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Fuller J, Chin-Yee B, Upshur REG. The argument framework is a flexible approach to evidence in healthcare. Nat Med 2024:10.1038/s41591-024-02930-x. [PMID: 38671239 DOI: 10.1038/s41591-024-02930-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Affiliation(s)
- Jonathan Fuller
- Department of History and Philosophy of Science, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Benjamin Chin-Yee
- Division of Hematology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of History and Philosophy of Science, University of Cambridge, Cambridge, UK
| | - Ross E G Upshur
- Dalla Lana School of Public Health and Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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2
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Millest A, Saeed S, Symons C, Carter H. Effect of face-covering use on adherence to other COVID-19 protective behaviours: A systematic review. PLoS One 2024; 19:e0284629. [PMID: 38603671 PMCID: PMC11008824 DOI: 10.1371/journal.pone.0284629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/23/2024] [Indexed: 04/13/2024] Open
Abstract
During the COVID-19 pandemic, concerns were raised that face covering use may elicit risk compensation; a false sense of security resulting in reduced adherence to other protective behaviours such as physical distancing. This systematic review aimed to investigate the effect of face covering use on adherence to other COVID-19 related protective behaviours. Medline, Embase, PsychInfo, EmCare, medRxiv preprints, Research Square and WHO COVID-19 Research Database were searched for all primary research studies published from 1st January 2020 to 17th May 2022 that investigated the effect of face covering use on adherence to other protective behaviours in public settings during the COVID-19 pandemic. Papers were selected and screened in accordance with the PRISMA framework. Backwards and forwards citation searches of included papers were also conducted on 16th September 2022, with eligible papers published between 1st January 2020 and that date being included. A quality appraisal including risk of bias was assessed using the Academy of Nutrition and Dietetics' Quality Criteria Checklist. This review is registered on PROSPERO, number CRD42022331961. 47 papers were included, with quality ranging from low to high. These papers investigated the effects of face covering use and face covering policies on adherence to six categories of behaviour: physical distancing; mobility; face-touching; hand hygiene; close contacts; and generalised protective behaviour. Results reveal no consistent evidence for or against risk compensation, with findings varying according to behaviour and across study types, and therefore confident conclusions cannot be made. Any policy decisions related to face coverings must consider the inconsistencies and caveats in this evidence base.
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Affiliation(s)
- Adam Millest
- Behavioural Science and Insights Unit, UK Health Security Agency, London, United Kingdom
| | - Sidra Saeed
- Behavioural Science and Insights Unit, UK Health Security Agency, London, United Kingdom
| | - Charles Symons
- Behavioural Science and Insights Unit, UK Health Security Agency, London, United Kingdom
| | - Holly Carter
- Behavioural Science and Insights Unit, UK Health Security Agency, London, United Kingdom
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3
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Gbagbo FY, Opoku R, Quarcoo R. Towards prevention of new COVID-19 infections in institutions of higher education: factors influencing compliance with mask-wearing among public university students in Ghana. BMC Infect Dis 2024; 24:236. [PMID: 38383360 PMCID: PMC10882752 DOI: 10.1186/s12879-024-09110-9] [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: 08/04/2023] [Accepted: 02/07/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Ghana's mask-wearing compliance with COVID-19 prevention protocols has not been as impressive among the general population. In this study, we examined factors influencing compliance with mask-wearing among public university students in Ghana to make recommendations for the prevention of new COVID-19 infections in public universities. METHODS We conducted this Census in a public university in Ghana between January and December 2022. The study design was an exploratory-cross-sectional and online survey. Structured questionnaires developed by the authors were used to collect data from 3,272 students. Data were analyzed with Jeffreys's Amazing Statistics Program (JASP). Frequency distributions were used to summarize the data into tables and graphs whilst logistic regression analysis was done to examine the factors influencing compliance with mask-wearing among participants as well as their mask-wearing behaviors in school. RESULTS Compliance with mask-wearing measures was high with 85.9% of the students wearing a nose mask always or often. Agreeing that the reusable masks do not last long was associated with a reduced chance of non-compliance (OR = 0.70, 95% CI = 0.57, 0.86). However, agreeing with some challenges was associated with increased chances of non-compliance. These included concerns that it is boring to mask after wearing makeup or having a haircut (OR = 1.71, 95% CI = 1.37, 2.14), and that masking is burdensome because it has to be removed when talking (OR = 1.26, 95% CI 1.01, 1.57), and that it is difficult to hear while masked (OR = 1.36, 95% CI = 1.04, 1.79). CONCLUSION Cost-benefit analyses, opinions about one's look, and communication difficulties are the key factors influencing students' non-compliance with mask-wearing regulations. To encourage student compliance with mask-wearing regulations at Ghana's public universities, we recommend innovation in nose mask manufacture.
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Affiliation(s)
- Fred Yao Gbagbo
- Department of Health Administration and Education, University of Education, Winneba, Ghana
| | - Richmond Opoku
- Department of Health Administration and Education, University of Education, Winneba, Ghana.
| | - Rosemary Quarcoo
- Department of Clothing and Textiles Education, University of Education, Winneba, Ghana.
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Schrecker T. Downing the Master's Tools? New Research Strategies to Address Social Determinants of Health Inequalities. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2023:27551938231161932. [PMID: 37032455 DOI: 10.1177/27551938231161932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
A dramatic increase in the volume of research literature referencing social determinants of health (SDH) since the report of the World Health Organization Commission on the topic in 2008 has not been matched by expansion of policies and interventions to reduce health inequalities by way of SDH. This article argues that familiar hierarchies of evidence that privilege clinical epidemiology as used in evidence-based medicine are inappropriate to address SDH. They misunderstand both the range of relevant evidence and the value-based nature of standards of proof. A richer conceptual armamentarium is available; it includes several applications of the concepts of epidemiological worlds and the lifecourse, which are explained in the article. A more appropriate evidentiary approach to SDH and health inequalities requires "downing the master's tools," to adapt Audre Lorde's phrase, and instead applying a multidisciplinary approach to assessing the evidence that adequately reflects the complexity of the relevant causal pathways. Doing so is made more difficult by the power structures that shape research priorities, yet it is essential.
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Affiliation(s)
- Ted Schrecker
- Emeritus Professor of Global Health Policy, Faculty of Medical Sciences, Newcastle University, Population Health Sciences Institute, Newcastle upon Tyne, UK
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5
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Mercuri M. A pandemic of nonsense. J Eval Clin Pract 2022; 28:927-931. [PMID: 35927932 PMCID: PMC9539227 DOI: 10.1111/jep.13750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Mathew Mercuri
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Canada.,Institute of Health Policy, Management, and Evaluation, and Victoria College, University of Toronto, Toronto, Canada.,Department of Philosophy, University of Johannesburg, Auckland Park, South Africa
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Compliance with wearing facemasks by university teaching staff during the second wave of COVID-19 pandemic: a cross sectional study. DISCOVER SOCIAL SCIENCE AND HEALTH 2022; 2:8. [PMID: 35754445 PMCID: PMC9207867 DOI: 10.1007/s44155-022-00011-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/27/2022] [Indexed: 11/23/2022]
Abstract
Objective We aimed to explore compliance with and barriers to wearing facemasks at the workplace among university teaching staff in Egypt. Methods An online survey was shared with teaching staff members at 11 public and 12 private Egyptian universities and high institutes, and 218 responses were received. All participants were asked about beliefs related to wearing facemasks. For participants who taught in-person classes, compliance with and barriers to wearing facemasks at the workplace were assessed. Compliance level was classified into: Non-compliance, inadequate and adequate, based on the degree of adherence to having facemasks on and not taking them off at five main work settings. We compared demographic characteristics, beliefs, and barriers scores across compliance levels. Results Most participants (81.7%) believed that facemasks reduce infection risk to others and 74.3% believed facemasks can reduce risk to the wearer. Around 80% of the respondents who taught in-person classes wore facemasks, but only 37.8% met the criteria of adequate compliance. Difficulty breathing and impaired communication were cited as major barriers by 42.2% and 30.3% of in-person class tutors respectively. The risk of reporting COVID-19 like symptoms among non-compliant participants was double the risk among those with adequate compliance (45.9% vs 25.7% respectively). Adequate compliance was significantly associated with higher positive beliefs scores and lower barriers scores. Conclusion Adequate compliance with wearing facemasks at the workplace was low. Addressing negative beliefs may improve compliance. Difficulty breathing, and impaired communication were important barriers, therefore we recommend replacing in-person interactions with online classes whenever applicable. Supplementary Information The online version contains supplementary material available at 10.1007/s44155-022-00011-3.
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Breckon J. Communicating and using systematic reviews-Learning from other disciplines. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1294. [PMID: 36908845 PMCID: PMC9745728 DOI: 10.1002/cl2.1294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
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Hanna E, Martin G, Campbell A, Connolly P, Fearon K, Markham S. Experiences of face mask use during the COVID-19 pandemic: A qualitative study. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:1481-1499. [PMID: 36040759 PMCID: PMC9538649 DOI: 10.1111/1467-9566.13525] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
The use of face masks and coverings has been a central component of efforts to mitigate the impact of the COVID-19 pandemic and has been legally mandated in some countries. Most academic studies to date, however, have focussed primarily on its effectiveness in reducing SARS-CoV-2 transmission, largely neglecting the social dimensions of mask mandates. In this narrative interview-based study, we consider experiences of face masks, with a particular focus on groups considered to be at a potential disadvantage from compulsory masking. Drawing on 40 telephone, video-call and e-mail interviews, we highlight the impact of inconsistent communication and the notion of mask wearing as an act of altruism on participants' experiences. In particular, we show how intolerance towards individuals who did not wear masks could result in stigma and exclusion, regardless of the legitimacy of their reasons. We suggest that more is needed to mitigate the 'dark side' of discourses of collective effort and altruism at a time of societal stress and fracture, and to account for the needs and interests of groups for whom compulsory masking may result in further marginalisation.
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Arnaldi M, Engebretsen E, Forsdick C. Translating COVID-19: From Contagion to Containment. THE JOURNAL OF MEDICAL HUMANITIES 2022; 43:387-404. [PMID: 35713804 PMCID: PMC9204076 DOI: 10.1007/s10912-022-09742-5] [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] [Accepted: 05/14/2022] [Indexed: 06/15/2023]
Abstract
This article tests the hypothesis that all pandemics are inherently translational. We argue that translation and translation theory can be fruitfully used to understand and manage epidemics, as they help us explore concepts of infectivity and immunity in terms of cultural and biological resistance. After examining the linkage between translation and coronavirus disease from three different yet interlinked perspectives-cultural, medical, and biocultural-we make a case for a translational medical humanities framework for tackling the multifactorial crisis brought about by the SARS-CoV-2 infection. This innovative entanglement of perspectives has the merit of carving out a new space for translation research at the intersection of the sciences and the humanities, providing sustainable ways to conceptualize the production of science at times of crisis, and challenging conventional views of translation as a primarily linguistic and cultural phenomenon that traditionally does not engage with science.
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Affiliation(s)
- Marta Arnaldi
- Faculty of Medieval and Modern Languages, University of Oxford, Oxford, UK.
| | | | - Charles Forsdick
- Department of Modern Languages and Cultures, University of Liverpool, Liverpool, UK
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10
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Omura M, Stone T. Editorial: Facemasks revisited: what should health professionals be telling the public now about the use of masks? Nurs Health Sci 2022; 24:531-534. [PMID: 35909241 PMCID: PMC9353413 DOI: 10.1111/nhs.12977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/04/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Mieko Omura
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Teresa Stone
- Yamaguchi University, Faculty of Medicine and Health Sciences, Yamaguchi University, 1-1-1, Minami Kogushi, Ube City, Japan
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11
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Green J, Fischer EF, Fitzgerald D, Harvey TS, Thomas F. The publics of public health: learning from COVID-19. CRITICAL PUBLIC HEALTH 2022. [DOI: 10.1080/09581596.2022.2077701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Judith Green
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
| | - Edward F. Fischer
- Department of Anthropology, Vanderbilt University, Nashville, TN, USA
| | - Des Fitzgerald
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
| | - T. S. Harvey
- Department of Anthropology, Vanderbilt University, Nashville, TN, USA
| | - Felicity Thomas
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
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Shkolnikov VM, Klimkin I, McKee M, Jdanov DA, Alustiza-Galarza A, Németh L, Timonin SA, Nepomuceno MR, Andreev EM, Leon DA. What should be the baseline when calculating excess mortality? New approaches suggest that we have underestimated the impact of the COVID-19 pandemic and previous winter peaks. SSM Popul Health 2022; 18:101118. [PMID: 35573866 PMCID: PMC9075981 DOI: 10.1016/j.ssmph.2022.101118] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 01/28/2022] [Accepted: 05/03/2022] [Indexed: 12/23/2022] Open
Abstract
Excess mortality has been used to measure the impact of COVID-19 over time and across countries. But what baseline should be chosen? We propose two novel approaches: an alternative retrospective baseline derived from the lowest weekly death rates achieved in previous years and a within-year baseline based on the average of the 13 lowest weekly death rates within the same year. These baselines express normative levels of the lowest feasible target death rates. The excess death rates calculated from these baselines are not distorted by past mortality peaks and do not treat non-pandemic winter mortality excesses as inevitable. We obtained weekly series for 35 industrialized countries from the Human Mortality Database for 2000–2020. Observed, baseline and excess mortalities were measured by age-standardized death rates. We assessed weekly and annual excess death rates driven by the COVID-19 pandemic in 2020 and those related to seasonal respiratory infections in earlier years. There was a distinct geographic pattern with high excess death rates in Eastern Europe followed by parts of the UK, and countries of Southern and Western Europe. Some Asia-Pacific and Scandinavian countries experienced lower excess mortality. In 2020 and earlier years, the alternative retrospective and the within-year excess mortality figures were higher than estimates based on conventional metrics. While the latter were typically negative or close to zero in years without extraordinary epidemics, the alternative estimates were substantial. Cumulation of this "usual" excess over 2–3 years results in human losses comparable to those caused by COVID-19. Challenging the view that non-pandemic seasonal winter mortality is inevitable would focus attention on reducing premature mortality in many countries. As SARS-CoV-2 is unlikely to be the last respiratory pathogen with the potential to cause a pandemic, such measures would also strengthen global resilience in the face of similar threats in the future. Conventional estimates of excess mortality underestimate potentially avoidable losses. We propose metrics based on best weeks in the same and in earlier years. Our alternative metrics estimate higher annual excess mortality in 2020 and 2005-19. Mortality peaks in non-pandemic years should be regarded as potentially avoidable.
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Affiliation(s)
- Vladimir M. Shkolnikov
- Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, 18057, Rostock, Germany
- International Laboratory for Population and Health, National Research University Higher School of Economics, Myasnitskaya 20, 101000, Moscow, Russian Federation
- Corresponding author. Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, 18057, Rostock, Germany.
| | - Ilya Klimkin
- International Laboratory for Population and Health, National Research University Higher School of Economics, Myasnitskaya 20, 101000, Moscow, Russian Federation
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Dmitri A. Jdanov
- Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, 18057, Rostock, Germany
- International Laboratory for Population and Health, National Research University Higher School of Economics, Myasnitskaya 20, 101000, Moscow, Russian Federation
| | - Ainhoa Alustiza-Galarza
- Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, 18057, Rostock, Germany
| | - László Németh
- Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, 18057, Rostock, Germany
| | - Sergey A. Timonin
- Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, 18057, Rostock, Germany
| | - Marília R. Nepomuceno
- Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, 18057, Rostock, Germany
| | - Evgeny M. Andreev
- International Laboratory for Population and Health, National Research University Higher School of Economics, Myasnitskaya 20, 101000, Moscow, Russian Federation
| | - David A. Leon
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
- Department of Community Medicine, UiT Arctic University of Norway, Hansine Hansens veg 18, 9019, Tromsø, Norway
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Kretzschmar ME, Ashby B, Fearon E, Overton CE, Panovska-Griffiths J, Pellis L, Quaife M, Rozhnova G, Scarabel F, Stage HB, Swallow B, Thompson RN, Tildesley MJ, Villela D. Challenges for modelling interventions for future pandemics. Epidemics 2022; 38:100546. [PMID: 35183834 PMCID: PMC8830929 DOI: 10.1016/j.epidem.2022.100546] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 12/16/2022] Open
Abstract
Mathematical modelling and statistical inference provide a framework to evaluate different non-pharmaceutical and pharmaceutical interventions for the control of epidemics that has been widely used during the COVID-19 pandemic. In this paper, lessons learned from this and previous epidemics are used to highlight the challenges for future pandemic control. We consider the availability and use of data, as well as the need for correct parameterisation and calibration for different model frameworks. We discuss challenges that arise in describing and distinguishing between different interventions, within different modelling structures, and allowing both within and between host dynamics. We also highlight challenges in modelling the health economic and political aspects of interventions. Given the diversity of these challenges, a broad variety of interdisciplinary expertise is needed to address them, combining mathematical knowledge with biological and social insights, and including health economics and communication skills. Addressing these challenges for the future requires strong cross-disciplinary collaboration together with close communication between scientists and policy makers.
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Affiliation(s)
- Mirjam E Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Ben Ashby
- Department of Mathematical Sciences, University of Bath, Bath BA2 7AY, UK
| | - Elizabeth Fearon
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK; Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, UK
| | - Christopher E Overton
- Department of Mathematics, University of Manchester, UK; Joint UNIversities Pandemic and Epidemiological Research, UK; Clinical Data Science Unit, Manchester University NHS Foundation Trust, UK
| | - Jasmina Panovska-Griffiths
- The Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK; The Queen's College, University of Oxford, Oxford, UK
| | - Lorenzo Pellis
- Department of Mathematics, University of Manchester, UK; Joint UNIversities Pandemic and Epidemiological Research, UK; The Alan Turing Institute, London, UK
| | - Matthew Quaife
- TB Modelling Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK
| | - Ganna Rozhnova
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; BioISI-Biosystems & Integrative Sciences Institute, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Francesca Scarabel
- Department of Mathematics, University of Manchester, UK; Joint UNIversities Pandemic and Epidemiological Research, UK; CDLab - Computational Dynamics Laboratory, Department of Mathematics, Computer Science and Physics, University of Udine, Italy
| | - Helena B Stage
- Department of Mathematics, University of Manchester, UK; Joint UNIversities Pandemic and Epidemiological Research, UK; University of Potsdam, Germany; Humboldt University of Berlin, Germany
| | - Ben Swallow
- School of Mathematics and Statistics, University of Glasgow, Glasgow, UK; Scottish Covid-19 Response Consortium, UK
| | - Robin N Thompson
- Joint UNIversities Pandemic and Epidemiological Research, UK; Mathematics Institute, University of Warwick, Coventry CV4 7AL, UK; Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, University of Warwick, Coventry CV4 7AL, UK
| | - Michael J Tildesley
- Joint UNIversities Pandemic and Epidemiological Research, UK; Mathematics Institute, University of Warwick, Coventry CV4 7AL, UK; Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, University of Warwick, Coventry CV4 7AL, UK
| | - Daniel Villela
- Program of Scientific Computing, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Conroy D. Mental imagery interventions to promote face covering use among UK university students and employees during the COVID-19 pandemic: study protocol for a randomized controlled trial. Trials 2022; 23:51. [PMID: 35042564 PMCID: PMC8764318 DOI: 10.1186/s13063-021-05852-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 11/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The 2020 COVID-19 pandemic has witnessed wide-ranging efforts to minimize the spread of the virus and to protect those most vulnerable to becoming unwell following viral infection. Core COVID-19 preventive measures include social distancing, regular hand washing, and wearing face coverings in public places. Understanding links between social cognitive factors relating to beliefs/skills is important in the context of the COVID-19 pandemic, as this can suggest which factors might be targeted via behaviour change interventions to promote adherence to COVID-19 preventative behaviours. In this context, mental imagery exercises-self-directed imagining of an anticipated outcome or processes linked to a defined behaviour/activity-offer a well-evidenced, relatively simple behaviour change intervention. In the mental imagery invention reported in this protocol, individuals will be randomly assigned to one of four separate conditions (outcome imagery, process imagery, outcome and process imagery, control). METHODS The primary objective of this randomized controlled study is to assess the effectiveness of a mental imagery intervention on wearing face coverings, as a defined core COVID-19 preventative behaviour. Participants will consist of UK university students and university employees of any age. Participants will be randomized to complete an 'outcome imagery' or a 'process imagery' exercise, both exercises (i.e. a combined condition) or neither exercise (i.e. a control condition). A total of 260 individuals will be recruited into the study. Outcomes for all study condition arms will be assessed at baseline (Time 1), immediately post-intervention (Time 2), and at 1-month follow-up (Time 3). The primary outcome is frequency of wearing face covering, as reported at T2 and T3. Secondary outcomes include intervention effects on face covering attitudes, social norms, perceived behavioural control and barrier self-efficacy at T2 and T3. Putative moderators of intervention effects are conscientiousness, narcissism and 'light triad' personality traits. DISCUSSION This trial will contribute toward the currently sparse evidence base concerning behaviour change techniques designed to promote COVID-19 preventative behaviours among UK university students and university employees. TRIAL REGISTRATION ClinicalTrials.gov (U.S. National Library of Medicine) NCT04583449 . Retrospectively registered on 20 October 2020.
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Affiliation(s)
- Dominic Conroy
- School of Social Sciences and Professions, London Metropolitan University, Tower Building, 166-220 Holloway Road, London, N7 8DB, UK.
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Strand MA, Shyllon O, Hohman A, Jansen RJ, Sidhu S, McDonough S. Evaluating the Association of Face Covering Mandates on COVID-19 Severity by State. J Prim Care Community Health 2022; 13:21501319221086720. [PMID: 35343833 PMCID: PMC8966126 DOI: 10.1177/21501319221086720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective: During the COVID-19 pandemic in the United States, mitigation measures were implemented on a state-by-state basis. Governors were responsible for establishing interventions appropriate for their states and the timing of implementation. This paper evaluated the association between the presence and timing of a mask mandate and the severity of the COVID-19 epidemic by state. Methods: The states were divided into 3 categories based on when the governors of each state implemented a mask mandate: Early (mask mandate implemented between March 2020 and June 2020), Late (July 2020-December 2020), and Never (no mask mandate implemented). The rates of hospitalizations and mortality (per 100 000) were assessed at the different time points during the pandemic across these categories from March to December 2020. Results: The mortality rates across all 3 groups were observed to be highest in the beginning and toward the end of the pandemic in 2020 with the peak observed in the Early group between April and May 2020. Also, the rates of hospitalization increased steadily across all groups. The Early mask group was comprised of 86.7% and 13.3% states with Democratic and Republican governors respectively, and no states in the Never category had Democratic governors. Conclusion: These results support the benefit of implementing a mask mandate to minimize the impact of the COVID-19 pandemic and the role of political affiliation of governors on that impact.
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Affiliation(s)
| | | | - Adam Hohman
- North Dakota State University, Fargo, ND, USA
| | | | | | - Stephen McDonough
- University of North Dakota School of Medicine, Pediatric Medicine Bismarck, ND, USA
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Buts J, Baker M, Luz S, Engebretsen E. Epistemologies of evidence-based medicine: a plea for corpus-based conceptual research in the medical humanities. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:621-632. [PMID: 34057664 PMCID: PMC8165676 DOI: 10.1007/s11019-021-10027-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 05/28/2023]
Abstract
Evidence-based medicine has been the subject of much controversy within and outside the field of medicine, with its detractors characterizing it as reductionist and authoritarian, and its proponents rejecting such characterization as a caricature of the actual practice. At the heart of this controversy is a complex linguistic and social process that cannot be illuminated by appealing to the semantics of the modifier evidence-based. The complexity lies in the nature of evidence as a basic concept that circulates in both expert and non-expert spheres of communication, supports different interpretations in different contexts, and is inherently open to contestation. We outline a new methodology that combines a social epistemological perspective with advanced methods of corpus linguistics and elements of conceptual history to investigate this and other basic concepts that underpin the practice and ethos of modern medicine. The potential of this methodology to offer new insights into controversies such as those surrounding EBM is demonstrated through a case study of the various meanings supported by evidence and based, as attested in a large electronic corpus of online material written by non-experts as well as a variety of experts in different fields, including medicine.
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Affiliation(s)
- Jan Buts
- Boğaziçi University, Istanbul, Turkey
| | | | - Saturnino Luz
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Eivind Engebretsen
- Faculty of Medicine, University of Oslo, Blindern, BOX 1078, 0316, Oslo, Norway.
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17
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John S. Science, politics and regulation: The trust-based approach to the demarcation problem. STUDIES IN HISTORY AND PHILOSOPHY OF SCIENCE 2021; 90:1-9. [PMID: 34500262 DOI: 10.1016/j.shpsa.2021.08.006] [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: 11/03/2020] [Revised: 08/06/2021] [Accepted: 08/13/2021] [Indexed: 06/13/2023]
Abstract
Drawing on literature on values in science and a case-study of UK cancer policy, this paper argues for a novel account of the demarcation project in terms of trustworthiness. The first part of the paper addresses the relationship between science, politics and demarcation. In 2010, the UK government decided to pay more for cancer drugs than for drugs for other diseases; in 2016, this Cancer Drugs Fund was reformed so as to lower the evidential standards for approving cancer drugs, rather than paying more for them. Are these two ways of treating cancer as "special" importantly different? This paper argues that, if we the argument from inductive risk seriously, they seem equivalent. This result provides further reason to doubt the notion of demarcating science from non-science. However, the second part of the paper complicates this story, arguing that considerations of epistemic trust might give us reasons to prefer epistemic communities centred around "broadly acceptable" standards, and which are "sociologically well-ordered", regardless of inductive risk concerns. After developing these claims through the cancer case-study, the final section suggests how these concerns might motivate novel versions of the demarcation project.
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Affiliation(s)
- Stephen John
- Department of History and Philosophy of Science, University of Cambridge, Cambridge, CB2 3RH, UK.
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18
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Escandón K, Rasmussen AL, Bogoch II, Murray EJ, Escandón K, Popescu SV, Kindrachuk J. COVID-19 false dichotomies and a comprehensive review of the evidence regarding public health, COVID-19 symptomatology, SARS-CoV-2 transmission, mask wearing, and reinfection. BMC Infect Dis 2021; 21:710. [PMID: 34315427 PMCID: PMC8314268 DOI: 10.1186/s12879-021-06357-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/24/2021] [Indexed: 02/07/2023] Open
Abstract
Scientists across disciplines, policymakers, and journalists have voiced frustration at the unprecedented polarization and misinformation around coronavirus disease 2019 (COVID-19) pandemic. Several false dichotomies have been used to polarize debates while oversimplifying complex issues. In this comprehensive narrative review, we deconstruct six common COVID-19 false dichotomies, address the evidence on these topics, identify insights relevant to effective pandemic responses, and highlight knowledge gaps and uncertainties. The topics of this review are: 1) Health and lives vs. economy and livelihoods, 2) Indefinite lockdown vs. unlimited reopening, 3) Symptomatic vs. asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 4) Droplet vs. aerosol transmission of SARS-CoV-2, 5) Masks for all vs. no masking, and 6) SARS-CoV-2 reinfection vs. no reinfection. We discuss the importance of multidisciplinary integration (health, social, and physical sciences), multilayered approaches to reducing risk ("Emmentaler cheese model"), harm reduction, smart masking, relaxation of interventions, and context-sensitive policymaking for COVID-19 response plans. We also address the challenges in understanding the broad clinical presentation of COVID-19, SARS-CoV-2 transmission, and SARS-CoV-2 reinfection. These key issues of science and public health policy have been presented as false dichotomies during the pandemic. However, they are hardly binary, simple, or uniform, and therefore should not be framed as polar extremes. We urge a nuanced understanding of the science and caution against black-or-white messaging, all-or-nothing guidance, and one-size-fits-all approaches. There is a need for meaningful public health communication and science-informed policies that recognize shades of gray, uncertainties, local context, and social determinants of health.
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Affiliation(s)
- Kevin Escandón
- School of Medicine, Universidad del Valle, Cali, Colombia.
| | - Angela L Rasmussen
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, Canada
- Georgetown Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
| | - Isaac I Bogoch
- Division of Infectious Diseases, University of Toronto, Toronto General Hospital, Toronto, Canada
| | - Eleanor J Murray
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Karina Escandón
- Department of Anthropology, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Saskia V Popescu
- Georgetown Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
- Schar School of Policy and Government, George Mason University, Fairfax, VA, USA
| | - Jason Kindrachuk
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
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19
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Ogilvie D, Bauman A, Foley L, Guell C, Humphreys D, Panter J. Making sense of the evidence in population health intervention research: building a dry stone wall. BMJ Glob Health 2021; 5:bmjgh-2020-004017. [PMID: 33298470 PMCID: PMC7733100 DOI: 10.1136/bmjgh-2020-004017] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 12/23/2022] Open
Abstract
To effectively tackle population health challenges, we must address the fundamental determinants of behaviour and health. Among other things, this will entail devoting more attention to the evaluation of upstream intervention strategies. However, merely increasing the supply of such studies is not enough. The pivotal link between research and policy or practice should be the cumulation of insight from multiple studies. If conventional evidence synthesis can be thought of as analogous to building a wall, then we can increase the supply of bricks (the number of studies), their similarity (statistical commensurability) or the strength of the mortar (the statistical methods for holding them together). However, many contemporary public health challenges seem akin to herding sheep in mountainous terrain, where ordinary walls are of limited use and a more flexible way of combining dissimilar stones (pieces of evidence) may be required. This would entail shifting towards generalising the functions of interventions, rather than their effects; towards inference to the best explanation, rather than relying on binary hypothesis-testing; and towards embracing divergent findings, to be resolved by testing theories across a cumulated body of work. In this way we might channel a spirit of pragmatic pluralism into making sense of complex sets of evidence, robust enough to support more plausible causal inference to guide action, while accepting and adapting to the reality of the public health landscape rather than wishing it were otherwise. The traditional art of dry stone walling can serve as a metaphor for the more ‘holistic sense-making’ we propose.
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Affiliation(s)
- David Ogilvie
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Adrian Bauman
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise Foley
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Cornelia Guell
- European Centre for Environment and Human Health, University of Exeter, Truro, UK
| | - David Humphreys
- Department of Social Policy and Innovation, University of Oxford, Oxford, UK
| | - Jenna Panter
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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20
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Bakhit M, Krzyzaniak N, Scott AM, Clark J, Glasziou P, Del Mar C. Downsides of face masks and possible mitigation strategies: a systematic review and meta-analysis. BMJ Open 2021; 11:e044364. [PMID: 33619199 PMCID: PMC7903088 DOI: 10.1136/bmjopen-2020-044364] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To identify, appraise and synthesise studies evaluating the downsides of wearing face masks in any setting. We also discuss potential strategies to mitigate these downsides. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase, CENTRAL and EuropePMC were searched (inception-18 May 2020), and clinical registries were searched via CENTRAL. We also did a forward-backward citation search of the included studies. INCLUSION CRITERIA We included randomised controlled trials and observational studies comparing face mask use to any active intervention or to control. DATA EXTRACTION AND ANALYSIS Two author pairs independently screened articles for inclusion, extracted data and assessed the quality of included studies. The primary outcomes were compliance, discomforts, harms and adverse events of wearing face masks. RESULTS We screened 5471 articles, including 37 (40 references); 11 were meta-analysed. For mask wear adherence, 47% (95% CI 25% to 68%, p<0.0001), more people wore face masks in the face mask group compared with control; adherence was significantly higher (26%, 95% CI 8% to 46%, p<0.01) in the surgical/medical mask group than in N95/P2 group. The largest number of studies reported on the discomfort and irritation outcome (20 studies); fewest reported on the misuse of masks, and none reported on mask contamination or risk compensation behaviour. Risk of bias was generally high for blinding of participants and personnel and low for attrition and reporting biases. CONCLUSIONS There are insufficient data to quantify all of the adverse effects that might reduce the acceptability, adherence and effectiveness of face masks. New research on face masks should assess and report the harms and downsides. Urgent research is also needed on methods and designs to mitigate the downsides of face mask wearing, particularly the assessment of possible alternatives. SYSTEMATIC REVIEW REGISTRATION Open Science Framework website https://osf.io/sa6kf/ (timestamp 20-05-2020).
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Affiliation(s)
- Mina Bakhit
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Natalia Krzyzaniak
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Anna Mae Scott
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Chris Del Mar
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
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21
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Ortelan N, Ferreira AJF, Leite L, Pescarini JM, Souto AC, Barreto ML, Aquino EML. Cloth masks in public places: an essential intervention to prevent COVID-19 in Brazil. CIENCIA & SAUDE COLETIVA 2021; 26:669-692. [PMID: 33605343 DOI: 10.1590/1413-81232021262.36702020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/02/2020] [Indexed: 02/08/2023] Open
Abstract
There is increasing evidence that the use of masks is an indispensable protective measure against COVID-19, given the high transmissibility of the new coronavirus through the respiratory system, including by asymptomatic individuals. The use of cloth masks in public places has been established as a protective measure to be adopted alongside social distancing and hand hygiene. This narrative review aims to systematize the scientific evidence that informs the widespread use of cloth masks as a preventive measure against COVID-19 and to describe the evolution of positions contrary to or in favor of its use outside the home, in view of the advance of the new coronavirus pandemic globally. The scientific articles, technical notes, governmental decrees and other documents analyzed indicate that widespread use of masks has the potential to reduce the spread of the new coronavirus. We recommend that the Brazilian government adopt strategies to increase the supply of reusable cloth masks to the public, especially to vulnerable populations and to support studies on the impact of this measure to control the pandemic in the country. Finally, it is imperative to ensure that use of masks does not exacerbate stigmatization of racial groups that already face prejudice.
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Affiliation(s)
- Naiá Ortelan
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz Bahia. R. Mundo s/n, Trobogy. 41745-715 Salvador BA Brasil.
| | | | | | - Julia Moreira Pescarini
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz Bahia. R. Mundo s/n, Trobogy. 41745-715 Salvador BA Brasil.
| | - Ana Cristina Souto
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA). Salvador BA Brasil
| | - Mauricio Lima Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz Bahia. R. Mundo s/n, Trobogy. 41745-715 Salvador BA Brasil.
| | - Estela M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA). Salvador BA Brasil
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22
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Howard J, Huang A, Li Z, Tufekci Z, Zdimal V, van der Westhuizen HM, von Delft A, Price A, Fridman L, Tang LH, Tang V, Watson GL, Bax CE, Shaikh R, Questier F, Hernandez D, Chu LF, Ramirez CM, Rimoin AW. An evidence review of face masks against COVID-19. Proc Natl Acad Sci U S A 2021. [PMID: 33431650 DOI: 10.20944/preprints202004.0203.v1] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
The science around the use of masks by the public to impede COVID-19 transmission is advancing rapidly. In this narrative review, we develop an analytical framework to examine mask usage, synthesizing the relevant literature to inform multiple areas: population impact, transmission characteristics, source control, wearer protection, sociological considerations, and implementation considerations. A primary route of transmission of COVID-19 is via respiratory particles, and it is known to be transmissible from presymptomatic, paucisymptomatic, and asymptomatic individuals. Reducing disease spread requires two things: limiting contacts of infected individuals via physical distancing and other measures and reducing the transmission probability per contact. The preponderance of evidence indicates that mask wearing reduces transmissibility per contact by reducing transmission of infected respiratory particles in both laboratory and clinical contexts. Public mask wearing is most effective at reducing spread of the virus when compliance is high. Given the current shortages of medical masks, we recommend the adoption of public cloth mask wearing, as an effective form of source control, in conjunction with existing hygiene, distancing, and contact tracing strategies. Because many respiratory particles become smaller due to evaporation, we recommend increasing focus on a previously overlooked aspect of mask usage: mask wearing by infectious people ("source control") with benefits at the population level, rather than only mask wearing by susceptible people, such as health care workers, with focus on individual outcomes. We recommend that public officials and governments strongly encourage the use of widespread face masks in public, including the use of appropriate regulation.
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Affiliation(s)
- Jeremy Howard
- fast.ai, San Francisco, CA 94105;
- Data Institute, University of San Francisco, San Francisco, CA 94105
| | - Austin Huang
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903
| | - Zhiyuan Li
- Center for Quantitative Biology, Peking University, Beijing 100871, China
| | - Zeynep Tufekci
- School of Information, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Vladimir Zdimal
- Institute of Chemical Process Fundamentals, Czech Academy of Sciences, CZ-165 02 Praha 6, Czech Republic
| | - Helene-Mari van der Westhuizen
- Department of Primary Health Care Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
- TB Proof, Cape Town 7130, South Africa
| | - Arne von Delft
- TB Proof, Cape Town 7130, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Amy Price
- Anesthesia Informatics and Media Lab, School of Medicine, Stanford University, Stanford, CA 94305
| | - Lex Fridman
- Department of Aeronautics and Astronautics, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Lei-Han Tang
- Department of Physics, Hong Kong Baptist University, Hong Kong SAR, China
- Complex Systems Division, Beijing Computational Science Research Center, Beijing 100193, China
| | - Viola Tang
- Department of Information Systems, Business Statistics and Operations Management, Hong Kong University of Science and Technology, Hong Kong SAR, China
| | - Gregory L Watson
- Department of Biostatistics, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095
| | - Christina E Bax
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | | | - Frederik Questier
- Teacher Education Department, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | | | - Larry F Chu
- Anesthesia Informatics and Media Lab, School of Medicine, Stanford University, Stanford, CA 94305
| | - Christina M Ramirez
- Department of Biostatistics, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095
| | - Anne W Rimoin
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095
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23
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Howard J, Huang A, Li Z, Tufekci Z, Zdimal V, van der Westhuizen HM, von Delft A, Price A, Fridman L, Tang LH, Tang V, Watson GL, Bax CE, Shaikh R, Questier F, Hernandez D, Chu LF, Ramirez CM, Rimoin AW. An evidence review of face masks against COVID-19. Proc Natl Acad Sci U S A 2021; 118:e2014564118. [PMID: 33431650 PMCID: PMC7848583 DOI: 10.1073/pnas.2014564118] [Citation(s) in RCA: 603] [Impact Index Per Article: 201.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The science around the use of masks by the public to impede COVID-19 transmission is advancing rapidly. In this narrative review, we develop an analytical framework to examine mask usage, synthesizing the relevant literature to inform multiple areas: population impact, transmission characteristics, source control, wearer protection, sociological considerations, and implementation considerations. A primary route of transmission of COVID-19 is via respiratory particles, and it is known to be transmissible from presymptomatic, paucisymptomatic, and asymptomatic individuals. Reducing disease spread requires two things: limiting contacts of infected individuals via physical distancing and other measures and reducing the transmission probability per contact. The preponderance of evidence indicates that mask wearing reduces transmissibility per contact by reducing transmission of infected respiratory particles in both laboratory and clinical contexts. Public mask wearing is most effective at reducing spread of the virus when compliance is high. Given the current shortages of medical masks, we recommend the adoption of public cloth mask wearing, as an effective form of source control, in conjunction with existing hygiene, distancing, and contact tracing strategies. Because many respiratory particles become smaller due to evaporation, we recommend increasing focus on a previously overlooked aspect of mask usage: mask wearing by infectious people ("source control") with benefits at the population level, rather than only mask wearing by susceptible people, such as health care workers, with focus on individual outcomes. We recommend that public officials and governments strongly encourage the use of widespread face masks in public, including the use of appropriate regulation.
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Affiliation(s)
- Jeremy Howard
- fast.ai, San Francisco, CA 94105;
- Data Institute, University of San Francisco, San Francisco, CA 94105
| | - Austin Huang
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903
| | - Zhiyuan Li
- Center for Quantitative Biology, Peking University, Beijing 100871, China
| | - Zeynep Tufekci
- School of Information, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Vladimir Zdimal
- Institute of Chemical Process Fundamentals, Czech Academy of Sciences, CZ-165 02 Praha 6, Czech Republic
| | - Helene-Mari van der Westhuizen
- Department of Primary Health Care Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
- TB Proof, Cape Town 7130, South Africa
| | - Arne von Delft
- TB Proof, Cape Town 7130, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Amy Price
- Anesthesia Informatics and Media Lab, School of Medicine, Stanford University, Stanford, CA 94305
| | - Lex Fridman
- Department of Aeronautics and Astronautics, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Lei-Han Tang
- Department of Physics, Hong Kong Baptist University, Hong Kong SAR, China
- Complex Systems Division, Beijing Computational Science Research Center, Beijing 100193, China
| | - Viola Tang
- Department of Information Systems, Business Statistics and Operations Management, Hong Kong University of Science and Technology, Hong Kong SAR, China
| | - Gregory L Watson
- Department of Biostatistics, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095
| | - Christina E Bax
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | | | - Frederik Questier
- Teacher Education Department, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | | | - Larry F Chu
- Anesthesia Informatics and Media Lab, School of Medicine, Stanford University, Stanford, CA 94305
| | - Christina M Ramirez
- Department of Biostatistics, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095
| | - Anne W Rimoin
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095
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24
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Howard J, Huang A, Li Z, Tufekci Z, Zdimal V, van der Westhuizen HM, von Delft A, Price A, Fridman L, Tang LH, Tang V, Watson GL, Bax CE, Shaikh R, Questier F, Hernandez D, Chu LF, Ramirez CM, Rimoin AW. An evidence review of face masks against COVID-19. Proc Natl Acad Sci U S A 2021; 118:2014564118. [PMID: 33431650 DOI: 10.20944/preprints202004.0203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
The science around the use of masks by the public to impede COVID-19 transmission is advancing rapidly. In this narrative review, we develop an analytical framework to examine mask usage, synthesizing the relevant literature to inform multiple areas: population impact, transmission characteristics, source control, wearer protection, sociological considerations, and implementation considerations. A primary route of transmission of COVID-19 is via respiratory particles, and it is known to be transmissible from presymptomatic, paucisymptomatic, and asymptomatic individuals. Reducing disease spread requires two things: limiting contacts of infected individuals via physical distancing and other measures and reducing the transmission probability per contact. The preponderance of evidence indicates that mask wearing reduces transmissibility per contact by reducing transmission of infected respiratory particles in both laboratory and clinical contexts. Public mask wearing is most effective at reducing spread of the virus when compliance is high. Given the current shortages of medical masks, we recommend the adoption of public cloth mask wearing, as an effective form of source control, in conjunction with existing hygiene, distancing, and contact tracing strategies. Because many respiratory particles become smaller due to evaporation, we recommend increasing focus on a previously overlooked aspect of mask usage: mask wearing by infectious people ("source control") with benefits at the population level, rather than only mask wearing by susceptible people, such as health care workers, with focus on individual outcomes. We recommend that public officials and governments strongly encourage the use of widespread face masks in public, including the use of appropriate regulation.
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Affiliation(s)
- Jeremy Howard
- fast.ai, San Francisco, CA 94105;
- Data Institute, University of San Francisco, San Francisco, CA 94105
| | - Austin Huang
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903
| | - Zhiyuan Li
- Center for Quantitative Biology, Peking University, Beijing 100871, China
| | - Zeynep Tufekci
- School of Information, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Vladimir Zdimal
- Institute of Chemical Process Fundamentals, Czech Academy of Sciences, CZ-165 02 Praha 6, Czech Republic
| | - Helene-Mari van der Westhuizen
- Department of Primary Health Care Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
- TB Proof, Cape Town 7130, South Africa
| | - Arne von Delft
- TB Proof, Cape Town 7130, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Amy Price
- Anesthesia Informatics and Media Lab, School of Medicine, Stanford University, Stanford, CA 94305
| | - Lex Fridman
- Department of Aeronautics and Astronautics, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Lei-Han Tang
- Department of Physics, Hong Kong Baptist University, Hong Kong SAR, China
- Complex Systems Division, Beijing Computational Science Research Center, Beijing 100193, China
| | - Viola Tang
- Department of Information Systems, Business Statistics and Operations Management, Hong Kong University of Science and Technology, Hong Kong SAR, China
| | - Gregory L Watson
- Department of Biostatistics, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095
| | - Christina E Bax
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | | | - Frederik Questier
- Teacher Education Department, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | | | - Larry F Chu
- Anesthesia Informatics and Media Lab, School of Medicine, Stanford University, Stanford, CA 94305
| | - Christina M Ramirez
- Department of Biostatistics, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095
| | - Anne W Rimoin
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095
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25
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Stephens M, Bartley C, Samuriwo R, Stubbs N. Evaluating the impact of the Tissue Viability Seating guidelines. J Tissue Viability 2021; 30:3-8. [PMID: 33390309 DOI: 10.1016/j.jtv.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/21/2020] [Accepted: 12/18/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Internationally, guidelines are developed to ensure safe, effective, person centred, timely, efficient, and effective practice. However, their use in clinical practice is found to be variable. The Tissue Viability Society (TVS) published updated seating guidelines in 2017, yet, little is known about how these guidelines are being used. METHODS The aim of this evaluation was to gauge the impact of the Tissue Viability Seating Guidelines on clinical practice and policy. A cross-sectional questionnaire was used to elicit the responses from anyone with an interest or role within seating and pressure ulcer prevention and management. The survey was distributed through a variety of methods including email to members of the Tissue Viability Society and social media platforms from September to December 2019. RESULTS and Discussion: There were thirty-nine responses, the bulk of which were from healthcare professionals across primary and secondary care. All but one respondent was from the United Kingdom. Eleven had incorporated the latest TVS seating guidance into policy and sixteen into practice. The results of our survey demonstrates congruence with the literature as the main themes that emerged included incorporating the guidance into everyday clinical practice, education, and training, and as a resource or dissemination tool. Barriers to implementation included being unaware of the guidelines and unaware of one's own professional and collective organisational responsibility to guideline dissemination. However, many respondents were planning to incorporate the guidelines using a variety of methods. CONCLUSION This survey has shown there are some examples of successful implementation of the TVS Seating guidelines. Future TVS guidelines should include implementation strategies, interventions, and goals for local champions to ensure barriers to implementation are both assessed and addressed. Future work could also include a trial of the guidelines within a pilot project.
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Affiliation(s)
- Melanie Stephens
- School of Health and Society, Mary Seacole Building, University of Salford, UK.
| | - Carol Bartley
- Occupational Therapist Rehab for Independence Ltd, Heskin, UK.
| | - Ray Samuriwo
- School of Healthcare Sciences, Cardiff University, Cardiff, UK; Wales Centre for Evidence Based Care, Cardiff University, Cardiff, UK.
| | - Nikki Stubbs
- Interim Professional Lead for Nursing and Clinical Project Lead -Integrated Wound Care Project Leeds Community Healthcare NHS Trust, UK.
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Surgical Mask Use in Physical Ecercise in Young Healthy Subjects Sume Trial. CENTRAL EUROPEAN JOURNAL OF SPORT SCIENCES AND MEDICINE 2021. [DOI: 10.18276/cej.2021.3-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Rosolanka R, Henao-Martinez AF, Pisney L, Franco-Paredes C, Krsak M. COVID-19: a review of current knowledge regarding exposure, quarantine, isolation and other preventive measures. Ther Adv Infect Dis 2021; 8:20499361211032039. [PMID: 34349986 PMCID: PMC8287266 DOI: 10.1177/20499361211032039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/23/2021] [Indexed: 01/08/2023] Open
Abstract
Deeper understanding of the spread, morbidity, fatality, and development of immune response associated with coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, is necessary in order to establish an appropriate epidemiological and clinical response. Exposure control represents a key part of the combat against COVID-19, as the effectiveness of current therapeutic options remains partial. Since the preventive measures have not been sufficiently able to slow down this pandemic, in this article we explore some of the pertinent knowledge gaps, while overall looking to effective vaccination strategies as a way out. Early on, such strategies may need to rely on counting the convalescents as protected in order to speed up the immunization of the whole population.
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Affiliation(s)
- Robert Rosolanka
- Department of Infectology and Travel Medicine, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollárova 2, Martin, 036 01, Slovakia
| | | | - Larissa Pisney
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Carlos Franco-Paredes
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Hospital Infantil de México, Federico Gomez, México City, México
| | - Martin Krsak
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Mercuri PhD M. Just follow the science: A government response to a pandemic. J Eval Clin Pract 2020; 26:1575-1578. [PMID: 33043527 PMCID: PMC7675691 DOI: 10.1111/jep.13491] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Mathew Mercuri PhD
- Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Institute of Health Policy, Management and EvaluationDalla Lana School of Public Health, University of TorontoTorontoOntarioCanada
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30
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Exercising and face masks: An important hypothesis buried in a selective review. Med Hypotheses 2020; 144:110255. [PMID: 33254562 PMCID: PMC7494435 DOI: 10.1016/j.mehy.2020.110255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/05/2020] [Indexed: 12/23/2022]
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Haischer MH, Beilfuss R, Hart MR, Opielinski L, Wrucke D, Zirgaitis G, Uhrich TD, Hunter SK. Who is wearing a mask? Gender-, age-, and location-related differences during the COVID-19 pandemic. PLoS One 2020; 15:e0240785. [PMID: 33057375 PMCID: PMC7561164 DOI: 10.1371/journal.pone.0240785] [Citation(s) in RCA: 243] [Impact Index Per Article: 60.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/02/2020] [Indexed: 02/07/2023] Open
Abstract
Masks are an effective tool in combatting the spread of COVID-19, but some people still resist wearing them and mask-wearing behavior has not been experimentally studied in the United States. To understand the demographics of mask wearers and resistors, and the impact of mandates on mask-wearing behavior, we observed shoppers (n = 9935) entering retail stores during periods of June, July, and August 2020. Approximately 41% of the June sample wore a mask. At that time, the odds of an individual wearing a mask increased significantly with age and was also 1.5x greater for females than males. Additionally, the odds of observing a mask on an urban or suburban shopper were ~4x that for rural areas. Mask mandates enacted in late July and August increased mask-wearing compliance to over 90% in all groups, but a small percentage of resistors remained. Thus, gender, age, and location factor into whether shoppers in the United States wear a mask or face covering voluntarily. Additionally, mask mandates are necessary to increase mask wearing among the public to a level required to mitigate the spread of COVID-19.
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Affiliation(s)
- Michael H. Haischer
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, United States of America
- Athletic and Human Performance Research Center, Marquette University, Milwaukee, Wisconsin, United States of America
| | - Rachel Beilfuss
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, United States of America
- Athletic and Human Performance Research Center, Marquette University, Milwaukee, Wisconsin, United States of America
| | - Meggie Rose Hart
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, United States of America
| | - Lauren Opielinski
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, United States of America
| | - David Wrucke
- Department of Biomedical Sciences, Marquette University, Milwaukee, Wisconsin, United States of America
| | - Gretchen Zirgaitis
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, United States of America
| | - Toni D. Uhrich
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, United States of America
- Athletic and Human Performance Research Center, Marquette University, Milwaukee, Wisconsin, United States of America
| | - Sandra K. Hunter
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, United States of America
- Athletic and Human Performance Research Center, Marquette University, Milwaukee, Wisconsin, United States of America
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32
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Beesoon S, Behary N, Perwuelz A. Universal masking during COVID-19 pandemic: Can textile engineering help public health? Narrative review of the evidence. Prev Med 2020; 139:106236. [PMID: 32795645 PMCID: PMC7418702 DOI: 10.1016/j.ypmed.2020.106236] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/07/2020] [Accepted: 08/09/2020] [Indexed: 12/29/2022]
Abstract
The Coronavirus Disease-2019 (COVID-19) pandemic caused by the virus SARS-CoV-2 is spreading very quickly around the world. In less than 7 months since it became known to the international community, the virus has infected 18 million in more than 180 countries and killing more than 700,000 people. Person-to-person transmission through infected respiratory droplets from patients with symptoms and asymptomatic carriers is the main mode of spread in the community. There is currently no standard agreed upon drug to treat the disease and the prospect of having a safe and efficacious vaccine might be years away. Thus, public health interventions such as social distancing and hand washing have been introduced and has, to some extent, slowed the progression of the pandemic. Universal masking as a public health intervention is currently mandatory in a vast majority of countries around the world. To avoid personal protective equipment (PPE) shortage crisis for medical staff and other frontline workers, health authorities are recommending the use cloth masks. Although in theory, cloth masks can be helpful to limit the spread of the COVID-19, serious consideration should be given to the choice of textile, the number of layers of cloth used, pre-treatment of the material with water repellent material and other compounds that can enhance the filtration efficiency of the masks without compromising their breathability. This review uses concepts of textile engineering and the theoretical principles of filtration to make suggestions and recommendations to improve the quality and safety of cloth masks for the general public.
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Affiliation(s)
- Sanjay Beesoon
- Surgery Strategic Clinical Network, Alberta Health Services, Canada; Division of Community Engagement, Faculty of Medicine and Dentistry, University of Alberta, Canada.
| | - Nemeshwaree Behary
- Ecole Nationale Supérieure des Arts et Industries Textiles (ENSAIT), GEMTEX Laboratory, 2 allée Louise et Victor Champier BP 30329, 59056 Roubaix, France; Université de Lille, Nord de France, F-59000 Lille, France
| | - Anne Perwuelz
- Ecole Nationale Supérieure des Arts et Industries Textiles (ENSAIT), GEMTEX Laboratory, 2 allée Louise et Victor Champier BP 30329, 59056 Roubaix, France; Université de Lille, Nord de France, F-59000 Lille, France
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Baigrie B, Mercuri M. Relevance, validity, and evidential reasoning in clinical practice. J Eval Clin Pract 2020; 26:1341-1343. [PMID: 32941705 DOI: 10.1111/jep.13474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Brian Baigrie
- The Institute for the History and Philosophy of Science and Technology, University of Toronto, Toronto, Ontario, Canada.,The Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Mathew Mercuri
- The Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Bax A, Bax CE, Stadnytskyi V, Anfinrud P. SARS-CoV-2 transmission via speech-generated respiratory droplets. THE LANCET. INFECTIOUS DISEASES 2020; 21:318. [PMID: 32926836 PMCID: PMC7486060 DOI: 10.1016/s1473-3099(20)30726-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/28/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Adriaan Bax
- Laboratory of Chemical Physics, NIDDK, National Institutes of Health, Bethesda, MD 20892-0520, USA.
| | - Christina E Bax
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Valentyn Stadnytskyi
- Laboratory of Chemical Physics, NIDDK, National Institutes of Health, Bethesda, MD 20892-0520, USA
| | - Philip Anfinrud
- Laboratory of Chemical Physics, NIDDK, National Institutes of Health, Bethesda, MD 20892-0520, USA
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van der Westhuizen HM, Kotze K, Tonkin-Crine S, Gobat N, Greenhalgh T. Face coverings for covid-19: from medical intervention to social practice. BMJ 2020; 370:m3021. [PMID: 32816815 DOI: 10.1136/bmj.m3021] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | - Koot Kotze
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
- TB Proof, South Africa
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Nina Gobat
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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Robblee J, Buse DC, Halker Singh RB, Schusse CM, Riggins N, Rayhill ML, Loder EW, Donnelly M, Borrero-Mejias C. Ten Eleven Things Not to Say to Healthcare Professionals During the Coronavirus Disease 2019 Pandemic. Headache 2020; 60:1837-1845. [PMID: 32696455 DOI: 10.1111/head.13932] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 12/31/2022]
Abstract
On March 11, 2020, the infection caused by the coronavirus disease 2019 (COVID-19) virus was declared a pandemic. Throughout this pandemic, healthcare professionals (HCPs) have experienced difficulties stemming from poor communications, resource scarcity, lack of transparency, disbelief, and threats to the safety of their loved ones, their patients, and themselves. As part of these hardships, negative statements have been heard repeatedly. This paper describes 11 scenarios of unhelpful and dysfunctional messages heard by the authors and their colleagues during the COVID-19 pandemic, reported to us by a combination of peers, administrative leadership, and the public. We explain why not to use such messaging, and we suggest more helpful and compassionate expressions based upon recommendations published by scientific organizations and well-established psychological principles. The first 10 scenarios discussed include (1) lack of understanding regarding the extent of the pandemic; (2) shaming over not seeing patients in person; (3) lack of clear and consistent communication from leadership on pandemic-related practice changes; (4) opinions that personal protective equipment (PPE) use by HCPs causes fear or is unnecessary; (5) forcing in-person care without appropriate PPE; (6) the risk of exposure to asymptomatic individuals as it relates to opening clinics; (7) media gag orders; (8) pay and benefit reductions; (9) spreading of misinformation about the COVID-19 pandemic; and (10) workload expectations. The 11th scenario addresses HCPs' psychological and physical reactions to this challenging and prolonged stressful situation. We close by discussing the need for support and compassion at this difficult and unpredictable time and by offering suggestions to foster resilience and feelings of self-efficacy among HCPs.
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Affiliation(s)
- Jennifer Robblee
- Department of Neurology, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Dawn C Buse
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rashmi B Halker Singh
- Division of Headache Medicine, Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
| | - Courtney M Schusse
- Department of Neurology, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Nina Riggins
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Melissa L Rayhill
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Elizabeth W Loder
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Megan Donnelly
- Novant Health Neurology & Headache - SouthPark, Charlotte, NC, USA
| | - Clarimar Borrero-Mejias
- Department of Neurology, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, USA
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38
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Affiliation(s)
- John T Brooks
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jay C Butler
- Centers for Disease Control and Prevention, Atlanta, Georgia
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