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Ling L, Ukkusuri SV. Investigating the effects of vaccine on COVID-19 disease propagation using a Bayesian approach. Sci Rep 2023; 13:13374. [PMID: 37591905 PMCID: PMC10435512 DOI: 10.1038/s41598-023-37972-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/30/2023] [Indexed: 08/19/2023] Open
Abstract
The causal impact of COVID-19 vaccine coverage on effective reproduction number R(t) under the disease control measures in the real-world scenario is understudied, making the optimal reopening strategy (e.g., when and which control measures are supposed to be conducted) during the recovery phase difficult to design. In this study, we examine the demographic heterogeneity and time variation of the vaccine effect on disease propagation based on the Bayesian structural time series analysis. Furthermore, we explore the role of non-pharmaceutical interventions (NPIs) and the entrance of the Delta variant of COVID-19 in the vaccine effect for U.S. counties. The analysis highlights several important findings: First, vaccine effects vary among the age-specific population and population densities. The vaccine effect for areas with high population density or core airport hubs is 2 times higher than for areas with low population density. Besides, areas with more older people need a high vaccine coverage to help them against the more contagious variants (e.g., the Delta variant). Second, the business restriction policy and mask requirement are more effective in preventing COVID-19 infections than other NPI measures (e.g., bar closure, gather ban, and restaurant restrictions) for areas with high population density and core airport hubs. Furthermore, the mask requirement consistently amplifies the vaccine effects against disease propagation after the presence of contagious variants. Third, areas with a high percentage of older people are suggested to postpone relaxing the restaurant restriction or gather ban since they amplify the vaccine effect against disease infections. Such empirical insights assist recovery phases of the pandemic in designing more efficient reopening strategies, vaccine prioritization, and allocation policies.
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Affiliation(s)
- Lu Ling
- Lyles School of Civil Engineering, Purdue University, West Lafayette city, 47906, USA
| | - Satish V Ukkusuri
- Lyles School of Civil Engineering, Purdue University, West Lafayette city, 47906, USA.
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Clemente I, Santini SJ, Vittorini P, Pallotta E, Sinatti G, Fontana A, Mammarella L, Rancitelli E, Balsano C. Fall of viral and bacterial pneumonia hospitalizations following COVID-19 pandemic mitigation strategies: a central Italian Region retrospective study. Intern Emerg Med 2023; 18:1181-1189. [PMID: 36750536 PMCID: PMC9904871 DOI: 10.1007/s11739-023-03213-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/30/2023] [Indexed: 02/09/2023]
Abstract
Community-Acquired Pneumonia (CAP) represents one of the first causes of hospitalization and death in the elderly all over the world and weighs heavily on public health system. Since the beginning of the COVID-19 (CoronaVirus Disease-19) pandemic, everybody's behavior was forced to change, as the result of a global lockdown strategy and the obligation of using personal protection equipment (PPE). We aimed to evaluate how the mitigation strategies adopted to fight SARS-CoV-2 (Severe Acute Respiratory Coronavirus Syndrome 2) infection have influenced hospitalizations due to CAP in two different Local Health Boards (LHBs) of central Italy. We considered two main periods of observation: before and after the national start of lockdown, in two Abruzzo's LHBs. We analyzed 19,558 hospital discharge records of bacterial and viral CAP. Excluding SARS-CoV2 infection, a significant decrease in CAP hospitalizations was observed. Through the analysis of Diagnosis Related Group (DRG) values, we highlighted a significant saving of founds for the Regional Health Service. The enactment of social distancing measures to contain COVID-19 spread, brought down admissions for bacterial and viral pneumonia. Our study emphasizes that costs for hospitalizations due to CAP could be drastically reduced by mask wearing and social distancing.
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Affiliation(s)
- Irma Clemente
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
| | - Silvano Junior Santini
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
- Francesco Balsano Foundation, Via Giovanni Battista Martini 6, 00198, Rome, Italy
| | - Pierpaolo Vittorini
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
| | - Enrico Pallotta
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
| | - Gaia Sinatti
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
| | - Antonella Fontana
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
| | - Leondino Mammarella
- U.O.S.D. Servizio Gestione Flussi Informativi e Statistica Sanitaria, L'Aquila, Italy
| | | | - Clara Balsano
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy.
- Francesco Balsano Foundation, Via Giovanni Battista Martini 6, 00198, Rome, Italy.
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Babatola A, Solomon O, Ojo T, Solomon O, Olatunya O, Fadare J, Oluwadiya K. Knowledge, practice and technique of facemask usage among healthcare workers in a tertiary hospital in Ado-Ekiti, Nigeria. SCIENTIFIC AFRICAN 2023; 19:e01559. [PMID: 36713352 PMCID: PMC9859637 DOI: 10.1016/j.sciaf.2023.e01559] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
Introduction Infection prevention and control remains very key to safety in healthcare settings and community. The use of personal protective equipment is now more relevant especially with the advent of COVID-19 pandemic. This study aimed to assess the knowledge, attitude, practice and technique of wearing facemask among healthcare workers at Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. Methods A descriptive cross-sectional questionnaire-based study explored knowledge, attitude and reported practice on the use of facemask. Also, a checklist was used to directly observe how participants put on and remove facemasks. Results Of the 450 respondents, 316 (70.2%) had good knowledge score. Only 255 (56.7%) had good attitude and barely half of the respondents 229 (50.9%) had good practice. However, the majority of those who were observed had good technique of wearing facemask 387 (86.4%). Also, 188 (41.8%) of the healthcare workers believed that face shield alone offers adequate protection against transmission of COVID-19. Conclusions Our finding suggests that knowledge does not translate to good practice. Furthermore, the fact that two out of every five healthcare workers held erroneous belief about face shield, and another one-third had poor knowledge points to the need for training and retraining of healthcare workers with the aim of reinforcing the need for consistent and correct use of facemasks. This should have a salubrious effect on the community knowledge of COVID-19 prevention as healthcare workers are believed to be the most common sources of health information to the lay public.
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Affiliation(s)
- Adefunke Babatola
- Department of Paediatrics and Child Health, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria,Corresponding author
| | - Oluremi Solomon
- Department of Community Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - Temitope Ojo
- Department of Community Health, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Olusoji Solomon
- Department of Family medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - Oladele Olatunya
- Department of Paediatrics and Child Health, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - Kehinde Oluwadiya
- Department of Orthopaedic Surgery and Traumatology, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
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Almehmadi M, Alqahtani JS. Healthcare Research in Mass Religious Gatherings and Emergency Management: A Comprehensive Narrative Review. Healthcare (Basel) 2023; 11:healthcare11020244. [PMID: 36673612 PMCID: PMC9859393 DOI: 10.3390/healthcare11020244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Religious mass gatherings, especially pilgrimages of various faiths, involve overcrowding and the international movement of people, exposing individuals to significant health risks, such as the spread of infectious diseases, crowds, exposure to bad weather, physical stress, or risks due to pre-existing medical conditions. This paper aims to review the literature related to health care research on religious mass gatherings, with special reference to the role of awareness creation, training, and risk awareness for individuals during Hajj. The results indicated that the research on health risks associated with large-scale gatherings showed that some countries (which witness religious gatherings) follow effective preventive measures to reduce health risks, while some countries did not (and linked this to its poor infrastructure and the low standard of living in it, such as India). It also showed that most studies overlooked identifying the causes of infectious diseases and determining the perceptions of participants in mass gatherings. While it showed that environmental factors strongly influence the emergence of infectious diseases among individuals, the results also showed the scarcity of research that revolves around the awareness of community members, the health risks of mass gatherings, preventive measures against diseases, and the main effects on individuals' perceptions of risks. The results also showed a lack of research evidence on how pilgrims perceive risks, adopt information, and interact with their willingness to be trained in preventive measures.
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Affiliation(s)
- Mater Almehmadi
- UCL Institute for Risk and Disaster, University College London, London WC1E 6BT, UK
- Correspondence:
| | - Jaber S. Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia
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Manca F, Pawlak J, Sivakumar A. Impact of perceptions and attitudes on air travel choices in the post-COVID-19 era: A cross-national analysis of stated preference data. TRAVEL BEHAVIOUR & SOCIETY 2023; 30:220-239. [PMID: 36247181 PMCID: PMC9550670 DOI: 10.1016/j.tbs.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic and the consequent travel restrictions have had an unprecedented impact on the air travel market. However, a rigorous analysis of the potential role of safety perceptions and attitudes towards COVID-19 interventions on future air passenger choices has been lacking to date. To investigate this matter, 1469 individuals were interviewed between April and September 2020 in four multi-airport cities (London, New York City, Sao Paulo, Shanghai). The core analysis draws upon data from a set of stated preference (SP) experiments in which respondents were asked to reflect on a hypothetical air travel journey taking place when travel restrictions are lifted but there is still a risk of infection. The hybrid choice model results show that alongside traditional attributes, such as fare, duration and transfer, attitudinal and safety perception factors matter to air passengers when making future air travel choices. The cross-national analysis points towards differences in responses across the cities to stem from culturally-driven attitudes towards interpersonal distance and personal space. We also report the willingness to pay for travel attributes under the expected future conditions and discuss post-pandemic implications for the air travel sector, including video-conferencing as a substitute for air travel.
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Affiliation(s)
- Francesco Manca
- Urban Systems Lab, Centre for Transport Studies, Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, UK
| | - Jacek Pawlak
- Urban Systems Lab, Centre for Transport Studies, Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, UK
| | - Aruna Sivakumar
- Urban Systems Lab, Centre for Transport Studies, Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, UK
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Ayala‐Peña VB, Martin MJ, Favatela F, Otarola J, Morán P, Ventura M, Gentili C, Salcedo MF, Mansilla A, Pérez S, Dolcini G, Alvarez V, Lassalle V. Chitosan-Based Formulations Intended as Protective Spray for Mask Surfaces in Prevention of Coronavirus Dissemination. ChemistrySelect 2022; 7:e202202410. [PMID: 36711229 PMCID: PMC9874787 DOI: 10.1002/slct.202202410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/13/2022] [Indexed: 02/01/2023]
Abstract
The extraordinary occurrence of COVID-19 by the fast expansion of viral infections has propelled particular interest in developing novel antiviral and virucidal agents to guarantee personal security. The main objective of this work is to propose novel formulations able to optimize the use of personal protection elements. In recent years, chitosan (CH) has attracted attention for being an interesting multifunctional, biodegradable, non-antigenic, non-toxic, and biocompatible natural polymer with antimicrobial properties. In this work, formulations based on a CH matrix containing silver, and Copper based nanoparticles have been developed. The novelty of this proposal is that almost liquid formulations have been reached, possessing verified properties to inhibit evolved virus such as herpes simplex type 1 (HSV-1) and bovine betacoronavirus (BCoV), the latter belonging to the same family of the well-known the well-known SARS-CoV-2. Besides antibacterial bioactivity; as well as the ability of these formulations to be easily sprayed on various surfaces, including conventional face masks, have been verified and discussed. The results presented in this contribution provide strong evidence on CH films as an ideal biosafe surface-protective for several daily used materials including the conventional face masks.
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Affiliation(s)
- Victoria Belen Ayala‐Peña
- INIBIBBDepartamento de BiologíaBioquímica y FarmaciaUniversidad Nacional del Sur (UNS)-CONICET.Camino La Carrindanga km 7B8000Bahía BlancaProvincia de Buenos AiresArgentina
| | - María Julia Martin
- INQUISURDepartamento de QuímicaUniversidad Nacional del Sur (UNS)-CONICET.Av. Leandro Niceforo Alem 1253B8000Bahía BlancaProvincia de Buenos AiresArgentina,INBIOSURDepartamento de BiologíaBioquímica y FarmaciaUniversidad Nacional del Sur (UNS)-CONICETSan Juan 671B8000Bahía BlancaProvincia de Buenos AiresArgentina
| | - Florencia Favatela
- INQUISURDepartamento de QuímicaUniversidad Nacional del Sur (UNS)-CONICET.Av. Leandro Niceforo Alem 1253B8000Bahía BlancaProvincia de Buenos AiresArgentina
| | - Jessica Otarola
- INQUISURDepartamento de QuímicaUniversidad Nacional del Sur (UNS)-CONICET.Av. Leandro Niceforo Alem 1253B8000Bahía BlancaProvincia de Buenos AiresArgentina
| | - Pedro Morán
- CIVETAN - CONICET, Facultad de Ciencias Veterinarias, UNCPBA, Pje ArroyoSeco s/n campus universitarioB7000TandilArgentina
| | - María Ventura
- IAE-Instituto Analítico EspecializadoCórdoba3935, B1653BJKVilla Ballester - Pcia.deBuenos AiresArgentina
| | - Claudia Gentili
- INBIOSURDepartamento de BiologíaBioquímica y FarmaciaUniversidad Nacional del Sur (UNS)-CONICETSan Juan 671B8000Bahía BlancaProvincia de Buenos AiresArgentina
| | - María Florencia Salcedo
- Instituto de Investigaciones BiológicasUE-CONICET-UNMdPFacultad de Ciencias Exactas y NaturalesUniversidad Nacional de Mar del Plata. DéanFunes 3240B7600Mar del PlataArgentina
| | - Andrea Mansilla
- Instituto de Investigaciones BiológicasUE-CONICET-UNMdPFacultad de Ciencias Exactas y NaturalesUniversidad Nacional de Mar del Plata. DéanFunes 3240B7600Mar del PlataArgentina
| | - Sandra Pérez
- CIVETAN - CONICET, Facultad de Ciencias Veterinarias, UNCPBA, Pje ArroyoSeco s/n campus universitarioB7000TandilArgentina
| | - Guillermina Dolcini
- CIVETAN - CONICET, Facultad de Ciencias Veterinarias, UNCPBA, Pje ArroyoSeco s/n campus universitarioB7000TandilArgentina
| | - Vera Alvarez
- INTEMAFacultad de IngenieríaUniversidad Nacional de Mar del Plata (UNMdP)-CONICET.Av. Cristóbal Colón 10850B7600Mar del PlataArgentina
| | - Verónica Lassalle
- INQUISURDepartamento de QuímicaUniversidad Nacional del Sur (UNS)-CONICET.Av. Leandro Niceforo Alem 1253B8000Bahía BlancaProvincia de Buenos AiresArgentina
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Effectiveness of Mask-Wearing on Respiratory Illness Transmission in Community Settings: A Rapid Review. Disaster Med Public Health Prep 2022; 17:e96. [PMID: 35249589 PMCID: PMC9623601 DOI: 10.1017/dmp.2021.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Respiratory illnesses, including coronavirus disease 2019 (COVID-19), have resulted in millions of deaths globally. Guidance on mask-wearing in community settings has been inconsistent. This review examined the effectiveness of mask-wearing on respiratory virus transmission in community settings. METHODS A search was conducted for English language reports of randomized controlled trials of mask-wearing in the community and effect on laboratory-confirmed respiratory infections or influenza-like illness. Investigators abstracted study characteristics and assessed bias. Meta-analysis was conducted to calculate pooled risk estimates. RESULTS Eleven studies were included. In 7 studies that evaluated influenza-like illness symptoms as an outcome (3029 participants), this study found mask-wearing associated with a decreased risk of influenza-like illness (overall risk ratio [RR], 0.83; 95% confidence interval [CI], 0.71 to 0.96). Studies examining laboratory-confirmed respiratory infections as an outcome (10,531 participants) showed no statistically significant association between mask-wearing and infections (RR, 1.04; 95% CI, 0.60-1.80). However, masking combined with enhanced hand hygiene was associated with a decreased risk for both influenza-like illness symptoms (RR, 0.88; 95% CI, 0.51-1.51) and laboratory-confirmed respiratory infection (RR, 0.79; 95% CI, 0.52-1.18). CONCLUSIONS Masking in community settings decreases transmission of influenza-like illness. Mask-wearing combined with enhanced hand hygiene reduces transmission of influenza-like illness and laboratory-confirmed respiratory infection.
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Ayed IIA, Khalil R, Adam I, Al-Wutayd O. Face Mask Practice and Technique During the COVID-19 Pandemic: A Nonrepresentative Cross-Sectional Study in Sudan. Patient Prefer Adherence 2022; 16:1163-1176. [PMID: 35535254 PMCID: PMC9078352 DOI: 10.2147/ppa.s366099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The World Health Organization issued guidelines for face mask use in community settings during the current COVID-19 pandemic. However, data are limited on public compliance with those guidelines in Sudan. Therefore, this study assessed face mask-wearing practice and technique during the COVID-19 pandemic among residents of Sudan. METHODS A cross-sectional study was conducted from July to September 2021 among Sudanese aged ≥18 years. A web-based questionnaire was shared through different social media platforms. Personal characteristics, four knowledge-associated items, three attitude-associated items, one item concerning mask-wearing practice, and five items related to mask-wearing technique were determined. Univariate, bivariate, and multivariable analyses were performed using STATA v17. RESULTS The survey included 1059 participants (48% males, 52% females) from different regions of Sudan. The overall mean ± SD was 3 ± 0.73 for knowledge of COVID-19 transmission; 2.3 ± 0.71 for attitude toward wearing face masks; 0.38 ± 0.49 for the practice of wearing a face mask; and 4.17 ± 0.97 for face mask-wearing technique. Approximately one-third (38%) of participants always wore a face mask during the pandemic, with age, sex, education level, family income, face mask attitude, occupation, and history of COVID-19 infection affecting the practice. All steps of face mask-wearing technique were performed by 46% of participants (59% performed hand hygiene before putting on a mask and 86% after removing it; 98% covered mouth and nose; 90% adjusted masks at the nose bridge, and 84% tied masks securely), and associated with age, occupation, family income, history of COVID-19 infection, and face-mask attitude. CONCLUSION Although knowledge and attitude were relatively good, the practice of wearing a face mask and using proper techniques among participants were low. To ensure optimal face mask use and proper mask-wearing techniques, educational intervention and establishing governmental regulations are highly recommended.
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Affiliation(s)
- Itimad I A Ayed
- Department of Basic Medical Sciences, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
- Department of Pharmacology, Faculty of Medicine, International University of Africa, Khartoum, Sudan
| | - Rehana Khalil
- Department of Family and Community Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
| | - Osama Al-Wutayd
- Department of Family and Community Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
- Correspondence: Osama Al-Wutayd, Email
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Hassen S, Adane M. Facemask-wearing behavior to prevent COVID-19 and associated factors among public and private bank workers in Ethiopia. PLoS One 2021; 16:e0259659. [PMID: 34851973 PMCID: PMC8635365 DOI: 10.1371/journal.pone.0259659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/22/2021] [Indexed: 12/23/2022] Open
Abstract
Background Given widespread vulnerability to COVID-19 infection in areas with low vaccination rates, facemask wearing is repeatedly emphasized for the general population including bank workers, who have contact with many customers each day. Over the first year of the COVID-19 pandemic, studies focused on facemask wearing among healthcare workers but not among bank workers, who are also at risk of COVID-19. To address this gap and to consider intervention measures that encourage the wearing of facemasks, this study was conducted to identify behaviors of facemask wearing and associated factors among bank workers in Dessie City, Ethiopia. Materials and methods An institution-based cross-sectional study was conducted among 413 bank workers who were selected using a simple random sampling technique from January 1st to 30th, 2021 in Dessie City, Ethiopia. Data were collected using a structured questionnaire and on-the-spot observational checklist. The collected data were checked, coded and entered to EpiData version 4.6 and exported to Statistical Package for Social Sciences (SPSS) version 25.0 for data cleaning and analysis. Data were analyzed using bivariable (crude odds ratio [COR]) and multivariable (adjusted odds ratio [AOR]) logistic regression model at 95% confidence interval (CI). Variables from the bivariable analysis with a p-value <0.25 were considered for multivariable analysis. Then, variables that had a p-value <0.05 were declared as factors significantly associated with behavior of facemask wearing. Main findings In this study, the behavior of facemask wearing among bank workers was 50.4% [95%CI: 45.3–55.2%] with 21.1% always wearing a facemask, 72.4% sometimes, and 6.5% never. A majority of the bank workers 350 (84.7%) had good knowledge of COVID-19 and half of them 208 (50.4%) had a positive attitude towards taking precautions against COVID-19. Just over two-thirds of the respondents 284 (68.8%) preferred to wear a non-medical mask. Two hundred fifty-five (61.7%) said wearing a facemask interfered with communication and 259 (62.7%) felt that wearing a facemask was not comfortable. Facemask-wearing behavior was significantly associated with a high level of positive attitude towards taking precautions against COVID-19 (AOR = 3.27, 95% CI: 1.75–6.11), the perception that the consequences of getting COVID-19 could be serious (AOR = 4.87, 95% CI: 2.38–9.94), the presence of chronic illness (AOR = 2.19, 95% CI: 1.07–4.48), sex being female (AOR = 1.87, 95% CI: 1.06–3.32) and age being greater or equal to 35 years (AOR = 9.25, 95% CI: 4.79–17.88). Conclusion The main finding of the study showed that the behavior of facemask wearing among bank workers was relatively low (50.4%) compared to other types of workers as found in other studies. To increase the behavior of facemask wearing among bank workers, health decision makers need to develop updated guidance for promotion of facemask wearing to increase the practical and appropriate use of facemasks among bank workers. Bank managers and concerned government bodies should enforce mask use to change behavior of these workers.
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Affiliation(s)
- Seada Hassen
- Department of Environmental Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
- * E-mail:
| | - Metadel Adane
- Department of Environmental Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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Fu M, Guo J, Zhang Y, Zhao Y, Zhang Y, Wang Z, Hou Z. Effect of Wearing Medical Masks on Perioperative Respiratory Complications in Older Adults with Hip Fracture: A Retrospective Cohort Study. Clin Interv Aging 2021; 16:1967-1974. [PMID: 34824528 PMCID: PMC8610772 DOI: 10.2147/cia.s333238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/06/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Respiratory complication is one of the major challenges in the treatment of older adults with hip fractures. However, no study so far has investigated the effect of wearing medical masks on the prevention of perioperative respiratory complications in these patients. Patients and Methods In this retrospective cohort study, 1016 consecutive patients aged ≥65 years with hip fractures were included and assigned to two groups: the control group and the observation group. The two groups received the same perioperative management modalities. In addition, patients in the observation group were asked to wear medical masks for protection. Data of patients’ demographics, fracture type, surgical methods, comorbidities, the incidence of perioperative respiratory and other complications, and hospital outcomes were collected and compared between the two groups. Subgroup analyses were also performed stratified by fracture types. Results A total of 1016 patients (292 females and 724 males) with a mean age of 79.4±7.3 years were analyzed in the study, including 533 in the control group and 483 in the observation group. The overall incidence of perioperative respiratory complication, and the incidence of pulmonary infection, respiratory failure and arrhythmia in the observation group were significantly lower than the control group, especially in winter and spring. There was no difference in other complications, hospital length of stay, and total hospital costs. Further subgroup analyses showed that the incidence of heart failure and arrhythmia in the observation group was lower than that in the control group for patients with femoral neck fractures, which was different from patients with intertrochanteric fractures. Conclusion The incidence of perioperative respiratory complications, including pulmonary infection and respiratory failure, could be reduced in older adults with hip fractures by strengthening personal protection, including wearing medical masks, especially in winter and spring. Wearing medical masks could also effectively reduce the incidence of perioperative heart failure and arrhythmia in femoral neck fracture patients and do not increase the incidence of other complications and the burden of hospitalization.
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Affiliation(s)
- Mingming Fu
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Junfei Guo
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Yaqian Zhang
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yuqi Zhao
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China.,Chinese Academy of Engineering, Beijing, 100088, People's Republic of China
| | - Zhiqian Wang
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China
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11
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Olry de Labry-Lima A, Bermúdez-Tamayo C, Martinez-Olmos J, Martin-Ruiz E. The use of masks to protect against respiratory infections: An umbrella review. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2021; 39:436-444. [PMID: 34446392 PMCID: PMC8382596 DOI: 10.1016/j.eimce.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/15/2020] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The global health emergency caused by the current COVID-19 pandemic is resulting in a huge challenge at all levels. The use of masks may reduce the spread of the infection by minimising the excretion of Flügge droplets. The objective of this study was to compile the evidence available on the use of masks in relation to respiratory infections. METHODOLOGY An umbrella review (review of systematic reviews) was conducted. Two reviewers independently carried out the screening process, data extraction and data analysis. Discrepancies were resolved with a third reviewer, and the assessment of the risk of bias of the studies was carried out using the AMSTAR 2 tool. The Rayyan QCRI program was used for the screening process. RESULTS A total of eight systematic reviews were included. The studies analysed the use of masks in the general population, in long-term care facilities, in hospitals and at mass gatherings, and compared the effectiveness thereof in preventing infection. The results of this review revealed that the use of masks is associated with a protective effect against respiratory infections in healthcare facilities, in long-term care facilities and at mass gatherings. CONCLUSIONS In light of the results, it seems reasonable to recommend the use of masks to the general population, but this use should be accompanied by a training programme to improve compliance, as not using them properly may increase the risk of infection.
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Affiliation(s)
- Antonio Olry de Labry-Lima
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain,Instituto de Investigación Biosanitaria ibs. Granada. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain,CIBER en Epidemiología y Salud Pública (CIBERESP), Spain,Corresponding author
| | - Clara Bermúdez-Tamayo
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain,Instituto de Investigación Biosanitaria ibs. Granada. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain,CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
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12
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Dabiri D, Conti SR, Sadoughi Pour N, Chong A, Dadjoo S, Dabiri D, Wiese C, Badal J, Hoogland MA, Conti HR, Taylor TR, Choueiri G, Amili O. A Multi-Disciplinary Review on the Aerobiology of COVID-19 in Dental Settings. FRONTIERS IN DENTAL MEDICINE 2021; 2. [PMID: 35574425 PMCID: PMC9098049 DOI: 10.3389/fdmed.2021.726395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The COVID-19 pandemic pushed dental health officials around the world to reassess and adjust their existing healthcare practices. As studies on controlled COVID-19 transmission remain challenging, this review focuses on particles that can carry the virus and relevant approaches to mitigate the risk of pathogen transmission in dental offices. This review gives an overview of particles generated in clinical settings and how size influences their distribution, concentration, and generation route. A wide array of pertinent particle characterization and counting methods are reviewed, along with their working range, reliability, and limitations. This is followed by a focus on the effectiveness of personal protective equipment (PPE) and face shields in protecting patients and dentists from aerosols. Direct studies on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are still limited, but the literature supports the use of masks as an important and effective non-pharmaceutical preventive measure that could reduce the risk of contracting a respiratory infection by up to 20%. In addition to discussing about PPE used by most dental care professionals, this review describes other ways by which dental offices can protect patients and dental office personnel, which includes modification of the existing room design, dental equipment, and heating, ventilation, and air conditioning (HVAC) system. More affordable modifications include positioning a high-efficiency particulate air (HEPA) unit within proximity of the patient’s chair or using ultraviolet germicidal irradiation in conjunction with ventilation. Additionally, portable fans could be used to direct airflow in one direction, first through the staff working areas and then through the patient treatment areas, which could decrease the number of airborne particles in dental offices. This review concludes that there is a need for greater awareness amongst dental practitioners about the relationship between particle dynamics and clinical dentistry, and additional research is needed to fill the broad gaps of knowledge in this field.
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Affiliation(s)
- Darya Dabiri
- Department of Dentistry, Division of Pediatric Dentistry, University of Toledo, Toledo, OH, United States
- Correspondence: Darya Dabiri,
| | - Samuel Richard Conti
- Department of Biological Sciences, University of Toledo, Toledo, OH, United States
| | - Niloufar Sadoughi Pour
- Department of Mechanical, Industrial and Manufacturing Engineering (MIME), University of Toledo, Toledo, OH, United States
| | - Andrew Chong
- Department of Cariology, Restorative Sciences & Endodontics, University of Michigan, Ann Arbor, MI, United States
| | - Shaahin Dadjoo
- Department of Orthodontics and Dentofacial Orthopedics, The Eastman Institute for Oral Health, University of Rochester, Rochester, NY, United States
| | - Donya Dabiri
- Department of Dentistry, Division of Pediatric Dentistry, University of Toledo, Toledo, OH, United States
| | - Carol Wiese
- Department of Dentistry, Division of Pediatric Dentistry, University of Toledo, Toledo, OH, United States
| | - Joyce Badal
- Department of Medicine, University of Toledo, Toledo, OH, United States
| | | | - Heather Raquel Conti
- Department of Biological Sciences, University of Toledo, Toledo, OH, United States
| | - Travis Roger Taylor
- Department of Medical Microbiology and Immunology, University of Toledo, Toledo, OH, United States
| | - George Choueiri
- Department of Mechanical, Industrial and Manufacturing Engineering (MIME), University of Toledo, Toledo, OH, United States
| | - Omid Amili
- Department of Mechanical, Industrial and Manufacturing Engineering (MIME), University of Toledo, Toledo, OH, United States
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13
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Keykhaei M, Koolaji S, Mohammadi E, Kalantar R, Saeedi Moghaddam S, Aminorroaya A, Zokaei S, Azadnajafabad S, Rezaei N, Ghasemi E, Rezaei N, Haghshenas R, Farzi Y, Rashedi S, Larijani B, Farzadfar F. Dissection of non-pharmaceutical interventions implemented by Iran, South Korea, and Turkey in the fight against COVID-19 pandemic. J Diabetes Metab Disord 2021; 20:1919-1931. [PMID: 34540760 PMCID: PMC8437736 DOI: 10.1007/s40200-021-00877-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 08/10/2021] [Indexed: 11/30/2022]
Abstract
Purpose The novel coronavirus disease 2019 (COVID-19) has imposed a great global burden on public health. As one of the most affected countries, Iran has tackled emerging challenges in the path to overcoming the epidemic, with three peaks of the disease propagation as of February 19, 2020. To flatten the curve of the COVID-19 pandemic, most countries have implemented bundles of intrusive, sometimes extremely stringent non-pharmaceutical interventions (NPIs). In this communication, we have dissected the effectiveness of NPIs and compared the strategies implemented by Iran, Turkey, and South Korea to mitigate the disease’s spread. Methods We searched online databases via PubMed, Web of Knowledge, and Scopus. Titles/abstracts and full-texts were screened by two reviewers and discrepancies were resolved upon discussion. Results Our results provide insights into five domains: prevention, screening, in-patient and out-patient facilities, governance, and management of diabetes mellitus. Analysis of previous efforts put in place illustrates that by fostering efficient social distancing measures, increasing the capability to perform prompt polymerase chain reaction tests, applying smart contact tracing, and supplying adequate personal protective equipment, Turkey and South Korea have brought the epidemic sub-optimally under control. Conclusion From the perspective of policymakers, these achievements are of utmost importance given that attaining the aspirational goals in the management of the COVID-19 necessities a suitable adjustment of previous successful strategies. Hence, policymakers should be noticed that a suitable combination of NPIs is necessary to stem the disease’s propagation.
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Affiliation(s)
- Mohammad Keykhaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713137 Tehran, Iran
| | - Sogol Koolaji
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713137 Tehran, Iran
| | - Esmaeil Mohammadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713137 Tehran, Iran
| | - Reyhaneh Kalantar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713137 Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713137 Tehran, Iran
| | - Arya Aminorroaya
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713137 Tehran, Iran.,Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Zokaei
- School of Advanced Medical Sciences, Islamic Azad University, Tehran Medical Branch, Tehran, Iran
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713137 Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713137 Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713137 Tehran, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713137 Tehran, Iran
| | - Rosa Haghshenas
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713137 Tehran, Iran
| | - Yosef Farzi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713137 Tehran, Iran
| | - Sina Rashedi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713137 Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713137 Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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14
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Johansson B. Challenges and Controversies in COVID-19: Masking the General Population may Attenuate This Pandemic's Outbreak. Front Public Health 2021; 9:643991. [PMID: 34568248 PMCID: PMC8455895 DOI: 10.3389/fpubh.2021.643991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
SARS-CoV-2, the virus that causes COVID-19, spreads i. a., by respiratory droplets. The use of masks in preventing spread is controversial; masks are considered useless by many, while being mandated in some locations. Here, the effect of masking the general population on a COVID-19-like epidemic is estimated by computer simulation using three separate types of software. The main questions are whether mask use by the general population can limit the spread of SARS-CoV-2 in a country and how to identify opportunities when mask use is cost-effective and safe. To address these questions, the protective effects of different types of masks, the side-effects of masks, and avenues for improvements of masks and masking are addressed. Main results: (i) Any type of mask, even simple home-made ones, may be of value, even if the protective effect of each mask (here dubbed "one mask-protection") is low. Strict adherence to mask use does not appear to be critical but increasing one mask-protection to >50% was found to be advantageous. (ii) Masks do seem to reduce the number of new cases even if introduced at a late stage in an epidemic, but early implementation helps reduce the cumulative and total number of cases. (iii) The simulations suggest that it might be possible to eliminate a COVID-19 outbreak by widespread mask use during a limited period. There is a brief discussion of why the reported effect size of masking varies widely, and is expected to do so, because of different filtration abilities of different masks, differences in compliance and fitting, other routes of transmission, pre-existing immunity, and because a system of interconnected, disease-prone individuals has non-linear properties. A software solution to visualize infection spread is presented. The results from these simulations are encouraging, but do not necessarily represent the real-life situation, so it is suggested that clinical trials of masks are now carried out while continuously monitoring effects and side-effects. As mask use is not without risks and costs, it is suggested that governments and scientists have an important role in advising the public about the sensible use of masks.
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Affiliation(s)
- Björn Johansson
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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15
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Ford N, Holmer HK, Chou R, Villeneuve PJ, Baller A, Van Kerkhove M, Allegranzi B. Mask use in community settings in the context of COVID-19: A systematic review of ecological data. EClinicalMedicine 2021; 38:101024. [PMID: 34308320 PMCID: PMC8287197 DOI: 10.1016/j.eclinm.2021.101024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The wearing of medical and non-medical masks by the general public in community settings is one intervention that is important for the reduction of SARS-CoV-2 transmission, and has been the subject of considerable research, policy, advocacy and debate. Several observational studies have used ecological (population-level) data to assess the effect of masks on transmission, hospitalization, and mortality at the region or community level. METHODS We undertook this systematic review to summarize the study designs, outcomes, and key quality indicators of using ecological data to evaluate the association between mask wearing and COVID-19 outcomes. We searched the World Health Organization (WHO) COVID-19 global literature database up to 5 March 2021 for studies reporting the impact of mask use in community settings on outcomes related to SARS-CoV-2 transmission using ecological data. FINDINGS Twenty one articles were identified that analysed ecological data to assess the protective effect of policies mandating community mask wearing. All studies reported SARS-CoV-2 benefits in terms of reductions in either the incidence, hospitalization, or mortality, or a combination of these outcomes. Few studies assessed compliance to mask wearing policies or controlled for the possible influence of other preventive measures such as hand hygiene and physical distancing, and information about compliance to these policies was lacking. INTERPRETATION Ecological studies have been cited as evidence to advocate for the adoption of universal masking policies. The studies summarized by this review suggest that community mask policies may reduce the population-level burden of SARS-CoV-2. Methodological limitations, in particular controlling for the actual practice of mask wearing and other preventive policies make it difficult to determine causality. There are several important limitations to consider for improving the validity of ecological data.
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Affiliation(s)
- Nathan Ford
- Guidelines Review Committee, World Health Organization, Geneva, Switzerland
- Corresponding author.
| | - Haley K. Holmer
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Roger Chou
- Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, OR, United States
| | - Paul J. Villeneuve
- School of Mathematics and Statistics and Department of Neuroscience, Faculty of Science Carleton University, Ottawa, Canada
| | - April Baller
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Maria Van Kerkhove
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Benedetta Allegranzi
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
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16
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Escandón K, Rasmussen AL, Bogoch II, Murray EJ, Escandón K, Popescu SV, Kindrachuk J. COVID-19 false dichotomies and a comprehensive review of the evidence regarding public health, COVID-19 symptomatology, SARS-CoV-2 transmission, mask wearing, and reinfection. BMC Infect Dis 2021; 21:710. [PMID: 34315427 PMCID: PMC8314268 DOI: 10.1186/s12879-021-06357-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/24/2021] [Indexed: 02/07/2023] Open
Abstract
Scientists across disciplines, policymakers, and journalists have voiced frustration at the unprecedented polarization and misinformation around coronavirus disease 2019 (COVID-19) pandemic. Several false dichotomies have been used to polarize debates while oversimplifying complex issues. In this comprehensive narrative review, we deconstruct six common COVID-19 false dichotomies, address the evidence on these topics, identify insights relevant to effective pandemic responses, and highlight knowledge gaps and uncertainties. The topics of this review are: 1) Health and lives vs. economy and livelihoods, 2) Indefinite lockdown vs. unlimited reopening, 3) Symptomatic vs. asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 4) Droplet vs. aerosol transmission of SARS-CoV-2, 5) Masks for all vs. no masking, and 6) SARS-CoV-2 reinfection vs. no reinfection. We discuss the importance of multidisciplinary integration (health, social, and physical sciences), multilayered approaches to reducing risk ("Emmentaler cheese model"), harm reduction, smart masking, relaxation of interventions, and context-sensitive policymaking for COVID-19 response plans. We also address the challenges in understanding the broad clinical presentation of COVID-19, SARS-CoV-2 transmission, and SARS-CoV-2 reinfection. These key issues of science and public health policy have been presented as false dichotomies during the pandemic. However, they are hardly binary, simple, or uniform, and therefore should not be framed as polar extremes. We urge a nuanced understanding of the science and caution against black-or-white messaging, all-or-nothing guidance, and one-size-fits-all approaches. There is a need for meaningful public health communication and science-informed policies that recognize shades of gray, uncertainties, local context, and social determinants of health.
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Affiliation(s)
- Kevin Escandón
- School of Medicine, Universidad del Valle, Cali, Colombia.
| | - Angela L Rasmussen
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, Canada
- Georgetown Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
| | - Isaac I Bogoch
- Division of Infectious Diseases, University of Toronto, Toronto General Hospital, Toronto, Canada
| | - Eleanor J Murray
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Karina Escandón
- Department of Anthropology, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Saskia V Popescu
- Georgetown Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
- Schar School of Policy and Government, George Mason University, Fairfax, VA, USA
| | - Jason Kindrachuk
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
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17
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Liu X, Xu X, Li G, Xu X, Sun Y, Wang F, Shi X, Li X, Xie G, Zhang L. Differential impact of non-pharmaceutical public health interventions on COVID-19 epidemics in the United States. BMC Public Health 2021; 21:965. [PMID: 34020613 PMCID: PMC8139542 DOI: 10.1186/s12889-021-10950-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 12/09/2020] [Indexed: 12/12/2022] Open
Abstract
Background The widespread pandemic of novel coronavirus disease 2019 (COVID-19) poses an unprecedented global health crisis. In the United States (US), different state governments have adopted various combinations of non-pharmaceutical public health interventions (NPIs), such as non-essential business closures and gathering bans, to mitigate the epidemic from February to April, 2020. Quantitative assessment on the effectiveness of NPIs is greatly needed to assist in guiding individualized decision making for adjustment of interventions in the US and around the world. However, the impacts of these approaches remain uncertain. Methods Based on the reported cases, the effective reproduction number (Rt) of COVID-19 epidemic for 50 states in the US was estimated. Measurements on the effectiveness of nine different NPIs were conducted by assessing risk ratios (RRs) between Rt and NPIs through a generalized linear model (GLM). Results Different NPIs were found to have led to different levels of reduction in Rt. Stay-at-home contributed approximately 51% (95% CI 46–57%), wearing (face) masks 29% (15–42%), gathering ban (more than 10 people) 19% (14–24%), non-essential business closure 16% (10–21%), declaration of emergency 13% (8–17%), interstate travel restriction 11% (5–16%), school closure 10% (7–14%), initial business closure 10% (6–14%), and gathering ban (more than 50 people) 7% (2–11%). Conclusions This retrospective assessment of NPIs on Rt has shown that NPIs played critical roles on epidemic control in the US in the past several months. The quantitative results could guide individualized decision making for future adjustment of NPIs in the US and other countries for COVID-19 and other similar infectious diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10950-2.
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Affiliation(s)
| | - Xiao Xu
- Ping An Healthcare Technology, Beijing, China
| | - Guanqiao Li
- Center for Global Health and Infectious Diseases, School of Medicine, Tsinghua University, Beijing, China
| | - Xian Xu
- Ping An Healthcare Technology, Beijing, China
| | - Yuyao Sun
- Ping An Healthcare Technology, Beijing, China
| | - Fei Wang
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, USA
| | - Xuanling Shi
- Center for Global Health and Infectious Diseases, School of Medicine, Tsinghua University, Beijing, China
| | - Xiang Li
- Ping An Healthcare Technology, Beijing, China.
| | - Guotong Xie
- Ping An Healthcare Technology, Beijing, China. .,Ping An Health Cloud Company Limited, Beijing, China. .,Ping An International Smart City Technology Co., Ltd., Beijing, China.
| | - Linqi Zhang
- Center for Global Health and Infectious Diseases, School of Medicine, Tsinghua University, Beijing, China.
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18
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AlSayegh MAK, Iqbal A. The impact of the precautionary measures taken in the kingdom of Bahrain to contain the outbreak of COVID-19. ARAB JOURNAL OF BASIC AND APPLIED SCIENCES 2021. [DOI: 10.1080/25765299.2021.1903143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
| | - Azhar Iqbal
- Department of Mathematics, College of Science, University of Bahrain, Bahrain
- School of Electrical & Electronic Engineering, University of Adelaide, SA, Australia
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19
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Yuen E, Fried J, Salvador C, Gudis DA, Schlosser RJ, Nguyen SA, Brennan EA, Rowan NR. Nonpharmacological interventions to reduce respiratory viral transmission: an evidence-based review with recommendations. Rhinology 2021; 59:114-132. [PMID: 33760909 DOI: 10.4193/rhin20.563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Viral respiratory infections are a leading cause of worldwide mortality and exert the potential to cause global socioeconomic crises. However, inexpensive, efficacious, and rapidly deployable strategies to reduce viral transmission are increasingly important in the setting of an ongoing pandemic, though not entirely understood. This article provides a comprehensive review of commonly employed nonpharmacological interventions to interrupt viral spread and provides evidence-based recommendations for their use. METHODOLOGY A systematic review of three databases was performed. Studies with defined endpoints of subjects receiving one of five interventions (nasal washing, gargling, personal protective equipment (PPE), social distancing, and hand hygiene) were included. An evidence-based review of the highest level of evidence, with recommendations, was created in accordance with a previously described, rigorous, iterative process. RESULTS Fifty-four primary studies were included. The most commonly studied intervention was hand hygiene, followed by PPE, gargling, saline nasal washing, and social distancing. CONCLUSIONS Mask use and hand hygiene are strong recommendations for prevention of viral transmission. Donning gloves, gowns, and eye protection are a recommendation in healthcare settings. Saline nasal washing and gargling are options in selected populations. Although an aggregate level of evidence is not provided, the authors recommend social distancing.
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Affiliation(s)
- E Yuen
- Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA
| | - J Fried
- Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA
| | - C Salvador
- Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA
| | - D A Gudis
- Columbia University Irving Medical Centre, Department of Otolaryngology-Head and Neck Surgery, New York, NY, USA
| | - R J Schlosser
- Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA
| | - S A Nguyen
- Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA
| | - E A Brennan
- Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA
| | - N R Rowan
- The Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, MD, USA
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20
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Al-Ansari F, Mirzaei M, Al-Ansari B, Al-Ansari MB, Abdulzahra MS, Rashid H, Hill-Cawthorne GA, Al Ansari M, Negin J, Conigrave K. Health Risks, Preventive Behaviours and Respiratory Illnesses at the 2019 Arbaeen: Implications for COVID-19 and Other Pandemics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063287. [PMID: 33810092 PMCID: PMC8005097 DOI: 10.3390/ijerph18063287] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 01/03/2023]
Abstract
COVID-19 poses grave challenges for mass gatherings. One of the world’s largest annual gatherings, Arbaeen, occurs in Iraq. We studied respiratory symptoms and risk and protective factors using representative sampling of Arbaeen pilgrims in 2019 to inform prevention of COVID-19 transmission. Structured sampling was used to recruit walking pilgrims. A questionnaire asked about respiratory symptoms, risk, and preventive factors, including hygiene-related resources of toilet facilities. The commonest symptom reported by the 1842 participants (63.3% male, 36.7% female) was cough (25.6%). Eating in mawkibs (rest areas) with indoor kitchens and drinking only packaged water were associated with lower risk of cough (AOR = 0.72, CI = 0.56–0.94; AOR = 0.60; CI = 0.45–0.78, p < 0.05). Facemask use was associated with increased risk of cough (AOR = 2.71, CI = 2.08–3.53, p < 0.05). Handwashing was not protective against cough, or against (one or more of) cough, fever, or breathlessness in multivariate analysis. Toilet facilities often lacked running water (32.1%) and soap (26.1%), and had shared hand towels (17%). To reduce risk of respiratory infections including COVID-19 during Arbaeen or other mass gatherings, needs include running water, soap, and hygienic hand drying options or hand sanitiser. Education on proper handwashing and facemask approaches and monitoring around food preparation and eating spaces are needed.
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Affiliation(s)
- Farah Al-Ansari
- Faculty of Medicine and Health, Sydney School of Medicine (Central Clinical School), University of Sydney, Camperdown, NSW 2006, Australia; (B.A.-A.); (M.A.A.); (K.C.)
- Correspondence:
| | - Masoud Mirzaei
- Yazd Cardiovascular Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd 89151-73160, Iran;
| | - Basma Al-Ansari
- Faculty of Medicine and Health, Sydney School of Medicine (Central Clinical School), University of Sydney, Camperdown, NSW 2006, Australia; (B.A.-A.); (M.A.A.); (K.C.)
| | | | | | - Harunor Rashid
- The Children’s Hospital at Westmead, National Centre for Immunisation Research and Surveillance (NCIRS), Westmead, NSW 2145, Australia;
- The Discipline of Child and Adolescent Health, Children’s Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
| | - Grant A. Hill-Cawthorne
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Camperdown, NSW 2006, Australia; (G.A.H.-C.); (J.N.)
| | - Mustafa Al Ansari
- Faculty of Medicine and Health, Sydney School of Medicine (Central Clinical School), University of Sydney, Camperdown, NSW 2006, Australia; (B.A.-A.); (M.A.A.); (K.C.)
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Camperdown, NSW 2006, Australia; (G.A.H.-C.); (J.N.)
| | - Joel Negin
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Camperdown, NSW 2006, Australia; (G.A.H.-C.); (J.N.)
| | - Katherine Conigrave
- Faculty of Medicine and Health, Sydney School of Medicine (Central Clinical School), University of Sydney, Camperdown, NSW 2006, Australia; (B.A.-A.); (M.A.A.); (K.C.)
- Drug Health Services, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia
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Natnael T, Alemnew Y, Berihun G, Abebe M, Andualem A, Ademe S, Tegegne B, Adane M. Facemask wearing to prevent COVID-19 transmission and associated factors among taxi drivers in Dessie City and Kombolcha Town, Ethiopia. PLoS One 2021; 16:e0247954. [PMID: 33711038 PMCID: PMC7954338 DOI: 10.1371/journal.pone.0247954] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/17/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) has pointed out that urban taxi drivers and their passengers are at higher risk of transmitting coronavirus disease 19 (COVID-19) due to frequent contact among many people. Facemask wearing is one of the preventive measures recommended to control the transmission of the virus. A lack of evidence of the proportion of facemask wearing among taxi drivers and associated factors in Ethiopia, including Dessie City and Kombolcha Town, hinders the design of targeted interventions to advocate for facemask use. This study was designed to address this gap. METHODS A cross-sectional study was conducted among 417 taxi drivers in Dessie City and Kombolcha Town from July to August, 2020. The study participants were selected using a simple random sampling technique after proportionally allocating the sample size from the total number of taxi drivers working in Dessie City and Kombolcha Town. The data were collected by trained data collectors using a structured questionnaire and an on-the-spot observational checklist. The collected data were checked, coded and entered to EpiData version 4.6 and exported to Statistical Package for Social Sciences (SPSS) version 25.0 for data cleaning and analysis. Bivariate (Crude Odds Ratio [COR]) and multivariable (Adjusted Odds Ratio [AOR]) logistic regression analyses were employed using 95% CI (confidence interval). From bivariate logistic regression analysis, variables with p-value < 0.250 were retained into multivariable logistic regression analysis. Then, from the multivariable analysis, variables with p-value < 0.050 were declared as factors significantly associated with facemask wearing among taxi drivers in Dessie City and Kombolcha Town. MAIN FINDINGS The proportion of taxi drivers who wore a facemask was 54.68% [95%CI: 50.10-59.7%]. The majority (58.3%) of drivers were using cloth facemasks, followed by N95 facemasks (24.5%) and surgical facemasks (17.3%). Out of the total 417 taxi drivers, more than two-thirds (69.8%) of them had a good knowledge about COVID-19 and 67.6% of taxi drivers had a positive attitude towards taking precautions against transmission of COVID-19. Three-fourths (74.1%) of the taxi drivers believed that wearing a facemask could prevent COVID-19. More than half (52.5%) felt discomfort when wearing a facemask. Almost three-fourths (72.2%) of taxi drivers felt that the presence of local government pressure helped them to wear a facemask. We found that marital status [AOR = 3.14, 95%CI: 1.97-5.01], fear of the disease [AOR = 2.1, 95%CI: 1.28-3.47], belief in the effectiveness of a facemask [AOR = 5.6, 95%CI: 3.1-10.16] and feeling government pressure [AOR = 3.6, 95%CI: 2.16-6.13] were factors significantly associated with wearing a facemask. CONCLUSION We found that the proportion of facemask wearers among taxi drivers was relatively low in Dessie City and Kombolcha Town. In order to increase that number, government bodies should work aggressively to encourage more taxi drivers to wear a facemask. We also recommend that government and non-government organizations work very closely together to implement strategies that promote facemask use, including increasing the availability of inexpensive facemasks, and monitoring and controlling facemask use.
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Affiliation(s)
- Tarikuwa Natnael
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yeshiwork Alemnew
- Department of Biology, College of Natural Sciences, Wollo University, Dessie, Ethiopia
| | - Gete Berihun
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Masresha Abebe
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Atsedemariam Andualem
- Department of Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Sewunet Ademe
- Department of Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Belachew Tegegne
- Department of Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Metadel Adane
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Ganczak M, Pasek O, Duda-Duma Ł, Świstara D, Korzeń M. Use of masks in public places in Poland during SARS-Cov-2 epidemic: a covert observational study. BMC Public Health 2021; 21:393. [PMID: 33622279 PMCID: PMC7901005 DOI: 10.1186/s12889-021-10418-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/09/2021] [Indexed: 12/24/2022] Open
Abstract
Background Face masks have been employed in the COVID-19 pandemic plans as a public and personal health control measure against the spread of SARS-CoV-2. In Poland, obligatory wearing of masks in public spaces was introduced on April 10th, 2020; a relaxation of previous universal measures was announced on May 29th, 2020, limiting use to indoor public places. Objective To assess use of masks or other protective devices in public spaces in Poland during the SARS-Cov-2 epidemic. Methods A non-participatory covert observational study was conducted on three dates, (10.05/18.05/25.05.2020) at public spaces in 13 regions with different risks. Ten consecutive individuals were observed by each of 82 medical students (n = 2460 observations), using a structured checklist. Results Among 2353 observed persons, the female/male ratios were 1.0, 1.1, and 1.0 on the three dates. Almost three quarters - 73.6% (n = 552/750) were using masks on date 1, 66.5% (544/818) on date 2; and 65.7% (516/785) on date 3. Cloth masks predominated on all dates (64.7–62.3%-62.6%), followed by medical (23.4–28.5%-26.9%). Being female (OR = 1.77–1.47-1.53 respectively) and location in a closed space (OR = 2.60–2.59-2.32) were each associated with higher usage. Participants in sports were about two times less likely to use masks (OR = 0.64–0.53-0.53) as compared to other activities. The proportion using masks correctly decreased gradually over time (364/552; 65.9%; 339/544; 62.3% and 304/516; 58.9%). More females wore masks correctly (date 1: 205/294; 69.7% vs 159/258; 61.6%, and date 3: 186/284; 65.5% vs 118/232; 50.9%; p = 0.045; p = 0.0008 respectively). Uncovered noses (47.3–52.7%) and masks around the neck (39.2–42.6%) were the most frequent incorrect practices. Conclusions Practices were not in line with official recommendations, especially among males, and deteriorated over time. Cloth masks were predominantly used in public spaces. Health promotion, through utilizing all available communication channels, would be helpful to increase compliance.
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Affiliation(s)
- Maria Ganczak
- Department of Infectious Diseases, Collegium Medicum, Uniwersytet Zielonogórski, Zielona Góra, Poland.
| | - Oskar Pasek
- Collegium Medicum, Uniwersytet Zielonogórski, Zielona Góra, Poland
| | - Łukasz Duda-Duma
- Collegium Medicum, Uniwersytet Zielonogórski, Zielona Góra, Poland
| | - Dawid Świstara
- Collegium Medicum, Uniwersytet Zielonogórski, Zielona Góra, Poland
| | - Marcin Korzeń
- Department of Methods of Artificial Intelligence & Applied Mathematics, Westpomeranian University of Technology, Szczecin, Poland
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Wang PW, Chen YL, Chang YP, Wu CF, Lu WH, Yen CF. Sources of COVID-19-Related Information in People with Various Levels of Risk Perception and Preventive Behaviors in Taiwan: A Latent Profile Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042091. [PMID: 33669977 PMCID: PMC7924873 DOI: 10.3390/ijerph18042091] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023]
Abstract
The present study aimed to identify the distinct levels of risk perception and preventive behaviors during the coronavirus disease 2019 (COVID-19) outbreak among people in Taiwan and to examine the roles of information sources in various levels of risk perception and preventive behavior. The online survey recruited 1984 participants through a Facebook advertisement. Their self-reported risk perception, adopted preventive behaviors and COVID-19-related information were collected. We analyzed individuals’ risk perception and adopted preventive behaviors by using latent profile analysis and conducted multinomial logistic regression of latent class membership on COVID-19-related information sources. Four latent classes were identified, including the risk neutrals with high preventive behaviors, the risk exaggerators with high preventive behaviors, the risk deniers with moderate preventive behaviors, and the risk deniers with low preventive behaviors. Compared with the risk neutrals, the risk exaggerators with high preventive behaviors were more likely to obtain COVID-19 information from multiple sources, whereas the risk deniers with moderate preventive behaviors and risk deniers with low preventive behaviors were less likely to obtain COVID-19 information compared with the risk neutrals. Governments and health professions should take the variety of risk perception and adopted preventive behaviors into consideration when disseminating information on COVID-19 to the general public.
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Affiliation(s)
- Peng-Wei Wang
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (P.-W.W.); (C.-F.W.)
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
| | - Yi-Lung Chen
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan;
- Department of Psychology, Asia University, Taichung 41354, Taiwan
| | - Yu-Ping Chang
- School of Nursing, The State University of New York, University at Buffalo, New York, NY 14214-3079, USA;
| | - Chia-Fen Wu
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (P.-W.W.); (C.-F.W.)
| | - Wei-Hsin Lu
- Department of Psychiatry, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City 60002, Taiwan
- Correspondence: (W.-H.L.); (C.-F.Y.)
| | - Cheng-Fang Yen
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (P.-W.W.); (C.-F.W.)
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Correspondence: (W.-H.L.); (C.-F.Y.)
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Tai YL, Chi H, Chiu NC, Tseng CY, Huang YN, Lin CY. The Effect of a Name-Based Mask Rationing Plan in Taiwan on Public Anxiety Regarding a Mask Shortage During the COVID-19 Pandemic: Observational Study. JMIR Form Res 2021; 5:e21409. [PMID: 33400678 PMCID: PMC7837388 DOI: 10.2196/21409] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/17/2020] [Accepted: 12/24/2020] [Indexed: 12/21/2022] Open
Abstract
Background The COVID-19 pandemic is a severe global health crisis. Wearing a mask is a straightforward action that can be taken, but shortage of stock and equity of allocation were important issues in Taiwan. Furthermore, increased anxiety leading to the stockpiling of masks has been common during the pandemic. Objective We aim to summarize the name-based mask rationing plan implemented in Taiwan and explore the public’s perceived anxiety about mask shortages. Methods The government of Taiwan took action to control the supply and allocation of face masks. We summarize the timeline and important components of the mask rationing plan. A survey that aimed to investigate the overall response to the mask rationing plan was answered by 44 participants. Results The mask rationing plan was implemented in late January 2020. Daily production capacity was increased from 2 million masks to 16 million masks in April 2020. People could buy 9 masks in 14 days by verification via their National Health Insurance card. Digital face mask availability maps were created. Moreover, the mask plan safeguarded the purchase of masks and resulted in decreased anxiety about a mask shortage (4.05 [SD 1.15] points; 72.7% [n=32] of participants answered “agree” or “strongly agree”). The majority of people felt that the mask plan was satisfactory (4.2 [SD 0.92] points; 79.5% [n=35] of participants answered “agree” or “strongly agree”). Conclusions We found that the unique name-based mask rationing plan allowed for control of the production and supply of masks, and contributed to the appropriate allocation of masks. The mask rationing plan not only provided the public with physical protection, but also resulted in reduced anxiety about mask shortages during the pandemic.
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Affiliation(s)
- Yu-Lin Tai
- Hsinchu MacKay Memorial Hospital, Department of Pediatrics and Infectious Disease, Hsinchu, Taiwan
| | - Hsin Chi
- MacKay Children's Hospital, Department of Pediatrics and Infectious Disease, Taipei, Taiwan.,MacKay Medical College, Department of Medicine, New Taipei, Taiwan
| | - Nan-Chang Chiu
- MacKay Children's Hospital, Department of Pediatrics and Infectious Disease, Taipei, Taiwan.,MacKay Medical College, Department of Medicine, New Taipei, Taiwan
| | - Cheng-Yin Tseng
- Hsinchu MacKay Memorial Hospital, Department of Pediatrics and Infectious Disease, Hsinchu, Taiwan.,China Medical University, Graduate Institute of Chinese Medicine, School of Chinese Medicine, Taichung, Taiwan
| | - Ya-Ning Huang
- MacKay Children's Hospital, Department of Pediatrics and Infectious Disease, Taipei, Taiwan
| | - Chien-Yu Lin
- Hsinchu MacKay Memorial Hospital, Department of Pediatrics and Infectious Disease, Hsinchu, Taiwan.,MacKay Medical College, Department of Medicine, New Taipei, Taiwan
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A Mixed-Methods Systematic Review of the Impacts of Coronavirus on Society and Culture. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020491. [PMID: 33435337 PMCID: PMC7827960 DOI: 10.3390/ijerph18020491] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 12/19/2022]
Abstract
Little is understood of the social and cultural effects of coronaviruses such as coronavirus disease 2019 (COVID-19), severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS-CoV). This systematic review aims to synthesize existing findings (both qualitative and quantitative) that focus on the social and cultural impacts of coronaviruses in order to gain a better understanding of the COVID-19 pandemic. Utilizing a predetermined search strategy, we searched CINAHL, PsycINFO, PubMed, and Web of Science to identify existing (qualitative, quantitative, and mixed-methods) studies pertaining to the coronavirus infections and their intersection with societies and cultures. A narrative synthesis approach was applied to summarize and interpret findings of the study. Stemming from SARS outbreak in 2003, qualitative and quantitative findings (twelve adopted quantitative methods and eight exclusively used qualitative methods) were organized under five topical domains: governance, crisis communication and public knowledge, stigma and discrimination, social compliance of preventive measures, and the social experience of health workers. The selected studies suggest that current societies are not equipped for effective coronavirus response and control. This mixed-methods systematic review demonstrates that the effects of coronaviruses on a society can be debilitating.
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Brainard J, Jones NR, Lake IR, Hooper L, Hunter PR. Community use of face masks and similar barriers to prevent respiratory illness such as COVID-19: a rapid scoping review. ACTA ACUST UNITED AC 2021; 25. [PMID: 33303066 PMCID: PMC7730486 DOI: 10.2807/1560-7917.es.2020.25.49.2000725] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BackgroundEvidence for face-mask wearing in the community to protect against respiratory disease is unclear.AimTo assess effectiveness of wearing face masks in the community to prevent respiratory disease, and recommend improvements to this evidence base.MethodsWe systematically searched Scopus, Embase and MEDLINE for studies evaluating respiratory disease incidence after face-mask wearing (or not). Narrative synthesis and random-effects meta-analysis of attack rates for primary and secondary prevention were performed, subgrouped by design, setting, face barrier type, and who wore the mask. Preferred outcome was influenza-like illness. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) quality assessment was undertaken and evidence base deficits described.Results33 studies (12 randomised control trials (RCTs)) were included. Mask wearing reduced primary infection by 6% (odds ratio (OR): 0.94; 95% CI: 0.75-1.19 for RCTs) to 61% (OR: 0.85; 95% CI: 0.32-2.27; OR: 0.39; 95% CI: 0.18-0.84 and OR: 0.61; 95% CI: 0.45-0.85 for cohort, case-control and cross-sectional studies respectively). RCTs suggested lowest secondary attack rates when both well and ill household members wore masks (OR: 0.81; 95% CI: 0.48-1.37). While RCTs might underestimate effects due to poor compliance and controls wearing masks, observational studies likely overestimate effects, as mask wearing might be associated with other risk-averse behaviours. GRADE was low or very low quality.ConclusionWearing face masks may reduce primary respiratory infection risk, probably by 6-15%. It is important to balance evidence from RCTs and observational studies when their conclusions widely differ and both are at risk of significant bias. COVID-19-specific studies are required.
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Affiliation(s)
- Julii Brainard
- The Norwich School of Medicine, University of East Anglia, Norwich, Norfolk, United Kingdom
| | - Natalia R Jones
- School of Environmental Sciences, University of East Anglia, Norwich, Norfolk, United Kingdom
| | - Iain R Lake
- School of Environmental Sciences, University of East Anglia, Norwich, Norfolk, United Kingdom
| | - Lee Hooper
- The Norwich School of Medicine, University of East Anglia, Norwich, Norfolk, United Kingdom
| | - Paul R Hunter
- The Norwich School of Medicine, University of East Anglia, Norwich, Norfolk, United Kingdom
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Alasmari AK, Edwards PJ, Assiri AM, Behrens RH, Bustinduy AL. Use of face masks and other personal preventive measures by Hajj pilgrims and their impact on health problems during the Hajj. J Travel Med 2020; 27:5903249. [PMID: 32901805 DOI: 10.1093/jtm/taaa155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/25/2020] [Accepted: 08/24/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND The Hajj is one of the world's largest pilgrimage and gathers millions of Muslims from different nationalities every year. Communicable diseases have been reported frequently, during and following the Hajj, and these have been linked to individual behavioural measures. This study aimed to measure the effect of personal preventive measures, such as face mask use, hand hygiene and others, adopted by pilgrims in reducing the acquisition of infectious diseases. METHODS We conducted a cross-sectional study at the Hajj terminal in King Abdulaziz International Airport in Jeddah, Saudi Arabia. Pilgrims were approached in the airport lounges after the 2017 Hajj season and prior to the departure of their flights from Jeddah to their home countries. An electronic data collection tool ('Open Data Kit') was used to gather survey data in regards to health problems and preventive measures during the Hajj. RESULTS A total of 2973 Hajj pilgrims were surveyed. In all, 38.7% reported symptoms of upper respiratory tract infections (URTIs) and 5.4% reported symptoms of travel diarrhoea. Compliance with face mask use was 50.2%. Changing a face mask every 4 h was found to be significantly associated with lower prevalence of URTIs [adjusted odds ratio 0.56 (95% confidence interval 0.34-0.92), P = 0.02]. There was no statistical difference between overall face mask use and URTI acquisition. The main sources of food, eating raw vegetables/food, frequency of hand washing or use of hand sanitizers were not found to be significantly associated with reported travellers' diarrhoea. Unlicensed barbers were used by 12% of pilgrims and 9.2% of pilgrims reported using blades that were reused by other pilgrims. CONCLUSION Preventive measures are the most effective way to prevent infections. Pilgrims can benefit from face masks by changing them frequently. There is still limited information on the effect of the use of face mask in decreasing the risk of URTI in mass gatherings.
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Affiliation(s)
- Abrar K Alasmari
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Phil J Edwards
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Abdullah M Assiri
- Preventive Health, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Ronald H Behrens
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Amaya L Bustinduy
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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Community interventions in Low-And Middle-Income Countries to inform COVID-19 control implementation decisions in Kenya: A rapid systematic review. PLoS One 2020; 15:e0242403. [PMID: 33290402 PMCID: PMC7723273 DOI: 10.1371/journal.pone.0242403] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/02/2020] [Indexed: 12/21/2022] Open
Abstract
Globally, public health measures like face masks, hand hygiene and maintaining social distancing have been implemented to delay and reduce local transmission of COVID-19. To date there is emerging evidence to provide effectiveness and compliance to intervention measures on COVID-19 due to rapid spread of the disease. We synthesized evidence of community interventions and innovative practices to mitigate COVID-19 as well as previous respiratory outbreak infections which may share some aspects of transmission dynamics with COVID-19. In the study, we systematically searched the literature on community interventions to mitigate COVID-19, SARS (severe acute respiratory syndrome), H1N1 Influenza and MERS (middle east respiratory syndrome) epidemics in PubMed, Google Scholar, World Health Organization (WHO), MEDRXIV and Google from their inception until May 30, 2020 for up-to-date published and grey resources. We screened records, extracted data, and assessed risk of bias in duplicates. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO (CRD42020183064). Of 41,138 papers found, 17 studies met the inclusion criteria in various settings in Low- and Middle-Income Countries (LMICs). One of the papers from LMICs originated from Africa (Madagascar) with the rest from Asia 9 (China 5, Bangladesh 2, Thailand 2); South America 5 (Mexico 3, Peru 2) and Europe 2 (Serbia and Romania). Following five studies on the use of face masks, the risk of contracting SARS and Influenza was reduced OR 0.78 and 95% CI = 0.36–1.67. Equally, six studies on hand hygiene practices reported a reduced risk of contracting SARS and Influenza OR 0.95 and 95% CI = 0.83–1.08. Further two studies that looked at combined use of face masks and hand hygiene interventions showed the effectiveness in controlling the transmission of influenza OR 0.94 and 95% CI = 0.58–1.54. Nine studies on social distancing intervention demonstrated the importance of physical distance through closure of learning institutions on the transmission dynamics of disease. The evidence confirms the use of face masks, good hand hygiene and social distancing as community interventions are effective to control the spread of SARS and influenza in LMICs. However, the effectiveness of community interventions in LMICs should be informed by adherence of the mitigation measures and contextual factors taking into account the best practices. The study has shown gaps in adherence/compliance of the interventions, hence a need for robust intervention studies to better inform the evidence on compliance of the interventions. Nevertheless, this rapid review of currently best available evidence might inform interim guidance on similar respiratory infectious diseases like Covid-19 in Kenya and similar LMIC context.
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Barceló J, Sheen GCH. Voluntary adoption of social welfare-enhancing behavior: Mask-wearing in Spain during the COVID-19 outbreak. PLoS One 2020; 15:e0242764. [PMID: 33259531 PMCID: PMC7707551 DOI: 10.1371/journal.pone.0242764] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/09/2020] [Indexed: 11/24/2022] Open
Abstract
With the spread of COVID-19, more countries now recommend their citizens to wear facemasks in public. The uptake of facemasks, however, remains far from universal in countries where this practice lacks cultural roots. In this paper, we aim to identify the barriers to mask-wearing in Spain, a country with no mask-wearing culture. We conduct one of the first nationally representative surveys (n = 4,000) about this unprecedented public health emergency and identify the profile of citizens who are more resistant to face-masking: young, educated, unconcerned with being infected, and with an introverted personality. Our results further indicate a positive correlation between a social norm of mask-wearing and mask uptake and demonstrate that uptake of facemasks is especially high among the elderly living in localities where mask-wearing behavior is popular. These results are robust when controlling for respondents' demographics, time spent at home, and occupation fixed effects. Our findings can be useful for policymakers to devise effective programs for improving public compliance.
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Affiliation(s)
- Joan Barceló
- Division of Social Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Greg Chih-Hsin Sheen
- Division of Social Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
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Cowling BJ, Leung GM. Face masks and COVID-19: don't let perfect be the enemy of good. Euro Surveill 2020; 25:2001998. [PMID: 33303063 PMCID: PMC7730488 DOI: 10.2807/1560-7917.es.2020.25.49.2001998] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/09/2020] [Indexed: 01/31/2023] Open
Affiliation(s)
- Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
| | - Gabriel M Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
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Brainard J, Jones NR, Lake IR, Hooper L, Hunter PR. Community use of face masks and similar barriers to prevent respiratory illness such as COVID-19: a rapid scoping review. Euro Surveill 2020; 25. [PMID: 33303066 DOI: 10.1101/2020.04.01.20049528] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023] Open
Abstract
BackgroundEvidence for face-mask wearing in the community to protect against respiratory disease is unclear.AimTo assess effectiveness of wearing face masks in the community to prevent respiratory disease, and recommend improvements to this evidence base.MethodsWe systematically searched Scopus, Embase and MEDLINE for studies evaluating respiratory disease incidence after face-mask wearing (or not). Narrative synthesis and random-effects meta-analysis of attack rates for primary and secondary prevention were performed, subgrouped by design, setting, face barrier type, and who wore the mask. Preferred outcome was influenza-like illness. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) quality assessment was undertaken and evidence base deficits described.Results33 studies (12 randomised control trials (RCTs)) were included. Mask wearing reduced primary infection by 6% (odds ratio (OR): 0.94; 95% CI: 0.75-1.19 for RCTs) to 61% (OR: 0.85; 95% CI: 0.32-2.27; OR: 0.39; 95% CI: 0.18-0.84 and OR: 0.61; 95% CI: 0.45-0.85 for cohort, case-control and cross-sectional studies respectively). RCTs suggested lowest secondary attack rates when both well and ill household members wore masks (OR: 0.81; 95% CI: 0.48-1.37). While RCTs might underestimate effects due to poor compliance and controls wearing masks, observational studies likely overestimate effects, as mask wearing might be associated with other risk-averse behaviours. GRADE was low or very low quality.ConclusionWearing face masks may reduce primary respiratory infection risk, probably by 6-15%. It is important to balance evidence from RCTs and observational studies when their conclusions widely differ and both are at risk of significant bias. COVID-19-specific studies are required.
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Affiliation(s)
- Julii Brainard
- The Norwich School of Medicine, University of East Anglia, Norwich, Norfolk, United Kingdom
| | - Natalia R Jones
- School of Environmental Sciences, University of East Anglia, Norwich, Norfolk, United Kingdom
| | - Iain R Lake
- School of Environmental Sciences, University of East Anglia, Norwich, Norfolk, United Kingdom
| | - Lee Hooper
- The Norwich School of Medicine, University of East Anglia, Norwich, Norfolk, United Kingdom
| | - Paul R Hunter
- The Norwich School of Medicine, University of East Anglia, Norwich, Norfolk, United Kingdom
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Wang J, Pan L, Tang S, Ji JS, Shi X. Mask use during COVID-19: A risk adjusted strategy. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 266:115099. [PMID: 32623270 PMCID: PMC7314683 DOI: 10.1016/j.envpol.2020.115099] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 05/19/2023]
Abstract
In the context of Coronavirus Disease (2019) (COVID-19) cases globally, there is a lack of consensus across cultures on whether wearing face masks is an effective physical intervention against disease transmission. This study 1) illustrates transmission routes of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2); 2) addresses controversies surrounding the mask from perspectives of attitude, effectiveness, and necessity of wearing the mask with evidence that the use of mask would effectively interrupt the transmission of infectious diseases in both hospital settings and community settings; and 3) provides suggestion that the public should wear the mask during COVID-19 pandemic according to local context. To achieve this goal, government should establish a risk adjusted strategy of mask use to scientifically publicize the use of masks, guarantee sufficient supply of masks, and cooperate for reducing health resources inequities.
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Affiliation(s)
- Jiao Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China
| | - Lijun Pan
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China
| | - Song Tang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China; Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, 211166, China
| | - John S Ji
- Environmental Research Center, Duke Kunshan University, Kunshan, Jiangsu, 215316, China; Nicholas School of the Environment, Duke University, Durham, NC, 27708, USA
| | - Xiaoming Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China; Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, 211166, China.
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Olry de Labry-Lima A, Bermúdez-Tamayo C, Martinez-Olmos J, Martin-Ruiz E. The use of masks to protect against respiratory infections: an umbrella review. Enferm Infecc Microbiol Clin 2020; 39:S0213-005X(20)30262-7. [PMID: 33097294 PMCID: PMC7575638 DOI: 10.1016/j.eimc.2020.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The global health emergency caused by the current COVID-19 pandemic is resulting in a huge challenge at all levels. The use of masks may reduce the spread of the infection by minimising the excretion of Flügge droplets. The objective of this study was to compile the evidence available on the use of masks in relation to respiratory infections. METHODOLOGY An umbrella review (review of systematic reviews) was conducted. Two reviewers independently carried out the screening process, data extraction and data analysis. Discrepancies were resolved with a third reviewer, and the assessment of the risk of bias of the studies was carried out using the AMSTAR 2 tool. The Rayyan QCRI program was used for the screening process. RESULTS A total of eight systematic reviews were included. The studies analysed the use of masks in the general population, in long-term care facilities, in hospitals and at mass gatherings, and compared the effectiveness thereof in preventing infection. The results of this review revealed that the use of masks is associated with a protective effect against respiratory infections in healthcare facilities, in long-term care facilities and at mass gatherings. CONCLUSIONS In light of the results, it seems reasonable to recommend the use of masks to the general population, but this use should be accompanied by a training programme to improve compliance, as not using them properly may increase the risk of infection.
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Affiliation(s)
- Antonio Olry de Labry-Lima
- Escuela Andaluza de Salud Pública (EASP), Granada, España; Instituto de Investigación Biosanitaria ibs. Granada. Hospitales Universitarios de Granada/Universidad de Granada, Granada, España; CIBER en Epidemiología y Salud Pública (CIBERESP), España.
| | - Clara Bermúdez-Tamayo
- Escuela Andaluza de Salud Pública (EASP), Granada, España; Instituto de Investigación Biosanitaria ibs. Granada. Hospitales Universitarios de Granada/Universidad de Granada, Granada, España; CIBER en Epidemiología y Salud Pública (CIBERESP), España
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Alfelali M, Haworth EA, Barasheed O, Badahdah AM, Bokhary H, Tashani M, Azeem MI, Kok J, Taylor J, Barnes EH, El Bashir H, Khandaker G, Holmes EC, Dwyer DE, Heron LG, Wilson GJ, Booy R, Rashid H. Facemask against viral respiratory infections among Hajj pilgrims: A challenging cluster-randomized trial. PLoS One 2020; 15:e0240287. [PMID: 33048964 PMCID: PMC7553311 DOI: 10.1371/journal.pone.0240287] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 09/24/2020] [Indexed: 12/24/2022] Open
Abstract
Background In this large-scale cluster-randomized controlled trial (cRCT) we sought to assess the effectiveness of facemasks against viral respiratory infections. Methods and results Over three consecutive Hajj seasons (2013, 2014, 2015) pilgrims’ tents in Makkah were allocated to ‘facemask’ or ‘no facemask’ group. Fifty facemasks were offered to participants in intervention tents, to be worn over four days, and none were offered to participants in control tents. All participants recorded facemask use and respiratory symptoms in health diaries. Nasal swabs were collected from the symptomatic for virus detection by reverse transcription polymerase chain reaction. Clinical symptoms and laboratory results were analyzed by ‘intention- to-treat’ and ‘per-protocol’. A total of 7687 adult participants from 318 tents were randomized: 3864 from 149 tents to the intervention group, and 3823 from 169 tents to the control group. Participants were aged 18 to 95 (median 34, mean 37) years, with a male to female ratio of 1:1.2. Overall, respiratory viruses were detected in 277 of 650 (43%) nasal/pharyngeal swabs collected from symptomatic pilgrims. Common viruses were rhinovirus (35.1%), influenza (4.5%) and parainfluenza (1.7%). In the intervention arm, respectively 954 (24.7%) and 1842 (47.7%) participants used facemasks daily and intermittently, while in the control arm, respectively 546 (14.3%) and 1334 (34.9%) used facemasks daily and intermittently. By intention-to-treat analysis, facemask use did not seem to be effective against laboratory-confirmed viral respiratory infections (odds ratio [OR], 1.4; 95% confidence interval [CI], 0.9 to 2.1, p = 0.18) nor against clinical respiratory infection (OR, 1.1; 95% CI, 0.9 to 1.4, p = 0.40). Similarly, in a per-protocol analysis, facemask use did not seem to be effective against laboratory-confirmed viral respiratory infections (OR 1.2, 95% CI 0.9–1.7, p = 0.26) nor against clinical respiratory infection (OR 1.3, 95% CI 1.0–1.8, p = 0.06). Conclusion This trial was unable to provide conclusive evidence on facemask efficacy against viral respiratory infections most likely due to poor adherence to protocol.
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Affiliation(s)
- Mohammad Alfelali
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead and The University of Sydney, Sydney, New South Wales, Australia
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Osamah Barasheed
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead and The University of Sydney, Sydney, New South Wales, Australia
- Research Center, King Abdullah Medical City, Mecca, Saudi Arabia
| | - Al-Mamoon Badahdah
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead and The University of Sydney, Sydney, New South Wales, Australia
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hamid Bokhary
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Life & Environmental Sciences and School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
- Umm Al-Qura University, Mecca, Saudi Arabia
| | - Mohamed Tashani
- Discipline of Child and Adolescent Health, The Children’s Hospital at Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine, The University of Tripoli, Ain Zara, Tripoli, Libya
| | - Mohammad I. Azeem
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead and The University of Sydney, Sydney, New South Wales, Australia
| | - Jen Kok
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Life & Environmental Sciences and School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
- NSW Health Pathology - Institute for Clinical Pathology and Medical Research, Westmead Hospital and The University of Sydney, Sydney, New South Wales, Australia
| | - Janette Taylor
- NSW Health Pathology - Institute for Clinical Pathology and Medical Research, Westmead Hospital and The University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth H. Barnes
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Haitham El Bashir
- Rehabilitation Department, Al Jalila Children Specialty Hospital, Dubai, United Arab Emirates
| | - Gulam Khandaker
- Discipline of Child and Adolescent Health, The Children’s Hospital at Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Edward C. Holmes
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Life & Environmental Sciences and School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Dominic E. Dwyer
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Life & Environmental Sciences and School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
- NSW Health Pathology - Institute for Clinical Pathology and Medical Research, Westmead Hospital and The University of Sydney, Sydney, New South Wales, Australia
| | - Leon G. Heron
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead and The University of Sydney, Sydney, New South Wales, Australia
| | - Godwin J. Wilson
- Department of Laboratory Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead and The University of Sydney, Sydney, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Life & Environmental Sciences and School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead and The University of Sydney, Sydney, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Life & Environmental Sciences and School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
- * E-mail:
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Fadare OO, Okoffo ED. Covid-19 face masks: A potential source of microplastic fibers in the environment. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 737:140279. [PMID: 32563114 PMCID: PMC7297173 DOI: 10.1016/j.scitotenv.2020.140279] [Citation(s) in RCA: 417] [Impact Index Per Article: 104.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 04/15/2023]
Abstract
•Disposable face masks (single use) are used to slow down the transmission rate of Covid-19 from person to person. •Unprecedented rise in the global production of face masks present a new environmental challenge due to Covid-19 pandemic. •Polymer-based face masks waste management issues are increasing. •Covid-19 is playing a key role in microplastic pollution. •Research and community awareness will be successful in making the public mindful of this problem.
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Affiliation(s)
- Oluniyi O Fadare
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China.
| | - Elvis D Okoffo
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, QLD 4102, Australia
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Maher B, Chavez R, Tomaz GCQ, Nguyen T, Hassan Y. A fluid mechanics explanation of the effectiveness of common materials for respiratory masks. Int J Infect Dis 2020; 99:505-513. [PMID: 32861829 PMCID: PMC7452831 DOI: 10.1016/j.ijid.2020.07.066] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Face masks are an important component of personal protection equipment employed in preventing the spread of diseases such as COVID-19. As the supply of mass-produced masks has decreased, the use of homemade masks has become more prevalent. It is important to quantify the effectiveness of different types of materials to provide useful information, which should be considered for homemade masks. METHODS Filtration effects of different types of common materials were studied by measuring the aerosol droplet concentrations in the upstream and downstream regions. Flow-field characteristics of surrounding regions of tested materials were investigated using a laser-diagnostics technique, i.e., particle image velocimetry. The pressure difference across the tested materials was measured. RESULTS Measured aerosol concentrations indicated a breakup of large-size particles into smaller particles. Tested materials had higher filtration efficiency for large particles. Single-layer materials were less efficient, but they had a low pressure-drop. Multilayer materials could produce greater filtering efficiency with an increased pressure drop, which is an indicator of comfort level and breathability. The obtained flow-fields indicated a flow disruption downstream of the tested materials as the velocity magnitude noticeably decreased. CONCLUSIONS The obtained results provide an insight into flow-field characteristics and filtration efficiency of different types of household materials commonly used for homemade masks. This study allows comparison with mass-produced masks under consistent test conditions while employing several well-established techniques.
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Affiliation(s)
- Blake Maher
- Thermal-Hydraulic Research Laboratory, Texas A& M University, College Station, Texas 77843, USA; J. Mike Walker' 66 Department of Mechanical Engineering, Texas A& M University, College Station, Texas 77843, USA
| | - Reynaldo Chavez
- Thermal-Hydraulic Research Laboratory, Texas A& M University, College Station, Texas 77843, USA; J. Mike Walker' 66 Department of Mechanical Engineering, Texas A& M University, College Station, Texas 77843, USA
| | - Gabriel C Q Tomaz
- Thermal-Hydraulic Research Laboratory, Texas A& M University, College Station, Texas 77843, USA; Department of Nuclear Engineering, Texas A& M University, College Station, Texas 77843, USA
| | - Thien Nguyen
- Thermal-Hydraulic Research Laboratory, Texas A& M University, College Station, Texas 77843, USA; Department of Nuclear Engineering, Texas A& M University, College Station, Texas 77843, USA.
| | - Yassin Hassan
- Thermal-Hydraulic Research Laboratory, Texas A& M University, College Station, Texas 77843, USA; J. Mike Walker' 66 Department of Mechanical Engineering, Texas A& M University, College Station, Texas 77843, USA; Department of Nuclear Engineering, Texas A& M University, College Station, Texas 77843, USA
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Goni MD, Hasan H, Wan-Arfah N, Naing NN, Deris ZZ, Arifin WN, Baaba AA, Aliyu A, Adam BM. Health Education Intervention as an Effective Means for Prevention of Respiratory Infections Among Hajj Pilgrims: A Review. Front Public Health 2020; 8:449. [PMID: 33014965 PMCID: PMC7494962 DOI: 10.3389/fpubh.2020.00449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/21/2020] [Indexed: 11/13/2022] Open
Abstract
The prevalence of respiratory illness has continued to surge among Hajj pilgrims from different countries despite having some practices of preventive measures. Respiratory illnesses during Hajj could be due to many reasons and many factors that promote disease spread. These factors include overcrowding, cigarette smoking, and direct contact with infectious agents particularly viruses promote the spread of respiratory infections. However, due to the longer duration of the pilgrimage, there are high chances of pilgrims contracting various respiratory illnesses due to exposure to respiratory pathogens. Hajj pilgrims' knowledge, attitudes, and practices toward respiratory tract infections are used as the determinant of the effectiveness of the health education interventions. Knowledge and application of basic hygiene principles, use of face masks, following cough etiquettes, engaging in social distancing, and engaging in other measures are highly important. In this paper, we reviewed the various effective intervention strategies implemented to help prevent respiratory tract infections during Hajj.
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Affiliation(s)
- Mohammed Dauda Goni
- Department of Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Habsah Hasan
- Department of Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Nadiah Wan-Arfah
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
| | - Nyi Nyi Naing
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
| | - Zakuan Zainy Deris
- Department of Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Wan Nor Arifin
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Aisha Abubakar Baaba
- Centre for Language Studies and Generic Development, Universiti Malaysia Kelantan, Kota Bharu, Malaysia
| | - Abdulwahab Aliyu
- Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, Gombe State University, Gombe, Nigeria
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Zar HJ, Dawa J, Fischer GB, Castro-Rodriguez JA. Challenges of COVID-19 in children in low- and middle-income countries. Paediatr Respir Rev 2020; 35:70-74. [PMID: 32654854 PMCID: PMC7316049 DOI: 10.1016/j.prrv.2020.06.016] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 12/31/2022]
Abstract
As the coronavirus pandemic extends to low and middle income countries (LMICs), there are growing concerns about the risk of coronavirus disease (COVID-19) in populations with high prevalence of comorbidities, the impact on health and economies more broadly and the capacity of existing health systems to manage the additional burden of COVID-19. The direct effects of COVID are less of a concern in children, who seem to be largely asymptomatic or to develop mild illness as occurs in high income countries; however children in LMICs constitute a high proportion of the population and may have a high prevalence of risk factors for severe lower respiratory infection such as HIV or malnutrition. Further diversion of resources from child health to address the pandemic among adults may further impact on care for children. Poor living conditions in LMICs including lack of sanitation, running water and overcrowding may facilitate transmission of SARS-CoV-2. The indirect effects of the pandemic on child health are of considerable concern, including increasing poverty levels, disrupted schooling, lack of access to school feeding schemes, reduced access to health facilities and interruptions in vaccination and other child health programs. Further challenges in LMICs include the inability to implement effective public health measures such as social distancing, hand hygiene, timely identification of infected people with self-isolation and universal use of masks. Lack of adequate personal protective equipment, especially N95 masks is a key concern for health care worker protection. While continued schooling is crucial for children in LMICs, provision of safe environments is especially challenging in overcrowded resource constrained schools. The current crisis is a harsh reminder of the global inequity in health in LMICs. The pandemic highlights key challenges to the provision of health in LMICs, but also provides opportunities to strengthen child health broadly in such settings.
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Affiliation(s)
- Heather J. Zar
- Department of Paediatrics and Child Health, SA MRC Unit on Child and Adolescent Health, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa,Corresponding author
| | - Jeanette Dawa
- College of Health Sciences, University of Nairobi, Nairobi, Kenya,Washington State University – Global Health Program, Nairobi, Kenya
| | - Gilberto Bueno Fischer
- Universidade Federal de Ciências da Saúde de Porto Alegre School of Medicine, Porto Alegre, Brazil,Pneumology Department Hospital da Criança Santo Antonio Porto Alegre, Porto Alegre, Brazil
| | - Jose A. Castro-Rodriguez
- Department of Pediatric Pulmonology, Division of Pediatrics, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Chiu NC, Chi H, Tai YL, Peng CC, Tseng CY, Chen CC, Tan BF, Lin CY. Impact of Wearing Masks, Hand Hygiene, and Social Distancing on Influenza, Enterovirus, and All-Cause Pneumonia During the Coronavirus Pandemic: Retrospective National Epidemiological Surveillance Study. J Med Internet Res 2020; 22:e21257. [PMID: 32750008 PMCID: PMC7471891 DOI: 10.2196/21257] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/29/2020] [Accepted: 08/01/2020] [Indexed: 01/12/2023] Open
Abstract
Background The coronavirus disease (COVID-19) pandemic is an important health crisis worldwide. Several strategies were implemented to combat COVID-19, including wearing masks, hand hygiene, and social distancing. The impact of these strategies on COVID-19 and other viral infections remains largely unclear. Objective We aim to investigate the impact of implemented infectious control strategies on the incidences of influenza, enterovirus infection, and all-cause pneumonia during the COVID-19 pandemic. Methods We utilized the electronic database of the Taiwan National Infectious Disease Statistics System and extracted incidences of COVID-19, influenza virus, enterovirus, and all-cause pneumonia. We compared the incidences of these diseases from week 45 of 2016 to week 21 of 2020 and performed linear regression analyses. Results The first case of COVID-19 in Taiwan was reported in late January 2020 (week 4). Infectious control strategies have been promoted since late January. The influenza virus usually peaks in winter and decreases around week 14. However, a significant decrease in influenza was observed after week 6 of 2020. Regression analyses produced the following results: 2017, R2=0.037; 2018, R2=0.021; 2019, R2=0.046; and 2020, R2=0.599. A dramatic decrease in all-cause pneumonia was also reported (R2 values for 2017-2020 were 0.435, 0.098, 0.352, and 0.82, respectively). Enterovirus had increased by week 18 in 2017-2019, but this was not observed in 2020. Conclusions Using this national epidemiological database, we found a significant decrease in cases of influenza, enterovirus, and all-cause pneumonia during the COVID-19 pandemic. Wearing masks, hand hygiene, and social distancing may contribute not only to the prevention of COVID-19 but also to the decline of other respiratory infectious diseases. Further studies are warranted to elucidate the causal relationship.
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Affiliation(s)
- Nan-Chang Chiu
- MacKay Children's Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Hsin Chi
- MacKay Children's Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Yu-Lin Tai
- Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Chun-Chih Peng
- MacKay Children's Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | | | - Chung-Chu Chen
- Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.,Teaching Center of Natural Science, Minghsin University of Science and Technology, Hsinchu, Taiwan
| | - Boon Fatt Tan
- National Taiwan University, Hsinchu Branch, Hsinchu, Taiwan
| | - Chien-Yu Lin
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan.,Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
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40
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Aloui-Zarrouk Z, El Youssfi L, Badu K, Francis Fagbamigbe A, Matoke-Muhia D, Ngugi C, Dukhi N, Mwaura G. The wearing of face masks in African countries under the COVID-19 crisis: luxury or necessity? AAS Open Res 2020. [DOI: 10.12688/aasopenres.13079.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The unforeseeable global crisis of the spread of coronavirus disease 2019 (COVID-19) has caused almost all affected countries to adopt a range of protective measures as recommended by the World Health Organization. However, the speed, type and level of adoption of these protective measures have been remarkably different. Social distancing and quarantine were the main measures adopted in addition to observing basic hygiene. Based on the available evidences, WHO continues to recommend wearing of face masks for healthcare workers and for those people caring for COVID-19 patients. However, some countries and organisations have recommended, and some have even made it mandatory, for their citizens to wear face masks. Particularly in low- and middle-income countries, protecting by wearing face masks is viewed as an affordable yet proactive preventive measure to avoid and slow down viral spread based on the experience of other affected countries. However, the wearing of face masks is controversial due to shortages in their stocks and uncertainty around the quality of masks, as well as their efficiency as a protective mechanism. Masks should be used based on appropriate use and management guidelines. This paper discusses the wearing of face masks from the perspective of low- and middle-income countries, particularly in Africa; and then makes some recommendations that will greatly inform policy makers on epidemic mitigation strategies throughout the African continent.
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Greenhalgh T. Face coverings for the public: Laying straw men to rest. J Eval Clin Pract 2020; 26:1070-1077. [PMID: 32455503 PMCID: PMC8581764 DOI: 10.1111/jep.13415] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/24/2022]
Abstract
Background This article responds to one by Graham Martin and colleagues, who offered a critique of my previous publications on face coverings for the lay public in the Covid-19 pandemic. Their paper reflects criticisms that have been made of face coverings policies more generally. Method Narrative rebuttal. Results I address charges that my coauthors and I had misapplied the precautionary principle; drawn conclusions that were not supported by empirical research; and failed to take account of potential harms But before that, I remind my critics that the evidence on face coverings goes beyond the contested trials and observational studies they place centre stage. I set out some key findings from basic science, epidemiology, mathematical modelling, case studies, and natural experiments, and use this rich and diverse body of evidence as the backdrop for my rebuttal of their narrowly framed objections. I challenge my critics' apparent assumption that a particular kind of systematic review should be valorised over narrative and real-world evidence, since stories are crucial to both our scientific understanding and our moral imagination. Conclusion I conclude by thanking my academic adversaries for the intellectual sparring match, but exhort them to remember our professional accountability to a society in crisis. It is time to lay straw men to rest and embrace the full range of evidence in the context of the perilous threat the world is now facing.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
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42
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Affiliation(s)
- Eleni Mantzari
- Department of Public Health and Primary Care, Behaviour and Heath Research Unit, University of Cambridge, Cambridge, UK
| | - G James Rubin
- Department of Psychological Medicine, King's College London, London, UK
| | - Theresa M Marteau
- Department of Public Health and Primary Care, Behaviour and Heath Research Unit, University of Cambridge, Cambridge, UK
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43
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Chen J, He H, Cheng W, Liu Y, Sun Z, Chai C, Kong Q, Sun W, Zhang J, Guo S, Shi X, Wang J, Chen E, Chen Z. Potential transmission of SARS-CoV-2 on a flight from Singapore to Hangzhou, China: An epidemiological investigation. Travel Med Infect Dis 2020; 36:101816. [PMID: 32645477 PMCID: PMC7336905 DOI: 10.1016/j.tmaid.2020.101816] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Between January 24, 2020 and February 15, 2020, an outbreak of COVID-19 occurred among 335 passengers on a flight from Singapore to Hangzhou in China. This study aimed to investigate the source of the outbreak and assess the risk of transmission of COVID-19 during the flight. METHOD Using a standardized questionnaire, we collected information on the travelers' demographic characteristics and illness before, during, and after the flight. We also collected data on factors potentially associated with COVID-19 transmission during the flight. RESULTS A total of 16 COVID-19 patients were diagnosed among all passengers; the overall attack rate was 4.8%. The attack rate among passengers who had departed from Wuhan was significantly higher than that among those who had departed from other places. One passenger without an epidemiological history of exposure before boarding developed COVID-19. During the flight, he was seated near four infected passengers from Wuhan for approximately an hour and did not wear his facemask correctly during the flight. CONCLUSIONS COVID-19 transmission may have occurred during the flight. However, the majority of the cases in the flight-associated outbreak could not be attributed to transmission on the flight but were associated with exposure to the virus in Wuhan or to infected members in a single tour group.
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Affiliation(s)
- Junfang Chen
- HangZhou Center for Disease Control and Prevention, Hangzhou, China
| | - Hanqing He
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Wei Cheng
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Yan Liu
- HangZhou Center for Disease Control and Prevention, Hangzhou, China
| | - Zhou Sun
- HangZhou Center for Disease Control and Prevention, Hangzhou, China
| | - Chengliang Chai
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Qingxin Kong
- HangZhou Center for Disease Control and Prevention, Hangzhou, China
| | - Wanwan Sun
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Jiaqi Zhang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Song Guo
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Xuguang Shi
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Jinna Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Enfu Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.
| | - Zhiping Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.
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44
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Sud SR. COVID-19 and Keeping Clean: A Narrative Review To Ascertain the Efficacy of Personal Protective Equipment To Safeguard Health Care Workers Against SARS-CoV-2. Hosp Pediatr 2020; 10:570-576. [PMID: 32385055 DOI: 10.1542/hpeds.2020-0135] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Identifying the optimal amount of personal protective equipment (PPE) is a formidable challenge when faced with a new contagion such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Unequivocally, there are dangers to health care workers (and by extension, their patients, colleagues, and communities) if not enough equipment is donned to safeguard them. And yet, there are also dangers to patients, colleagues, and the community if resources are overconsumed and result in hoarding, shortages, and inequitable distribution, all of which are occurring as the worldwide coronavirus disease 2019 (COVID-19) pandemic continues.Research to ascertain the precise PPE required to defend specifically against SARS-CoV-2 encompasses an area of active investigation that will likely remain unresolved for some time. While awaiting more definitive conclusions, we must look to past evidence to provide a reasonable basis on which protocols and policies might be refined. What follows is a narrative review of PPE efficacy and how existing evidence might apply to protecting health care workers against COVID-19. Findings are extrapolated from investigations in 4 general domains: early investigations into SARS-CoV-2, retrospective studies about severe acute respiratory syndrome coronavirus 1, prospective studies of influenza and other common respiratory viruses, and laboratory PPE studies.Available evidence suggests that contact and droplet precautions, in addition to eye protection and standard hygiene measures, should be adequate in the vast majority of clinical settings when caring for patients with SARS-CoV-2. Adherence to guidelines promoting appropriate levels of PPE should safeguard practitioners while mitigating against resource overuse.
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Affiliation(s)
- Sohil R Sud
- Department of Pediatrics, University of California, San Francisco, San Francisco, California
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45
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Alqahtani AS, Tashani M, Heywood AE, Almohammed ABS, Booy R, Wiley KE, Rashid H. Tracking Australian Hajj Pilgrims' Health Behavior before, during and after Hajj, and the Effective Use of Preventive Measures in Reducing Hajj-Related Illness: A Cohort Study. PHARMACY 2020; 8:pharmacy8020078. [PMID: 32375320 PMCID: PMC7355622 DOI: 10.3390/pharmacy8020078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 12/23/2022] Open
Abstract
This study assessed Australian Hajj pilgrims’ knowledge, attitude and practices throughout their Hajj journey to understand their health behaviors, use of preventative measures and development of illness symptoms. A prospective cohort study with data collection at three phases (before, during and after Hajj) was conducted among Australian pilgrims between August and December 2015. Baseline data were collected from 421 pilgrims before Hajj, with 391 providing follow-up data during Hajj and 300 after their home return. Most participants (78% [329/421]) received one or more recommended vaccines; travel agents’ advice was the main factor affecting vaccination uptake. Most participants (69% [270/391]) practiced hand hygiene with soap and sanitizers frequently, followed by disposable handkerchief use (36% [139/391]) and washing hands with water only (28% [111/391]). During Hajj 74% (288/391) of participants reported one or more illness symptoms, 86% (248/288) of these symptoms were respiratory. Cough was less often reported among pilgrims who received vaccinations, cleaned their hands with soap or alcoholic hand rubs, while a runny nose was less common among those who frequently washed their hands with plain water but was more common among those who used facemasks. This study reveals that most Australian Hajj pilgrims complied with key preventative measures, and that tour group operators’ advice played an important role in compliance. Pilgrims who were vaccinated and practiced hand hygiene were less likely to report infection symptoms.
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Affiliation(s)
- Amani Salem Alqahtani
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (A.S.A.); (M.T.); (R.B.)
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
- Saudi Food and Drug Authority, Executive Department of Research and Studies, Riyadh 22332, Saudi Arabia
| | - Mohamed Tashani
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (A.S.A.); (M.T.); (R.B.)
- Discipline of Child and Adolescent Health Children’s Hospital at Westmead Clinical School, the Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2145, Australia
- Department of Paediatrics, Faculty of Medicine, University of Tripoli, Ain Zara 13275, Libya
| | - Anita Elizabeth Heywood
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052, Australia;
| | | | - Robert Booy
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (A.S.A.); (M.T.); (R.B.)
- Discipline of Child and Adolescent Health Children’s Hospital at Westmead Clinical School, the Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2145, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Sydney, NSW 2145, Australia
- WHO Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Flinders University, Adelaide, SA 5000, Australia
| | - Kerrie Elizabeth Wiley
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (A.S.A.); (M.T.); (R.B.)
- Discipline of Child and Adolescent Health Children’s Hospital at Westmead Clinical School, the Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2145, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Sydney, NSW 2145, Australia
- Correspondence: ; Tel.: +61-29845-1489
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46
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Respiratory tract infections among French Hajj pilgrims from 2014 to 2017. Sci Rep 2019; 9:17771. [PMID: 31780750 PMCID: PMC6883043 DOI: 10.1038/s41598-019-54370-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/11/2019] [Indexed: 01/03/2023] Open
Abstract
Respiratory tract infections (RTIs) are common among Hajj pilgrims, but risk factors for RTIs and respiratory pathogen acquisition during the Hajj are not clearly identified. Based on previous studies, most frequent pathogens acquired by Hajj pilgrims were investigated: rhinovirus, human coronaviruses, influenza viruses, Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae and Haemophilus influenzae. 485 pilgrims were included. 82.1% presented with RTIs. Respiratory chronic diseases were associated with cough, Influenza-like illness (ILI) and the acquisition of H. influenzae. Vaccination against invasive pneumococcal diseases (IPD) and influenza was associated with a decrease in the acquisition of S. pneumoniae and prevalence of ILI (aRR = 0.53, 95%CI [0.39-0.73] and aRR = 0.69, 95%CI [0.52-0.92] respectively). Individuals carrying rhinovirus and H. influenzae-S. pneumoniae together were respectively twice and five times more likely to have respiratory symptoms. Individual with H. influenzae-K. pneumoniae carriage were twice (p = 0.04) as likely to develop a cough. The use of disposable handkerchiefs was associated with a decrease in the acquisition of S. aureus (aRR = 0.75, 95%CI [0.57-0.97]). Results could be used to identify pilgrims at increased risk of RTIs and acquisition of respiratory pathogens. Results also confirm the effectiveness of influenza and IPD vaccinations in reducing ILI symptoms and acquisition of S. pneumoniae carriage respectively.
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47
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Alqahtani AS, Althimiri NA, BinDhim NF. Saudi Hajj pilgrims' preparation and uptake of health preventive measures during Hajj 2017. J Infect Public Health 2019; 12:772-776. [PMID: 31023600 DOI: 10.1016/j.jiph.2019.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 04/03/2019] [Accepted: 04/07/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Few studies have reported the uptake of health preventive measures among Hajj pilgrims from Saudi Arabia. Yet, none of these studies have explored their perceptions of health risks at Hajj or pretravel health-advice-seeking behavior. METHODS A cross-sectional survey conducted among Hajj pilgrims from Saudi Arabia. RESULTS Of 344 pilgrims who completed the survey, 44% sought some form of pretravel health information; among them, 38% from non-medical sources. About 67% of participants received an influenza vaccine, and 8.7% received a pneumococcal vaccine. Lack of aware of vaccine availability was the main reason for nonreceipt (26%). Being employed and having a high level of education were significant factors in vaccine uptake. Two thirds of pilgrims carried some medications to use during Hajj; analgesics, antipyretics and antibiotics were the most reported drugs. Various methods of hand hygiene were the most used preventive measures (≈65%) followed by facemask use (53%). Those who concerned about food poisoning at Hajj were more likely to cleaned their hands with hand sanitizers (aOR = 2.5, 95% CI = 1.1-5.4, p = 0.01) and avoid eating food from street vendors (aOR = 2.9, 95% CI = 1.1-7.5, p = 0.02). CONCLUSION Pretravel health-advice-seeking behavior and the use of preventive measures during Hajj were suboptimal among Saudi Hajj pilgrims.
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Goeijenbier M, van Genderen P, Ward BJ, Wilder-Smith A, Steffen R, Osterhaus ADME. Travellers and influenza: risks and prevention. J Travel Med 2017; 24:taw078. [PMID: 28077609 PMCID: PMC5505480 DOI: 10.1093/jtm/taw078] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Influenza viruses are among the major causes of serious human respiratory tract infection worldwide. In line with the high disease burden attributable to influenza, these viruses play an important, but often neglected, role in travel medicine. Guidelines and recommendations regarding prevention and management of influenza in travellers are scarce. Of special interest for travel medicine are risk populations and also circumstances that facilitate influenza virus transmission and spread, like travel by airplane or cruise ship and mass gatherings. METHODS We conducted a PUBMED/MEDLINE search for a combination of the MeSH terms Influenza virus, travel, mass gathering, large scale events and cruise ship. In addition we gathered guidelines and recommendations from selected countries and regarding influenza prevention and management in travellers. By reviewing these search results in the light of published knowledge in the fields of influenza prevention and management, we present best practice advice for the prevention and management of influenza in travel medicine. RESULTS Seasonal influenza is among the most prevalent infectious diseases in travellers. Known host-associated risk factors include extremes of age and being immune-compromised, while the most relevant environmental factors are associated with holiday cruises and mass gatherings. CONCLUSIONS Pre-travel advice should address influenza and its prevention for travellers, whenever appropriate on the basis of the epidemiological situation concerned. Preventative measures should be strongly recommended for travellers at high-risk for developing complications. In addition, seasonal influenza vaccination should be considered for any traveller wishing to reduce the risk of incapacitation, particularly cruise ship crew and passengers, as well as those participating in mass gatherings. Besides advice concerning preventive measures and vaccination, advice on the use of antivirals may be considered for some travellers.
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Affiliation(s)
- M Goeijenbier
- Institute for Tropical Diseases, Havenziekenhuis, Rotterdam, The Netherlands
| | - P van Genderen
- Institute for Tropical Diseases, Havenziekenhuis, Rotterdam, The Netherlands
| | - B J Ward
- Research institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - A Wilder-Smith
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Institute of Public Health, University of Heidelberg, Germany
| | - R Steffen
- Epidemiology, Biostatistics and Prevention Institute, WHO Collaborating Centre for Travelers Health, University of Zurich Travel Health Centre, Zurich, Switzerland
| | - A D M E Osterhaus
- ARTEMIS One Health Research Institute Utrecht, The Netherlands
- Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine, Hannover, Germany
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Zumla A, McCloskey B, Bin Saeed AA, Dar O, Al Otabi B, Perlmann S, Gautret P, Roy N, Blumberg L, Azhar EI, Barbeschi M, Memish Z, Petersen E. What is the experience from previous mass gathering events? Lessons for Zika virus and the Olympics 2016. Int J Infect Dis 2016; 47:1-4. [PMID: 27321962 PMCID: PMC7110488 DOI: 10.1016/j.ijid.2016.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/08/2016] [Indexed: 01/15/2023] Open
Abstract
All previous experiences from different mass gathering show that vaccine preventable diseases is the most important infections like influemza, hepatitis A, polio and meningitis. Three mass gathering held in Africa during the Ebola outbreak accepted participants from West Africa and was able to handle the theoretical risk without any incident. Therefore we believe that the Olympc games in Rio de Janeiro should not be canceled. The number of visitors to the games is a tine fraction (1%) of other visitors to Zika endemic con tries and it will have no measurable effect on the risk of spreading Zika virus, if the games was cancelled.
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Affiliation(s)
- A Zumla
- Division of Infection and Immunity, University College London, and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK
| | - B McCloskey
- Global Health Department, Public Health England, London, UK
| | - A A Bin Saeed
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - O Dar
- Public Health England, London, UK
| | - B Al Otabi
- WHO Collaborating Centre for Mass Gatherings Medicine, Office of the Deputy Minister for Preventive Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - S Perlmann
- Department of Microbiology, University of Iowa, Iowa, USA
| | - P Gautret
- Infectious Diseases and Tropical Medicine Unit, North Hospital, Marseille, France
| | - N Roy
- Environmental Health Resource Hub, School of Habitat Studies, Tata Institute of Social Sciences, Deonar, Mumbai, India
| | - L Blumberg
- National Institute for Communicable Diseases, Division of Public Health Surveillance and Response, Sandringham, Johannesburg, South Africa
| | - E I Azhar
- Special Infectious Agents Unit, King Fahd Medical Research Center and Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - M Barbeschi
- World Health Organization, Geneva, Switzerland
| | - Z Memish
- Ministry of Health, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - E Petersen
- Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark; Department of Infectious Diseases, The Royal Hospital, Muscat, Sultanate of Oman.
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