N95 Filtering Facepiece Respirator Use during Pregnancy: A Systematic Review

A Comparative Evaluation of the Effects of N95 and Surgical Facemasks on Pregnant Women Performing Moderate-Intensity Exercise: A Prospective Randomized Study

Background and objective A facemask is often indicated for the control of the spread of airborne pathogens. At the peak of the COVID-19 pandemic, there was mass enforcement of mask use across the globe. Pregnant women were not excluded. While several studies have been conducted to evaluate and compare the efficacy of various mask types, data on their effects on pregnant women during exercise are scarce. The objective of this study was to evaluate and compare the effects of N95 and surgical facemasks on the cardiopulmonary functions of pregnant women during moderate-intensity exercise. Methods A prospective randomized study was conducted among 104 healthy women with advanced singleton pregnancies performing moderate-intensity exercise wearing either surgical or N95 masks during routine antenatal care. Their respiratory rates were counted, and arterial oxygen saturation (SPO2) and radial pulses (heart rates) were recorded with a mobile digital pulse oximeter at baseline and after 30 minutes of exercise. The mean values were calculated. Data analysis was done using Statistical Product and Service Solutions (SPSS, version 25; IBM SPSS Statistics for Windows, Armonk, NY). An independent t-test was used to compare the mean SPO2 and radial pulse between the two groups. Chi-square was used to examine differences in categorical variables. The level of significance was set at 0.05. Results Their demographic profiles and measured baseline parameters were comparable. Following a 30-minute exercise, the N95 mask group had lower mean SPO2 compared to the surgical mask group (95.5% versus 97.0%; P=0.028, 95%CI; -2.607 to 0.15). Further, the N95 group recorded a higher mean heart rate than the surgical mask group ((97.23 b/m versus 95.02b/m, respectively, mean difference (MD)=2.212, P=0.021, 95%Cl: 1.249-3.672). The mean respiratory rates were also higher among women in the N95 mask group (32.1 c/m versus 29.08 c/m, MD=3.018, 95%CI: 1.392-4.662, P=0.001). Conclusion The study, comparing the relative effects of the surgical and N95 facemask on the cardiorespiratory functions of exercising pregnant women, findings suggest that surgical facemasks may be better tolerated in advanced pregnancy when performing routine antenatal aerobic exercise in comparison with N95 masks.

Wildfire Smoke Exposure during Pregnancy: A Review of Potential Mechanisms of Placental Toxicity, Impact on Obstetric Outcomes, and Strategies to Reduce Exposure

Climate change is accelerating the intensity and frequency of wildfires globally. Understanding how wildfire smoke (WS) may lead to adverse pregnancy outcomes and alterations in placental function via biological mechanisms is critical to mitigate the harms of exposure. We aim to review the literature surrounding WS, placental biology, biological mechanisms underlying adverse pregnancy outcomes as well as interventions and strategies to avoid WS exposure in pregnancy. This review includes epidemiologic and experimental laboratory-based studies of WS, air pollution, particulate matter (PM), and other chemicals related to combustion in relation to obstetric outcomes and placental biology. We summarized the available clinical, animal, and placental studies with WS and other combustion products such as tobacco, diesel, and wood smoke. Additionally, we reviewed current recommendations for prevention of WS exposure. We found that there is limited data specific to WS; however, studies on air pollution and other combustion sources suggest a link to inflammation, oxidative stress, endocrine disruption, DNA damage, telomere shortening, epigenetic changes, as well as metabolic, vascular, and endothelial dysregulation in the maternal-fetal unit. These alterations in placental biology contribute to adverse obstetric outcomes that disproportionally affect the most vulnerable. Limiting time outdoors, wearing N95 respirator face masks and using high quality indoor air filters during wildfire events reduces exposure to related environmental exposures and may mitigate morbidities attributable to WS.

Effect Of Surgical And N95 Facial Masks On Exercise Tolerance, Heart Rate, Respiratory Rate And Blood Oxygen Saturation

Background — Although wearing masks is inevitable these days, the effects of wearing them on physiologic parameters have not been reported. This study aimed to assess the effects of wearing no mask, a three-layer standard surgical mask, and wearing an N95 mask on blood oxygen saturation, aerobic tolerance, and performance during exercise. Methods — Twenty-one participants were enrolled in the study. Each participant was monitored with electrocardiography (ECG) while performing an exercise tolerance test using the Bruce treadmill protocol. Testing was conducted three times on different dates. Participants did not use any mask in the first test but did wear surgical and N95 masks during the second and third tests respectively. Respiratory rate (RR) was assessed for 10 seconds and then multiplied by 6. Heart rate (HR) was monitored by ECG, and oxygen saturation levels were monitored (O2Sat) via digital pulse-oximetry. Assessments were done before warm-up, at the middle and end of each Bruce stage, and as well at 1, 2, and 5 minutes into recovery (masks were worn during recovery). Results — HR, RR, and O2Sat measured data were all significantly different between the three trials at end-stage 3 of Bruce treadmill protocol (p<0.05). Although HR was still higher through the recovery period in the N95 trial in comparison with other trials (p<0.05), RR and O2Sat measured data were not different in the recovery phase. Conclusion — HR, RR, O2Sat and exercise tolerance are significantly affected by wearing surgical and N95 masks.

COVID-19 and physical activity in sedentary individuals: differences in metabolic, cardiovascular, and respiratory responses during aerobic exercise performed with and without a surgical face masks

BACKGROUND

The Coronavirus-19 (COVID-19) impairs metabolic, cardiovascular, and pulmonary functions in human metabolism, and wearing face masks is recommended for the prevention of contracting or exposing others to cardio-respiratory infections. Since the effect of wearing a surgical face mask (SFM) on cardiopulmonary exercise capacity has not been systematically reported we aimed to determine the effects of wearing SFM during an incremental walking test on metabolic, cardiovascular, and pulmonary gas exchange responses in sedentary individuals.

METHODS

The evaluations were performed using a repeated measures study design. Seven sedentary males (age:40years, height:178cm, weight:88kg, BMI:28kg/m2, VO2max:32.7±3.9ml/kg/min) and 7 sedentary female participants (age:34years, height:169cm, weight:62kg, BMI:22kg/m2, VO2max:32.1±6.8 ml/kg/min) volunteered to participate in the current study. Anthropometric parameters were measured using a Bioelectrical impedance analysis prior to each testing session. The measures of lung function assessed by spirometry, breathing pattern, maximal exercise capacity with-and-without mask were measured with a breath-by-breath automated exercise metabolic system during incremental Bruce protocol on a treadmill with two consecutive sessions with 48-h intervals. Blood pressure values (systolic and diastolic pressure) of the individuals were taken and recorded within 1 minute at the end of every ten minutes, without speed changes.

RESULTS

VO2, VCO2, and VE were significantly lower during exercise performed with SFM (p<0.001). Heart rate, systolic and diastolic blood pressure were also found significantly higher during exercise performed with SFM (p<0.01).

CONCLUSIONS

Wearing a SFM during incremental walking predispose a decrease in oxygen delivery while increasing pulmonary ventilation in sedentary individuals. Thus, it could be speculated that surgical face masks have a negative impact on oxygen delivery during exercise which results in decreased exercise performance due to the restricted ventilatory conditions.

Is a Mask That Covers the Mouth and Nose Free from Undesirable Side Effects in Everyday Use and Free of Potential Hazards?

Many countries introduced the requirement to wear masks in public spaces for containing SARS-CoV-2 making it commonplace in 2020. Up until now, there has been no comprehensive investigation as to the adverse health effects masks can cause. The aim was to find, test, evaluate and compile scientifically proven related side effects of wearing masks. For a quantitative evaluation, 44 mostly experimental studies were referenced, and for a substantive evaluation, 65 publications were found. The literature revealed relevant adverse effects of masks in numerous disciplines. In this paper, we refer to the psychological and physical deterioration as well as multiple symptoms described because of their consistent, recurrent and uniform presentation from different disciplines as a Mask-Induced Exhaustion Syndrome (MIES). We objectified evaluation evidenced changes in respiratory physiology of mask wearers with significant correlation of O2 drop and fatigue (p < 0.05), a clustered co-occurrence of respiratory impairment and O2 drop (67%), N95 mask and CO2 rise (82%), N95 mask and O2 drop (72%), N95 mask and headache (60%), respiratory impairment and temperature rise (88%), but also temperature rise and moisture (100%) under the masks. Extended mask-wearing by the general population could lead to relevant effects and consequences in many medical fields.

A descriptive audit of healthcare workers exposed to COVID-19 at a tertiary care center in India

Objective

To provide a descriptive audit of healthcare workers (HCWs) exposed to COVID‐19, and their contacts, to understand the dynamics of transmission among HCWs.

Methods

Retrospective analysis of contact tracing data of infected HCWs was done from March 1, 2020 to July 31, 2020 at a tertiary care center in New Delhi, India. Contacts were categorized according to the nature of contact and followed for 14 days.

Results

Qualitative RT‐PCR testing was performed on 106 HCWs (from a total of 257) owing to exposure or development of symptoms. Positive results were found in 16 HCWs (6.2%) who were exposed to 120 other HCWs, generating 197 exposure incidents. Of these, 30 (15.2%) exposure incidents were high risk with multiple exposures in 48 (40.0%) HCWs. Exposure to infected HCWs was noted in 3 (18.8%) of 16 positive cases. Of the 197 exposure incidents, 54 (27.4%) were deemed avoidable exposures. Infection prevention and control policies were periodically reviewed, and the department implemented mitigating steps to minimize the risk to healthcare providers.

Conclusion

Instituting appropriate infection prevention and control policies and use of adequate precautions by HCWs is vital to minimize high‐risk exposure to COVID‐19.

COVID‐19 infection among healthcare workers can be avoided using appropriate on‐duty precautions to help provide sustained patient care during the current pandemic and beyond.

[The use of anti-pollution masks in daily life - a review]

INTRODUCTION

"Anti-pollution" masks are a form of personal protective equipment intended to ensure filtration of ambient particulate air pollution.

STATE OF THE ART

Although according to tests performed in the lab, their filtration power is high, the filtering efficiency of these masks in real conditions of use, that is to say, during physical effort, is generally lower than that established in the laboratory and this information is rarely available on commercial products on sale. Clinical studies, which are rarely double-blind, demonstrate a lower incidence of symptoms and a somewhat better cardiac performance when exercise is performed while wearing a mask. For short-term use, the tolerance of these masks is fair.

PERSPECTIVES

There is room for technical improvements in mask design improved fitting to the face, lowering inspiratory resistance and dead space, as well as preventing the accumulation of humidity on the mask. Manufacturers should include information in their packaging on the filtering power and design masks usable by children. Clinical studies should be performed to assess the long-term safety and effectiveness of mask in susceptible populations, especially people with asthma.

CONCLUSION

Anti-pollution filtering face piece respirators have a theoretical high filtering power towards particles, but their efficiency in real-life conditions is more limited. Because such devices may confer to users a false sense of protection, the French agency on environment and health do not support their use.

Commentary: Physiological and Psychological Impact of Face Mask Usage during the COVID-19 Pandemic

In this commentary, we discuss the physiological effects of wearing masks for prolonged periods of time, including special considerations, such as mask wearing among those who engage in exercise training, and concerns for individuals with pre-existing chronic diseases. In healthy populations, wearing a mask does not appear to cause any harmful physiological alterations, and the potentially life-saving benefits of wearing face masks seem to outweigh the documented discomforts (e.g. headaches). However, there continues to be controversy over mask wearing in the United States, even though wearing a mask appears to have only minor physiological drawbacks. While there are minimal physiological impacts on wearing a mask, theoretical evidence suggests that there may be consequential psychological impacts of mask wearing on the basic psychological needs of competence, autonomy, and relatedness. These psychological impacts may contribute to the controversy associated with wearing masks during the COVID-19 pandemic in the United States. After we discuss the physiological impacts of mask wearing, we will discuss psychological effects associated with wearing masks during the COVID-19 pandemic.