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Dörr T, Güsewell S, Flury D, Süveges M, Gaza Valera CB, Botero-Mesa S, Zanella MC, Iten A, Balmelli C, Troillet N, Tschudin-Sutter S, W Schreiber P, Jent P, Damonti L, Sommerstein R, Portmann L, Vuichard-Gysin D, Cusini A, Nussbaumer-Ochsner Y, Heininger U, Berger C, Zimmermann P, Gardiol C, Keiser O, Schlegel M, Kohler P, P Kuster S. Association of institutional masking policies with healthcare-associated SARS-CoV-2 infections in Swiss acute care hospitals during the BA.4/5 wave (CH-SUR study): a retrospective observational study. Antimicrob Resist Infect Control 2024; 13:64. [PMID: 38886813 PMCID: PMC11184728 DOI: 10.1186/s13756-024-01422-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/05/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND In the initial phase of the SARS-CoV-2 pandemic, masking has been widely accepted in healthcare institutions to mitigate the risk of healthcare-associated infection. Evidence, however, is still scant and the role of masks in preventing healthcare-associated SARS-CoV-2 acquisition remains unclear.We investigated the association of variation in institutional mask policies with healthcare-associated SARS-CoV-2 infections in acute care hospitals in Switzerland during the BA.4/5 2022 wave. METHODS SARS-CoV-2 infections in hospitalized patients between June 1 and September 5, 2022, were obtained from the "Hospital-based surveillance of COVID-19 in Switzerland"-database and classified as healthcare- or community-associated based on time of disease onset. Institutions provided information regarding institutional masking policies for healthcare workers and other prevention policies. The percentage of healthcare-associated SARS-CoV-2 infections was calculated per institution and per type of mask policy. The association of healthcare-associated SARS-CoV-2 infections with mask policies was tested using a negative binominal mixed-effect model. RESULTS We included 2'980 SARS-CoV-2 infections from 13 institutions, 444 (15%) were classified as healthcare-associated. Between June 20 and June 30, 2022, six (46%) institutions switched to a more stringent mask policy. The percentage of healthcare-associated infections subsequently declined in institutions with policy switch but not in the others. In particular, the switch from situative masking (standard precautions) to general masking of HCW in contact with patients was followed by a strong reduction of healthcare-associated infections (rate ratio 0.39, 95% CI 0.30-0.49). In contrast, when compared across hospitals, the percentage of health-care associated infections was not related to mask policies. CONCLUSIONS Our findings suggest switching to a more stringent mask policy may be beneficial during increases of healthcare-associated SARS-CoV-2 infections at an institutional level.
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Affiliation(s)
- Tamara Dörr
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, Rorschacher Strasse 95, St. Gallen, CH-9007, Switzerland
| | - Sabine Güsewell
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, Rorschacher Strasse 95, St. Gallen, CH-9007, Switzerland
| | - Domenica Flury
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, Rorschacher Strasse 95, St. Gallen, CH-9007, Switzerland
| | - Maria Süveges
- Faculté de Médecine de l'Université de Genève, Institut de Santé Globale, 24 rue du Général- Dufour, Genève 4, 1211, Switzerland
| | - Camille Beatrice Gaza Valera
- Faculté de Médecine de l'Université de Genève, Institut de Santé Globale, 24 rue du Général- Dufour, Genève 4, 1211, Switzerland
| | - Sara Botero-Mesa
- Faculté de Médecine de l'Université de Genève, Institut de Santé Globale, 24 rue du Général- Dufour, Genève 4, 1211, Switzerland
| | - Marie-Céline Zanella
- Service de prévention et contrôle de l'infection, Direction médicale et qualité, Hôpitaux universitaires Genève, Rue Gabrielle-Perret-Gentil 4, Genève, 1205, Switzerland
- Infection Control Program and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, Genève, 1205, Switzerland
| | - Anne Iten
- Service de prévention et contrôle de l'infection, Direction médicale et qualité, Hôpitaux universitaires Genève, Rue Gabrielle-Perret-Gentil 4, Genève, 1205, Switzerland
| | - Carlo Balmelli
- Infection Control Programme, EOC Hospitals, Viale Officina 3, Bellinzona, 6500, Switzerland
| | - Nicolas Troillet
- Service of Infectious Diseases, Central Institute, Valais Hospitals, Av. Grand-Champsec 80, Sion, 1951, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Petersgraben 4, Basel, 4031, Switzerland
| | - Peter W Schreiber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Philipp Jent
- Department of Infectious Diseases, Bern University Hospital (Inselspital), University of Bern, Länggassstrasse 122, Bern, 3012, Switzerland
| | - Lauro Damonti
- Department of Infectious Diseases, Bern University Hospital (Inselspital), University of Bern, Länggassstrasse 122, Bern, 3012, Switzerland
| | - Rami Sommerstein
- Department of Infectious Diseases, Bern University Hospital (Inselspital), University of Bern, Länggassstrasse 122, Bern, 3012, Switzerland
- Faculty of Health Sciences and Medicine, Clinic St. Anna, University of Lucerne, Alpenquai 4, Lucerne, 6005, Switzerland
| | - Lea Portmann
- Faculty of Health Sciences and Medicine, Clinic St. Anna, University of Lucerne, Alpenquai 4, Lucerne, 6005, Switzerland
| | - Danielle Vuichard-Gysin
- Department of Infectious Diseases, Thurgau Cantonal Hospital, Spitalcampus 1, Muensterlingen, 8596, Switzerland
| | - Alexia Cusini
- Department of Infectious Diseases, Cantonal Hospital Graubuenden, Loëstrasse 170, Chur, 7000, Switzerland
| | - Yvonne Nussbaumer-Ochsner
- Klinik für Innere Medizin, Kantonsspital Spitäler Schaffhausen, Geissbergstrasse 81, Schaffhausen, 8208, Switzerland
| | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Spitalstrasse 33, Basel, 4056, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Children's Research Centre, University Children's Hospital Zurich, Steinwiesstrasse 75, Zurich, 8032, Switzerland
| | - Petra Zimmermann
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Chemin du Musée 8, Fribourg, 1700, Switzerland
- Department of Paediatrics, Fribourg Hospital HFR, Chemin des Pensionnats 2-6, Fribourg, Villars-sur-Glâne, 1752, Switzerland
| | - Céline Gardiol
- Swiss Federal Office of Public Health, Schwarzenburgstrasse 157, Bern, 3003, Switzerland
| | - Olivia Keiser
- Faculté de Médecine de l'Université de Genève, Institut de Santé Globale, 24 rue du Général- Dufour, Genève 4, 1211, Switzerland
| | - Matthias Schlegel
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, Rorschacher Strasse 95, St. Gallen, CH-9007, Switzerland
| | - Philipp Kohler
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, Rorschacher Strasse 95, St. Gallen, CH-9007, Switzerland
| | - Stefan P Kuster
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, Rorschacher Strasse 95, St. Gallen, CH-9007, Switzerland.
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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 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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Ghosh S, Dave V, Sharma P, Patel A, Kuila A. Protective face mask: an effective weapon against SARS-CoV-2 with controlled environmental pollution. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:41656-41682. [PMID: 37968481 DOI: 10.1007/s11356-023-30460-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/10/2023] [Indexed: 11/17/2023]
Abstract
Masks are face coverings that give protection from infectious agents, airborne pathogens, bacteria, viruses, surgical fog, dust, and other chemical hazards by acting as a barrier between the wearer and the environment. In the COVID-19 pandemic, this major personal protective equipment's became essential part of our daily life. The aim of this review is to analyze and discuss the different types of masks with their pros and cons, manufacturing procedures, evaluation criteria, and application with some of the sterilization process for reuse and smart mask. The review used a thorough examination of the literature to analyze the preventive effects of surgical, N95, smart mask, and potential environmental damage from those masks. Several studies and evidence were also examined to understand the efficiency of different mask on different environment. N95 respirators are capable of filtering out non-oil-based 95% air-born particles, and surgical masks act as a protective barrier between the wearer and the environment. The application of spoon bond and melt blown techniques in the fabrication process of those masks improves their protective nature and makes them lightweight and comfortable. But the high demand and low supply forced users to reuse and extend their use after sterilizations, even though those masks are recommended to be used once. Universal masking in the SARS-COV-2 pandemic increased the chance of environmental pollution, so the application of smart masks became essential because of their high protection power and self-sterilizing and reusing capabilities.
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Affiliation(s)
- Shovan Ghosh
- Department of Pharmacy, School of Health Science, Central University of South Bihar, Bihar, India
| | - Vivek Dave
- Department of Pharmacy, School of Health Science, Central University of South Bihar, Bihar, India.
| | - Prashansa Sharma
- Department of Home Science, Mahila Maha Vidyalaya, Banaras Hindu University, Varanasi, India
| | - Akash Patel
- Department of Pharmacy, School of Health Science, Central University of South Bihar, Bihar, India
| | - Arindam Kuila
- Department of Bioscience and Biotechnology, Banasthali Vidyapith, Sikar, Rajasthan, 304022, India
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Sharma M, Sra H, Painter C, Pan-ngum W, Luangasanatip N, Chauhan A, Prinja S, Singh M. Cost-effectiveness analysis of surgical masks, N95 masks compared to wearing no mask for the prevention of COVID-19 among health care workers: Evidence from the public health care setting in India. PLoS One 2024; 19:e0299309. [PMID: 38768249 PMCID: PMC11104672 DOI: 10.1371/journal.pone.0299309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/08/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Nonpharmacological interventions, such as personal protective equipment for example, surgical masks and respirators, and maintenance of hand hygiene along with COVID-19 vaccines have been recommended to reduce viral transmission in the community and health care settings. There is evidence from the literature that surgical and N95 masks may reduce the initial degree of exposure to the virus. A limited research that has studied the cost-effective analysis of surgical masks and N95 masks among health care workers in the prevention of COVID-19 in India. The objective of this study was to estimate the cost-effectiveness of N95 and surgical mask compared to wearing no mask in public hospital settings for preventing COVID-19 infection among Health care workers (HCWs) from the health care provider's perspective. METHODS A deterministic baseline model, without any mask use, based on Eikenberry et al was used to form the foundation for parameter estimation and to estimate transmission rates among HCWs. Information on mask efficacy, including the overall filtering efficiency of a mask and clinical efficiency, in terms of either inward efficiency(ei) or outward efficiency(e0), was obtained from published literature. Hospitalized HCWs were assumed to be in one of the disease states i.e., mild, moderate, severe, or critical. A total of 10,000 HCWs was considered as representative of the size of a tertiary care institution HCW population. The utility values for the mild, moderate and severe model health states were sourced from the primary data collection on quality-of-life of HCWs COVID-19 survivors. The utility scores for mild, moderate, and severe COVID-19 conditions were 0.88, 0.738 and 0.58, respectively. The cost of treatment for mild sickness (6,500 INR per day), moderate sickness (10,000 INR per day), severe (require ICU facility without ventilation, 15,000 INR per day), and critical (require ICU facility with ventilation per day, 18,000 INR) per day as per government and private COVID-19 treatment costs and capping were considered. One way sensitivity analyses were performed to identify the model inputs which had the largest impact on model results. RESULTS The use of N95 masks compared to using no mask is cost-saving of $1,454,632 (INR 0.106 billion) per 10,000 HCWs in a year. The use of N95 masks compared to using surgical masks is cost-saving of $63,919 (INR 0.005 billion) per 10,000 HCWs in a year. the use of surgical masks compared to using no mask is cost-saving of $1,390,713 (INR 0.102 billion) per 10,000 HCWs in a year. The uncertainty analysis showed that considering fixed transmission rate (1.7), adoption of mask efficiency as 20%, 50% and 80% reduces the cumulative relative mortality to 41%, 79% and 94% respectively. On considering ei = e0 (99%) for N95 and surgical mask with ei = e0 (90%) the cumulative relative mortality was reduced by 97% and the use of N95 masks compared to using surgical masks is cost-saving of $24,361 (INR 0.002 billion) per 10,000 HCWs in a year. DISCUSSION Both considered interventions were dominant compared to no mask based on the model estimates. N95 masks were also dominant compared to surgical masks.
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Affiliation(s)
- Meenakshi Sharma
- Queens University, Belfast, United Kingdom
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harnoor Sra
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chris Painter
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Wirichada Pan-ngum
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Nantasit Luangasanatip
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Anil Chauhan
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Meenu Singh
- All India Institute of Medical Sciences, Rishikesh, India
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5
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Brosseau LM, Gold DD, Materna B, McPhaul K, Rosen M, Seminario P, Thomason J. Preventing Aerosol-Transmissible Diseases in Healthcare Settings: The Need for Protective Guidelines and Standards-Workshop Report. New Solut 2024; 33:236-247. [PMID: 38128919 DOI: 10.1177/10482911231215498] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
There is an urgent need for stronger protection from aerosol-transmissible diseases in healthcare settings-for workers, patients, volunteers, and visitors. Concerned that the Centers for Disease Control and Prevention (CDC) Healthcare Infection Control Practices Advisory Committee (HICPAC) lacks diversity in expertise and experience and has not consulted widely with all concerned parties regarding a planned update to the 2007 Guideline for Isolation Precautions, a workshop was developed to consider the science and lessons learned before and during the COVID-19 pandemic. Sponsored by the New York/New Jersey Occupational Safety and Health Center, Preventing Aerosol-Transmissible Diseases in Healthcare Settings: The Need for Protective Guidelines and Standards was held on October 13, 2023, with these goals: describe current CDC/HICPAC infection prevention guidelines, review current scientific understanding of aerosol-transmissible pathogens, and consider perspectives from a wide range of groups currently excluded from the CDC HICPAC process.
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Affiliation(s)
| | | | | | - Kate McPhaul
- University of Maryland School of Public Health, College Park, MD
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Collis B, Tacey M, McGrath C, Madigan V, Kainer M, Tramontana A, Aboltins C. P2/N95 fit testing and the risk of COVID-19 in Healthcare Workers. Infect Dis Health 2024; 29:8-14. [PMID: 37573216 DOI: 10.1016/j.idh.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/23/2023] [Accepted: 07/23/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Guidelines recommend healthcare workers (HCWs) undertake fit testing of P2/N95 respirators to mitigate the risk of infectious aerosols, however few studies have assessed whether fit testing reduces COVID-19 infection. METHODS A retrospective cohort study was conducted amongst HCWs across two tertiary health services in Melbourne, Australia during a period of low community transmission. Institution-wide quantitative fit testing and detailed questionnaires assessing COVID-19 acquisition risk factors were undertaken from September 2020. HCWs diagnosed with COVID-19 in the period prior to the fit testing program (February 1st - August 31st 2020) were matched on a 1:3 ratio to HCWs who had not been diagnosed with COVID-19. Risk factors for COVID-19 acquisition, including fit testing outcome, were compared between groups. RESULTS A total of 1571 HCWs took part in fit testing programs. Seventy-two (4.6%) were diagnosed with COVID-19 within the study period. Younger age, nursing staff, close contact with a COVID-19 case, and working longer periods in wards with COVID-19 patients, were associated with COVID-19 infection. After matching for intensity of occupational exposure to infectious aerosols, close contact was the only independent variable associated with COVID-19 infection (OR 3.50, 95% CI:1.65-7.44, p = 0.001). Adequate fit test for the respirator predominately worn before the fit testing period was not associated with COVID-19 (OR 1.08, 95% CI:0.59-1.98, p = 0.815). CONCLUSION After controlling for intensity of occupational exposure to infectious aerosols, P2/N95 respirator fit testing was not associated with reduced risk of COVID-19 infection. The utility of widespread fit testing to reduce HCW COVID-19 infections should be reconsidered.
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Affiliation(s)
- Brennan Collis
- Department of Infectious Diseases, The Northern Hospital, 185 Cooper Street, Epping, Victoria, 3076, Australia.
| | - Mark Tacey
- Department of Infectious Diseases, The Northern Hospital, 185 Cooper Street, Epping, Victoria, 3076, Australia; Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria, 3053, Australia
| | - Christian McGrath
- Department of Infectious Diseases, The Northern Hospital, 185 Cooper Street, Epping, Victoria, 3076, Australia
| | - Victoria Madigan
- Department of Infectious Diseases, The Northern Hospital, 185 Cooper Street, Epping, Victoria, 3076, Australia
| | - Marion Kainer
- Department of Infectious Diseases, Western Health, 176 Furlong Road, St. Albans, Victoria, 3021, Australia
| | - Adrian Tramontana
- Department of Infectious Diseases, Western Health, 176 Furlong Road, St. Albans, Victoria, 3021, Australia
| | - Craig Aboltins
- Department of Infectious Diseases, The Northern Hospital, 185 Cooper Street, Epping, Victoria, 3076, Australia; Northern Clinical School, The University of Melbourne, 185 Cooper Street, Epping, Victoria, 3076, Australia
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7
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Brosseau LM, Gold D, Materna B, Rosen J, Seminario P, Thomason J. Public Health Experts Ask CDC Director to Broaden Input on Revisions to Key Infection Control Guidelines. New Solut 2023; 33:165-173. [PMID: 37621093 DOI: 10.1177/10482911231195898] [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: 08/26/2023]
Abstract
On July 20, 2023 a letter was sent to the Director of the Centers for Disease Control and Prevention requesting the agency's Healthcare Infection Control Practice Advisory Committee seek input from more stakeholders and the public, recognize the importance of infectious disease transmission by inhalation of human-generated aerosols, and ensure the application of interventions from all levels of the control hierarchy.
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Affiliation(s)
- Lisa M Brosseau
- Center for Infectious Disease Research and Policy, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | | | | | | | | | - Jane Thomason
- Health and Safety Division, National Nurses United, Oakland, CA, USA
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8
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Gupta DK, Vishwakarma A, Singh A. Release of microplastics from disposable face mask in tropical climate. REGIONAL STUDIES IN MARINE SCIENCE 2023; 61:102847. [PMID: 36741923 PMCID: PMC9884611 DOI: 10.1016/j.rsma.2023.102847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/29/2022] [Accepted: 01/26/2023] [Indexed: 05/04/2023]
Abstract
Outbreak of COVID 19 has caused an abrupt surge in the consumption of disposable face masks around the world. WHO has stated that wearing a face mask in public reduces the chances of being exposed to COVID 19 virus. With unchecked disposal of these used masks, a new kind of pollutant has emerged in the environment. Since these masks are generally made of polypropylene and polyurethane material, they can be considered as a potential source of microplastics (MPs) in the environment. In this study, we have evaluated the release of MPs particles from these face masks (namely from N95 and surgical masks) in deionized (DI) water and tap water over the span of 1 to 180 days. More specifically, a systematic study has been carried out to see the effect of temperature on release of MPs in water. MPs particles released in tap water (837 ± 113 particles/piece in 30 days) were significantly higher than that in DI water (564 ± 37 particles/piece in 30 days). When these masks were kept at a constant temperature of 45 °C for 30 Days, highest amount of MPs release (N95 899 ± 65 particles, Surgical 1038 ± 65 particles/piece) was observed as compared to other conditions. Most of the MPs particles released were polypropylene which were transparent and white in case of N95 while for surgical mask they were found to be of blue and white colour. With the aging of masks in water, quantity of MPs release was increased with simultaneous reduction in their size. Our study indicates that these disposable face masks are emerging to be a prominent source of MPs release in the environment and more hazardous for the tropical climate.
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Affiliation(s)
- Dinesh Kumar Gupta
- Advanced Materials and Processes Research Institute, Hoshangabad Road, Bhopal, 462026, India
- Department of Civil Engineering, University Institute of Technology RGPV, Bhopal, 462033, India
| | - Amit Vishwakarma
- Department of Civil Engineering, University Institute of Technology RGPV, Bhopal, 462033, India
| | - Archana Singh
- Advanced Materials and Processes Research Institute, Hoshangabad Road, Bhopal, 462026, India
- Academy of Scientific and Innovative Research, Ghaziabad, 201002, India
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Checchi V, Montevecchi M, Valeriani L, Checchi L. Bioburden Variation of Filtering Face Piece Respirators over Time: A Preliminary Study. MATERIALS (BASEL, SWITZERLAND) 2022; 15:8790. [PMID: 36556594 PMCID: PMC9785761 DOI: 10.3390/ma15248790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/29/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The microbial contamination of a respirator can be evaluated through a count of the number of bacteria living on a non-sterilized surface (bioburden). This preliminary study investigated the external contamination of two different FFP2s over time by studying the bioburden values in increasing exposure times. METHODS FFP2 respirators of two different brands were used during routine clinical settings and examined through the bioburden test; for each brand, three devices were tested at 8, 16, and 30 h. RESULTS No significant differences were observed between mask brands (p = 0.113). There were only significant CFU differences between each mask and its control (p = 0.027 and p = 0.004). CONCLUSIONS Both brands of respirators were found to be contaminated and this contamination increased with the increase in exposure time. Further studies are needed to investigate the exact amount of contamination that could be considered acceptable before discarding each used mask.
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Affiliation(s)
- Vittorio Checchi
- Unit of Dentistry and Oral-Maxillo-Facial Surgery, Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Marco Montevecchi
- Unit of Dentistry, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40100 Bologna, Italy
| | - Leoluca Valeriani
- Unit of Dentistry, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40100 Bologna, Italy
| | - Luigi Checchi
- Unit of Dentistry, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40100 Bologna, Italy
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Li M, Hou Z, Meng R, Hao S, Wang B. Unraveling the potential human health risks from used disposable face mask-derived micro/nanoplastics during the COVID-19 pandemic scenario: A critical review. ENVIRONMENT INTERNATIONAL 2022; 170:107644. [PMID: 36413926 PMCID: PMC9671534 DOI: 10.1016/j.envint.2022.107644] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 06/09/2023]
Abstract
With the global spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), disposable face masks (DFMs) have caused negative environmental impacts. DFMs will release microplastics (MPs) and nanoplastics (NPs) during environmental degradation. However, few studies reveal the release process of MPs/NPs from masks in the natural environment. This review presents the current knowledge on the abiotic and biotic degradation of DFMs. Though MPs and NPs have raised serious concerns about their potentially detrimental effects on human health, little attention was paid to their impacts on human health from DFM-derived MPs and NPs. The potential toxicity of mask-derived MPs/NPs, such as gastrointestinal toxicity, pneumotoxicity, neurotoxicity, hepatotoxicity, reproductive and transgenerational toxicity, and the underlying mechanism will be discussed in the present study. MPs/NPs serve as carriers of toxic chemicals and pathogens, leading to their bioaccumulation and adverse effects of biomagnification by food chains. Given human experiments are facing ethical issues and animal studies cannot completely reveal human characteristics, advanced human organoids will provide promising models for MP/NP risk assessment. Moreover, in-depth investigations are required to identify the release of MPs/NPs from discarded face masks and characterize their transportation through the food chains. More importantly, innovative approaches and eco-friendly strategies are urgently demanded to reduce DFM-derived MP/NP pollution.
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Affiliation(s)
- Minghui Li
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400030, China; Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Zongkun Hou
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400030, China
| | - Run Meng
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400030, China
| | - Shilei Hao
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400030, China.
| | - Bochu Wang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400030, China.
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11
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Ganesapillai M, Mondal B, Sarkar I, Sinha A, Ray SS, Kwon YN, Nakamura K, Govardhan K. The face behind the Covid-19 mask - A comprehensive review. ENVIRONMENTAL TECHNOLOGY & INNOVATION 2022; 28:102837. [PMID: 35879973 PMCID: PMC9299984 DOI: 10.1016/j.eti.2022.102837] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/16/2022] [Accepted: 07/16/2022] [Indexed: 05/07/2023]
Abstract
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.
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Affiliation(s)
- Mahesh Ganesapillai
- Mass Transfer Group, School of Chemical Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Bidisha Mondal
- Mass Transfer Group, School of Chemical Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Ishita Sarkar
- Mass Transfer Group, School of Chemical Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Aritro Sinha
- Mass Transfer Group, School of Chemical Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Saikat Sinha Ray
- Department of Urban and Environmental Engineering, Ulsan National Institute of Science and Technology, Republic of Korea
| | - Young-Nam Kwon
- Department of Urban and Environmental Engineering, Ulsan National Institute of Science and Technology, Republic of Korea
| | - Kazuho Nakamura
- Faculty of Engineering, Division of Material Science and Chemical Engineering, Yokohama National University, Tokiwadai, Yokohama, Kanagawa 240-8501, Japan
| | - K Govardhan
- Department of Micro and Nano-Electronics, School of Electronics Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, India
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12
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Sung YJ, Song S, Sim SJ. A Rapid and High-Throughput Assay for Light Scattering of SARS-CoV-2 Virion-Sized Particulates via Microfluidic Spray Device Reveals the Protection Performance of Face Masks against Virus Infection. NANO LETTERS 2022; 22:6744-6752. [PMID: 35930264 DOI: 10.1021/acs.nanolett.2c02278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
To prevent interhuman transmission of viruses, new mask types─claiming improved filtration─require careful performance characterization. Here, a microfluidic spray device that can effectively simulate droplets emitted during coughing or sneezing was developed to spray droplets containing gold nanoparticles (AuNPs) that mimic SARS-CoV-2 to overcome the shortcomings associated with using biosamples. The light scattered by the AuNPs passing through the mask is successfully analyzed by using an automated scattering light mapping system within a duration of 2 min, thereby enabling high-throughput analysis of the filtering efficiency of various types of commercial masks. The differences in efficiency in terms of same mask type from different manufacturers, double masking, and prolonged usage, which are challenging to analyze with conventional testing systems, can also be assessed. AuNP-mediated mask performance evaluation enables the rapid determination of mask efficiency according to particle size and can contribute to the rapid response to counter new emerging infectious biohazards.
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Affiliation(s)
- Young Joon Sung
- Department of Chemical and Biological Engineering, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Sojin Song
- Department of Chemical and Biological Engineering, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Sang Jun Sim
- Department of Chemical and Biological Engineering, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
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13
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Boi C, Borsetti F, Brugo T, Cappelletti M, De Angelis M, Fedi S, Di Giacomo S, Fabiani T, Foli G, Garelli A, Genchi U, Ghezzi D, Gualandi C, Lalli E, Magnani M, Maurizzi A, Mazzi F, Mehrabi N, Minelli M, Montalbano R, Morelli L, Nici S, Onesti R, Paglianti A, Papchenko K, Pappalardo S, Parisi N, Rapino S, Reggio M, Roselli M, Ruggeri E, Sabatini L, Saracino E, Scarponi G, Serra L, Signorini V, Storione A, Torsello M, Tugnoli E, Vargiu C, Vidali G, Violante F. One year of surgical mask testing at the University of Bologna labs: Lessons learned from data analysis. Sep Purif Technol 2022; 294:121180. [PMID: 35573908 PMCID: PMC9075986 DOI: 10.1016/j.seppur.2022.121180] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/15/2022] [Accepted: 04/25/2022] [Indexed: 01/25/2023]
Abstract
The outbreak of SARS-CoV-2 pandemic highlighted the worldwide lack of surgical masks and personal protective equipment, which represent the main defense available against respiratory diseases as COVID-19. At the time, masks shortage was dramatic in Italy, the first European country seriously hit by the pandemic: aiming to address the emergency and to support the Italian industrial reconversion to the production of surgical masks, a multidisciplinary team of the University of Bologna organized a laboratory to test surgical masks according to European regulations. The group, driven by the expertise of chemical engineers, microbiologists, and occupational physicians, set-up the test lines to perform all the functional tests required. The laboratory started its activity on late March 2020, and as of the end of December of the same year 435 surgical mask prototypes were tested, with only 42 masks compliant to the European standard. From the analysis of the materials used, as well as of the production methods, it was found that a compliant surgical mask is most likely composed of three layers, a central meltblown filtration layer and two external spunbond comfort layers. An increase in the material thickness (grammage), or in the number of layers, does not improve the filtration efficiency, but leads to poor breathability, indicating that filtration depends not only on pure size exclusion, but other mechanisms are taking place (driven by electrostatic charge). The study critically reviewed the European standard procedures, identifying the weak aspects; among the others, the control of aerosol droplet size during the bacterial filtration test results to be crucial, since it can change the classification of a mask when its performance lies near to the limiting values of 95 or 98%.
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Affiliation(s)
- C. Boi
- Department of Civil, Chemical, Environmental and Materials Engineering (DICAM), Alma Mater Studiorum - University of Bologna, Italy,Interdepartmental Centre for Industrial Research in Health Sciences and Technologies (CIRI-SDV), Alma Mater Studiorum - University of Bologna, Italy,General Hospital Sant’Orsola Foundation, Bologna, Italy,Corresponding authors at: Department of Civil, Chemical, Environmental and Materials Engineering (DICAM), Alma Mater Studiorum - University of Bologna, Italy (C.Boi). School of Engineering, University of Edinburgh, Sanderson Building, Robert Stevenson Road, EH9 3FB, UK (M.G. De Angelis)
| | - F. Borsetti
- Department of Pharmacy and Biotechnology (FaBit), Alma Mater Studiorum - University of Bologna, Italy
| | - T.M. Brugo
- Department of Industrial Engineering (DIN), Alma Mater Studiorum -University of Bologna, Italy
| | - M. Cappelletti
- Interdepartmental Centre for Industrial Research in Health Sciences and Technologies (CIRI-SDV), Alma Mater Studiorum - University of Bologna, Italy,Department of Pharmacy and Biotechnology (FaBit), Alma Mater Studiorum - University of Bologna, Italy
| | - M.G. De Angelis
- School of Engineering, University of Edinburgh, Sanderson Building, Robert Stevenson Road, EH9 3FB, UK,Corresponding authors at: Department of Civil, Chemical, Environmental and Materials Engineering (DICAM), Alma Mater Studiorum - University of Bologna, Italy (C.Boi). School of Engineering, University of Edinburgh, Sanderson Building, Robert Stevenson Road, EH9 3FB, UK (M.G. De Angelis)
| | - S. Fedi
- Department of Pharmacy and Biotechnology (FaBit), Alma Mater Studiorum - University of Bologna, Italy
| | - S. Di Giacomo
- Department of Pharmacy and Biotechnology (FaBit), Alma Mater Studiorum - University of Bologna, Italy,General Hospital Sant’Orsola Foundation, Bologna, Italy
| | - T. Fabiani
- Department of Civil, Chemical, Environmental and Materials Engineering (DICAM), Alma Mater Studiorum - University of Bologna, Italy,General Hospital Sant’Orsola Foundation, Bologna, Italy
| | - G. Foli
- General Hospital Sant’Orsola Foundation, Bologna, Italy,Institute of Organic Synthesis and Photoreactivity (ISOF) – National Research Council (CNR), Bologna, Italy
| | - A. Garelli
- Department of Chemistry “Giacomo Ciamician”, Alma Mater Studiorum - University of Bologna, Italy
| | - U. Genchi
- Department of Pharmacy and Biotechnology (FaBit), Alma Mater Studiorum - University of Bologna, Italy,General Hospital Sant’Orsola Foundation, Bologna, Italy
| | - D. Ghezzi
- Department of Pharmacy and Biotechnology (FaBit), Alma Mater Studiorum - University of Bologna, Italy,Laboratory of NanoBiotechnology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - C. Gualandi
- Department of Chemistry “Giacomo Ciamician”, Alma Mater Studiorum - University of Bologna, Italy
| | - E. Lalli
- Department of Civil, Chemical, Environmental and Materials Engineering (DICAM), Alma Mater Studiorum - University of Bologna, Italy,General Hospital Sant’Orsola Foundation, Bologna, Italy
| | - M. Magnani
- General Hospital Sant’Orsola Foundation, Bologna, Italy
| | - A. Maurizzi
- Department of Pharmacy and Biotechnology (FaBit), Alma Mater Studiorum - University of Bologna, Italy,General Hospital Sant’Orsola Foundation, Bologna, Italy
| | - F. Mazzi
- General Hospital Sant’Orsola Foundation, Bologna, Italy
| | - N. Mehrabi
- Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Occupational Medicine Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Italy
| | - M. Minelli
- Department of Civil, Chemical, Environmental and Materials Engineering (DICAM), Alma Mater Studiorum - University of Bologna, Italy
| | - R. Montalbano
- Department of Civil, Chemical, Environmental and Materials Engineering (DICAM), Alma Mater Studiorum - University of Bologna, Italy,General Hospital Sant’Orsola Foundation, Bologna, Italy
| | - L. Morelli
- Department of Pharmacy and Biotechnology (FaBit), Alma Mater Studiorum - University of Bologna, Italy,General Hospital Sant’Orsola Foundation, Bologna, Italy
| | - S. Nici
- Department of Pharmacy and Biotechnology (FaBit), Alma Mater Studiorum - University of Bologna, Italy,General Hospital Sant’Orsola Foundation, Bologna, Italy
| | - R. Onesti
- Department of Civil, Chemical, Environmental and Materials Engineering (DICAM), Alma Mater Studiorum - University of Bologna, Italy,General Hospital Sant’Orsola Foundation, Bologna, Italy
| | - A. Paglianti
- Department of Industrial Chemistry “Toso Montanari” (CHIMIND), Alma Mater Studiorum - University of Bologna, Italy
| | - K. Papchenko
- Department of Civil, Chemical, Environmental and Materials Engineering (DICAM), Alma Mater Studiorum - University of Bologna, Italy
| | - S. Pappalardo
- Department of Civil, Chemical, Environmental and Materials Engineering (DICAM), Alma Mater Studiorum - University of Bologna, Italy,General Hospital Sant’Orsola Foundation, Bologna, Italy
| | - N.F. Parisi
- Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Occupational Medicine Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Italy
| | - S. Rapino
- Department of Chemistry “Giacomo Ciamician”, Alma Mater Studiorum - University of Bologna, Italy
| | - M. Reggio
- Department of Pharmacy and Biotechnology (FaBit), Alma Mater Studiorum - University of Bologna, Italy,General Hospital Sant’Orsola Foundation, Bologna, Italy
| | - M. Roselli
- Department of Civil, Chemical, Environmental and Materials Engineering (DICAM), Alma Mater Studiorum - University of Bologna, Italy,Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Occupational Medicine Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Italy
| | - E. Ruggeri
- Department of Pharmacy and Biotechnology (FaBit), Alma Mater Studiorum - University of Bologna, Italy,General Hospital Sant’Orsola Foundation, Bologna, Italy
| | - L. Sabatini
- Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Occupational Medicine Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Italy
| | - E. Saracino
- General Hospital Sant’Orsola Foundation, Bologna, Italy,Institute of Organic Synthesis and Photoreactivity (ISOF) – National Research Council (CNR), Bologna, Italy
| | - G.E. Scarponi
- Department of Civil, Chemical, Environmental and Materials Engineering (DICAM), Alma Mater Studiorum - University of Bologna, Italy
| | - L. Serra
- Department of Pharmacy and Biotechnology (FaBit), Alma Mater Studiorum - University of Bologna, Italy,General Hospital Sant’Orsola Foundation, Bologna, Italy
| | - V. Signorini
- Department of Civil, Chemical, Environmental and Materials Engineering (DICAM), Alma Mater Studiorum - University of Bologna, Italy
| | - A. Storione
- Department of Civil, Chemical, Environmental and Materials Engineering (DICAM), Alma Mater Studiorum - University of Bologna, Italy
| | - M. Torsello
- General Hospital Sant’Orsola Foundation, Bologna, Italy,Department of Chemistry “Giacomo Ciamician”, Alma Mater Studiorum - University of Bologna, Italy
| | - E. Tugnoli
- Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Occupational Medicine Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Italy
| | - C.M. Vargiu
- Department of Pharmacy and Biotechnology (FaBit), Alma Mater Studiorum - University of Bologna, Italy,General Hospital Sant’Orsola Foundation, Bologna, Italy
| | - G. Vidali
- Department of Pharmacy and Biotechnology (FaBit), Alma Mater Studiorum - University of Bologna, Italy,General Hospital Sant’Orsola Foundation, Bologna, Italy
| | - F.S. Violante
- Interdepartmental Centre for Industrial Research in Health Sciences and Technologies (CIRI-SDV), Alma Mater Studiorum - University of Bologna, Italy,Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Occupational Medicine Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Italy
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14
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Blaylock RL. Responses to comments on my paper: “COVID Update: What is the truth?”. Surg Neurol Int 2022; 13:316. [PMID: 35928323 PMCID: PMC9345089 DOI: 10.25259/sni_578_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/04/2022] Open
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15
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Understanding the coevolution of mask wearing and epidemics: A network perspective. Proc Natl Acad Sci U S A 2022; 119:e2123355119. [PMID: 35733262 PMCID: PMC9245665 DOI: 10.1073/pnas.2123355119] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Nonpharmaceutical interventions (NPIs) such as mask wearing can be effective in mitigating the spread of infectious diseases. Therefore, understanding the behavioral dynamics of NPIs is critical for characterizing the dynamics of disease spread. Nevertheless, standard infection models tend to focus only on disease states, overlooking the dynamics of "beneficial contagions," e.g., compliance with NPIs. In this work, we investigate the concurrent spread of disease and mask-wearing behavior over multiplex networks. Our proposed framework captures both the competing and complementary relationships between the dueling contagion processes. Further, the model accounts for various behavioral mechanisms that influence mask wearing, such as peer pressure and fear of infection. Our results reveal that under the coupled disease-behavior dynamics, the attack rate of a disease-as a function of transition probability-exhibits a critical transition. Specifically, as the transmission probability exceeds a critical threshold, the attack rate decreases abruptly due to sustained mask-wearing responses. We empirically explore the causes of the critical transition and demonstrate the robustness of the observed phenomena. Our results highlight that without proper enforcement of NPIs, reductions in the disease transmission probability via other interventions may not be sufficient to reduce the final epidemic size.
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16
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Shechtman L, Ben-Haim G, Ben-Zvi I, Steel L, Ironi A, Huszti E, Chatterji S, Levy L. Physiological Effects of Wearing N95 Respirator on Medical Staff During Prolong Work Hours in Covid-19 Departments. J Occup Environ Med 2022; 64:e378-e380. [PMID: 35543650 PMCID: PMC9275795 DOI: 10.1097/jom.0000000000002542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of the current study was to determine gas exchange abnormalities and physiological changes among healthcare workers during a 4-hour emergency department (ED) shift while wearing the N95 respirator. METHODS Single-center prospective observational study. Comparisons of paired measurements were performed using a non-parametric Wilcoxon matched-pairs signed-rank test. Results: Forty-one subjects were included. Prolonged N95 respirator use was associated with a significant decline in plasma pH (7.35 mmHg vs 7.34 mmHg, P = 0.02), PvO 2 (23.2 mmHg vs 18.6 mmHg, P < 0.001) and a concurrent increase in EtCO 2 (32.5 mmHg vs 38.5 mmHg, P < 0.0001). PvCO 2 and bicarbonate levels did not differ. No significant change was observed for heart rate or oxygen saturation. CONCLUSION Using an N95 respirator for prolonged periods by healthcare professionals may provoke changes in gas exchange. The clinical significance of these changes remains to be determined.
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Affiliation(s)
- Liran Shechtman
- From the Internal Medicine Department, Sheba Medical Center, Tel Hashomer, Israel (Dr Shechtman and Dr Ben-Zvi); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr Shechtman, Dr ben-Haim, Dr Ben-Zvi, Dr Steel, Dr Ironi, Dr Chatterji, and Dr Levy); Department of Emergency Medicine, Sheba Medical Center, Tel Hashomer, Israel (Dr Ben-Haim, Dr Steel, and Dr Ironi); Biostatistics Research Unit, University Health Network, University of Toronto, Toronto, ON, Canada (Dr Huszti); Institute of Pulmonary Medicine, Sheba Medical Center, Tel-Hashomer, Israel (Dr Chatterji and Dr Levy)
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17
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Bahl P, Doolan C, de Silva C, Chughtai AA, Bourouiba L, MacIntyre CR. Airborne or Droplet Precautions for Health Workers Treating Coronavirus Disease 2019? J Infect Dis 2022. [PMID: 32301491 DOI: 10.1093/infdis/jiaa189/5820886] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
Cases of coronavirus disease 2019 (COVID-19) have been reported in more than 200 countries. Thousands of health workers have been infected, and outbreaks have occurred in hospitals, aged care facilities, and prisons. The World Health Organization (WHO) has issued guidelines for contact and droplet precautions for healthcare workers caring for suspected COVID-19 patients, whereas the US Centers for Disease Control and Prevention (CDC) has initially recommended airborne precautions. The 1- to 2-meter (≈3-6 feet) rule of spatial separation is central to droplet precautions and assumes that large droplets do not travel further than 2 meters (≈6 feet). We aimed to review the evidence for horizontal distance traveled by droplets and the guidelines issued by the WHO, CDC, and European Centre for Disease Prevention and Control on respiratory protection for COVID-19. We found that the evidence base for current guidelines is sparse, and the available data do not support the 1- to 2-meter (≈3-6 feet) rule of spatial separation. Of 10 studies on horizontal droplet distance, 8 showed droplets travel more than 2 meters (≈6 feet), in some cases up to 8 meters (≈26 feet). Several studies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) support aerosol transmission, and 1 study documented virus at a distance of 4 meters (≈13 feet) from the patient. Moreover, evidence suggests that infections cannot neatly be separated into the dichotomy of droplet versus airborne transmission routes. Available studies also show that SARS-CoV-2 can be detected in the air, and remain viable 3 hours after aerosolization. The weight of combined evidence supports airborne precautions for the occupational health and safety of health workers treating patients with COVID-19.
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Affiliation(s)
- Prateek Bahl
- School of Mechanical and Manufacturing Engineering, UNSW Sydney, New South Wales, Australia
| | - Con Doolan
- School of Mechanical and Manufacturing Engineering, UNSW Sydney, New South Wales, Australia
| | - Charitha de Silva
- School of Mechanical and Manufacturing Engineering, UNSW Sydney, New South Wales, Australia
| | - Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, UNSW Sydney, New South Wales, Australia
| | - Lydia Bourouiba
- The Fluid Dynamics of Disease Transmission Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - C Raina MacIntyre
- The Kirby Institute, UNSW Sydney, New South Wales, Australia
- College of Public Service & Community Solutions, and College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
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18
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Ma X, Luo XF, Li L, Li Y, Sun GQ. The influence of mask use on the spread of COVID-19 during pandemic in New York City. RESULTS IN PHYSICS 2022; 34:105224. [PMID: 35096521 PMCID: PMC8782758 DOI: 10.1016/j.rinp.2022.105224] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 05/09/2023]
Abstract
In New York City, the situation of COVID-19 is so serious that it has caused hundreds of thousands of people to be infected due to its strong infectivity. The desired effect of wearing masks by the public is not ideal, though increasingly recommended by the WHO. In order to reveal the potential effect of mask use, we posed a dynamical model with the effective coverage of wearing face masks to assess the impact of mask use on the COVID-19 transmission. We obtained the basic reproduction number R 0 which determined the global dynamics. According to the implement of policies in New York City, we divided the transmission of COVID-19 in three stages. Based on mathematical model and data, we obtain the mean value R 0 = 1 . 822 in the first stage of New York City, while R 0 = 0 . 6483 in the second stage due to that the US Centers for Disease Control and Prevention (CDC) recommended the public wear masks on April 3, 2020, R 0 = 1 . 024 in the third stage after reopening. It was found that if the effective coverage rate of mask use α exceed a certain value α c = 0 . 182 , COVID-19 can be well controlled in the second stage of New York City. Additionally, when the effective coverage of masks reaches a certain level α = 0 . 5 , the benefits are not obvious with the increased coverage rate compared to the cost of medical resources. Moreover, if the effective coverage of mask use in public reaches 20% in the first stage, then the cumulative confirmed cases will be reduced about 50% by 03 April, 2020. Our results demonstrated a new insight on the effect of mask use in controlling the transmission of COVID-19.
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Affiliation(s)
- Xia Ma
- School of Big Data, North University of China, Taiyuan, 030051, China
- Department of Mathematics, North University of China, Taiyuan, 030051, China
- Department of Science, Taiyuan Institute of Technology, Taiyuan, 030008, China
| | - Xiao-Feng Luo
- Department of Mathematics, North University of China, Taiyuan, 030051, China
| | - Li Li
- School of Computer and Information Technology, Shanxi University, Taiyuan, 030006, China
| | - Yong Li
- School of Information and Mathematics, Yangtze University, Jingzhou, 434023, China
| | - Gui-Quan Sun
- School of Big Data, North University of China, Taiyuan, 030051, China
- Department of Mathematics, North University of China, Taiyuan, 030051, China
- Complex Systems Research Center, Shanxi University, Taiyuan, 030006, China
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19
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Everts RJ, Al Ghusaini S, Telfar-Barnard L, Barclay E, Tan S, Jekel S, Jennings L, Choi DH, Hilson D, Gibson B. Liquid-Immersion Reprocessing Effects on Filtration Efficiency of 'Single-Use' Commercial Medical Face Masks. Ann Work Expo Health 2022; 66:246-259. [PMID: 34564717 PMCID: PMC8500144 DOI: 10.1093/annweh/wxab079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/08/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Medical masks have inferior filtration efficiency and fit to filtering facepiece respirators (FFRs) but are widely used in healthcare and the community. These masks are intended for disposal after use but in the event of mask shortage re-use after reprocessing may be an option. We investigated eight reprocessing methods that each involved washing or soaking in liquid, are likely to eliminate respiratory viruses, and are safe and available in most community and healthcare settings. METHODS Three brands of EN 14683 standards-compliant commercial medical mask were each reprocessed 10 times by one of eight methods. We measured filtration efficiency for poly-dispersed sodium chloride particles and pressure differential. RESULTS Compared with new medical masks, reprocessed masks had significantly reduced filtration efficiency. The reduction was mild-moderate (6.5-25.8%) after warm water wash, hot water soak or boiling water soak; and moderate-large (24.1-51.5%) after detergent, soap or laundry machine wash, or bleach soak. There were mixed and minor changes in pressure differential. Most reprocessed standards-compliant masks had better filtration efficiency than new non-standard commercial masks and then cotton and cotton-polyester mix fabric samples, even triple-layered fabrics. CONCLUSIONS High-quality commercial medical masks reprocessed 10 times by water immersion methods had better filtration efficiency than new non-standard masks and washable fabrics. These findings have particular relevance for community and low-resource healthcare settings.
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Affiliation(s)
- Richard J Everts
- Infectious Disease Service, Nelson Bays Primary Health, 281 Queen St, Richmond, Nelson, New Zealand
| | | | - Lucy Telfar-Barnard
- Department of Public Health, University of Otago, 23a Mein St, Newton, Wellington, New Zealand
| | - Ella Barclay
- University of Otago, 2 Riccarton Ave, Christchurch, New Zealand
| | - Shaun Tan
- Lanaco, 2–4 Sultan St, Ellerslie, Auckland, New Zealand
| | - Sonja Jekel
- Lanaco, 2–4 Sultan St, Ellerslie, Auckland, New Zealand
| | - Lance Jennings
- Department of Pathology and Biomedical Sciences, University of Otago, 2 Riccarton Ave, Christchurch, New Zealand
- Canterbury Health Laboratories, Hagley Ave, Christchurch, New Zealand
| | - Dong Hoon Choi
- Biomedical Engineering Department, Nelson Hospital, Tipahi St, Nelson, New Zealand
| | - Dougal Hilson
- University of Otago, 2 Riccarton Ave, Christchurch, New Zealand
| | - Barbara Gibson
- Infection Prevention and Control Service, Nelson Hospital, Tipahi St, Nelson, New Zealand
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20
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Cazzaniga S, Pezzolo E, Colombo P, Naldi L. Face mask use in the community and cutaneous reactions to them during the COVID-19 pandemic: results of a national survey in Italy. Dermatol Reports 2022; 14:9394. [PMID: 36199903 PMCID: PMC9527677 DOI: 10.4081/dr.2022.9394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/12/2021] [Indexed: 11/25/2022] Open
Abstract
To mitigate the outbreak of coronavirus disease 2019 pandemic, many countries have imposed the public use of face masks. We investigated attitudes and skin reactions in the Italian individuals wearing face masks during the pandemic. A cross-sectional survey on a random sample (N=1001) of the Italian adult population was conducted in May 2020 by the Italian Group for Epidemiological Research in Dermatology, and the Gallup International Association. Univariable and multivariable regression analysis were used to estimate the odds ratios and their 95% confidence intervals. Most individuals (72.5%) wore a mask, 56.5% used a surgical mask and 53.0% a disposable mask. One-third changed the mask at least once a day, two-thirds kept a distance of at least one meter from each other, 50% washed their hands before wearing a mask, and 17.6% adopted multiple hygienic behaviors. Twenty percent of individuals reported redness, swelling, itching or erosions in the skin area of mask contact; the risk of this reaction was associated with young age, the use of respirators and a history of pre-existing contact eczema, psoriasis or atopic dermatitis. Health educational programs may improve compliance with combined preventive measures and reduce skin reactions.
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21
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Adam MG, Tran PTM, Balasubramanian R. Air quality changes in cities during the COVID-19 lockdown: A critical review. ATMOSPHERIC RESEARCH 2021; 264:105823. [PMID: 34456403 PMCID: PMC8384485 DOI: 10.1016/j.atmosres.2021.105823] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/11/2021] [Accepted: 08/21/2021] [Indexed: 05/04/2023]
Abstract
In response to the rapid spread of coronavirus disease-2019 (COVID-19) within and across countries and the need to protect public health, governments worldwide introduced unprecedented measures such as restricted road and air travel and reduced human mobility in 2020. The curtailment of personal travel and economic activity provided a unique opportunity for researchers to assess the interplay between anthropogenic emissions of primary air pollutants, their physical transport, chemical transformation, ultimate fate and potential health impacts. In general, reductions in the atmospheric levels of outdoor air pollutants such as particulate matter (PM), nitrogen dioxide (NO2), carbon monoxide (CO), sulfur dioxide (SO2), and volatile organic compounds (VOCs) were observed in many countries during the lockdowns. However, the levels of ozone (O3), a secondary air pollutant linked to asthma and respiratory ailments, and secondary PM were frequently reported to remain unchanged or even increase. An increase in O3 can enhance the formation of secondary PM2.5, especially secondary organic aerosols, through the atmospheric oxidation of VOCs. Given that the gaseous precursors of O3 (VOCs and NOx) are also involved in the formation of secondary PM2.5, an integrated control strategy should focus on reducing the emission of the common precursors for the co-mitigation of PM2.5 and O3 with an emphasis on their complex photochemical interactions. Compared to outdoor air quality, comprehensive investigations of indoor air quality (IAQ) are relatively sparse. People spend more than 80% of their time indoors with exposure to air pollutants of both outdoor and indoor origins. Consequently, an integrated assessment of exposure to air pollutants in both outdoor and indoor microenvironments is needed for effective urban air quality management and for mitigation of health risk. To provide further insights into air quality, we do a critical review of scientific articles, published from January 2020 to December 2020 across the globe. Finally, we discuss policy implications of our review in the context of global air quality improvement.
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Affiliation(s)
- Max G Adam
- Department of Civil and Environmental Engineering, National University of Singapore, Singapore 117576, Singapore
| | - Phuong T M Tran
- Department of Civil and Environmental Engineering, National University of Singapore, Singapore 117576, Singapore
- Faculty of Environment, University of Science and Technology, The University of Danang, 54 Nguyen Luong Bang Street, Lien Chieu District, Danang City, Viet Nam
| | - Rajasekhar Balasubramanian
- Department of Civil and Environmental Engineering, National University of Singapore, Singapore 117576, Singapore
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22
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Roch C, Vogel U, Smol K, Pörner S, van Oorschot B. Admission of a Terminally Ill Lung Cancer Patient With the Accidental Diagnosis of SARS-CoV-2 to a Palliative Care Unit Resulting in a SARS-CoV-2 Outbreak. Workplace Health Saf 2021; 69:580-584. [PMID: 34894909 PMCID: PMC8669200 DOI: 10.1177/21650799211042518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The COVID-19 pandemic poses challenges for palliative care. Terminal patients cannot wear masks and may demonstrate unspecific symptoms reminiscent of those caused by COVID-19. This report is about a terminally ill patient with lung cancer who displayed fever, cough, and fatigue. During hospital admission screening, the patient tested negative for SARS-CoV-2. When admitting his wife to stay with him, she also had to test for SARS-CoV-2 and displayed a positive test result. Until the positive results were reported, six staff members were infected with SARS-CoV-2, even though they were routinely wearing respirators. This resulted in the palliative care unit having to be closed. Hospitals need strict and adequate testing and re-testing strategies even for intra-hospital transfers. Workers must strictly adhere to recommended respirator practices. Ventilation of patient rooms is essential due to the possible enrichment of particle aerosols containing viruses, as negative pressure rooms are not recommended in all countries.
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Affiliation(s)
| | - Ulrich Vogel
- University Hospital Würzburg.,University of Würzburg
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23
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Palumbo P, Massimi F, Biondi A, Cirocchi R, De Luca GM, Giraudo G, Intini SG, Monzani R, Sozio G, Usai S. Recommendations for outpatient activity in COVID-19 pandemic. Open Med (Wars) 2021; 16:1696-1704. [PMID: 34805532 PMCID: PMC8578809 DOI: 10.1515/med-2021-0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/23/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022] Open
Abstract
The spread of the COVID-19 disease substantially influenced the International Healthcare system, and the national governments worldwide had before long to decide how to manage the available resources, giving priority to the treatment of the COVID-infected patients. Then, in many countries, it was decided to limit the elective procedures to surgical oncology and emergency procedures. In fact, most of the routine, middle-low complexity surgical interventions were reduced, and the day surgery (DS) activities were almost totally interrupted. As a result of this approach, the waiting list of these patients has significantly increased. In the current phase, with a significant decrease in the incidence of COVID-19 cases, the surgical daily activity can be safely and effectively restarted. Adjustments are mandatory to resume the DS activity. The whole separation of pathways with respect to the long-stay and emergency surgery, an accurate preoperative protocol of patient management, with a proper selection and screening of all-day cases, careful scheduling of surgical organization in the operating room, and planning of the postoperative pathway are the goals for a feasible, safe, and effective resumption of DS activity.
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Affiliation(s)
- Piergaspare Palumbo
- Department of Surgical Sciences, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Fanny Massimi
- Department of Surgical Sciences, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Antonio Biondi
- Department of General Surgery and Surgical Specialities, University of Catania, Catania, Italy
| | - Roberto Cirocchi
- Deparment of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | | | - Giorgio Giraudo
- Department of Surgery, Santa Croce e Carle Hospital, Cuneo, Italy
| | | | - Roberta Monzani
- Department of Anesthesia and Intensive Care, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Giampaolo Sozio
- Department of General Surgery and Emergency, Alta Val D’Elsa Hospital, Poggibonsi (SI), Italy
| | - Sofia Usai
- Department of Surgical Sciences, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
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24
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Bessesen MT, Rattigan S, Frederick J, Cummings DA, Gaydos CA, Gibert CL, Gorse GJ, Nyquist AC, Price CS, Reich NG, Simberkoff MS, Brown AC, Radonovich LJ, Perl TM, Rodriguez-Barradas MC. Outpatient healthcare personnel knowledge and attitudes towards infection prevention measures for protection from respiratory infections. Am J Infect Control 2021; 49:1369-1375. [PMID: 34182066 DOI: 10.1016/j.ajic.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 05/21/2021] [Accepted: 06/21/2021] [Indexed: 12/27/2022]
Abstract
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.
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25
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Delanghe L, Cauwenberghs E, Spacova I, De Boeck I, Van Beeck W, Pepermans K, Claes I, Vandenheuvel D, Verhoeven V, Lebeer S. Cotton and Surgical Face Masks in Community Settings: Bacterial Contamination and Face Mask Hygiene. Front Med (Lausanne) 2021; 8:732047. [PMID: 34540873 PMCID: PMC8446422 DOI: 10.3389/fmed.2021.732047] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Abstract
During the current COVID-19 pandemic, the use of face masks has become increasingly recommended and even mandatory in community settings. To evaluate the risk of bacterial cross-contamination, this study analyzed the bacterial bioburden of disposable surgical masks and homemade cotton masks, and surveyed the habits and face mask preferences of the Flemish population. Using culture approaches and 16S rRNA gene amplicon sequencing, we analyzed the microbial community on surgical and/or cotton face masks of 13 healthy volunteers after 4 h of wearing. Cotton and surgical masks contained on average 1.46 × 105 CFU/mask and 1.32 × 104 CFU/mask, respectively. Bacillus, Staphylococcus, and Acinetobacter spp. were mostly cultured from the masks and 43% of these isolates were resistant to ampicillin or erythromycin. Microbial profiling demonstrated a consistent difference between mask types. Cotton masks mainly contained Roseomonas, Paracoccus, and Enhydrobacter taxa and surgical masks Streptococcus and Staphylococcus. After 4 h of mask wearing, the microbiome of the anterior nares and the cheek showed a trend toward an altered beta-diversity. According to dedicated questions in the large-scale Corona survey of the University of Antwerp with almost 25,000 participants, only 21% of responders reported to clean their cotton face mask daily. Laboratory results indicated that the best mask cleaning methods were boiling at 100°C, washing at 60°C with detergent or ironing with a steam iron. Taken together, this study suggests that a considerable number of bacteria, including pathobionts and antibiotic resistant bacteria, accumulate on surgical and even more on cotton face masks after use. Based on our results, face masks should be properly disposed of or sterilized after intensive use. Clear guidelines for the general population are crucial to reduce the bacteria-related biosafety risk of face masks, and measures such as physical distancing and increased ventilation should not be neglected when promoting face mask use.
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Affiliation(s)
- Lize Delanghe
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Eline Cauwenberghs
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Irina Spacova
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Ilke De Boeck
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Wannes Van Beeck
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Koen Pepermans
- Faculty of Social Sciences, University of Antwerp, Antwerp, Belgium
| | - Ingmar Claes
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Dieter Vandenheuvel
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Veronique Verhoeven
- Department of Primary and Interdisciplinary Care (FAMPOP), University of Antwerp, Antwerp, Belgium
| | - Sarah Lebeer
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
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26
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Li J, Qiu Y, Zhang Y, Gong X, He Y, Yue P, Zheng X, Liu L, Liao H, Zhou K, Hua Y, Li Y. Protective efficient comparisons among all kinds of respirators and masks for health-care workers against respiratory viruses: A PRISMA-compliant network meta-analysis. Medicine (Baltimore) 2021; 100:e27026. [PMID: 34449478 PMCID: PMC8389967 DOI: 10.1097/md.0000000000027026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 07/06/2021] [Indexed: 01/04/2023] Open
Abstract
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.
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27
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Das S, Sarkar S, Das A, Das S, Chakraborty P, Sarkar J. A comprehensive review of various categories of face masks resistant to Covid-19. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021; 12:100835. [PMID: 34368502 PMCID: PMC8326209 DOI: 10.1016/j.cegh.2021.100835] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/28/2021] [Accepted: 07/21/2021] [Indexed: 12/26/2022] Open
Abstract
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.
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Affiliation(s)
- Sonali Das
- Department of Botany, Dinabandhu Andrews College, 54, Raja S.C. Mallick Road, Garia, Kolkata, West Bengal, 700084, India
| | - Sagarika Sarkar
- Department of Botany, Sarojini Naidu College for Women, 30, Jessore Rd, K.B.Sarani, Golpark, Kolkata, West Bengal, 700028, India
| | - Anusree Das
- Department of Botany, Dinabandhu Andrews College, 54, Raja S.C. Mallick Road, Garia, Kolkata, West Bengal, 700084, India
| | - Shreyosree Das
- Department of Botany, Dinabandhu Andrews College, 54, Raja S.C. Mallick Road, Garia, Kolkata, West Bengal, 700084, India
| | - Pallab Chakraborty
- Department of Botany, Acharya Prafulla Chandra College, New Barrakpur, Kolkata, West Bengal, 700131, India
| | - Joy Sarkar
- Department of Botany, Dinabandhu Andrews College, 54, Raja S.C. Mallick Road, Garia, Kolkata, West Bengal, 700084, India
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28
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Chowell G, Dahal S, Bono R, Mizumoto K. Harnessing testing strategies and public health measures to avert COVID-19 outbreaks during ocean cruises. Sci Rep 2021; 11:15482. [PMID: 34326439 PMCID: PMC8322151 DOI: 10.1038/s41598-021-95032-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022] Open
Abstract
To ensure the safe operation of schools, workplaces, nursing homes, and other businesses during COVID-19 pandemic there is an urgent need to develop cost-effective public health strategies. Here we focus on the cruise industry which was hit early by the COVID-19 pandemic, with more than 40 cruise ships reporting COVID-19 infections. We apply mathematical modeling to assess the impact of testing strategies together with social distancing protocols on the spread of the novel coronavirus during ocean cruises using an individual-level stochastic model of the transmission dynamics of COVID-19. We model the contact network, the potential importation of cases arising during shore excursions, the temporal course of infectivity at the individual level, the effects of social distancing strategies, different testing scenarios characterized by the test's sensitivity profile, and testing frequency. Our findings indicate that PCR testing at embarkation and daily testing of all individuals aboard, together with increased social distancing and other public health measures, should allow for rapid detection and isolation of COVID-19 infections and dramatically reducing the probability of onboard COVID-19 community spread. In contrast, relying only on PCR testing at embarkation would not be sufficient to avert outbreaks, even when implementing substantial levels of social distancing measures.
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Affiliation(s)
- Gerardo Chowell
- Department of Population Heath Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA.
| | - Sushma Dahal
- Department of Population Heath Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Raquel Bono
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA
| | - Kenji Mizumoto
- Department of Population Heath Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
- Graduate School of Advanced Integrated Studies in Human Survivability, Kyoto University, Yoshida-Nakaadachi-cho, Sakyo-ku, Kyoto, Japan
- Hakubi Center for Advanced Research, Kyoto University, Yoshidahonmachi, Sakyo-ku, Kyoto, Japan
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29
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Cappa CD, Asadi S, Barreda S, Wexler AS, Bouvier NM, Ristenpart WD. Expiratory aerosol particle escape from surgical masks due to imperfect sealing. Sci Rep 2021; 11:12110. [PMID: 34103573 PMCID: PMC8187651 DOI: 10.1038/s41598-021-91487-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/27/2021] [Indexed: 01/20/2023] Open
Abstract
Wearing surgical masks or other similar face coverings can reduce the emission of expiratory particles produced via breathing, talking, coughing, or sneezing. Although it is well established that some fraction of the expiratory airflow leaks around the edges of the mask, it is unclear how these leakage airflows affect the overall efficiency with which masks block emission of expiratory aerosol particles. Here, we show experimentally that the aerosol particle concentrations in the leakage airflows around a surgical mask are reduced compared to no mask wearing, with the magnitude of reduction dependent on the direction of escape (out the top, the sides, or the bottom). Because the actual leakage flowrate in each direction is difficult to measure, we use a Monte Carlo approach to estimate flow-corrected particle emission rates for particles having diameters in the range 0.5-20 μm. in all orientations. From these, we derive a flow-weighted overall number-based particle removal efficiency for the mask. The overall mask efficiency, accounting both for air that passes through the mask and for leakage flows, is reduced compared to the through-mask filtration efficiency, from 93 to 70% for talking, but from only 94-90% for coughing. These results demonstrate that leakage flows due to imperfect sealing do decrease mask efficiencies for reducing emission of expiratory particles, but even with such leakage surgical masks provide substantial control.
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Affiliation(s)
- Christopher D Cappa
- Department of Civil and Environmental Engineering, University of California Davis, 1 Shields Ave., Davis, CA, 95616, USA.
| | - Sima Asadi
- Department of Chemical Engineering, University of California Davis, 1 Shields Ave., Davis, CA, 95616, USA
- Department of Chemical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Av., Cambridge, MA, 02139, USA
| | - Santiago Barreda
- Department of Linguistics, University of California Davis, 1 Shields Ave., Davis, CA, 95616, USA
| | - Anthony S Wexler
- Department of Chemical Engineering, University of California Davis, 1 Shields Ave., Davis, CA, 95616, USA
- Department of Mechanical and Aerospace Engineering, University of California Davis, 1 Shields Ave., Davis, CA, 95616, USA
- Air Quality Research Center, University of California Davis, 1 Shields Ave., Davis, CA, 95616, USA
- Department of Land, Air and Water Resources, University of California Davis, 1 Shields Ave., Davis, CA, 95616, USA
| | - Nicole M Bouvier
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA
- Department Microbiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA
| | - William D Ristenpart
- Department of Chemical Engineering, University of California Davis, 1 Shields Ave., Davis, CA, 95616, USA
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30
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Tarakji B, Nassani MZ, Alali FM, Abuderman AA. COVID-19 Guidelines to Protect Healthcare Workers at Hospitals and Dental Professionals at Dental Office. Ethiop J Health Sci 2021; 30:1037-1042. [PMID: 33883850 PMCID: PMC8047227 DOI: 10.4314/ejhs.v30i6.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Coronavirus disease 2019 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2. This study aimed to address the preventive procedures to protect healthcare workers at hospital to avoid COVID-19, and infection control procedures to protect dental professionals in dental office. Methods We conducted a search of published articles from PubMed, google scholar databases using key words such as COVID-19, healthcare worker, infection control, and dental practice. Relevant articles were identified and reviewed. Most published papers were clinical reports and case studies. We have selected some of the current published papers written in English in 2020. Results Infection control procedures to protect health workers at hospitals, and dental professionals at dental office were summurised and presented. Infection control procedures for healthcare workers at hospitals include Personal protective equipment, Korea filter (KF)94 respirator, goggles, face protector, disposable waterproof long-arm gown, and gloves, and others. Extra-protection procedures should be taken with old and vulnerable healthcare workers. Dental professionals should evaluate patients in advance before starting dental treatment. Aerosols generating procedures should be avoided and personal protective equipment should be used. Dental treatment should be restricted to emergency cases only. Conclusion Old medical staff should be in safer distance to avoid infection, but young physicians and nurses should work at frontline as their immunity is better than their colleagues at old age. Screening patients and measurement of the body temperature are essential measures before dental treatment.
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Affiliation(s)
- Bassel Tarakji
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, Prince Sattam Bin Abdulaziz University, College of Dentistry, Al Kharj, Saudi Arabi
| | - Mohammad Zakaria Nassani
- Department of Restorative and Prosthetic Dental Sciences, College of Dentistry, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Faisal Mehsen Alali
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, Prince Sattam Bin Abdulaziz University, College of Dentistry, Al Kharj, Saudi Arabi
| | - Abdulwahab A Abuderman
- Department of Basic Medical Sciences, Prince Sattam Bin Abdulaziz University, College of Medicine, Al Kharj, Saudi Arabi
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Park CE. Diagnostic Methods of Respiratory Virus Infections and Infection Control. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2021. [DOI: 10.15324/kjcls.2021.53.1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Chang-Eun Park
- Department of Biomedical Laboratory Science, Molecular Diagnostics Research Institute, Namseoul University, Cheonan, Korea
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Ionescu AC, Brambilla E, Manzoli L, Orsini G, Gentili V, Rizzo R. Efficacy of personal protective equipment against coronavirus transmission via dental handpieces. J Am Dent Assoc 2021; 152:631-640. [PMID: 34325779 PMCID: PMC7997726 DOI: 10.1016/j.adaj.2021.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/28/2021] [Accepted: 03/15/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND This laboratory study was done to evaluate the efficacy of personal protective equipment (PPE) and high-volume evacuation (HVE) against the spread of human coronavirus type 229E (HCoV-229E) during a standard dental procedure. METHODS Patient and operator manikins were used to recreate a dental setting inside a custom-built class III cabinet-like chamber. The mouth of the patient manikin was inoculated with an HCoV-229E suspension, the viral load of which was similar to that of asymptomatic people infected with severe acute respiratory syndrome coronavirus 2. The dental procedure was performed with an air turbine handpiece and HVE for 10 seconds. The efficacy of surgical masks, N95 (filtering facepiece class 2) and filtering facepiece class 3 respirators, and face shields was tested via quantitative real-time polymerase chain reaction. RESULTS The wide surface on which the inoculum was spread caused low contamination. Over the external surfaces of masks and respirators, when a face shield was not worn, viral loads ranged from 1.2 through 1.4 log10 mean gene copies per cm2. When the shield was worn, viral loads dropped below the detection limit (< 0.317 log10 gene copies/cm2) for all PPE. On the operator's forehead, viral loads were 0.6 through 0.8 log10 gene copies/cm2. Inside the operator manikin's mouth, viral loads were under the detection limit when using any PPE, with or without the shield. HVE did not significantly change viral loads. CONCLUSIONS All PPE combinations significantly reduced viral loads in the operator manikin's mouth to below the detection limit, but HVE did not decrease viral contamination. PRACTICAL IMPLICATIONS Although caution is suggested when removing and disposing of PPE to avoid self-contamination, the combination of PPE and face shields drastically decreases the risk of transmitting human coronavirus during aerosol-generating dental procedures.
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Costantino V, Kunasekaran M, MacIntyre CR. Modelling of optimal vaccination strategies in response to a bioterrorism associated smallpox outbreak. Hum Vaccin Immunother 2021; 17:738-746. [PMID: 33734944 PMCID: PMC7993194 DOI: 10.1080/21645515.2020.1800324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The reemergence of smallpox as a bioterrorism attack is now an increasing and legitimate concern. Advances in synthetic biology have now made it possible for the virus to be synthesized in a laboratory, with methods publicly available. Smallpox introduction into a susceptible population, with increased immunosuppression and an aging population, raises questions of how vaccination should be used in an epidemic situation when supply may be limited. We constructed three modified susceptible-latent-infectious-recovered (SEIR) models to simulate targeted, ring and mass vaccination in response to a smallpox outbreak in Sydney, Australia. We used age-specific distributions of susceptibility, infectivity, contact rates, and tested outputs under different assumptions. The number of doses needed of second- and third-generation vaccines are estimated, along with the total number of deaths at the end of the epidemic. We found a faster response is the key and ring vaccination of traced contacts is the most effective strategy and requires a smaller number of doses. However if public health authorities are unable to trace a high proportion of contacts, mass vaccination with at least 125,000 doses delivered per day is required. This study informs a better preparedness and response planning for vaccination in a case of a smallpox outbreak in a setting such as Sydney.
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Affiliation(s)
- Valentina Costantino
- Biosecurity Program, Kirby Institute, Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, Kirby Institute, Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Chandini Raina MacIntyre
- Biosecurity Program, Kirby Institute, Faculty of Medicine, The University of New South Wales, Sydney, Australia.,College of Public Service and Community Solutions, Arizona State University, Arizona, USA
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Armijo PR, Markin NW, Nguyen S, Ho DH, Horseman TS, Lisco SJ, Schiller AM. 3D printing of face shields to meet the immediate need for PPE in an anesthesiology department during the COVID-19 pandemic. Am J Infect Control 2021; 49:302-308. [PMID: 32763350 PMCID: PMC7402098 DOI: 10.1016/j.ajic.2020.07.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 11/19/2022]
Abstract
Background Anesthesia providers are at risk for contracting COVID-19 due to close patient contact, especially during shortages of personal protective equipment. We present an easy to follow and detailed protocol for producing 3D printed face shields and an effective decontamination protocol, allowing their reuse. Methods The University of Nebraska Medical Center (UNMC) produced face shields using a combination of 3D printing and assembly with commonly available products, and produced a simple decontamination protocol to allow their reuse. To evaluate the effectiveness of the decontamination protocol, we inoculated bacterial suspensions of E. coli and S. aureus on to the face shield components, performed the decontamination procedure, and finally swabbed and enumerated organisms onto plates that were incubated for 12-24 hours. Decontamination effectiveness was evaluated using the average log10 reduction in colony counts. Results Approximately 112 face shields were constructed and made available for use in 72 hours. These methods were successfully implemented for in-house production at UNMC and at Tripler Army Medical Center (Honolulu, Hawaii). Overall, the decontamination protocol was highly effective against both E. coli and S. aureus, achieving a ≥4 log10 (99.99%) reduction in colony counts for every replicate from each component of the face shield unit. Discussion Face shields not only act as a barrier against the soiling of N95 face masks, they also serve as more effective eye protection from respiratory droplets over standard eye shields. Implementation of decontamination protocols successfully allowed face shield and N95 mask reuse, offering a higher level of protection for anesthesiology providers at the onset of the COVID-19 pandemic. Conclusions In a time of urgent need, our protocol enabled the rapid production of face shields by individuals with little to no 3D printing experience, and provided a simple and effective decontamination protocol allowing reuse of the face shields.
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Affiliation(s)
- Priscila R Armijo
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Nicholas W Markin
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE
| | | | - Dao H Ho
- Department of Clinical Investigation, Tripler Army Medical Center, Tripler AMC, HI
| | - Timothy S Horseman
- Department of Clinical Investigation, Tripler Army Medical Center, Tripler AMC, HI
| | - Steven J Lisco
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE
| | - Alicia M Schiller
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE.
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Scarano A, Inchingolo F, Rapone B, Festa F, Rexhep Tari S, Lorusso F. Protective Face Masks: Effect on the Oxygenation and Heart Rate Status of Oral Surgeons during Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052363. [PMID: 33670983 PMCID: PMC7967725 DOI: 10.3390/ijerph18052363] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 12/23/2022]
Abstract
Background: Safety in medical work requires eye protection, such as glasses, and protective facial masks (PFM) during clinical practice to prevent viral respiratory infections. The use of facial masks and other full personal protective equipment increases air flow resistance, facial skin temperature and physical discomfort. The aim of the present study was to measure surgeons’ oxygenation status and discomfort before and after their daily routine activities of oral interventions. Methods: 10 male voluntary dentists, specializing in oral surgery, and 10 male voluntary doctors in dentistry, participating in master’s courses in oral surgery in the Department of Oral Surgery of the University of Chieti, with mean age 29 ± 6 (27–35), were enrolled. This study was undertaken to investigate the effects of wearing a PFM on oxygenation status while the oral surgeons were actively working. Disposable sterile one-way surgical paper masks (Surgical Face Mask, Euronda, Italy) and FFP2 (Surgical Face Mask, Euronda, Italy) were used and the mask position covering the nose did not vary during the procedures. The FFP2 was covered by a surgical mask during surgical treatment. A pulse oximeter was used to measure the blood oximetry saturation during the study. Results: In all 20 surgeons wearing FFP2 covered by surgical masks, a reduction in arterial O2 saturation from around 97.5% before surgery to 94% after surgery was recorded with increase of heart rates. A shortness of breath and light-headedness/headaches were also noted. Conclusions: In conclusion, wearing an FFP2 covered by a surgical mask induces a reduction in circulating O2 concentrations without clinical relevance, while an increase of heart frequency and a sensation of shortness of breath, light-headedness/headaches were recorded.
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Affiliation(s)
- Antonio Scarano
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy; (F.F.); (S.R.T.)
- Correspondence: ; Tel.: +39-0871-3554-084; Fax: +39-0871-3554-099
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy;
| | - Biagio Rapone
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, “Aldo Moro” University of Bari, 70121 Bari, Italy;
| | - Felice Festa
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy; (F.F.); (S.R.T.)
| | - Sergio Rexhep Tari
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy; (F.F.); (S.R.T.)
| | - Felice Lorusso
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy;
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Zhang Z, Bi Q, Fang S, Wei L, Wang X, He J, Wu Y, Liu X, Gao W, Zhang R, Gong W, Su Q, Azman AS, Lessler J, Zou X. Insight into the practical performance of RT-PCR testing for SARS-CoV-2 using serological data: a cohort study. THE LANCET. MICROBE 2021; 2:e79-e87. [PMID: 33495759 PMCID: PMC7816573 DOI: 10.1016/s2666-5247(20)30200-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Virological detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) through RT-PCR has limitations for surveillance. Serological tests can be an important complementary approach. We aimed to assess the practical performance of RT-PCR-based surveillance protocols and determine the extent of undetected SARS-CoV-2 infection in Shenzhen, China. METHODS We did a cohort study in Shenzhen, China and attempted to recruit by telephone all RT-PCR-negative close contacts (defined as those who lived in the same residence as, or shared a meal, travelled, or socially interacted with, an index case within 2 days before symptom onset) of all RT-PCR-confirmed cases of SARS-CoV-2 detected since January, 2020, via contact tracing. We measured anti-SARS-CoV-2 antibodies in serum samples from RT-PCR-negative close contacts 2-15 weeks after initial virological testing by RT-PCR, using total antibody, IgG, and IgM ELISAs. In addition, we did a serosurvey of volunteers from neighbourhoods with no reported cases, and from neighbourhoods with reported cases. We assessed rates of infection undetected by RT-PCR, performance of RT-PCR over the course of infection, and characteristics of individuals who were seropositive on total antibody ELISA but RT-PCR negative. FINDINGS Between April 12 and May 4, 2020, we enrolled and collected serological samples from 2345 (53·0%) of 4422 RT-PCR-negative close contacts of cases of RT-PCR-confirmed SARS-CoV-2. 1175 (50·1%) of 2345 were close contacts of cases diagnosed in Shenzhen with contact tracing details, and of these, 880 (74·9%) had serum samples collected more than 2 weeks after exposure to an index case and were included in our analysis. 40 (4·5%) of 880 RT-PCR-negative close contacts were positive on total antibody ELISA. The seropositivity rate with total antibody ELISA among RT-PCR-negative close contacts, adjusted for assay performance, was 4·1% (95% CI 2·9-5·7), which was significantly higher than among individuals residing in neighbourhoods with no reported cases (0·0% [95% CI 0·0-1·1]). RT-PCR-positive individuals were 8·0 times (95% CI 5·3-12·7) more likely to report symptoms than those who were RT-PCR-negative but seropositive, but both groups had a similar distribution of sex, age, contact frequency, and mode of contact. RT-PCR did not detect 48 (36% [95% CI 28-44]) of 134 infected close contacts, and false-negative rates appeared to be associated with stage of infection. INTERPRETATION Even rigorous RT-PCR testing protocols might miss a substantial proportion of SARS-CoV-2 infections, perhaps in part due to difficulties in determining the timing of testing in asymptomatic individuals for optimal sensitivity. RT-PCR-based surveillance and control protocols that include rapid contact tracing, universal RT-PCR testing, and mandatory 2-week quarantine were, nevertheless, able to contain community spread in Shenzhen, China. FUNDING The Bill & Melinda Gates Foundation, Special Foundation of Science and Technology Innovation Strategy of Guangdong Province, and Key Project of Shenzhen Science and Technology Innovation Commission.
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Affiliation(s)
- Zhen Zhang
- Department of Public Health Information, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Qifang Bi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shisong Fang
- Department of Pathogenic Biology, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Lan Wei
- Department of Public Health Information, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Xin Wang
- Department of Pathogenic Biology, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Jianfan He
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Yongsheng Wu
- Department of Public Health Information, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Xiaojian Liu
- Department of Public Health Information, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Wei Gao
- Department of Communicable Diseases Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Renli Zhang
- Department of Pathogenic Biology, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Wenfeng Gong
- The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Qiru Su
- Pediatric Research Institute, Shenzhen Children's Hospital, Shenzhen, China
| | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xuan Zou
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
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Liao M, Liu H, Wang X, Hu X, Huang Y, Liu X, Brenan K, Mecha J, Nirmalan M, Lu JR. A technical review of face mask wearing in preventing respiratory COVID-19 transmission. Curr Opin Colloid Interface Sci 2021; 52:101417. [PMID: 33642918 PMCID: PMC7902177 DOI: 10.1016/j.cocis.2021.101417] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Mingrui Liao
- Biological Physics Group, Department of Physics and Astronomy, School of Natural Sciences, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Huayang Liu
- Biological Physics Group, Department of Physics and Astronomy, School of Natural Sciences, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Xi Wang
- Textile Technology Group, Department of Materials, School of Natural Sciences, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Xuzhi Hu
- Biological Physics Group, Department of Physics and Astronomy, School of Natural Sciences, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Yuhao Huang
- Textile Technology Group, Department of Materials, School of Natural Sciences, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Xuqing Liu
- Textile Technology Group, Department of Materials, School of Natural Sciences, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Keith Brenan
- Division of Cancer Studies, School of Biological Sciences, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Jared Mecha
- School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Mahesan Nirmalan
- Division of Medical Education,School of Medical Sciences, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Jian Ren Lu
- Biological Physics Group, Department of Physics and Astronomy, School of Natural Sciences, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
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Wei J, Guo S, Long E, Zhang L, Shu B, Guo L. Why does the spread of COVID-19 vary greatly in different countries? Revealing the efficacy of face masks in epidemic prevention. Epidemiol Infect 2021; 149:e24. [PMID: 33441205 PMCID: PMC7844184 DOI: 10.1017/s0950268821000108] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 11/05/2022] Open
Abstract
The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is highly contagious, and the coronavirus disease 2019 (COVID-19) pandemic caused by it has forced many countries to adopt 'lockdown' measures to prevent the spread of the epidemic through social isolation of citizens. Some countries proposed universal mask wearing as a protection measure of public health to strengthen national prevention efforts and to limit the wider spread of the epidemic. In order to reveal the epidemic prevention efficacy of masks, this paper systematically evaluates the experimental studies of various masks and filter materials, summarises the general characteristics of the filtration efficiency of isolation masks with particle size, and reveals the actual efficacy of masks by combining the volume distribution characteristics of human exhaled droplets with different particle sizes and the SARS-CoV-2 virus load of nasopharynx and throat swabs from patients. The existing measured data show that the filtration efficiency of all kinds of masks for large particles and extra-large droplets is close to 100%. From the perspective of filtering the total number of pathogens discharged in the environment and protecting vulnerable individuals from breathing live viruses, the mask has a higher protective effect. If considering the weighted average filtration efficiency with different particle sizes, the filtration efficiencies of the N95 mask and the ordinary mask are 99.4% and 98.5%, respectively. The mask can avoid releasing active viruses to the environment from the source of infection, thus maximising the protection of vulnerable individuals by reducing the probability of inhaling a virus. Therefore, if the whole society strictly implements the policy of publicly wearing masks, the risk of large-scale spread of the epidemic can be greatly reduced. Compared with the overall cost of social isolation, limited personal freedoms and forced suspension of economic activities, the inconvenience for citizens caused by wearing masks is perfectly acceptable.
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Affiliation(s)
- Jincheng Wei
- MOE Key Laboratory of Deep Earth Science and Engineering, College of Architecture and Environment, Sichuan University, Chengdu, China
| | - Shurui Guo
- MOE Key Laboratory of Deep Earth Science and Engineering, College of Architecture and Environment, Sichuan University, Chengdu, China
| | - Enshen Long
- MOE Key Laboratory of Deep Earth Science and Engineering, College of Architecture and Environment, Sichuan University, Chengdu, China
| | - Li Zhang
- Department of Solid Waste Treatment Technology, Sichuan Environmental Protection Key Laboratory of Pollution Control for Heavy Metals, Sichuan Academy of Environmental Sciences, Chengdu, China
| | - Bizhen Shu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second Hospital of Sichuan University, Chengdu, China
| | - Lei Guo
- MOE Key Laboratory of Deep Earth Science and Engineering, College of Architecture and Environment, Sichuan University, Chengdu, China
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Tabatabaeizadeh SA. Airborne transmission of COVID-19 and the role of face mask to prevent it: a systematic review and meta-analysis. Eur J Med Res 2021; 26:1. [PMID: 33388089 PMCID: PMC7776300 DOI: 10.1186/s40001-020-00475-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/15/2020] [Indexed: 01/07/2023] Open
Abstract
Background and aims Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), belonging to the Coronaviridae family, is agent of 2019 novel coronavirus disease (COVID-19). COVID-19 emerged in Wuhan, Hubei province of China, in early December 2019 and is now considered a pandemic. This study aimed to investigate the airborne transmission of COVID-19 and the role of face mask to prevent it. Methods A systematic search for English-language literature was done via PUBMED/Medline and Google Scholar up to October 2020. There was two search strategy; for airborne transmission and the role of face mask for prevention of SARS-CoV-2 infection. Based on a fixed and random effects model, the RR and 95% CI were used to evaluate the combined risk. This meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) Guidelines. Results After eligibility assessment, four articles with a total of 7688 participants were included in this meta-analysis. The result of this meta-analysis has shown significant reduction in infection with face mask use; the pooled RR (95%CI) was 0.12 [0.06, 0.27] (P < 0.001). Conclusion In conclusion, this meta-analysis suggests that there is association between face mask use and reduction of COVID-19. However, COVID-19 spreads primarily with contact routes and respiratory droplets, but its transmissibility has many mysteries yet and there is controversy about airborne transmission of COVID-19.
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Affiliation(s)
- Seyed-Amir Tabatabaeizadeh
- Nutrition and Biochemistry Department, School of Medicine, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.
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40
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Guidelines for infection control and prevention in anaesthesia in South Africa. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2021. [DOI: 10.36303/sajaa.2021.27.4.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Singh T, Ichhpujani P, Singh RB. First Line of Defense in COVID-19: Masks in Clinical Practice. Asia Pac J Public Health 2020; 33:147-149. [PMID: 33291939 DOI: 10.1177/1010539520979928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tanu Singh
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Parul Ichhpujani
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Rohan Bir Singh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Abboah-Offei M, Salifu Y, Adewale B, Bayuo J, Ofosu-Poku R, Opare-Lokko EBA. A rapid review of the use of face mask in preventing the spread of COVID-19. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2020; 3:100013. [PMID: 33313575 PMCID: PMC7718106 DOI: 10.1016/j.ijnsa.2020.100013] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/21/2020] [Accepted: 11/19/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction The original use of face masks was to help protect surgical wounds from staff-generated nasal and oral bacteria. Currently governments across the world have instituted the mandatory use of masks and other face coverings so that face masks now find much broader usage in situations where close contact of people is frequent and inevitable, particularly inside public transport facilities, shopping malls and workplaces in response to the COVID-19. Objective We conducted a rapid review to investigate the impact face mask use has had in controlling transmission of respiratory viral infections. Method A rapid review was conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. Five electronic databases (CINAHL, Embase, Medline, PsycINFO and Global Health) were searched from database inception to date, using pre-defined search terms. We included all studies of any design and used descriptive analysis to report summary statistics of search results. Data were extracted including sample characteristics, study design, respiratory virus being controlled, type of face masks used and their effectiveness. Results 58 out of 84 studies met the inclusion criteria, of which 13 were classified as systematic reviews and 45 were quantitative studies (comprising randomised controlled trials, retrospective cohort studies, case control, cross-sectional, surveys, observational and descriptive studies). N = 27 studies were conducted amongst healthcare workers wearing face masks, n = 19 studies among the general population, n = 9 studies among healthcare workers the general population and patients wearing masks, and n = 3 among only patients. Face masks use have shown a great potential for preventing respiratory virus transmission including COVID-19. Conclusion Regardless of the type, setting, or who wears the face mask, it serves primarily a dual preventive purpose; protecting oneself from getting viral infection and protecting others. Therefore, if everyone wears a face mask in public, it offers a double barrier against COVID-19 transmission.
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Affiliation(s)
- Mary Abboah-Offei
- Department of Health Sciences, University of York, Heslington York Y10 5DD, United Kingdom
| | - Yakubu Salifu
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Bisi Adewale
- Faculty of Nursing, University of Alberta, Canada
| | - Jonathan Bayuo
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
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Masks or N95 Respirators During COVID-19 Pandemic-Which One Should I Wear? J Oral Maxillofac Surg 2020; 78:2114-2127. [PMID: 32926868 PMCID: PMC7451003 DOI: 10.1016/j.joms.2020.08.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/23/2020] [Accepted: 08/23/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE Coronavirus Disease 2019 (COVID-19) has caused suffering and death around the world. Careful selection of facial protection is paramount for preventing virus spread among healthcare workers and preserving mask and N95 respirator supplies. METHODS This paper is a comprehensive review of literature written in English and available on Pubmed comparing the risk of viral respiratory infections when wearing masks and N95 respirators. Current international oral and maxillofacial surgery guidelines for mask and N95 respirator use, patient COVID-19 disease status, aerosol producing procedures were also collected and incorporated into a workflow for selecting appropriate facial protection for oral and maxillofacial surgery procedures during the current pandemic. RESULTS Most studies suggest N95 respirators and masks are equally protective against respiratory viruses. Some evidence favors N95 respirators, which are preferred for high-risk procedures when aerosol production is likely or when the COVID-19 status of a patient is positive or unknown. N95 respirators may also be used for multiple patients or reused depending on the type of procedure and condition of the respirator after each patient encounter. CONCLUSION N95 respirators are preferred over masks against viral respiratory pathogens, especially during aerosol-generating procedures or when a patient's COVID-19 status is positive or unknown.
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Absenteeism and presenteeism in healthcare workers due to respiratory illness. Infect Control Hosp Epidemiol 2020; 42:268-273. [PMID: 33239124 DOI: 10.1017/ice.2020.444] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To assess influenza symptoms, adherence to mask use recommendations, absenteesm and presenteeism in acute care healthcare workers (HCWs) during influenza epidemics. METHODS The TransFLUas influenza transmission study in acute healthcare prospectively followed HCWs prospectively over 2 consecutive influenza seasons. Symptom diaries asking for respiratory symptoms and adherence with mask use recommendations were recorded on a daily basis, and study participants provided midturbinate nasal swabs for influenza testing. RESULTS In total, 152 HCWs (65.8% nurses and 13.2% physicians) were included: 89.1% of study participants reported at least 1 influenza symptom during their study season and 77.8% suffered from respiratory symptoms. Also, 28.3% of HCW missed at least 1 working day during the study period: 82.6% of these days were missed because of symptoms of influenza illness. Of all participating HCWs, 67.9% worked with symptoms of influenza infection on 8.8% of study days. On 0.3% of study days, symptomatic HCWs were shedding influenza virus while at work. Among HCWs with respiratory symptoms, 74.1% adhered to the policy to wear a mask at work on 59.1% of days with respiratory symptoms. CONCLUSIONS Respiratory disease is frequent among HCWs and imposes a significant economic burden on hospitals due to the number of working days lost. Presenteesm with respiratory illness, including influenza, is also frequent and poses a risk for patients and staff. TRIAL REGISTRATION NCT02478905 (clinicaltrials.gov).
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Wang Y, Yang M, Wang L, Dong H, Lu Z. Pregnancy and COVID-19: what anesthesiologists should know. Minerva Anestesiol 2020; 87:77-84. [PMID: 33231409 DOI: 10.23736/s0375-9393.20.14647-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Anesthetic management of parturients with COVID-19 is a big challenge to anesthesiologists. Limited data are available about COVID-19 during pregnancy; however, information on illnesses associated with SARS and MERS might provide insights into COVID-19's effects during pregnancy. EVIDENCE ACQUISITION Evidence from previous reports from SARS and MERS, and from COVID-19 cases were reviewed. Concepts from guidelines from the government and academic societies were collected as well. EVIDENCE SYNTHESIS The evidence was described and summarized. CONCLUSIONS Principles to minimize the risk of infection as well as optimize patients' safety during obstetric anesthesia were found to include careful evaluation, tight protection, and multi-discipline-based strategy. Though vertical transmission of COVID-19 still needs more definitive evidence, strict isolation is necessary for the newborn of COVID-19 mothers. Psychological support for the parturients is also an important issue during COVID-19 pandemic.
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Affiliation(s)
- Yonghui Wang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an Shaanxi, China
| | - Manping Yang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an Shaanxi, China
| | - Lini Wang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an Shaanxi, China
| | - Hailong Dong
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an Shaanxi, China
| | - Zhihong Lu
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an Shaanxi, China -
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Occupational Respiratory Infections. Clin Chest Med 2020; 41:739-751. [PMID: 33153691 DOI: 10.1016/j.ccm.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Occupational respiratory infections can be caused by bacterial, viral, and fungal pathogens. Transmission in occupational settings can occur from other humans, animals, or the environment, and occur in various occupations and industries. In this article, we describe 4 occupationally acquired respiratory infections at the focus of NIOSH investigations over the last decade: tuberculosis (TB), influenza, psittacosis, and coccidioidomycosis. We highlight the epidemiology, clinical manifestations, occupational risk factors, and prevention measures.
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One for Everyone: A Study of User Satisfaction Among Health-Care Providers Regarding Extended Use of N95 Masks During the COVID-19 Pandemic. Disaster Med Public Health Prep 2020; 16:619-626. [PMID: 33040770 PMCID: PMC7737120 DOI: 10.1017/dmp.2020.380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: This study was conducted to assess the feasibility of extended use of N95 masks in our hospital during the coronavirus disease 2019 (COVID-19) pandemic. We also studied the use pattern, user satisfaction, and issues faced during extended use of the mask. Methods: This cross-sectional study was conducted among health-care providers in a large tertiary care teaching hospital in northern India from April 1 to May 31, 2020. A list was prepared from the institute’s register, and participants were chosen by random sampling. The data collected from the physical forms were transferred to excel sheets. Results: A total of 1121 responses were received. The most common problem stated with reuse of N95 masks was loss of fit followed by damage to the slings, highlighted by 44.6% and 44.4% of the participants, respectively. A total of 476 (42.5%) participants responded that they would prefer “cup-shaped N95 mask with respirator”. The median scores regarding the satisfaction with the quality of masks and their fit was also 4 each. Conclusions: It was concluded that the extended use of N95 masks was acceptable, with more than 96% of the participants using these masks.
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Chao DL, Sridhar J, Kuriyan AE, Leng T, Barnett BP, Carlin AF, Wykoff CC, Gayer S, Mruthyunjaya P, Yonekawa Y, Fawzi AA, Berrocal AM, Yeh S, Ting D, Modi Y, Zacks DN, Yannuzzi N, Afshari NA, Murray T. Rationale for American Society of Retina Specialists Best Practice Recommendations for Conducting Vitreoretinal Surgery during the COVID-19 Era. JOURNAL OF VITREORETINAL DISEASES 2020; 4:420-429. [PMID: 34222758 PMCID: PMC8247449 DOI: 10.1177/2474126420941707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To detail the rationale behind recommendations recently published by the American Society of Retina Specialists (ASRS) outlining best practices for safety of vitreoretinal surgeons and staff while performing vitreoretinal surgery during the coronavirus disease (COVID)-19 pandemic. METHODS The committee for ASRS Best Practices for Retinal Surgery during the COVID-19 Pandemic reviewed existing evidence and information on SARS-CoV-2 transmission, and risk factors during vitreoretinal surgery. Recommendations were based on best available published data, cumulative clinical experiences, and recommendations and policies from other organizations. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the strength of recommendations and confidence in the evidence. These serve as interim recommendations which are routinely updated given gaps of knowledge and lack of high-quality data on this evolving subject. RESULTS Relevant existing literature related to methods of transmission, and ocular manifestations of SARS-CoV-2 are summarized. The data and clinical experiences driving recommendations for pre-operative, intraoperative and post-operative surgical considerations, anesthesia choice, as well as considerations for intravitreal injections are provided. CONCLUSION Recommendations are provided with the goal of protecting vitreoretinal surgeons and associated personnel from exposure to SARS-CoV-2 during interventional vitreoretinal procedures. This is a rapidly evolving topic with numerous remaining gaps in our current knowledge. As such, recommendations will evolve and the current manuscript is intended to serve as a foundation for continued dialogue on best practices.
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Affiliation(s)
- Daniel L. Chao
- Viterbi Family Department of Ophthalmology, Shiley Eye Institute,
University of California San Diego, La Jolla, CA, USA
| | - Jayanth Sridhar
- Bascom Palmer Eye Institute, University of Miami, Miami, FL,
USA
| | - Ajay E. Kuriyan
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson
University, Philadelphia, PA, USA
| | - Theodore Leng
- Department of Ophthalmology, Byers Eye Institute at Stanford,
Stanford University, Palo Alto, CA, USA
| | - Brad P. Barnett
- Department of Ophthalmology, Duke Eye Center, Duke University,
Durham, NC, USA
| | - Aaron F. Carlin
- Department of Medicine, Division of Infectious Diseases and Global
Public Health, University, of California, San Diego, La Jolla, CA, USA
| | - Charles C. Wykoff
- Retina Consultants of Houston, Retina Consultants of America;
Blanton Eye Institute, Houston Methodist Hospital & Weill Cornell Medical
College, Houston, TX, USA
| | - Stephen Gayer
- Department of Anesthesia, University of Miami, Miami, FL, USA
| | - Prithvi Mruthyunjaya
- Department of Ophthalmology, Byers Eye Institute at Stanford,
Stanford University, Palo Alto, CA, USA
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson
University, Philadelphia, PA, USA
| | - Amani A. Fawzi
- Department of Ophthalmology, Northwestern University, Chicago, IL,
USA
| | | | - Steven Yeh
- Department of Ophthalmology, Emory Eye Center, Emory University,
Atlanta, GA, USA
| | - Daniel Ting
- Singapore National Eye Center, Singapore, Singapore
| | - Yasha Modi
- Department of Ophthalmology, New York University, New York, NY,
USA
| | - David N. Zacks
- Department of Ophthalmology, Kellogg Eye Center, University of
Michigan, Ann Arbor, MI, USA
| | | | - Natalie A. Afshari
- Viterbi Family Department of Ophthalmology, Shiley Eye Institute,
University of California San Diego, La Jolla, CA, USA
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Ha JF. The COVID-19 pandemic, personal protective equipment and respirator: A narrative review. Int J Clin Pract 2020; 74:e13578. [PMID: 32511834 PMCID: PMC7300506 DOI: 10.1111/ijcp.13578] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/18/2020] [Accepted: 06/03/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The coronavirus disease 2019 pandemic has touched almost every continent. Personal protective equipment (PPE) is the final line of protection of healthcare workers (HCW). There is variation as well as controversy of infection control recommendation with regards to the use of PPE for HCW between institutions. The aim of this narrative review is to of examine and summarise the available evidence to guide recommendation for the safety of HCW. METHOD A literature search was conducted on the PubMed, MedLine and Embase databases with the keywords "personal protective equipment," "COVID 19," "n95," "health care worker" and "mortality." RESULTS SARS-nCoV-2 is highly contagious. About 3.5%-20% of HCW has been reported to be infected. The mortality ranges from 0.53% to 1.94%. PPE is part of the measure within a package of prevention and control of pandemic, rather than a replacement of. Respirators are more effective than masks in preventing aerosol transmission to HCWs. Extended use may be considered if guidelines are adhered. Powered air-purifying respirators if available should be used in high-risk procedures. CONCLUSION Transmission of viruses is multimodal and in the setting of a novel pathogen with high case fatality with no proven effective interventions, PPE that affords the best protection should be available to HCWs.
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Affiliation(s)
- Jennifer F. Ha
- Department of Paediatrics Otolaryngology Head & Neck SurgeryPerth Children’s HospitalNedlandsWAAustralia
- Wexford Medical CenterMurdoch ENTMurdochWAAustralia
- Department of SurgeryUniversity of Western AustraliaNedlandsWAAustralia
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Mohan S, Workman A, Barshak M, Welling DB, Abdul-Aziz D. Considerations in Management of Acute Otitis Media in the COVID-19 Era. Ann Otol Rhinol Laryngol 2020; 130:520-527. [DOI: 10.1177/0003489420958443] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To present the otologic findings of a patient with COVID-19 and complicated acute otitis media, evaluate for the presence of SARS-CoV-2 in middle ear fluid, and assess whether suctioning of middle ear fluid may be aerosol- generating. Methods: The case of a man with SARS-CoV-2 infection and complicated acute otitis media with facial paralysis is presented to illustrate unique clinical decisions made in context of the COVID-19 pandemic. A cadaveric temporal bone was used to simulate droplet spread during suctioning of fluorescein-labelled middle ear fluid and visualized with a blue-light filter. Results: A 23-year-old male who presented with complicated acute otitis media with facial paralysis was found to have an acute infection with SARS-CoV-2, with positive viral PCR of nasopharyngeal swab, and a negative PCR of the middle ear fluid. He was placed on isolation precautions and treated with myringotomy, topical and systemic antibiotics, and antivirals. Consistent with observations during endonasal suctioning, suctioning of middle ear fluid was not found to be aerosol or droplet generating. Conclusion: The case of a patient with active COVID-19 presenting with complicated acute otitis media in whom middle ear fluid was sampled to evaluate the etiology of the infection and the potential middle ear predilection of SARS-CoV-2 is described. This study has implications for the clinical management of patients with both known and unknown SARS-CoV-2 infection who present with ear disease. While middle ear suctioning may not be aerosol-generating, the risk of coughing or prolonged close contact requires heightened precautions during otologic procedures in patients with suspected or confirmed COVID-19.
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Affiliation(s)
- Suresh Mohan
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Alan Workman
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Miriam Barshak
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - D. Bradley Welling
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Dunia Abdul-Aziz
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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