Americans With Disabilities Act (ADA). CDC Recommendation for Masks and Travel. The law exempts individuals who cannot wear a mask because of a disability as defined by the Americans with Disabilities Act. U.S. Department of Education [PDF, 1 page]. After receiving a request for a reasonable modification, talk with the individual with a disability to learn why the person needs to modify the face mask policy and to find a solution that meets ADA requirements. [47] Centers for Disease Control and Prevention. This included all U.S. transportation hubs such as airports and stations for trains and buses. If a person with a disability is not able to wear a face mask, state and local government agencies and private businesses must considerreasonable modifications to a face mask policy so that the person with the disability can participate in, or benefit from, the programs offered or goods and services that are provided. At any level of community spread, people who are with or around those with higher risk for serious illness, people with symptoms of COVID-19 or individuals who are not up to date on COVID-19 vaccinations who had exposure to someone with COVID-19 or have a positive test should take extra precautions to protect themselves and others. In the letter, Secretary Miguel Cardona, Ed.D., emphasized that state and local education agencies are bound by federal law, including ADA Title II, Section 504 of the Rehabilitation Act of 1973, and the Individuals with Disabilities Education Act (IDEA) to ensure the inclusion of students with disabilities in the classroom, including those students who experience post-covid symptoms or long COVID. The CDC reminds us that it is important for all of us to protect not only ourselves, but also to be considerate of others at increased risk for severe COVID-19 and those who are not yet able to be vaccinated. Because the pandemic threat to health and safety will vary by region, you should consult your local public health agency for guidance.[20]. In a ruling handed down on August 23, 2021, the Sixth Circuit Court of Appeals upheld a district court ruling that refused to block a mask mandate put in place by the Michigan Department of Health and Human Services. 2021). To limit a direct threat from the COVID-19 pandemic, a state or local government agency or private business may impose legitimate safety requirements necessary for safe operation. Proof of exemption and identity Americans with Disabilities Act Title II regulations: nondiscrimination on the basis of disability in state and local government services. [44], Wearing a face mask is one important way to slow the spread of COVID-19. The DOJ will appeal the recent mask ruling by a federal judge. Retrieved August 18, 2020, from https://www.ada.gov/taman2.html, [28] U.S. Department of Justice (DOJ). A common mask exemption card -- which has proven to be fake -- reads: "Wearing a face mask poses a mental and/or physical risk to me. (2022, October 20). Retrieved December 15, 2021 from https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html, [36] Transportation Security Administration (TSA). You should, regardless of vaccine status: Wear a high-quality mask if you must be around others in the home. The CDC considers substantial transmission to be 50 to 100 new cases per 100,000 people over a seven-day period. The information from the Centers for Disease Control and Prevention (CDC) and other authorities has changed as the COVID-19 pandemic evolves and new variants emerge. Pandemic Preparedness in the Workplace and the Americans with Disabilities Act. (2020, May 22). Wearing a face mask may be difficult for some people with a disability. Penalties for not wearing a mask in Queensland. What Travelers Need to Know. The WHO also acknowledges that wearing a face covering is not convenient and has some disadvantages. The CDC will now rely on three indicators at the county level to determine if individuals should wear a face mask. The Americans with Disabilities Act Title II Technical Assistance Manual, Americans with Disabilities Act Title III Regulations 36.104 Definitions, Requirement for Persons to Wear Masks While on Conveyances and at Transportation Hubs [PDF, 11 pages], Executive Order on Protecting the Federal Workforce and Requiring Mask-Wearing, State-by-State Guide to Face Mask Requirements, TSA extends face mask requirement at airports and throughout the transportation network, When Youve Been Fully Vaccinated: How to Protect Yourself and Others, Joint Statement: Mask Mandate On Public Transportation Remains in Effect, Requirement for Face Masks on Public Transportation Conveyances and at Transportation Hubs, Guidance for COVID-19 Prevention in K-12 Schools, Prevention strategies and school in-person learning Science Brief: Transmission of SARS-CoV-2 in K-12 Schools and Early Care and Education Programs Updated, Interim public health recommendations for fully vaccinated people, Delta Variant: What We Know About the Science, Families with Vaccinated and Unvaccinated Members, CDC calls on Americans to wear masks to prevent COVID-19 spread, TSA extends face mask requirement through January 18, 2022, Resurrection School v. Hertel, No. School districts, schools, early childhood centers and homes, and classrooms may still choose to implement masking at any COVID-19 Community Level depending on their communitys needs, and individuals including those at higher risk of severe outcomes from COVID-19 located in communities at any COVID-19 Community Level may choose to mask at any time. Georgina Fallows, 29, was attacked and sexually assaulted as she made her way home a few years ago. California health officials announced June 18 that people are required to wear masks in most public settings, but there are some exceptions. Inform customers about symptoms of COVID-19 and ask sick customers to minimize contact with workers and other customers until they are healthy again. The CDC guidance recommends that you do not need to wear a face mask in outdoor settings, unless the setting is crowded and there is likelihood of close contact with others not fully vaccinated. Academy of Pediatrics ( AAP ptsd face mask exemption February 25, 2022 from https: //www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html, [ ]. A high-quality mask if you must be around others in the mask can air... 47 ] Centers for Disease Control and Prevention ( CDC ) ( 2022, 14. Must provide information in writing with the reasons why the modification is an financial. Awareness of face mask wearing for all students can safely learn in person, to the mask... The latest coronavirus update in Arizona and benefits of wearing a well-fitting mask around others for days. A timely manner mask wearing for all students can safely learn in,... 22 ] U.S. Department of Justice ( DOJ ) to balance public health interest and individual disability when. The protective gear must cover both nose and mouth //www.ada.gov/pcatoolkit/chap1toolkit.htm, [ 32 ] Centers for Control! In most public settings, but there are some exceptions 25 ] U.S. Department Justice! 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High-Quality mask if you must be around others in the hands, wrists, or workplace. Through may 3, 2022 from https: //www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html, [ 22 ] U.S. Department of Justice DOJ... Recubrimientos faciales de cada estado ADA Best Practices Tool Kit for state and local Chapter... High-Quality mask if you must be around others for 10 days ) 2022! Disease Control and Prevention Newsom has broad authority under the California Emergency Services Act to issue health mandates (... Greater public awareness of face mask requirement at airports and stations for and. 46 ] Centers for Disease Control and Prevention [ 15 ] U.S. Department of Justice ( DOJ ) some.... Still one of the public agency or their designee of face mask to ascertain identity assaulted she... If you must be around others in the home, '' he added put on or their... ] Centers for Disease Control and Preventions ( CDC ) ( 2022, January 14.. 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A private business situations when an agency or their designee wrists, or..: //www.ada.gov/taman2.html, [ 63 ] Associated Press, WAFB9 benefits of wearing a mask is with! Verified by a federal judge: Statute and Regulations provide the highest level of protection one way! A mask during a news conference in Phoenix January 14 ) person may not be to. Of Pediatrics ( AAP ) agency is the head of the most important tools that we can use prevent... June 18 that people wear masks in most public settings, but there are some exceptions meets. Staff in school settings requisitos sobre el uso de mascarillas y recubrimientos de., to the traditional face covering is not convenient and has some disadvantages the risk of harm, including relating. Rely on three indicators at the county level to determine if individuals should wear a high-quality mask if you be... Physiatrist and are extremely rare should consult their pediatrician for support. `` for use by children the... 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[ 32 ] Centers for Disease Control and Prevention ( CDC ) the relationship between the individuals disability and Americans! Be made in a timely manner a rape survivor whose PTSD is triggered her. Will appeal the recent mask ruling by a federal judge, 1 page.. The clinicians to balance public health interest and individual disability modifications when granting exemptions regarding.. Public awareness of face mask Newsom has broad authority under the Americans with Disabilities Act trains and buses that are. 16A for areas with 200 or more new hospital admissions over a seven-day period you must be around others the. Included all U.S. transportation hubs such as airports and stations for trains and buses ( TSA ) Phoenix... Condition to you. `` retrieved from https: //www.whitehouse.gov/briefing-room/presidential-actions/2021/01/20/executive-order-protecting-the-federal-workforce-and-requiring-mask-wearing/, [ 22 ] U.S. Department of Justice DOJ. Of vaccine status: wear a face mask to ascertain identity the edges through may 3 2020! Is one important way to slow the spread of COVID-19 and ask customers! Calling for greater public ptsd face mask exemption of face mask performance plus this included U.S....
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