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Greenhalgh T, MacIntyre CR, Baker MG, Bhattacharjee S, Chughtai AA, Fisman D, Kunasekaran M, Kvalsvig A, Lupton D, Oliver M, Tawfiq E, Ungrin M, Vipond J. Masks and respirators for prevention of respiratory infections: a state of the science review. Clin Microbiol Rev 2024; 37:e0012423. [PMID: 38775460 PMCID: PMC11326136 DOI: 10.1128/cmr.00124-23] [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] [Indexed: 06/14/2024] Open
Abstract
SUMMARYThis narrative review and meta-analysis summarizes a broad evidence base on the benefits-and also the practicalities, disbenefits, harms and personal, sociocultural and environmental impacts-of masks and masking. Our synthesis of evidence from over 100 published reviews and selected primary studies, including re-analyzing contested meta-analyses of key clinical trials, produced seven key findings. First, there is strong and consistent evidence for airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory pathogens. Second, masks are, if correctly and consistently worn, effective in reducing transmission of respiratory diseases and show a dose-response effect. Third, respirators are significantly more effective than medical or cloth masks. Fourth, mask mandates are, overall, effective in reducing community transmission of respiratory pathogens. Fifth, masks are important sociocultural symbols; non-adherence to masking is sometimes linked to political and ideological beliefs and to widely circulated mis- or disinformation. Sixth, while there is much evidence that masks are not generally harmful to the general population, masking may be relatively contraindicated in individuals with certain medical conditions, who may require exemption. Furthermore, certain groups (notably D/deaf people) are disadvantaged when others are masked. Finally, there are risks to the environment from single-use masks and respirators. We propose an agenda for future research, including improved characterization of the situations in which masking should be recommended or mandated; attention to comfort and acceptability; generalized and disability-focused communication support in settings where masks are worn; and development and testing of novel materials and designs for improved filtration, breathability, and environmental impact.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - C Raina MacIntyre
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Shovon Bhattacharjee
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, Australia
| | - Abrar A Chughtai
- School of Population Health, University of New South Wales, Sydney, Australia
| | - David Fisman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Amanda Kvalsvig
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Deborah Lupton
- Centre for Social Research in Health and Social Policy Research Centre, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, Australia
| | - Matt Oliver
- Professional Standards Advocate, Edmonton, Canada
| | - Essa Tawfiq
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Mark Ungrin
- Faculty of Veterinary Medicine; Department of Biomedical Engineering, Schulich School of Engineering; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Joe Vipond
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Shen J, Shi W. Post-Pandemic: Investigation of the Degradation of Various Commercial Masks in the Marine Environment. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2023; 39:10553-10564. [PMID: 37462155 PMCID: PMC10399566 DOI: 10.1021/acs.langmuir.3c01087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/02/2023] [Indexed: 08/02/2023]
Abstract
During COVID-19, personal protective equipment such as face masks was in urgent demand in the daily life. As the pandemic may have withdrawn from public attention, the disposal of face masks is a significant issue, especially plastic pollution. To address the degradation of the polymers in the marine environment, seven commercial masks were investigated via artificial weathering procedures in substitute ocean water. A suite of structural and chemical characterization techniques was employed, including scanning electron microscopy (SEM), X-ray photoelectron spectroscopy (XPS), Fourier transform infrared spectroscopy (FT-IR), Raman spectroscopy, X-ray diffraction (XRD), and contact angle goniometry, to probe the treatment impact on commercially available N95, surgical, polyurethane, polyester, nylon, silk, and cotton masks. This work provides insights into the comprehensive analysis of material degradation in nature and raises public awareness of environmental issues post-pandemic.
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Affiliation(s)
- Jiayi Shen
- Division of Natural and Applied
Sciences, Duke Kunshan University, Kunshan, Jiangsu Province 215316, China
| | - Weiwei Shi
- Division of Natural and Applied
Sciences, Duke Kunshan University, Kunshan, Jiangsu Province 215316, China
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Deng W, Sun Y, Yao X, Subramanian K, Ling C, Wang H, Chopra SS, Xu BB, Wang J, Chen J, Wang D, Amancio H, Pramana S, Ye R, Wang S. Masks for COVID-19. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2102189. [PMID: 34825783 PMCID: PMC8787406 DOI: 10.1002/advs.202102189] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/18/2021] [Indexed: 05/08/2023]
Abstract
Sustainable solutions on fabricating and using a face mask to block the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread during this coronavirus pandemic of 2019 (COVID-19) are required as society is directed by the World Health Organization (WHO) toward wearing it, resulting in an increasingly huge demand with over 4 000 000 000 masks used per day globally. Herein, various new mask technologies and advanced materials are reviewed to deal with critical shortages, cross-infection, and secondary transmission risk of masks. A number of countries have used cloth masks and 3D-printed masks as substitutes, whose filtration efficiencies can be improved by using nanofibers or mixing other polymers into them. Since 2020, researchers continue to improve the performance of masks by adding various functionalities, for example using metal nanoparticles and herbal extracts to inactivate pathogens, using graphene to make masks photothermal and superhydrophobic, and using triboelectric nanogenerator (TENG) to prolong mask lifetime. The recent advances in material technology have led to the development of antimicrobial coatings, which are introduced in this review. When incorporated into masks, these advanced materials and technologies can aid in the prevention of secondary transmission of the virus.
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Affiliation(s)
- Wei Deng
- Department of Mechanical EngineeringCity University of Hong KongHong Kong999077China
| | - Yajun Sun
- Department of Mechanical EngineeringCity University of Hong KongHong Kong999077China
| | - Xiaoxue Yao
- Department of Mechanical EngineeringCity University of Hong KongHong Kong999077China
| | - Karpagam Subramanian
- School of Energy and EnvironmentCity University of Hong KongHong Kong999077China
| | - Chen Ling
- Department of Mechanical EngineeringCity University of Hong KongHong Kong999077China
| | - Hongbo Wang
- Department of Mechanical EngineeringCity University of Hong KongHong Kong999077China
| | - Shauhrat S. Chopra
- School of Energy and EnvironmentCity University of Hong KongHong Kong999077China
| | - Ben Bin Xu
- Department of Mechanical and Construction EngineeringNorthumbria UniversityNewcastle upon TyneNE1 8STUK
| | - Jie‐Xin Wang
- State Key Laboratory of Organic Inorganic CompositesBeijing University of Chemical TechnologyBeijing100029China
| | - Jian‐Feng Chen
- State Key Laboratory of Organic Inorganic CompositesBeijing University of Chemical TechnologyBeijing100029China
| | - Dan Wang
- State Key Laboratory of Organic Inorganic CompositesBeijing University of Chemical TechnologyBeijing100029China
| | - Honeyfer Amancio
- Department of Chemical Engineering and BiotechnologyCambridge UniversityCambridgeCB2 1TNUK
| | - Stevin Pramana
- School of EngineeringNewcastle UniversityNewcastle upon TyneNE1 7RUUK
| | - Ruquan Ye
- Department of ChemistryCity University of Hong KongHong Kong999077China
| | - Steven Wang
- Department of Mechanical EngineeringCity University of Hong KongHong Kong999077China
- School of Energy and EnvironmentCity University of Hong KongHong Kong999077China
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K S Narayanan SS, Wang X, Paul J, Paley V, Weng Z, Ye L, Zhong Y. Disinfection and Electrostatic Recovery of N95 Respirators by Corona Discharge for Safe Reuse. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:15351-15360. [PMID: 34570480 DOI: 10.1021/acs.est.1c02649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
With the COVID-19 pandemic surging, the demand for masks is challenging, especially in less-developed areas across the world. Billions of used masks are threatening the environment as a new source of plastic pollution. In this paper, corona discharge (CD) was explored as a safe and reliable method for mask reuse to alleviate the situation. CD can disinfect masks and simultaneously restore electrostatic charges to prevent filtration efficiency deterioration. Electric field, ions, and reactive species generated by CD cause DNA damage and protein denaturation to effectively disinfect N95 respirators. Log reduction of 2-3 against Escherichia coli can be easily reached within 7.5 min. Log reduction of up to 6 can be reached after three cycles of treatment with optimized parameters. CD disinfection is a broad spectrum with log reduction >1 against yeast and >2.5 against spores. N95 respirators can be recharged within 30 s of treatment and the charges can be retained at a higher level than brand-new masks for at least 5 days. The filtration efficiency of masks was maintained at ∼95% after 15 cycles of treatment. CD can provide at least 10 cycles of safe reuse with benefits of high safety, affordability, accessibility, and device scalability/portability.
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Affiliation(s)
- Sriram S K S Narayanan
- Department of Mechanical Engineering, University of South Florida, 4202 E. Fowler Avenue, Tampa, Florida 33620, United States
| | - Xudong Wang
- Department of Cell Biology, Microbiology and Molecular Biology, University of South Florida, 4202 E. Fowler Avenue, Tampa, Florida 33620, United States
| | - Jose Paul
- Department of Mechanical Engineering, University of South Florida, 4202 E. Fowler Avenue, Tampa, Florida 33620, United States
| | - Vladislav Paley
- Department of Mechanical Engineering, University of South Florida, 4202 E. Fowler Avenue, Tampa, Florida 33620, United States
| | - Zijian Weng
- Department of Mechanical Engineering, University of South Florida, 4202 E. Fowler Avenue, Tampa, Florida 33620, United States
| | - Libin Ye
- Department of Cell Biology, Microbiology and Molecular Biology, University of South Florida, 4202 E. Fowler Avenue, Tampa, Florida 33620, United States
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, Florida 33612, United States
| | - Ying Zhong
- Department of Mechanical Engineering, University of South Florida, 4202 E. Fowler Avenue, Tampa, Florida 33620, United States
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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: 88] [Impact Index Per Article: 29.3] [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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Kemmelmeier M, Jami WA. Mask Wearing as Cultural Behavior: An Investigation Across 45 U.S. States During the COVID-19 Pandemic. Front Psychol 2021; 12:648692. [PMID: 34366970 PMCID: PMC8333278 DOI: 10.3389/fpsyg.2021.648692] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 05/27/2021] [Indexed: 11/25/2022] Open
Abstract
Although masks (face coverings) are a prime tool in fighting airborne pathogens, during the COVID-19 pandemic in the United States the use of masks encountered resistance based on existing patterns of cultural division. We argue that mask wearing must be understood basis on existing cultural frames assessed at both the individual level and the state level. We relied on prominent frameworks in cultural psychology: individualism-collectivism as well as independent and interdependent self-construals, the tightness-looseness framework, U.S. honor cultures, and political orientation as predictors. Using multilevel modeling, in a sample of 633 respondents from 45 U.S. states we investigated mask-wearing behavior, masks' perceived utility, implications for well-being, and the social meaning attributed to masks. Conservatism was linked to lower mask wearing, and consistently unfavorable perceptions of mask wearing. Collective interdependence predicted favorable perceptions of masks, as did state-level differences in collectivism; both constructs were linked with viewing mask wearing to be normative. Independent self-construal predicted a greater intent to wear masks, even though masks were also evaluated less favorably. Mediation analyses revealed that a single mediator, the perceived utility of mask wearing, was implicated in translating the effects of different cultural predictors into behavior. Additional findings highlighted that in tightener (vs. looser) states masks wearing was conceived of as a civic duty, whereas in U.S. honor states mask were seen as spoiling one's public image. Our discussion focuses on the cultural and political context of mask wearing, argues that different communities in the U.S. respond to its symbolic and social meaning, and suggest strategies to increase mask wearing among those who are otherwise reluctant to do so.
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Affiliation(s)
- Markus Kemmelmeier
- Interdisciplinary Social Psychology Ph.D. Program, University of Nevada, Reno, NV, United States
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Eke UA, Eke AC. Personal protective equipment in the siege of respiratory viral pandemics: strides made and next steps. Expert Rev Respir Med 2020; 15:441-452. [PMID: 33322947 DOI: 10.1080/17476348.2021.1865812] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Introduction: In December 2019, SARS-CoV-2 originated from China, and spread rapidly to several countries, bringing a frightening scarcity of personal protective equipment (PPE). The CDC recommends N95 or higher-level particulate filtering respirators as part of the PPE while caring for patients with COVID-19, with facemasks as an alternative; and cloth face-coverings in public where social distancing of at least 6 ft. is not feasible. With new evidence about the efficacy of facemasks, knowledge gaps remain.Areas covered: This reviews the history of respiratory viral pandemics and PPE use, exploring the influenza pandemics of the 20th and 21st century, and prior coronavirus pandemics. A literature search of PubMed and google was done between March 22nd to May 2nd, and on September 28, 2020. The evidence for PPE is described, to delineate their efficacy and 'best safe' practices. Solutions to ameliorate pandemic preparedness to meet surge-capacity to efficiently combat future pandemics, should they arise, are discussed.Expert opinion: PPE, when used appropriately in addition to other infection control measures, is effective protection during respiratory viral pandemics. The current evidence suggests that wearing facemasks in the community is protective, especially if used consistently and correctly with other infection control measures such as hand hygiene.
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Affiliation(s)
- Uzoamaka A Eke
- Division of Infectious Diseases and Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ahizechukwu C Eke
- Division of Maternal Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Community Knowledge About the Use, Reuse, Disinfection and Disposal of Masks and Filtering Facepiece Respirators: Results of a Study Conducted in a Dermatology Clinic at the University of Naples in Italy. J Community Health 2020; 46:786-793. [PMID: 33258051 PMCID: PMC7704022 DOI: 10.1007/s10900-020-00952-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 12/19/2022]
Abstract
In Italy, as well as in almost all countries, the use of masks in public with several other measures has been an important health measure during the ongoing COVID-19 pandemic. The correct use of masks is essential, as a wrong use and disposal may increase the rate of contagious. Herein, we report a descriptive study evaluating the knowledge and use, reuse and disposal of masks in community settings. An anonymous questionnaire called MaSK (Mask uSe and Knowledge) questionnaire was developed and offered to patients referring at our dermatologic outpatient clinic. A total of 2562 full complete patients’ questionnaires were considered for the study. Our results showed that awareness and information campaigns aimed at the general population are urgently needed in order to implement a correct use of masks and limit as much as possible the infection rate.
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