Mask-wearing and respiratory infection in healthcare workers in Beijing, China

Colonization of bacterial and viral respiratory pathogens among healthcare workers in China during COVID-19 pandemic

Background

Healthcare settings may amplify transmission of respiratory pathogens, however empirical evidence is lacking. We aimed to describe the spectrum and distribution of respiratory pathogens among healthcare workers in eastern China.

Methods

Healthcare workers were recruited from October 2020 to November 2021 in Jiangsu province. Participants were interviewed regarding demographic and hospital-based protective measures. Thirty-seven common respiratory pathogens were tested using real-time PCR/RT-PCR (Probe qPCR). The role of demographic and hospital-based protective measures on pathogens colonization using multivariable logistic regression models.

Results

Among 316 enrolled healthcare workers, a total of 21 pathogens were detected. In total, 212 (67.1%) healthcare workers had at least one respiratory pathogen; 195 (61.7%) and 70 (22.2%) with a bacterial and viral pathogen. The most commonly detected pathogen was streptococcus pneumoniae (47.5%) followed by Haemophilus influenzae (21.2%). One hundred and five (33.2%) healthcare workers with copathogens had at least two respiratory pathogens. Both bacterial and viral colonization were more common in 2020 compared to 2021. A decreased risk of colonization was seen in participants with infection prevention and control training and suitable hand hygiene.

Conclusions

Colonization of respiratory pathogens in healthcare workers from eastern China was high. Differential risk was impacted only by hospital-based protective measures and not demographic factors.

Effect of microfibers induced toxicity in marine sedentary polychaete Hydroides elegans: Insight from embryogenesis axis

Presence of surgical face masks in the environment are more than ever before after the COVID-19 pandemic, and it poses a newer threat to aquatic habitats around the world due to microfibers (MFs) and other contaminants that get discharged when these masks deteriorate. The mechanism behind the developmental toxicity of MFs, especially released from surgical masks, on the early life stages of aquatic organisms are not well understood. Toxicity test were developed to examine the effects of MFs released from surgical facemask upon deterioration using the early gametes and early life stages of marine sedentary polychaete Hydroides elegans. For MFs release, cut pieces of face masks were allowed to degrade in seawater for different time points (1 day, 30 days and 120 days) after which the fibers were obtained for further toxicity studies. The gametes of H. elegans were exposed to the MFs (length < 20 μm) separately for 20 min at a concentration of 50 MFs/ml before fertilization. In addition, we also analyzed the experimental samples for heavy metals and organic substances released from face masks. Our findings demonstrated that gametes exposed to MFs affected the percentage of successful development, considerably slowed down the mitotic cell division and significantly postponed the time of larval hatching and also produced an adverse effect during embryogenesis. When the sperm were exposed fertilization rate was decreased drastically, whereas when the eggs were exposed to MFs fertilization was not inhibited but a delay in early embryonic development observed. In addition the release of heavy metals and other volatile organics from the degrading face masks could also contribute to overall toxicity of these materials in environment. Our study thus shows that inappropriately discarded face masks and MFs and other pollutants released from such face masks could pose long-term hazard to coastal ecosystems.

Admissions for Bronchiolitis at Children's Hospitals Before and During the COVID-19 Pandemic

Importance

The COVID-19 pandemic has been associated with a transient decrease in bronchiolitis hospitalizations compared with prepandemic patterns, but current effects remain unknown.

Objective

To analyze changes in patterns of bronchiolitis admissions at US children's hospitals during the 2020-2023 bronchiolitis seasons compared with the 2010-2019 seasons.

Design, Setting, and Participants

This retrospective cross-sectional study used data from 41 US children's hospitals in the Pediatric Health Information System database. Bronchiolitis has winter-predominant seasonality, so hospitalizations were grouped according to bronchiolitis season (from July through June). This study included all patients aged younger than 2 years admitted with a diagnosis of bronchiolitis between July 1, 2010, and June 30, 2023. Bronchiolitis seasons from July through June between 2010-2011 and 2019-2020 were classified as the prepandemic era, and seasons between 2020-2021 and 2022-2023 were classified as the pandemic era. Data analysis was performed from July 1, 2010, through June 30, 2023.

Exposures

Admission date.

Main Outcomes and Measures

The primary outcome was number of hospitalizations for bronchiolitis by season and month. Monthly admission counts from the prepandemic era were transformed into time series and used to train seasonal ensemble forecasting models. Forecasts were compared to monthly admissions during the pandemic era.

Results

In this study, there were 400 801 bronchiolitis admissions among 349 609 patients between July 1, 2010, and June 30, 2023. The median patient age was 6 (IQR, 2-12) months; 58.7% were boys and 43.7% were White. Hospitalizations increased gradually during the prepandemic era (median, 29 309 [IQR, 26 196-34 157]), decreased 69.2% (n = 9030) in the 2020-2021 season, and increased 75.3% (n = 51 397) in the 2022-2023 season. Patients in the pandemic era were older than those in the prepandemic era (median, 7 [IQR, 3-14] vs 6 [2-12] months; P < .001). Intensive care unit (ICU) admissions increased from 32.2% (96 245 of 298 535) in the prepandemic era to 36.7% (37 516 of 102 266) in the pandemic era (P < .001). The seasonality of bronchiolitis admissions changed during the pandemic era. Admissions peaked in August 2021 (actual 5036 vs 943 [95% CI, 0-2491] forecasted) and November 2022 (actual 10 120 vs 5268 [95% CI, 3425-7419] forecasted). These findings were unchanged in sensitivity analyses excluding children with complex chronic conditions and excluding repeat admissions. In a sensitivity analysis including all viral lower respiratory tract infections in children aged younger than 5 years, there were 66 767 admissions in 2022-2023 vs 35 623 (31 301-41 002) in the prepandemic era, with the largest increase in children aged 24 to 59 months.

Conclusions and Relevance

The findings of this cross-sectional study suggest that bronchiolitis hospitalizations decreased transiently and then increased markedly during the COVID-19 pandemic era. Patients admitted during the pandemic era were older and were more likely to be admitted to an ICU. These findings suggest that bronchiolitis seasonality has not yet returned to prepandemic patterns, and US hospitals should prepare for the possibility of atypical timing again in 2023.

Role of masks in mitigating viral spread on networks

Masks have remained an important mitigation strategy in the fight against COVID-19 due to their ability to prevent the transmission of respiratory droplets between individuals. In this work, we provide a comprehensive quantitative analysis of the impact of mask-wearing. To this end, we propose a novel agent-based model of viral spread on networks where agents may either wear no mask or wear one of several types of masks with different properties (e.g., cloth or surgical). We derive analytical expressions for three key epidemiological quantities: The probability of emergence, the epidemic threshold, and the expected epidemic size. In particular, we show how the aforementioned quantities depend on the structure of the contact network, viral transmission dynamics, and the distribution of the different types of masks within the population. Through extensive simulations, we then investigate the impact of different allocations of masks within the population and tradeoffs between the outward efficiency and inward efficiency of the masks. Interestingly, we find that masks with high outward efficiency and low inward efficiency are most useful for controlling the spread in the early stages of an epidemic, while masks with high inward efficiency but low outward efficiency are most useful in reducing the size of an already large spread. Last, we study whether degree-based mask allocation is more effective in reducing the probability of epidemic as well as epidemic size compared to random allocation. The result echoes the previous findings that mitigation strategies should differ based on the stage of the spreading process, focusing on source control before the epidemic emerges and on self-protection after the emergence.

Effectiveness of Inexpensive Cloth Facemasks and Their Amendments to Reduce Ambient Particulate Exposures: A Case of Kathmandu, Nepal

Inexpensive cloth masks are widely used to reduce particulate exposures, but their use became ubiquitous after the outbreak of COVID-19. A custom experimental setup (semiactive at 5.1 m/s airflow rate) was fabricated to examine the efficiency of different types of commercial facemasks collected randomly from street vendors. The sample (N = 27) including (n = 16) cloth masks (CMs), (n = 7) surgical masks (SMs), and (n = 4) N95 filtering facepiece respirators (FFRs), of which SMs and N95 FFRs taken as a standard for efficiency comparison were all tested against ambient aerosols (PM2.5 and PM10 μg/m3). The prototype cloth masks (PTCMs) (N = 5) design was tailored, and their performance was assessed and compared with that of standard commercial masks. The filtering efficiency tested against ambient coarse particulates (PM10) ranged from (5% to 34%) for CMs with an average of 16%, (37% to 46%) for SMs with an average of 42%, (59% to 72%) for PTCMs with an average of 65%, and (70% to 75%) for N95 FFRs with an average of 71%, whereas against fine particulates (PM2.5), efficacy ranged from (4% to 29%) for CMs with an average of 13%, (34% to 44%) for SMs with an average of 39%, (53% to 68%) for PTCMs with an average of 60%, and (68% to 73%) for N95 FFRs with an average of 70%, respectively. The efficiency followed the order N95 FFRs > PTCMs > SMs > CMs showing poor exposure reduction potential in CMs and high exposure reduction potential in N95 FFRs and PTCMs. Amendment in existing CMs using eco-friendly cotton fabric with better facial adherence can protect human health from exposure to fine particulates <2.5 μm and can reduce the risk of micro-plastic pollution caused by polypropylene (PP) facemasks.

The face behind the Covid-19 mask - A comprehensive review

The threat of epidemic outbreaks like SARS-CoV-2 is growing owing to the exponential growth of the global population and the continual increase in human mobility. Personal protection against viral infections was enforced using ambient air filters, face masks, and other respiratory protective equipment. Available facemasks feature considerable variation in efficacy, materials usage and characteristic properties. Despite their widespread use and importance, face masks pose major potential threats due to the uncontrolled manufacture and disposal techniques. Improper solid waste management enables viral propagation and increases the volume of associated biomedical waste at an alarming rate. Polymers used in single-use face masks include a spectrum of chemical constituents: plasticisers and flame retardants leading to health-related issues over time. Despite ample research in this field, the efficacy of personal protective equipment and its impact post-disposal is yet to be explored satisfactorily. The following review assimilates information on the different forms of personal protective equipment currently in use. Proper waste management techniques pertaining to such special wastes have also been discussed. The study features a holistic overview of innovations made in face masks and their corresponding impact on human health and environment. Strategies with SDG3 and SDG12, outlining safe and proper disposal of solid waste, have also been discussed. Furthermore, employing the CFD paradigm, a 3D model of a face mask was created based on fluid flow during breathing techniques. Lastly, the review concludes with possible future advancements and promising research avenues in personal protective equipment.

Chitosan-Based Formulations Intended as Protective Spray for Mask Surfaces in Prevention of Coronavirus Dissemination

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.

Indirect effects of COVID-19 on the environment: How plastic contamination from disposable surgical masks affect early development of plants

Personal protective equipment, used extensively during the COVID-19 pandemic, heavily burdened the environment due to improper waste management. Owing to their fibrous structure, layered non-woven polypropylene (PP) disposable masks release secondary fragments at a much higher rate than other plastic waste types, thus, posing a barely understood new form of ecological hazard. Here we show that PP mask fragments of different sizes induce morphogenic responses in plants during their early development. Using in vitro systems and soil-filled rhizotrons, we found that several PP mask treatments modified the root growth of Brassica napus (L.) regardless of the experimental system. The environment around the root and mask fragments seemed to influence the effect of PP fabric fragment contamination on early root growth. In soil, primary root length was clearly inhibited by larger PP mask fragments at 1 % concentration, while the two smallest sizes of applied mask fragments caused distinct, concentration-dependent changes in the lateral root numbers. Our results indicate that PP can act as a stressor: contamination by PP surgical masks affects plant growth and hence, warrants attention. Further investigations regarding the effects of plastic pollution on plant-soil interactions involving various soil types are urgently needed.

Cross-sectional survey of changes in knowledge, attitudes and practice of mask use in Sydney and Melbourne during the 2020 COVID-19 pandemic

OBJECTIVES

Since mask uptake and the timing of mask use has the potential to influence the control of the COVID-19 pandemic, this study aimed to assess the changes in knowledge toward mask use in Sydney and Melbourne, Australia, during the 2020 COVID-19 pandemic.

DESIGN

An observational study, using a cross-sectional survey, was distributed to adults in Sydney and Melbourne, Australia, during July-August 2020 (survey 1) and September 2020 (survey 2), during the COVID-19 pandemic in Australia.

SETTING AND PARTICIPANTS

Participants aged 18 years or older and living in either Sydney or Melbourne.

PRIMARY AND SECONDARY OUTCOME MEASURES

Demographics, risk measures, COVID-19 severity and perception, mask attitude and uptake were determined in this study.

RESULTS

A total of 700 participants completed the survey. In both Sydney and Melbourne, a consistent decrease was reported in almost all risk-mitigation behaviours between March 2020 and July 2020 and again between March 2020 and September 2020. However, mask use and personal protective equipment use increased in both Sydney and Melbourne from March 2020 to September 2020. There was no significant difference in mask use during the pandemic between the two cities across both timepoints (1.24 (95% CI 0.99 to 1.22; p=0.072)). Perceived severity and perceived susceptibility of COVID-19 infection were significantly associated with mask uptake. Trust in information on COVID-19 from both national (1.77 (95% CI 1.29 to 2.44); p<0.000)) and state (1.62 (95% CI 1.19 to 2.22); p=0.003)) government was a predictor of mask use across both surveys.

CONCLUSION

Sydney and Melbourne both had high levels of reported mask wearing during July 2020 and September 2020, consistent with the second wave and mask mandates in Victoria, and cluster outbreaks in Sydney at the time. High rates of mask compliance may be explained by high trust levels in information from national and state government, mask mandates, risk perceptions, current outbreaks and the perceived level of risk of COVID-19 infection at the time.

Prevalence of dermatological manifestations due to face mask use and its associated factors during COVID-19 among the general population of Bangladesh: A nationwide cross-sectional survey

Following the worldwide COVID-19 pandemic, individuals have begun to take preventive measures to avoid exposure. Among the precautionary measures, facemask was mostly emphasized. This study aimed to determine the prevalence of dermatological symptoms linked with face mask usage and explore other associated factors. This cross-sectional survey was conducted throughout all eight divisions of Bangladesh. 1297 people were approached using a fixed-step procedure on a random route sample where 803 fulfilled the inclusion criteria. The overall prevalence of dermatological manifestation in this study was 40.85%. The common dermatological manifestations due to facemasks use were acne (26%), allergy symptoms (24%), traumatic symptoms (24%), and other symptoms (26%). Two important frequently reported risk factors were previous history of skin diseases and obesity. Females were more likely to have acne (CI: 1.199, 3.098; p = .007) and allergy issues (CI: 1.042, 2.359; p = .031). N95 and KN95 masks were more likely to produce allergic symptoms, while surgical mask users were more likely to develop acne. Acne was prevalent more than twice (CI: 1.42, 4.26; p = 0.001) in persons with a COVID-19 infection history. Further exploration is required to find out the reason. Surgical mask users reported more complaints than other types of masks, and prolonged use caused more skin symptoms. Modifications in the pattern of facemask usage and planning for work recesses might also be advised to provide for a pause from uninterrupted facemask use.

Prevalence of dermatological, oral and neurological problems due to face mask use during COVID-19 and its associated factors among the health care workers of Bangladesh

BACKGROUND

When caring for COVID-19 patients, using personal protective equipment (PPE) may significantly lower the risk of infection of health care workers (HCWs). However, adverse responses due to PPE use have been observed during the 2003 SARS pandemic. This study will highlight the different adverse reactions caused by face mask use, one of the essential components of PPE in the HCWs, and identify the factors associated with these problems.

METHODS

This cross-sectional survey was conducted between September and October 2021. 404 HCWs were selected by snowball sampling from four randomly selected healthcare facilities of Bangladesh. Trained volunteers collected data by face-to-face interview using a pretested structured questionnaire. Data were analyzed using STATA (v.16) and summarized using frequency and relative frequency. Later, the chi-square test was used to explore bivariate relationships, and the binary logistic regression model was fit to identify the predictors.

RESULTS

The majority of the respondents were 26-36 years (70.30%), male (69.80%), and doctors (74.50%). 48.76% of the respondents had unfavorable skin responses beneath the face masks; female gender, physicians, professionals working more than 32 hours a week, wearing N95, and more than one mask were predictors of skin problem. 28.47% and 60.15% of all participants suffered from some form of oral and neurological problems, respectively.

CONCLUSION

Face mask use sequelae, especially skin, oral and neurological problems, are prevalent among health care workers. Therefore, necessary precautionary measures should be taken to safeguard our frontlines.

Advances in the Prophylaxis of Respiratory Infections by the Nasal and the Oromucosal Route: Relevance to the Fight with the SARS-CoV-2 Pandemic

In this time of COVID-19 pandemic, the strategies for prevention of the infection are a primary concern. Looking more globally on the subject and acknowledging the high degree of misuse of protective face masks from the population, we focused this review on alternative pharmaceutical developments eligible for self-defense against respiratory infections. In particular, the attention herein is directed to the nasal and oromucosal formulations intended to boost the local immunity, neutralize or mechanically "trap" the pathogens at the site of entry (nose or mouth). The current work presents a critical review of the contemporary methods of immune- and chemoprophylaxis and their suitability and applicability in topical mucosal dosage forms for SARS-CoV-2 prophylaxis.

Assessment of cloth masks ability to limit Covid-19 particles spread: a systematic review

After the spread of Covid 19 worldwide, the use of cloth masks increased significantly due to a shortage of medical masks. Meanwhile, there were different opinions about the effectiveness of these masks and, so far, no study has been done to find the best fabric masks. This study reviews and summarizes all studies related to fabric masks' effectiveness and various fabrics against coronavirus. This systematic review is based on PRISMA rules. Two researchers separately examined three databases: PubMed, Scopus, and Web of Science. Laboratory and clinical studies were included. After extracting the articles, their quality was assessed with the Joanna Briggs Institute (JBI) tool. In addition to efficacy, other factors, including the penetration of masks, pressure drop, and quality factor, were examined to select the best fabrics. Of the 42 studies selected, 39 were laboratory studies, and 3 were clinical studies. Among the various fabrics examined, cotton quilt 120 thread per inch (TPI), copy paper (bonded), hybrid of cotton with chiffon/ silk, and flannel filtration were found to have over 90% effectiveness in the particle size range of Covid-19. The results and comparison of different factors (pressure drop, filtration efficacy, penetration, filtration quality, and fit factor have been evaluated) showed that among different fabrics, hybrid masks, 2-layered cotton quilt, 2-layered 100% cotton, cotton flannel, and hairy tea towel + fleece sweater had the best performance. Clinical studies have not explicitly examined cloth masks' effectiveness in Covid-19, so the effectiveness of these types of masks for Covid 19 is questionable, and more studies are needed.

Outpatient healthcare personnel knowledge and attitudes towards infection prevention measures for protection from respiratory infections

BACKGROUND

Healthcare personnel (HCP) knowledge and attitudes toward infection control measures are important determinants of practices that can protect them from transmission of infectious diseases.

METHODS

Healthcare personnel were recruited from Emergency Departments and outpatient clinics at seven sites. They completed knowledge surveys at the beginning and attitude surveys at the beginning and end of each season of participation. Attitudes toward infection prevention and control measures, especially medical masks and N95 respirators, were compared. The proportion of participants who correctly identified all components of an infection control bundle for seven clinical scenarios was calculated.

RESULTS

The proportion of participants in the medical mask group who reported at least one reason to avoid using medical masks fell from 88.5% on the pre-season survey to 39.6% on the post-season survey (odds ratio [OR] for preseason vs. postseason 0.11, 95% CI 0.10-0.14). Among those wearing N95 respirators, the proportion fell from 87.9% to 53.6% (OR 0.24, 95% CI 0.21-0.28). Participants correctly identified all components of the infection control bundle for 4.9% to 38.5% of scenarios.

CONCLUSIONS

Attitudes toward medical masks and N95 respirators improved significantly between the beginning and end of each season. The proportion of HCP who correctly identified the infection control precautions needed for clinical scenarios was low, but it improved over successive years of participation in the study.

Protective efficient comparisons among all kinds of respirators and masks for health-care workers against respiratory viruses: A PRISMA-compliant network meta-analysis

BACKGROUND

There is no definite conclusion about comparison of better effectiveness between N95 respirators and medical masks in preventing health-care workers (HCWs) from respiratory infectious diseases, so that conflicting results and recommendations regarding the protective effects may cause difficulties for selection and compliance of respiratory personal protective equipment use for HCWs, especially facing with pandemics of corona virus disease 2019.

METHODS

We systematically searched MEDLINE, Embase, PubMed, China National Knowledge Infrastructure, Wanfang, medRxiv, and Google Scholar from initiation to November 10, 2020 for randomized controlled trials, case-control studies, cohort studies, and cross-sectional studies that reported protective effects of masks or respirators for HCWs against respiratory infectious diseases. We gathered data and pooled differences in protective effects according to different types of masks, pathogens, occupations, concurrent measures, and clinical settings. The study protocol is registered with PROSPERO (registration number: 42020173279).

RESULTS

We identified 4165 articles, reviewed the full text of 66 articles selected by abstracts. Six randomized clinical trials and 26 observational studies were included finally. By 2 separate conventional meta-analyses of randomized clinical trials of common respiratory viruses and observational studies of pandemic H1N1, pooled effects show no significant difference between N95 respirators and medical masks against common respiratory viruses for laboratory-confirmed respiratory virus infection (risk ratio 0.99, 95% confidence interval [CI] 0.86-1.13, I2 = 0.0%), clinical respiratory illness (risk ratio 0.89, 95% CI 0.45-1.09, I2 = 83.7%, P = .002), influenza-like illness (risk ratio 0.75, 95% CI 0.54-1.05, I2 = 0.0%), and pandemic H1N1 for laboratory-confirmed respiratory virus infection (odds ratio 0.92, 95% CI 0.49-1.70, I2 = 0.0%, P = .967). But by network meta-analysis, N95 respirators has a significantly stronger protection for HCWs from betacoronaviruses of severe acute respiratory syndrome, middle east respiratory syndrome, and corona virus disease 2019 (odds ratio 0.43, 95% CI 0.20-0.94).

CONCLUSIONS

Our results provide moderate and very-low quality evidence of no significant difference between N95 respirators and medical masks for common respiratory viruses and pandemic H1N1, respectively. And we found low quality evidence that N95 respirators had a stronger protective effectiveness for HCWs against betacoronaviruses causative diseases compared to medical masks. The evidence of comparison between N95 respirators and medical masks for corona virus disease 2019 is open to question and needs further study.

A comprehensive review of various categories of face masks resistant to Covid-19

The science about the usage of face masks by the common public to avert COVID-19 transmission is proceeding swiftly. A primary route of transmission of COVID-19 is probably through small respiratory droplets, and it is transmissible from asymptomatic and pre-symptomatic individuals. According to the World Health Organization, wearing a mask in public can help reduce the transmission of the COVID-19 virus. Different categories and types of masks and their usage are reviewed in this work. In a nutshell, this review work elucidates the aspects of utilizing the various face masks along with all possibilities to fight against the ongoing pandemic of COVID-19.

A technical review of face mask wearing in preventing respiratory COVID-19 transmission

Since the outbreak of the COVID-19 pandemic, most countries have recommended their citizens to adopt social distance, hand hygiene, and face mask wearing. However, wearing face masks has not been well adopted by many citizens. While the reasons are complex, there is a general perception that the evidence to support face mask wearing is lacking, especially for the general public in a community setting. Face mask wearing can block or filter airborne virus-carrying particles through the working of colloid and interface science. This paper assesses current knowledge behind the design and functioning of face masks by reviewing the selection of materials, mask specifications, relevant laboratory tests, and respiratory virus transmission trials, with an overview of future development of reusable masks for the general public. This review highlights the effectiveness of face mask wearing in the prevention of COVID-19 infection.

How effective is a mask in preventing COVID-19 infection?

The main clinical characteristics of COVID‐19 are respiratory symptoms that can lead to serious cardiovascular damages and severe worsening of other medical conditions. One of the major strategies in preparedness and response to COVID 19 is effective utilization of personal protective equipment (PPE) among which the masks of different kinds are on the top of the list especially for activities in the public places. However, the underlying mechanisms of masks in preventing virus transmission have not been well identified and the current experimental data still show inconsistent outcomes that may mislead the public. For instance, the early understanding of the mask functions was limited especially in the escalating phase of the COVID 19 pandemic, resulting in quite controversial remarks on masks. Although extensive studies in mask functions have been carried out ever since the COVID‐19 outbreaks, most of the investigations appear to have focused on exhalation isolation of individuals who may have been infected with the disease. Less emphasis was laid on inhalation protection from virus transmission, an important aspect that undergirds the public health policies and protective strategies. This review provides the most up‐to‐date information on the transmission modes of COVID‐19 virus in terms of droplets and aerosols. The roles of masks in disease prevention and transmission reduction are evaluated on various types, structures and functions. More important, both aspects of exhalation isolation and inhalation protection are discussed based on virus transmission modes and the effectiveness of different types of masks under varied environmental conditions.

A novel perspective approach to explore pros and cons of face mask in prevention the spread of SARS-CoV-2 and other pathogens

Corona virus disease 2019 (COVID-19) outbreak has become a severe community health threat across the world. Covid-19 is a major illness, presently there is no as such any medicine and vaccine those can claim for complete treatment. It is spreading particularly in a feeble immune people and casualties are expanding abruptly and put the health system under strain. Among the strategic measures face mask is one of the most used measures to prevent spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Wearing a face mask possibly create a false sense of security lead to decline others measures. Face mask could be risk for the people of under lying medical conditions, old age group, outdoor exercise, acute and chronic respiratory disorders and feeble innate immune. Restrictive airflow due to face mask is the main cause of retention of CO2 called hypercapnia that can lead to respiratory failure with symptoms of tachycardia, flushed skin, dizziness, papilledema, seizure and depression. According to latest updates face shield and social distancing could be better substitute of face mask.

Increased Prevalence of Face Mask-Induced Itch in Health Care Workers

BACKGROUND

Face mask use has increased significantly due to the COVID-19 pandemic. Health care workers (HCW) wear masks for prolonged periods and are prone to adverse effects. Very little is known about face-mask-associated itch.

METHODS

This Internet survey study investigated the prevalence, intensity and clinical characteristics of itch related to the use of face masks by HCW during the COVID-19 pandemic. The results were subsequently compared to the students' group.

RESULTS

A total of 1156 HCW completed the survey. Among them, 31.6% (365) reported suffering from itch associated with face mask use. Itch was more frequent among females. Moreover, subjects who reported sensitive skin, atopic predispositions and facial dermatoses tended to report itch more frequently. The worst case of itch in the seven days prior to the study, assessed with the numeric rating scale (NRS), was 4.6 ± 2.0 points. Itch prevalence increased along with the duration of face mask use, being 34.6% among those who wore masks for more than 4 h. HCW reported itch significantly more frequently than students.

CONCLUSIONS

Face-mask-associated itch is a frequent problem among HCW in the COVID-19 pandemic. Itch sensation may cause scratching, which may decrease necessary protection during the pandemic.

Surgical face masks as a potential source for microplastic pollution in the COVID-19 scenario

Although there have been enormous reports on the microplastic pollution from different plastic products, impacts, controlling mechanisms in recent years, the surgical face masks, made up of polymeric materials, as a source of microplastic pollution potential in the ecosystem are not fully understood and considered yet. Current studies are mostly stated out that microplastics pollution should be a big deal because of their enormous effect on the aquatic biota, and the entire environment. Due to the complicated conditions of the aquatic bodies, microplastics could have multiple effects, and reports so far are still lacking. In addition to real microplastic pollutions which has been known before, face mask as a potential microplastic source could be also researching out, including the management system, in detail. It is noted that face masks are easily ingested by higher organisms, such as fishes, and microorganisms in the aquatic life which will affect the food chain and finally chronic health problems to humans. As a result, microplastic from the face mask should be a focus worldwide.

Covid-19 face masks: A potential source of microplastic fibers in the environment

•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.

Efficacy and Use of Cloth Masks: A Scoping Review

During the coronavirus disease 2019 (COVID-19) pandemic, there has been a global shortage of personal protective equipment (PPE). In this setting, cloth masks may play an important role in limiting disease transmission; however, current literature on the use of cloth masks remains inconclusive. This review aims to integrate current studies and guidelines to determine the efficacy and use of cloth masks in healthcare settings and/or the community. Evidence-based suggestions on the most effective use of cloth masks during a pandemic are presented.

Embase, MEDLINE, and Google Scholar were searched on March 31, 2020, and updated on April 6, 2020. Studies reporting on the efficacy, usability, and accessibility of cloth masks were included. Additionally, a search of guidelines and recommendations on cloth mask usage was conducted through published material by international and national public health agencies.

Nine articles were included in this review after full-text screening. The clinical efficacy of a face mask is determined by the filtration efficacy of the material, fit of the mask, and compliance to wearing the mask. Household fabrics such as cotton T-shirts and towels have some filtration efficacy and therefore potential for droplet retention and protection against virus-containing particles. However, the percentage of penetration in cloth masks is higher than surgical masks or N95 respirators.

Cloth masks have limited inward protection in healthcare settings where viral exposure is high but may be beneficial for outward protection in low-risk settings and use by the general public where no other alternatives to medical masks are available.

Public Awareness and Mask Usage during the COVID-19 Epidemic: A Survey by China CDC New Media

An online survey conducted March 18-19, 2020 on the official China CDC WeChat account platform was used to evaluate the effect of public education about masks usage during the new coronavirus disease 2019 (COVID-19) epidemic. Chinese nationals older than 18 were eligible for the survey. The survey collected 5,761 questionnaires from the 31 provinces, municipalities, and autonomous regions of mainland China. 99.7% and 97.2% of the respondents answered correctly that respiratory droplets and direct contact were the main transmission routes. 73.3% of the respondents considered COVID-19 to be 'serious' or 'very serious'. When going to the hospital, 96.9% (2,885/2,976 had gone to a hospital) used a mask during the COVID-19 epidemic, while 41.1% (2,367/5,761) did not use a mask before the epidemic. Among the respondents that used public transportation and went shopping, 99.6% and 99.4%, respectively, wore masks. Among respondents who returned to work, 75.5% wore a mask at the workplace, while 86.3% of those who have not returned to work will choose to use masks when they return to the workplace. The Chinese public is highly likely to use a mask during COVID-19 epidemic, and the mask usage changed greatly since the COVID-19 outbreak. Therefore, public education has played an important role during the COVID-19 epidemic.

Face Masks in the New COVID-19 Normal: Materials, Testing, and Perspectives

The increasing prevalence of infectious diseases in recent decades has posed a serious threat to public health. Routes of transmission differ, but the respiratory droplet or airborne route has the greatest potential to disrupt social intercourse, while being amenable to prevention by the humble face mask. Different types of masks give different levels of protection to the user. The ongoing COVID-19 pandemic has even resulted in a global shortage of face masks and the raw materials that go into them, driving individuals to self-produce masks from household items. At the same time, research has been accelerated towards improving the quality and performance of face masks, e.g., by introducing properties such as antimicrobial activity and superhydrophobicity. This review will cover mask-wearing from the public health perspective, the technical details of commercial and home-made masks, and recent advances in mask engineering, disinfection, and materials and discuss the sustainability of mask-wearing and mask production into the future.

Layer-By-Layer Nanocoating of Antiviral Polysaccharides on Surfaces to Prevent Coronavirus Infections

In 2020, the world is being ravaged by the coronavirus, SARS-CoV-2, which causes a severe respiratory disease, Covid-19. Hundreds of thousands of people have succumbed to the disease. Efforts at curing the disease are aimed at finding a vaccine and/or developing antiviral drugs. Despite these efforts, the WHO warned that the virus might never be eradicated. Countries around the world have instated non-pharmaceutical interventions such as social distancing and wearing of masks in public to curb the spreading of the disease. Antiviral polysaccharides provide the ideal opportunity to combat the pathogen via pharmacotherapeutic applications. However, a layer-by-layer nanocoating approach is also envisioned to coat surfaces to which humans are exposed that could harbor pathogenic coronaviruses. By coating masks, clothing, and work surfaces in wet markets among others, these antiviral polysaccharides can ensure passive prevention of the spreading of the virus. It poses a so-called "eradicate-in-place" measure against the virus. Antiviral polysaccharides also provide a green chemistry pathway to virus eradication since these molecules are primarily of biological origin and can be modified by minimal synthetic approaches. They are biocompatible as well as biodegradable. This surface passivation approach could provide a powerful measure against the spreading of coronaviruses.

Nurses' health beliefs about paper face masks in Japan, Australia and China: a qualitative descriptive study

Aim

To explore the health beliefs of clinical and academic nurses from Japan, Australia and China regarding wearing paper masks to protect themselves and others, and to identify differences in participants' health beliefs regarding masks.

Background

The correct use of face masks and consensus among health professionals across the globe is essential for containing pandemics, and nurses need to act according to policy to protect themselves, educate the public and preserve resources for frontline health workers. Paper masks are worn by health professionals and the general public to avoid the transmission of respiratory infections, such as COVID‐19, but there appear to be differences in health beliefs of nurses within and between countries regarding these.

Methods

This qualitative descriptive study used content analysis with a framework approach.

Findings

There were major differences in nurse participants’ beliefs between and within countries, including how nurses use paper masks and their understanding of their efficacy. In addition, there were cultural differences in the way that nurses use masks in their daily lives and nursing practice contexts.

Conclusion

Nurses from different working environments, countries and areas of practice hold a variety of health beliefs about mask wearing at the personal and professional level.

Implications for nursing policy and health policy

The COVID‐19 pandemic has sparked much discussion about the critical importance of masks for the safety of health professionals, and there has been considerable discussion and disagreement about health policies regarding mask use by the general public. Improper use of masks may have a role in creating mask shortages or transmitting infections. An evidence‐based global policy on mask use for respiratory illnesses for health professionals, including nurses, and the general public needs to be adopted and supported by a wide‐reaching education campaign.

Effectiveness of Cloth Masks for Protection Against Severe Acute Respiratory Syndrome Coronavirus 2

Cloth masks have been used in healthcare and community settings to protect the wearer from respiratory infections. The use of cloth masks during the coronavirus disease (COVID-19) pandemic is under debate. The filtration effectiveness of cloth masks is generally lower than that of medical masks and respirators; however, cloth masks may provide some protection if well designed and used correctly. Multilayer cloth masks, designed to fit around the face and made of water-resistant fabric with a high number of threads and finer weave, may provide reasonable protection. Until a cloth mask design is proven to be equally effective as a medical or N95 mask, wearing cloth masks should not be mandated for healthcare workers. In community settings, however, cloth masks may be used to prevent community spread of infections by sick or asymptomatically infected persons, and the public should be educated about their correct use.

Effectiveness of Masks and Respirators Against Respiratory Infections in Healthcare Workers: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis quantified the protective effect of facemasks and respirators against respiratory infections among healthcare workers. Relevant articles were retrieved from Pubmed, EMBASE, and Web of Science. Meta-analyses were conducted to calculate pooled estimates. Meta-analysis of randomized controlled trials (RCTs) indicated a protective effect of masks and respirators against clinical respiratory illness (CRI) (risk ratio [RR] = 0.59; 95% confidence interval [CI]:0.46-0.77) and influenza-like illness (ILI) (RR = 0.34; 95% CI:0.14-0.82). Compared to masks, N95 respirators conferred superior protection against CRI (RR = 0.47; 95% CI: 0.36-0.62) and laboratory-confirmed bacterial (RR = 0.46; 95% CI: 0.34-0.62), but not viral infections or ILI. Meta-analysis of observational studies provided evidence of a protective effect of masks (OR = 0.13; 95% CI: 0.03-0.62) and respirators (OR = 0.12; 95% CI: 0.06-0.26) against severe acute respiratory syndrome (SARS). This systematic review and meta-analysis supports the use of respiratory protection. However, the existing evidence is sparse and findings are inconsistent within and across studies. Multicentre RCTs with standardized protocols conducted outside epidemic periods would help to clarify the circumstances under which the use of masks or respirators is most warranted.

Active Surveillance for Influenza Reduces but Does Not Eliminate Hospital Exposure to Patients With Influenza

OBJECTIVE To describe the frequency, characteristics, and exposure associated with influenza in hospitalized patients in a Toronto hospital DESIGN/METHOD Prospective data collected for consenting patients with laboratory-confirmed influenza and a retrospective review of infection control charts for roommates of cases over 3 influenza seasons RESULTS Of the 661 patients with influenza (age range: 1 week-103 years), 557 were placed on additional precautions upon admission. Of 104 with symptoms detected after admission, 57 cases were community onset and 47 were nosocomial (10 nosocomial were part of outbreaks). A total of 78 cases were detected after admission exposing 143 roommates. Among roommates tested for influenza after exposure, no roommates of community-onset cases and 2 of 16 roommates of nosocomial cases were diagnosed with influenza. Of 637 influenza-infected patients, 25% and 57% met influenza-like illness definitions from the Public Health Agency of Canada (PHAC) and Centers for Disease Control and Prevention (CDC), respectively, and 70.3% met the Provincial Infectious Diseases Advisory Committee (PIDAC) febrile respiratory illness definition. Among the 56 patients with community-onset influenza detected after admission, only 13%, 23%, and 34%, met PHAC, CDC, and PIDAC classifications, respectively. CONCLUSIONS In a setting with extensive screening and testing for influenza, 1 in 6 patients with influenza was not diagnosed until patients and healthcare workers had been exposed for >24 hours. Only 30% of patients with community-onset influenza detected after admission met the Ontario definition intended to identify cases, hampering efforts to prevent patient and healthcare worker exposures and reinforcing the need for prevention through vaccination. Infect Control Hosp Epidemiol 2017;38:387-392.

The tuberculocidal activity of polyaniline and functionalised polyanilines

Tuberculosis is considered a leading cause of death worldwide. More than 95% of cases and deaths occur in low- and middle-income countries. In resource-limited countries, hospitals often lack adequate facilities to manage and isolate patients with infectious tuberculosis (TB), relying instead on personal protective equipment, such as facemasks, to reduce nosocomial transmission of the disease. Facemasks impregnated with an antimicrobial agent may be a cost-effective way of adding an extra level of protection against the spread of TB by reducing the risk of disease transmission. Conducting polymers, such as polyaniline (PANI), and their functionalised derivatives are a novel class of antimicrobial agents with potential as non-leaching additives to provide contamination resistant surfaces. We have investigated the antimicrobial action of PANI and a functionalised derivative, poly-3-aminobenzoic acid (P3ABA), against mycobacteria and have determined the optimal treatment time and concentration to achieve significant knockdown of Mycobacterium smegmatis and Mycobacterium tuberculosis on an agar surface. Results indicated that P3ABA is a potential candidate for use as an anti-tuberculoid agent in facemasks to reduce TB transmission.

A cluster randomised trial of cloth masks compared with medical masks in healthcare workers

OBJECTIVE

The aim of this study was to compare the efficacy of cloth masks to medical masks in hospital healthcare workers (HCWs). The null hypothesis is that there is no difference between medical masks and cloth masks.

SETTING

14 secondary-level/tertiary-level hospitals in Hanoi, Vietnam.

PARTICIPANTS

1607 hospital HCWs aged ≥18 years working full-time in selected high-risk wards.

INTERVENTION

Hospital wards were randomised to: medical masks, cloth masks or a control group (usual practice, which included mask wearing). Participants used the mask on every shift for 4 consecutive weeks.

MAIN OUTCOME MEASURE

Clinical respiratory illness (CRI), influenza-like illness (ILI) and laboratory-confirmed respiratory virus infection.

RESULTS

The rates of all infection outcomes were highest in the cloth mask arm, with the rate of ILI statistically significantly higher in the cloth mask arm (relative risk (RR)=13.00, 95% CI 1.69 to 100.07) compared with the medical mask arm. Cloth masks also had significantly higher rates of ILI compared with the control arm. An analysis by mask use showed ILI (RR=6.64, 95% CI 1.45 to 28.65) and laboratory-confirmed virus (RR=1.72, 95% CI 1.01 to 2.94) were significantly higher in the cloth masks group compared with the medical masks group. Penetration of cloth masks by particles was almost 97% and medical masks 44%.

CONCLUSIONS

This study is the first RCT of cloth masks, and the results caution against the use of cloth masks. This is an important finding to inform occupational health and safety. Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection. Further research is needed to inform the widespread use of cloth masks globally. However, as a precautionary measure, cloth masks should not be recommended for HCWs, particularly in high-risk situations, and guidelines need to be updated.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry: ACTRN12610000887077.

Examining the policies and guidelines around the use of masks and respirators by healthcare workers in China, Pakistan and Vietnam

BACKGROUND

There is an ongoing debate regarding the type of respiratory protection that should be recommended for use for healthcare workers.

MATERIALS AND METHODS

A cross-sectional survey was conducted in three countries: China, Pakistan and Vietnam.

RESULTS

In China and Pakistan, the infection control guidelines were developed to be in line with the recommendations from the World Health Organization (WHO) and the Centers for Disease Control and Prevention, while in the Vietnamese guidelines the recommendations correspond with the WHO suggestions only. The guidelines from all three countries document the need for training and fit testing; however there is no system to monitor the training and fit testing programs. Across the three countries, there was some inconsistency with regard to the types of products (i.e. masks vs. respirators) recommended for influenza, severe acute respiratory syndrome (SARS) and tuberculosis.

CONCLUSIONS

Available evidence should be examined and a comprehensive policy should be developed on the use of masks and respirators. The policy should address critical areas such as regulation, training, fit testing and reuse.

Availability, consistency and evidence-base of policies and guidelines on the use of mask and respirator to protect hospital health care workers: a global analysis

BACKGROUND

Currently there is an ongoing debate and limited evidence on the use of masks and respirators for the prevention of respiratory infections in health care workers (HCWs). This study aimed to examine available policies and guidelines around the use of masks and respirators in HCWs and to describe areas of consistency between guidelines, as well as gaps in the recommendations, with reference to the WHO and the CDC guidelines.

METHODS

Policies and guidelines related to mask and respirator use for the prevention of influenza, SARS and TB were examined. Guidelines from the World Health Organization (WHO), the Center for Disease Control and Prevention (CDC), three high-income countries and six low/middle-income countries were selected.

RESULTS

Uniform recommendations are made by the WHO and the CDC in regards to protecting HCWs against seasonal influenza (a mask for low risk situations and a respirator for high risk situations) and TB (use of a respirator). However, for pandemic influenza and SARS, the WHO recommends mask use in low risk and respirators in high risk situations, whereas, the CDC recommends respirators in both low and high risk situations. Amongst the nine countries reviewed, there are variations in the recommendations for all three diseases. While, some countries align with the WHO recommendations, others align with those made by the CDC. The choice of respirator and the level of filtering ability vary amongst the guidelines and the different diseases. Lastly, none of the policies discuss reuse, extended use or the use of cloth masks.

CONCLUSION

Currently, there are significant variations in the policies and recommendations around mask and respirator use for protection against influenza, SARS and TB. These differences may reflect the scarcity of level-one evidence available to inform policy development. The lack of any guidelines on the use of cloth masks, despite widespread use in many low and middle-income countries, remains a policy gap. Health organizations and countries should jointly evaluate the available evidence, prioritize research to inform evidence gaps, and develop consistent policy on masks and respirator use in the health care setting.

Protection by face masks against influenza A(H1N1)pdm09 virus on trans-Pacific passenger aircraft, 2009

In response to several influenza A(H1N1)pdm09 infections that developed in passengers after they traveled on the same 2 flights from New York, New York, USA, to Hong Kong, China, to Fuzhou, China, we assessed transmission of influenza A(H1N1)pdm09 virus on these flights. We defined a case of infection as onset of fever and respiratory symptoms and detection of virus by PCR in a passenger or crew member of either flight. Illness developed only in passengers who traveled on the New York to Hong Kong flight. We compared exposures of 9 case-passengers with those of 32 asymptomatic control-passengers. None of the 9 case-passengers, compared with 47% (15/32) of control-passengers, wore a face mask for the entire flight (odds ratio 0, 95% CI 0-0.71). The source case-passenger was not identified. Wearing a face mask was a protective factor against influenza infection. We recommend a more comprehensive intervention study to accurately estimate this effect.