Can respirator face masks in a developing country reduce exposure to ambient particulate matter?

Effectiveness of respiratory face masks in reducing acute PM2.5 pollution exposure during peak pollution period in Delhi

The cities of North India, such as Delhi, face a significant public health threat from severe air pollution. Between October 2021 and January 2022, 79 % of Delhi's daily average PM2.5 (Particulate matter with an aerodynamic diameter ≤ 2.5 μm) values exceeded 100 μg/m3 (the permissible level being 60 μg/m3 as per Indian standards). In response to this acute exposure, using Respiratory Face Masks (RFMs) is a cost-effective solution to reduce immediate health risks while policymakers develop long-term emission control plans. Our research focuses on the health and economic benefits of using RFMs to prevent acute exposure to PM2.5 pollution in Delhi for different age groups. Our findings indicate that, among the fifty chosen RFMs, M50 has greatest potential to prevent short-term excess mortality (908 in age ranges 5-44), followed by M49 (745) and M48 (568). These RFMs resulted in estimated economic benefits of 500.6 (46 %), 411.1 (37 %), and 313.4 (29 %) million Indian Rupee (INR), respectively during October-January 2021-22. By wearing RFMs such as M50, M49, and M48 during episodes of bad air quality, it is estimated that 13 % of short-term excess mortality and associated costs could be saved if at least 30 % of Delhi residents followed an alert issued by an operational Air Quality Early Warning System (AQEWS) developed by the Ministry of Earth Sciences. Our research suggests that RFMs can notably decrease health and economic burdens amid peak PM2.5 pollution in post-monsoon and winter seasons until long-term emission reduction strategies are adopted. It is suggested that an advisory may be crafted in collaboration with statutory bodies and should be disseminated to assist the vulnerable population in using RFMs during winter. The analysis presented in this research is purely science based and outcomes of study are in no way to be construed as endorsement of product.

Atmosphere particulate matter and respiratory diseases during COVID-19 in Korea

We aimed to examine the impact of COVID-19 non-pharmaceutical interventions (NPIs) on the relationship between air pollutants and hospital admissions for respiratory and non-respiratory diseases in six metropolitan cities in South Korea. This study compared the associations between particulate matter (PM10 and PM2.5) and hospital admission for respiratory and non-respiratory diseases before (2016-2019) and during (2020) the implementation of COVID-19 NPIs by using distributed lag non-linear models. In the Pre-COVID-19 period, the association between PM10 and admission risk for asthma and COPD showed an inverted U-shaped pattern. For PM2.5, S-shaped and inverted U-shaped changes were observed in asthma and COPD, respectively. Extremely high and low levels of PM10 and extremely low levels of PM2.5 significantly decreased the risk of admission for asthma and COPD. In the Post-COVID-19 outbreak period, the overall cumulative relationship between PM10 and PM2.5 and respiratory diseases and the effects of extreme levels of PM10 and PM2.5 on respiratory diseases were completely changed. For non-respiratory diseases, PM10 and PM2.5 were statistically insignificant for admission risk during both periods. Our study may provide evidence that implementing NPIs and reducing PM10 and PM2.5 exposure during the COVID-19 pandemic has contributed to reducing hospital admissions for environment-based respiratory diseases.

Latin America and the Caribbean Code Against cancer 1st edition: Environment, occupation, and cancer

Within the framework of the Latin America and Caribbean region (LAC) Code Against Cancer 1st edition, the current work presents recommendations to reduce exposure to environmental and occupational carcinogenic agents relevant for LAC. Using the methodology established by the International Agency for Research on Cancer (IARC) in the World Code Against Cancer Framework and experience from developing the European Code Against Cancer 4th edition, a working group of LAC cancer-prevention experts reviewed the list of Group I IARC carcinogenic agents, identified prevalent environmental and occupational exposures in the region, and proposed evidence-based cancer prevention recommendations suited to the epidemiological, socioeconomic, and cultural conditions of LAC countries. Two sets of recommendations were drafted: those targeting the general public and a second set for policymakers. Outdoor and indoor air pollution, ultra-violet radiation and occupational exposures to silica dust, asbestos, benzene, diesel, and welding fumes were identified as prevalent carcinogens in LAC and as agents that could be reduced or eliminated to prevent cancers. Recommendations for additional risk factors were not included due to insufficient data of their attributable burden in LAC (sunbeds, radon, aflatoxin), or lack of a clear preventive action to be taken by the individual (arsenic in drinking water, medical radiation), or lack of evidence of carcinogenicity effect (bisphenol A, phthalates, and pesticides). A broad consensus was reached on environmental and occupational carcinogenic exposures present throughout the LAC region and on individual-level and public policy-level recommendations to reduce or eliminate these exposures. Key educational content for the dissemination of these recommendations was also developed as part of LAC Code Against Cancer 1st Edition.

Implication of nanotechnology to reduce the environmental risks of waste associated with the COVID-19 pandemic

The COVID-19 pandemic is the largest global public health outbreak in the 21st century so far. It has contributed to a significant increase in the generation of waste, particularly personal protective equipment and hazardous medical, as it can contribute to environmental pollution and expose individuals to various hazards. To minimize the risk of infection, the entire surrounding environment should be disinfected or neutralized regularly. Effective medical waste management can add value by reducing the spread of COVID-19 and increasing the recyclability of materials instead of sending them to landfill. Developing an antiviral coating for the surface of objects frequently used by the public could be a practical solution to prevent the spread of virus particles and the inactivation of virus transmission. Relying on an abundance of engineered materials identifiable by their useful physicochemical properties through versatile chemical functionalization, nanotechnology offers a number of approaches to address this emergency. Here, through a multidisciplinary perspective encompassing various fields such as virology, biology, medicine, engineering, chemistry, materials science, and computer science, we describe how nanotechnology-based strategies can support the fight against COVID-19 well as infectious diseases in general, including future pandemics. In this review, the design of the antiviral coating to combat the spread of COVID-19 was discussed, and technological attempts to minimize the coronavirus outbreak were highlighted.

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.

Health burden and economic loss attributable to ambient PM2.5 in Iran based on the ground and satellite data

We estimated mortality and economic loss attributable to PM_2·5 air pollution exposure in 429 counties of Iran in 2018. Ambient PM_2.5-related deaths were estimated using the Global Exposure Mortality Model (GEMM). According to the ground-monitored and satellite-based PM_2.5 data, the annual mean population-weighted PM_2·5 concentrations for Iran were 30.1 and 38.6 μg m^-3, respectively. We estimated that long-term exposure to ambient PM_2.5 contributed to 49,303 (95% confidence interval (CI) 40,914-57,379) deaths in adults ≥ 25 yr. from all-natural causes based on ground monitored data and 58,873 (95% CI 49,024-68,287) deaths using satellite-based models for PM_2.5. The crude death rate and the age-standardized death rate per 100,000 population for age group ≥ 25 year due to ground-monitored PM_2.5 data versus satellite-based exposure estimates was 97 (95% CI 81-113) versus 116 (95% CI 97-135) and 125 (95% CI 104-145) versus 149 (95% CI 124-173), respectively. For ground-monitored and satellite-based PM_2.5 data, the economic loss attributable to ambient PM_2.5-total mortality was approximately 10,713 (95% CI 8890-12,467) and 12,792.1 (95% CI 10,652.0-14,837.6) million USD, equivalent to nearly 3.7% (95% CI 3.06-4.29) and 4.3% (95% CI 3.6-4.5.0) of the total gross domestic product in Iran in 2018.

Investigating the field effectiveness of respirators against metal particle exposure in various workplaces: a systematic review

Welders are exposed to high levels of metal fumes, which could be resulting in various health impairments. Respirators became a practical protective option in workplaces, as they are lightweight and easy to use. This systematic review attempts to explore the field effectiveness of using respirators to reduce metal particle exposure in workplaces. We reviewed papers published from 1900 to April 2019 in five major bibliographic databases, including Embase, Web of Science, Medline, Scopus, and CINAHL, along with organizational websites to cover gray literature. In total, 983 references were identified from the databases, out of which, 520 duplicates were removed from the EndNote database. The remaining 463 references were screened for their title and abstract. Out of 463, 70 references went through the full-text screening. Finally, eight papers, including 19 workplace respirator studies, satisfied all the inclusion criteria and were reviewed in this report. The geometric means for metal levels in workers' breathing zone with and without respirators were 9.4 and 1,777 µg/m³ for iron, 1.1 and 139 µg/m³ for lead, 2.1 and 242 µg/m³ for zinc, and 27 and 1,398 µg/m³ for manganese oxide, respectively. Most reviewed studies reported significant differences between measured metal particle levels among workers who worn respirators and who did not. In addition, results showed that N95 provided significantly less protection than elastomeric half facepieces, full-face respirators, and powered air-purifying respirators (p<0.001). More field studies are recommended to investigate Workplace Protection Factor (WPF) and fit factor (FF) of different respirators to understand the actual protection levels that they could be provided to control welding fume exposure among welders in various workplaces.

Effects of respirators to reduce fine particulate matter exposures on blood pressure and heart rate variability: A systematic review and meta-analysis

Particulate-filtering respirators (PFRs) have been recommended as a practical personal-level intervention to protect individuals from the health effects of particulate matter exposure. However, the cardiovascular benefits of PFRs including improvements in key surrogate endpoints remain unclear. We performed a systematic review and meta-analysis of randomized studies (wearing versus not wearing PFRs) reporting the effects on blood pressure (BP) and heart rate variability (HRV). The search was performed on January 3, 2022 to identify published papers until this date. We queried three English databases, including PubMed, Web of Science Core Collection and Scopus. Of 527 articles identified, eight trials enrolling 312 participants (mean age ± standard deviation: 36 ± 19.8; 132 female) met our inclusion criteria for analyses. Study participants wore PFRs from 2 to 48 h during intervention periods. Wearing PFRs was associated with a non-significant pooled mean difference of -0.78 mmHg (95% confidence interval [CI]: -2.06, 0.50) and -0.49 mmHg (95%CI: -1.37, 0.38) in systolic and diastolic BP (SBP and DBP). There was a marginally significant reduction of mean arterial pressure (MAP) by nearly 1.1 mmHg (95%CI: -2.13, 0.01). The use of PFRs was associated with a significant increase of 38.92 ms2 (95%CI: 1.07, 76.77) in pooled mean high frequency (power in the high frequency band (0.15-0.4 Hz)) and a reduction in the low (power in the low frequency band (0.04-0.15Hz))-to-high frequency ratio [-0.14 (95%CI: -0.27, 0.00)]. Other HRV indices were not significantly changed. Our meta-analysis demonstrates modest or non-significant improvements in BP and many HRV parameters from wearing PFRs over brief periods. However, these findings are limited by the small number of trials as well as variations in experimental designs and durations. Given the mounting global public health threat posed by air pollution, larger-scale trials are warranted to elucidate more conclusively the potential health benefits of PFRs.

Face masks to fight against COVID-19 pandemics: A comprehensive review of materials, design, technology and product development

The outbreak of COVID-19 has created renewed attention on research and large scale manufacturing of face masks. In the last two decades, usage of face masks for respiratory protection has gained increased importance as a measure to control the maladies and fatalities due to exposure to particulate pollutants and toxic pathogens. Numerous variants of surgical and high-performance respirator masks are available in the market, and yet the fibrous materials science researchers, manufacturers and public health agencies are making concerted efforts towards improvising them with respect to self-sterilisability, facial fit, thermo-physiological comfort, reusability and biodegradability, while maintaining or rather enhancing the filtration efficiency. This review article presents a compendium of materials, design and performance standards of existing face masks, as well as elaborates on developments made for their performance enhancement. The criticality of inculcation of good hygiene habits and earnest compliance to correct mask donning and doffing practices has also been highlighted. This review is expected to make valuable contributions in the present COVID-19 scenario when donning a face mask has become mandatory.

A Simple Method to Quantify Outward Leakage of Medical Face Masks and Barrier Face Coverings: Implication for the Overall Filtration Efficiency

Face masking proved essential to reduce transmission of COVID-19 and other respiratory infections in indoor environments, but standards and literature do not provide simple quantitative methods for quantifying air leakage at the face seal. This study reports an original method to quantify outward leakage and how wearing style impacts on leaks and filtration efficiency. The amount of air leakage was evaluated on four medical masks and four barrier face coverings, exploiting a theoretical model and an instrumented dummy head in a range of airflows between 30 and 160 L/min. The fraction of air leaking at the face seal of the medical masks and barrier face coverings ranged from 43% to 95% of exhaled air at 30 L/min and reduced to 10-85% at 160 L/min. Filter breathability was the main driver affecting both leak fraction and total filtration efficiency that varied from 5% to 53% and from 15% to 84% at 30 and 160 L/min, respectively. Minor changes were related to wearing style, supporting indications on the correct mask use. The fraction of air leaking from medical masks and barrier face coverings during exhalation is relevant and varies according to design and wearing style. The use of highly breathable filter materials reduces air leaks and improve total filtration efficiency.

Sequential Multiscale Simulation of a Filtering Facepiece for Prediction of Filtration Efficiency and Resistance in Varied Particulate Scenarios

This study explores a novel approach of multiscale modeling and simulation to characterize the filtration behavior of a facepiece in varied particulate conditions. Sequential multiscale modeling was performed for filter media, filtering facepiece, and testing setup. The developed virtual models were validated for their morphological characteristics and filtration performance by comparing with the data from the physical experiments. Then, a virtual test was conducted in consideration of a time scale, simulating diverse particulate environments with different levels of particle size distribution, particle concentration, and face velocity. An environment with small particles and high mass concentration resulted in a rapid buildup of resistance, reducing the service life. Large particles were accumulated mostly at the entrance of the filter layer, resulting in a lower penetration and slower buildup of resistance. This study is significant in that the adopted virtual approach enables the prediction of filtration behavior and service life, applying diverse environmental conditions without involving the costs of extra setups for the physical experiments. This study demonstrates a novel and economic research method that can be effectively applied to the research and development of filters.

Mask Design for Life in the Midst of COVID-19

Existing medical masks have various disadvantages, such as the environmental damage caused by disposable masks, the discomfort and poor ventilation caused by prolonged mask wearing, and the lack of aesthetic design in mass-produced masks. Thus, this study used quality function deployment, the fuzzy analytic hierarchy process, and fuzzy comprehensive evaluation to research, develop, and design masks. The aforementioned methods were also used to determine the ranking of design requirements. The following priority ranking of design requirements from most to least important was obtained: reducing discomfort at the contact between the mask and the skin (0.265), avoiding foul odor inside the mask (0.187), convenient cleaning and portability (0.166), good airtightness (0.152), suitable aesthetic design for wearing in public and on social occasions (0.130), and reducing waste (0.100). Experts evaluated mask designs, and their opinions were subject to fuzzy analysis. Specifically, 50% of the experts evaluated the designs to be “good” or “very good”. Only 29% of the experts rated the design results as “average”. Thus, the innovative mask designed in this study can meet the needs of users, overcome the drawbacks of existing masks, and provide a feasible solution for the current COVID-19 pandemic.

The effect of COVID-19 pandemic on human mobility and ambient air quality around the world: A systematic review

We conducted this systematic review to identify and appraise studies investigating the coronavirus disease 2019 (COVID-19) effect on ambient air pollution status worldwide. The review of studies was conducted using determined search terms via three major electronic databases (PubMed, Web of Science, and Scopus) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. A total of 26 full-text studies were included in our analysis. The lockdown measures related to COVID-19 pandemic caused significant decreases in the concentrations of PM2.5, NO2, PM10, SO2 and CO globally in the range of 2.9%-76.5%, 18.0%-96.0%, 6.0%-75.0%, 6.8%-49.0% and 6.2%-64.8%, respectively. However, O3 concentration increased in the range of 2.4%-252.3%. The highest decrease of PM2.5 was found in 16 states of Malaysia (76.5%), followed by Zaragoza (Spain) with 58.0% and Delhi (India) with 53.1%. The highest reduction of NO2 was found in Salé city (Morocco) with 96.0%, followed by Mumbai (India) with 75.0%, India with 70.0%, Valencia (Spain) with 69.0%, and São Paulo (Brazil) with 68.0%, respectively. The highest increase of O3 was recorded for Milan (Italy) with 252.3% and 169.9% during the first and third phases of lockdown measures, and for Kolkata (India) with 87% at the second phase of lockdown measures. Owing to the lockdown restrictions in the studied countries and cities, driving and public transit as a proxy of human mobilities and the factors affecting emission sources of ambient air pollution decreased in the ranges of 30-88% and 45-94%, respectively. There was a considerable variation in the reduction of ambient air pollutants in the countries and cities as the degree of lockdown measures had varied there. Our results illustrated that the COVID-19 pandemic had provided lessons and extra motivations for comprehensive implementing policies to reduce air pollution and its health effects in the future.

COVID-19: Performance study of microplastic inhalation risk posed by wearing masks

Wearing face masks has become the new normal worldwide due to the global spread of the coronavirus disease 2019. The inhalation of microplastics due to the wearing of masks has rarely been reported. The present study used different types of commonly used masks to conduct breathing simulation experiments and investigate microplastic inhalation risk. Microplastic inhalation caused by reusing masks that underwent various treatment processes was also tested. Results implied that wearing masks considerably reduces the inhalation risk of particles (e.g., granular microplastics and unknown particles) even when they are worn continuously for 720 h. Surgical, cotton, fashion, and activated carbon masks wearing pose higher fiber-like microplastic inhalation risk, while all masks generally reduced exposure when used under their supposed time (<4 h). N95 poses less fiber-like microplastic inhalation risk. Reusing masks after they underwent different disinfection pretreatment processes can increase the risk of particle (e.g., granular microplastics) and fiber-like microplastic inhalation. Ultraviolet disinfection exerts a relatively weak effect on fiber-like microplastic inhalation, and thus, it can be recommended as a treatment process for reusing masks if proven effective from microbiological standpoint. Wearing an N95 mask reduces the inhalation risk of spherical-type microplastics by 25.5 times compared with not wearing a mask.

Composition and exposure characteristics of PM2.5 on subway platforms and estimates of exposure reduction by protective masks

There is limited information on exposure to metallic constituents of fine particulate matter in subway stations. We characterized the concentrations and composition of airborne fine particulate pollution on six subway platforms in Nanjing, China in both summer and winter of 2019. A microenvironment exposure model was used to evaluate the concentrations of elements in fine particulate matter and the contribution of exposure duration (time spent in the subway station) to overall daily exposure of subway workers and commuters with and without the use of N95 respirators, surgical masks, and cotton masks. We found that airborne fine particulate pollution on station platforms was much higher than in an urban reference site of ambient air, and the same was true for metallic constituents of the particles, such as iron, copper, manganese, strontium, and vanadium. Subway workers were exposed to higher levels of these airborne metals than commuters. The average daily exposure concentration of fine particulate matter was 73.5 μg/m³ for subway workers and 61.8 μg/m³ for commuters, while the average daily exposure to iron was 15.5 μg/m³ for subway workers and 2.0 μg/m³ for commuters. Subway workers were exposed to iron, copper, manganese, and strontium/vanadium at levels approximately eight-fold, four-fold, three-fold, and two-fold greater than the exposure sustained by commuters, respectively. We calculated that wearing N95 respirators or surgical masks can reduce the exposure to these airborne metallic particles significantly for both subway workers and commuters. Overall, we estimate that personal exposure to airborne fine particulate matter on subway platforms can be reduced through the use of N95 respirators or properly fitting masks.

Quantitative fit testing of filtering face-piece respirators during the COVID-19 pandemic reveals anthropometric deficits in most respirators available in Iran

PURPOSE

Frontline health care workers (HCWs) must wear a standard N95 or FFP2 respirator during worldwide pandemics of respiratory diseases including COVID-19 to protect against airborne infectious pathogens when performing care activities. This study aimed to quantitatively investigate the fit of most of the common FFRs used during the COVID-19 pandemic in Iran.

METHODS

A total of 37 volunteers were fit tested in 20 selected FFRs in a randomized order. The selected FFRs were underwent quantitative fit testing by PortaCount® model 8038. To determine the effects of face sizes on respirator fit, the participants' facial dimensions were measured using a digital caliper.

RESULTS

The rate of passing fit tests for the studied FFRs were surprisingly low with 11 out of 20 FFRs having less than 10% passing fit tests and the best performers having only 43% and 27% passing fit tests (brands 2 and 20, respectively). Cup-shaped respirators provided significantly greater fit than the vertical flat-fold ones (p < 0.001). A significantly different FFs were found among the respirator brands (F = 13.60, p < 0.001).

CONCLUSION

Overall, unacceptably low fit factors were obtained from the studied FFRs. The main reasons for this are suspected to single size and style for each studied FFR. It confirms the importance and requirement of the proper respirator selection in that way fitted optimally into facial dimensions, appropriate usage, and properly performing the fit testing procedure. A unique fit test panel should be developed to guide respirator wearers in selecting the appropriate FFR for their specific face sizes.

Cardiovascular health effects of wearing a particulate-filtering respirator to reduce particulate matter exposure: a randomized crossover trial

This randomized crossover trial sought to determine whether wearing a high-efficiency particulate-filtering respirator (PFR) improves cardiovascular function over 48 h among healthy college students in Tehran. This trial was conducted from February 14th to 23rd, 2019 and twenty-six participants completed two 48-h intervention periods. Brachial blood pressure (BP) measured by 24-h ambulatory monitoring was the primary health outcome. Secondary outcomes included 48-h heart rate variability (HRV) indices, high-sensitive cardiac troponin (hs-TnT) and other biomarkers. The participants wore the PFR between 10.2 and 11.1 h while awake during the interventions. More than 80% of participants reported increased respiratory resistance while wearing the PFR due to a lack of an exhalation valve. There were no significant differences in brachial BP levels between subjects who wore PFR respirator and those did not. Except for high frequency (HF) power and heart rate (HR), no significant differences between interventions were observed for other HRV metrics. Wearing the PFR led to an increase of 66.0 ms² (95% confidence interval [CI], 9.6-110.5) and 79.6 ms² (95% CI, 19.0-140.1) in HF power during the first day when the two groups of participants wore the PFR. Night-time HR was significantly increased during the PFR intervention period. Other secondary outcomes were not significantly different between interventions. It is plausible that incomplete exposure reduction due to wearing the PFR less than half of the time or increased respiratory resistance mitigated potential health benefits. Additional trials are warranted to validate the CV protection of wearing PFRs in heavily-polluted cities.