The Use of Facemasks During the COVID-19 Pandemic by the Brazilian Population

The Usability of Face Coverings Used to Prevent the Spread of COVID-19

OBJECTIVE

To describe the perceived usability and usability problems associated with face coverings used to prevent the spread of COVID-19.

BACKGROUND

Since public health experts have now identified the appropriate use of facemasks as one of the critical elements in an effective COVID mitigation strategy, understanding how people use and care for them has become important.

METHOD

Data were collected via a survey that was shared on social media to which 2148 people responded. Participants were asked to identify the category class of the face covering they most often wear, rate its usability, answer demographic information, and questions about their mask use and hygiene, and identify issues they may suffer in relation to face cover use.

RESULTS

Overall, users appear to perceive their face coverings favorably from a usability and satisfaction standpoint, even though almost two-thirds of users indicated that they experienced discomfort and problems with glasses fogging with the most popular mask types. When considering demographic information, users' political party affiliation appears related to how they perceive the usability of their face covering.

CONCLUSION

Designers should work to improve the fit and comfort properties of protective masks; evidence suggests the System Usability Scale may be a useful tool in those efforts.

APPLICATION

Understanding mask design and behavioral issues related to their use can help in the development of masks and will maximize their acceptance and effectiveness in the field.

Brazilian Adults’ Attitudes and Practices Regarding the Mandatory COVID-19 Vaccination and Their Hesitancy towards Childhood Vaccination

Background: This study investigated the attitudes and practices of Brazilian adults regarding the mandatory COVID-19 vaccination and their hesitancy towards the vaccination of children. Methods: Between March and May 2022, Brazilian adults answered an online questionnaire distributed through social media. The SAGE-WG questionnaire was adapted to measure hesitancy to the vaccination of children. Results: Of the 1007 participants, 67.4% believed that adult COVID-19 vaccination should be mandatory. Just over half of the participants (51.5%) believed that parents and/or guardians should decide if their children should be vaccinated against COVID-19 or not and 9.1% were unsure. Individuals who were younger, non-religious and had higher awareness of COVID-19 risks and critics of the federal government’s performance in combating the pandemic were more likely to agree with mandatory adult vaccination. However, less agreement among parents and/or guardians concerning children’s vaccination was observed, with lower scores for hesitancy to the vaccination of children. Conclusion: In Brazil, there is still far from a consensus on mandatory COVID-19 vaccination for adults and a significant proportion of the population believes that parents and/or guardians should be free to decide on their children’s vaccination. These views are associated with age, religion, knowledge of COVID-19 risks and political inclination.

[Mask use during the COVID-19 pandemic in Brazil: results of the EPICOVID19-BR study]

By March 3, 2022, the COVID-19 pandemic has caused more than 399 million infections and claimed the lives of more than five million people worldwide. To reduce infection rates, a series of prevention measures indicated by the World Health Organization (WHO) were adopted by countries, including the use of masks. This study aims to describe mask use in Brazil via data analysis from the EPICOVID19-BR, a population-based study conducted in 133 cities in the country in four phases between March and August 2020. The proportion of individuals who reported wearing a mask when they left their homes was 97.9% (95%CI: 97.8-98.0). The interviewer did not see interviewees' mask in 50% (95%CI: 49.9-51.1) of the cases at the time of the interview. However, between phase one and four of the survey, we observed a 4.4% decrease in the proportion of interviewees who failed to wear masks at the time of the interview. Mask non-visualization was more prominent in women, participants aged 10-19 and 20-29 years of indigenous, black, and brown skin color, and those with elementary and high school education and in the Central-West Region. The use of cloth masks showed a 91.4% predominance (95%CI: 91.2-1.5) with a 4.9% increase between phases 1 and 4. The results of the study bring important information to reinforce COVID-19 control policies in Brazil. The high percentage of people who failed to wear masks at the time of the interview suggests that it is still important to reinforce prevention and self-care, rather than relating mask wear to a mandatory measure.

Compliance with wearing facemasks by university teaching staff during the second wave of COVID-19 pandemic: a cross sectional study

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.

Perceived accessibility and mental health consequences of COVID-19 containment policies

BACKGROUND

Individuals have experienced various degrees of accessibility loss during the COVID-19 pandemic, which may consequently have influenced their mental health. Although efforts have been made to understand the mental health consequences of the pandemic and corresponding containment measures, the impacts of accessibility loss remain underexplored.

METHODS

Based on 186 family interviews, a 569-respondent panel survey was designed and distributed monthly from February to October 2020 in Kunming, China. A 3-wave cross-lagged panel model was developed to understand the causal relationship between mental health and perceived accessibility of daily necessities, key services, and social activities.

RESULTS

Goodness-of-fit indicators imply that the hypothesised model fits the observed data well: χ2/df = 2.221, AGFI = 0.910, NFI = 0.907, CFI = 0.933, RMSEA = 0.052. The results indicate that perceived accessibility of daily necessities and social activities had lagged effects on mental health status. The within-wave effects show that perceived accessibility of daily necessities (0.619, p < 0.01) and social activities (0.545, p < 0.01) significantly influenced respondents' mental health during the peak of the pandemic whilst perceived accessibility of social activities dominantly influenced their mental health after restrictions were lifted (0.779, p < 0.01). Perceived accessibility of public services such as healthcare did not significantly influence respondents' mental health in any wave. COVID-19 containment policies had different mental outcomes across population groups. Disadvantaged people experienced mental health issues due to accessibility loss for daily necessities and social activities until the lifting of compulsory QR-code-for-buses, whilst better-off populations had better mental health during the early phase of the outbreak and rapidly recovered their mental health after mobility restrictions eased.

CONCLUSION

Reduced perceived accessibility of daily necessities and social activities may be an underlying cause of mental health problems. Relative accessibility deprivation exacerbated mental health inequities during the COVID-19 pandemic.

Psychosocial Factors Associated With Adherence to COVID-19 Preventive Measures in Low-Middle- Income Countries, December 2020 to February 2021

Objectives: To investigate psychosocial factors associated with adherence to COVID-19 preventive measures in low- and middle-income countries (LMICs). Methods: This online cross-sectional survey included 10,183 adults (median age 45 years) from nine LMICs. Participants were asked about adhering to four COVID-19 preventive measures (physical distancing, wearing a face mask, hand, and cough hygiene); a composite adherence score was calculated, ranging from 0-4 positive responses. Psychosocial measures included worry, anxiety, depression, social and demographic, and COVID-19 related factors. Results: Factors associated with adherence to more preventive measures included being a participant from Malaysia or Bangladesh, older age, higher education, belonging to the healthcare sector (either as or worker), having health personnel as a trusted source of COVID-19 information/advice, possessing correct COVID-19 knowledge, worry or fear about being (re)infected with COVID-19, and screening negative for general anxiety symptoms. Conclusion: Moderate to high adherence to COVID-19 preventive measures was found, with significant variations across countries. Psychosocial factors (worry, anxiety, knowledge, education, age, and country) seemed determinant in predicting the number of measures to which participants adhered.

Face Mask Practice and Technique During the COVID-19 Pandemic: A Nonrepresentative Cross-Sectional Study in Sudan

Background

The World Health Organization issued guidelines for face mask use in community settings during the current COVID-19 pandemic. However, data are limited on public compliance with those guidelines in Sudan. Therefore, this study assessed face mask-wearing practice and technique during the COVID-19 pandemic among residents of Sudan.

Methods

A cross-sectional study was conducted from July to September 2021 among Sudanese aged ≥18 years. A web-based questionnaire was shared through different social media platforms. Personal characteristics, four knowledge-associated items, three attitude-associated items, one item concerning mask-wearing practice, and five items related to mask-wearing technique were determined. Univariate, bivariate, and multivariable analyses were performed using STATA v17.

Results

The survey included 1059 participants (48% males, 52% females) from different regions of Sudan. The overall mean ± SD was 3 ± 0.73 for knowledge of COVID-19 transmission; 2.3 ± 0.71 for attitude toward wearing face masks; 0.38 ± 0.49 for the practice of wearing a face mask; and 4.17 ± 0.97 for face mask-wearing technique. Approximately one-third (38%) of participants always wore a face mask during the pandemic, with age, sex, education level, family income, face mask attitude, occupation, and history of COVID-19 infection affecting the practice. All steps of face mask-wearing technique were performed by 46% of participants (59% performed hand hygiene before putting on a mask and 86% after removing it; 98% covered mouth and nose; 90% adjusted masks at the nose bridge, and 84% tied masks securely), and associated with age, occupation, family income, history of COVID-19 infection, and face-mask attitude.

Conclusion

Although knowledge and attitude were relatively good, the practice of wearing a face mask and using proper techniques among participants were low. To ensure optimal face mask use and proper mask-wearing techniques, educational intervention and establishing governmental regulations are highly recommended.

An exploration of the political, social, economic and cultural factors affecting how different global regions initially reacted to the COVID-19 pandemic

Responses to the early (February-July 2020) COVID-19 pandemic varied widely, globally. Reasons for this are multiple but likely relate to the healthcare and financial resources then available, and the degree of trust in, and economic support provided by, national governments. Cultural factors also affected how different populations reacted to the various pandemic restrictions, like masking, social distancing and self-isolation or self-quarantine. The degree of compliance with these measures depended on how much individuals valued their needs and liberties over those of their society. Thus, several themes may be relevant when comparing pandemic responses across different regions. East and Southeast Asian populations tended to be more collectivist and self-sacrificing, responding quickly to early signs of the pandemic and readily complied with most restrictions to control its spread. Australasian, Eastern European, Scandinavian, some Middle Eastern, African and South American countries also responded promptly by imposing restrictions of varying severity, due to concerns for their wider society, including for some, the fragility of their healthcare systems. Western European and North American countries, with well-resourced healthcare systems, initially reacted more slowly, partly in an effort to maintain their economies but also to delay imposing pandemic restrictions that limited the personal freedoms of their citizens.

COVID-19-related personal protective equipment (PPE) contamination in the highly urbanized southeast Brazilian coast

This study aimed to report personal protective equipment (PPE) contamination in Santos beaches (Brazil) using standardized procedures for the first time while comparing two periods to understand the progression of PPE contamination. The occurrence of PPE items was ubiquitous in all sampled sites, although the densities were relatively low compared to those in other parts of the world. Unlike previous studies, reusable face masks were the most common type of PPE. PPE density in the studied areas was similar in both sampling seasons, probably because of the influence of tourism, urbanization, and local hydrodynamic aspects. PPE items can release microfibers into the aquatic environment and pose entanglement hazards to marine biota. A wider monitoring of PPE pollution, accompanied by surveys on PPE usage and behavior, as well as chemical characterization of the discarded PPE items, is needed to fully understand this unprecedented form of plastic pollution.

COVID-19-related personal protective equipment (PPE) contamination in the highly urbanized southeast Brazilian coast

This study aimed to report personal protective equipment (PPE) contamination in Santos beaches (Brazil) using standardized procedures for the first time while comparing two periods to understand the progression of PPE contamination. The occurrence of PPE items was ubiquitous in all sampled sites, although the densities were relatively low compared to those in other parts of the world. Unlike previous studies, reusable face masks were the most common type of PPE. PPE density in the studied areas was similar in both sampling seasons, probably because of the influence of tourism, urbanization, and local hydrodynamic aspects. PPE items can release microfibers into the aquatic environment and pose entanglement hazards to marine biota. A wider monitoring of PPE pollution, accompanied by surveys on PPE usage and behavior, as well as chemical characterization of the discarded PPE items, is needed to fully understand this unprecedented form of plastic pollution.

COVID-appropriate facemask use: A study among patients attending outpatient Departments of a Public Health Institute in West Bengal

BACKGROUND

In the ongoing COVID-19 pandemic, facemask use has been the most feasible public health measure in preventing transmission of SARS-CoV2 with the dual benefit of controlling the source of infection and decreasing the risk of acquiring infection from infected people. Therefore, COVID-appropriate behavior regarding facemask use is imperative for controlling the pandemic. This study aimed to assess COVID-appropriate mask behavior and factors associated with it among the patients attending outpatient departments of a public health institute in West Bengal.

MATERIALS AND METHODS

This cross-sectional study was done among 298 patients attending outpatient departments of Rural and Urban Health Units of a public health institute of Kolkata, during October 2020-February 2021. A pretested questionnaire and an observational checklist based on the World Health Organization guidelines were used to collect data. COVID-appropriate mask behavior was assessed by a five-point domain-wise scale, where good practice regarding facemask usage was considered when the score was three or more. Statistical analyses were done in SPSS 16.0.

RESULTS

Good practices regarding COVID-19 appropriate mask-related activities were recorded among 30.2% of the study participants. No difficulties faced during or on wearing a mask (adjusted odds ratio [AOR] = 1.86, 95% confidence interval CI: 1.1-3.33) and higher socioeconomic status (AOR = 2.25, 95% CI: 1.22-4.15) were significantly associated with good practice regarding COVID-19 appropriate facemask usage.

CONCLUSION

The magnitude of poor practice regarding COVID-appropriate mask-related behaviors is quite high among the study participants. Awareness regarding correct mask handling, storage, hygiene, disposal, and place of wearing from a reliable source would go a long way to curb the myths and misinformation surrounding mask usage and encourage COVID-appropriate mask behaviors among the general population.

Facemask Usage Among People With Primary Ciliary Dyskinesia During the COVID-19 Pandemic: A Participatory Project

Objectives: Primary ciliary dyskinesia (PCD) is a rare genetic disease that causes recurrent respiratory infections. People with PCD may be at high risk of severe COVID-19 and protection against SARS-CoV-2 is therefore important. We studied facemask usage and problems reported in relation with their use among people with PCD. Methods: We used data from COVID-PCD, an international observational cohort study. A questionnaire was e-mailed to participants in October 2020 that asked about facemask usage. Results: In total, 282 participants from 27 countries were included (Median age 32 years; 63% female). In total, 252 (89%) wore facemasks everywhere in public, 13 (5%) wore facemasks in most places, and 17 (6%) did not wear facemasks in public. Half of the participants reported that it was uncomfortable to wear facemasks because of runny nose, cough, or difficulty breathing. Participants less often wore facemasks when there was no national requirement. Conclusion: Most people with PCD wore facemasks despite frequent respiratory problems related to their use. Facemask usage was most frequent in countries with a national requirement emphasizing the importance of nationwide policies mandating facemasks.

Historical Evolution and Filtering Characteristics of Masks and Respirators in Dentistry in the Context of COVID-19: A Literature Review

OBJECTIVES

At present, it is very important to identify the available literature regarding the use of masks and respirators by analyzing their historical evolution in the medical field. In addition, consideration should be given to the major filtering characteristics of those most used due to the current SARS-CoV-2 pandemic. Therefore, the purpose of this literature review is to describe the qualitative evolution that facemasks and respirators have undergone along with their different characteristics.

MATERIALS AND METHODS

This literature review was conducted between September and December 2020. Articles were identified from PubMed Central, Scopus, and Web of Science. The following keywords were used: "COVID-19," "dentistry," and "masks." These MeSH terms were combined with the Boolean operators "AND" and "OR."

RESULTS

We found 36 articles in PubMed Central, 21 in Scopus, and 17 in Web of Science, which included reviews, clinical, descriptive, and experimental trials.

CONCLUSION

The emergence of new pathogens leads to continuous improvement in masks and respirators. It was determined that for the dental field, respirators with filtration characteristics greater than 95%, such as FFP3, N100, N95, and KN95, are indicated in addition to their decontamination and reuse processes.

Changes of perceptions and behaviours during the phases of COVID-19 pandemic in German elderly people with neurological disorders: an observational study using telephone interviews

OBJECTIVES

Describing perceived limitations in everyday life, psychological burden and approval to easing of measures during the COVID-19 phases in elderly people with neurological disorders.

DESIGN

Observational, prospective study SETTING: This is a monocentric study conducted at a university hospital in Germany.

PARTICIPANTS

Overall, 452 elderly people participated in the NeuroGerAdh study (DRKS00016774) and were interviewed by telephone between 18 March and 30 August 2020.

RESULTS

Overall, 307 (67.9%) patients had relevant limitations in daily life due to the measures. These limitations significantly decreased during the pandemic phases. At the beginning of the pandemic, people complained about restricted social contacts and mobility, which were the most common reasons for perceived limitations in daily life. Later, since June 2020, wearing a mouth-nose mask had become the main reason for perceived limitations. In the elastic net regularisation, model higher perceived limitations in daily life were among others associated with younger age and earlier pandemic phases. Higher psychological burden was mainly associated with early pandemic phase, younger age and depression.The perceived psychological burden decreased as the pandemic phases passed, even though the reasons for psychological burden (anxiety or fear of infection, insecurity and concerns) did not remarkably change during the phases. From 16 June 2020, the patients were asked whether they approve the easing of measures. Sixty-seven of 136 patients (49.3%) approved and 55 (40.4%) did not. The common reasons for disapproval were fear of increased risk of infection and irresponsible behaviour of other people.

CONCLUSION

While limitations in daily life decreased during the study period, anxiety remains a common psychological burden in elderly sick people, and this needs special attention. Accordingly, most people do not approve easing of measures. Special strategies are needed to cope with changing measures during the COVID-19 pandemic.

Achieving Universal Wearing of Face Masks During the COVID-19 Pandemic: A Practical Solution from Shanghai, China

Background

Face masks are basic protective equipment for preventing respiratory infectious diseases. The measures to properly dispose of and allocate face masks during the early stage of an epidemic caused by respiratory infectious diseases deserve worldwide attention.

Methods

A qualitative research approach was used to document the practice of a citywide face mask–wearing strategy of the Shanghai Municipal Government (called the “Shanghai solution” in this article). Based on data from government work documents, an online face mask–allocation and sales system was built to offer real-time updates of face-mask appointments and sales information in all designated pharmacies and neighborhood committees in Shanghai.

Results

In the Shanghai solution, a total of 24.8 million residents in 6,031 committees were covered, in order to achieve universal wearing of face masks during the COVID-19 crisis. Up to 110 million face masks were dispensed to residents in six rounds of face-mask allocation during February to April. This practical experience in Shanghai solved two key problems (insufficient face-mask capacity, protection of vulnerable population) with the supply of face masks by addressing four essential characteristics: overall coordination, on-demand distribution, efficient distribution, and technical support.

Conclusion

The practice of the citywide face mask–supply strategy of Shanghai could provide several pointers for management of a shortage of emergency materials, dispatch, and transport to other countries during the pandemic.