Dynamic Response Systems of Healthcare Mask Production to COVID-19: A Case Study of Korea

Evaluating Droplet Survivability on Face Masks with X-ray Microtomography

When a person talks, coughs, or sneezes, respiratory droplets are expelled and inevitably land on several surfaces, representing a route for respiratory disease transmission. Here, face masks act as a barrier by obstructing the passage of droplets during exhalation and inhalation. Being constantly exposed to respiratory events and carrying droplet residue, understanding the evaporation and absorption dynamics for tiny droplets on face masks and the fate of viral particle deposition is necessary to analyze the contamination risk. We explore the ideal design for masks from the interaction of mask surfaces with surrogate respiratory droplets by X-ray microscopy and microtomography. We show that the respiratory droplet survivability is significantly reduced in masks with a hydrophilic surface where absorption takes place, leading to a reduction of the postevaporation droplet residue at the mask surface compared with a hydrophobic surface. The results allow us to propose a better mask layer design dependent on wettability, reducing the risk of contamination from respiratory droplets.

Post-Pandemic: Investigation of the Degradation of Various Commercial Masks in the Marine Environment

During COVID-19, personal protective equipment such as face masks was in urgent demand in the daily life. As the pandemic may have withdrawn from public attention, the disposal of face masks is a significant issue, especially plastic pollution. To address the degradation of the polymers in the marine environment, seven commercial masks were investigated via artificial weathering procedures in substitute ocean water. A suite of structural and chemical characterization techniques was employed, including scanning electron microscopy (SEM), X-ray photoelectron spectroscopy (XPS), Fourier transform infrared spectroscopy (FT-IR), Raman spectroscopy, X-ray diffraction (XRD), and contact angle goniometry, to probe the treatment impact on commercially available N95, surgical, polyurethane, polyester, nylon, silk, and cotton masks. This work provides insights into the comprehensive analysis of material degradation in nature and raises public awareness of environmental issues post-pandemic.

Measuring the quantity of harmful volatile organic compounds inhaled through masks

An increase in the concentration of environmental particulate matter and the spread of the COVID-19 virus have dramatically increased our time spent wearing masks. If harmful chemicals are released from these masks, there may be harmful effects on human health. In this study, the concentration of volatile organic compounds (VOCs) emitted from some commonly used masks was assessed qualitatively and quantitatively under diverse conditions (including different mask material types, time between opening the product and wearing, and mask temperature). In KF94 masks, 1-methoxy-2-propanol (221 ± 356 µg m-3), N,N-dimethylacetamide (601 ± 450 µg m-3), n-hexane (268 ± 349 µg m-3), and 2-butanone (160 ± 244 µg m-3) were detected at concentrations 22.9-147 times higher than those found in masks made from other materials, such as cotton and other functional fabrics. In addition, in KF94 masks, the total VOC (TVOC) released amounted to 3730 ± 1331 µg m-3, about 14 times more than that released by the cotton masks (267.5 ± 51.6 µg m-3). In some KF94 masks, TVOC concentration reached over 4000 µg m-3, posing a risk to human health (based on indoor air quality guidelines established by the German Environment Agency). Notably, 30 min after KF94 masks were removed from their packaging, TVOC concentrations decreased by about 80% from their initial levels to 724 ± 5.86 µg m-3; furthermore, 6 h after removal, TVOC concentrations were found to be less than 200 µg m-3. When the temperature of the KF94 masks was raised to 40 oC, TVOC concentrations increased by 119-299%. Since the types and concentrations of VOCs that will be inhaled by mask wearers vary depending on the mask use conditions, it is necessary to comply with safe mask wearing conditions.

Nonpharmaceutical interventions reduce the incidence and mortality of COVID‐19: A study based on the survey from the International COVID‐19 Research Network (ICRN)

The recently emerged novel coronavirus, “severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2),” caused a highly contagious disease called coronavirus disease 2019 (COVID‐19). It has severely damaged the world's most developed countries and has turned into a major threat for low‐ and middle‐income countries. Since its emergence in late 2019, medical interventions have been substantial, and most countries relied on public health measures collectively known as nonpharmaceutical interventions (NPIs). We aimed to centralize the accumulative knowledge of NPIs against COVID‐19 for each country under one worldwide consortium. International COVID‐19 Research Network collaborators developed a cross‐sectional online survey to assess the implications of NPIs and sanitary supply on the incidence and mortality of COVID‐19. The survey was conducted between January 1 and February 1, 2021, and participants from 92 countries/territories completed it. The association between NPIs, sanitation supplies, and incidence and mortality were examined by multivariate regression, with the log‐transformed value of population as an offset value. The majority of countries/territories applied several preventive strategies, including social distancing (100.0%), quarantine (100.0%), isolation (98.9%), and school closure (97.8%). Individual‐level preventive measures such as personal hygiene (100.0%) and wearing facial masks (94.6% at hospitals; 93.5% at mass transportation; 91.3% in mass gathering facilities) were also frequently applied. Quarantine at a designated place was negatively associated with incidence and mortality compared to home quarantine. Isolation at a designated place was also associated with reduced mortality compared to home isolation. Recommendations to use sanitizer for personal hygiene reduced incidence compared to the recommendation to use soap. Deprivation of masks was associated with increased incidence. Higher incidence and mortality were found in countries/territories with higher economic levels. Mask deprivation was pervasive regardless of economic level. NPIs against COVID‐19 such as using sanitizer, quarantine, and isolation can decrease the incidence and mortality of COVID‐19.

Research on the Anti-Risk Mechanism of Mask Green Supply Chain from the Perspective of Cooperation between Retailers, Suppliers, and Financial Institutions

Against the background of the pandemic, the mask supply chain faces the risk of pollution caused by discarded masks, the risk of insufficient funds of retailers, and the risk of mask overstock. To better guard against the above risks, this study constructed a two-party game model and a cusp catastrophe model from the perspective of the mask green supply chain, and studied the strategic choices of retailers and suppliers in the supply chain affected by the risk of capital constraints and overstock. The result shows that the risk shocks will lead to the disruption of the mask green supply chain, and the main factors affecting the strategy choice of mask suppliers and retailers are mask recycling rate, deposit ratio, risk occurrence time, etc. In further research, this study involved a mechanism for financial institutions, mask retailers, and the government to jointly deal with the risk of mask overstock, the risk of retailers' insufficient funds, and the risk of environmental pollution from discarded masks. The research path and conclusion of this study reveal the risks in the circulation area of mask supplies during the pandemic, and provide recommendations for planning for future crises and risk prevention.

Nonpharmaceutical interventions reduce the incidence and mortality of COVID-19: A study based on the survey from the International COVID-19 Research Network (ICRN)

The recently emerged novel coronavirus, "severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)," caused a highly contagious disease called coronavirus disease 2019 (COVID-19). It has severely damaged the world's most developed countries and has turned into a major threat for low- and middle-income countries. Since its emergence in late 2019, medical interventions have been substantial, and most countries relied on public health measures collectively known as nonpharmaceutical interventions (NPIs). We aimed to centralize the accumulative knowledge of NPIs against COVID-19 for each country under one worldwide consortium. International COVID-19 Research Network collaborators developed a cross-sectional online survey to assess the implications of NPIs and sanitary supply on the incidence and mortality of COVID-19. The survey was conducted between January 1 and February 1, 2021, and participants from 92 countries/territories completed it. The association between NPIs, sanitation supplies, and incidence and mortality were examined by multivariate regression, with the log-transformed value of population as an offset value. The majority of countries/territories applied several preventive strategies, including social distancing (100.0%), quarantine (100.0%), isolation (98.9%), and school closure (97.8%). Individual-level preventive measures such as personal hygiene (100.0%) and wearing facial masks (94.6% at hospitals; 93.5% at mass transportation; 91.3% in mass gathering facilities) were also frequently applied. Quarantine at a designated place was negatively associated with incidence and mortality compared to home quarantine. Isolation at a designated place was also associated with reduced mortality compared to home isolation. Recommendations to use sanitizer for personal hygiene reduced incidence compared to the recommendation to use soap. Deprivation of masks was associated with increased incidence. Higher incidence and mortality were found in countries/territories with higher economic levels. Mask deprivation was pervasive regardless of economic level. NPIs against COVID-19 such as using sanitizer, quarantine, and isolation can decrease the incidence and mortality of COVID-19.

Public Interest, Risk, Trust, and Personal Protective Equipment Purchase and Usage: Face Masks Amid the COVID-19 Pandemic

This analysis considers public interest in COVID-19-related issues as well as individuals’ risk perception and trust in society in their demand for face masks during the pandemic. Through a national survey, we examine demand during both the outbreak and the recovery stage of the pandemic and differentiate demand into purchasing and usage. The examination allows us to observe the evolvement of demand over time and stockpiling. We find that public interest and risk perception had a more significant association with mask demand during the outbreak stage, and trust was more connected with mask demand during the recovery stage. While stocking was evident in both stages, consumers were much less price sensitive in the outbreak stage. Overall, the relationship between most factors and mask demand was smaller in the recovery stage. Our research is useful for policymakers to assess the creation and termination of temporary legislation to help manage the value chain of personal protective equipment during a major public health crisis.

Public Health Financing and Responses to COVID-19: Lessons from South Korea

Health financing strategies contribute significantly to containing the outbreak of the Coronavirus disease 2019 (COVID-19). This study aims to reassess Korea’s financing strategies in response to COVID-19 in 2020, to ascertain its effects and sustainability. The Joint External Evaluation tool was adopted to analyze the data collected from government reports, official statistics, and other sources. Findings show that Korea could maintain a low incidence and fatality rate compared with other countries, at low costs. It was a result of rapidly procured healthcare resources based on laws and policies established after the 2015 epidemic, and the National Health Insurance. However, to achieve long-term sustainability, it is important to enhance the financial stability of the national health insurance and increase the proportion of the public sector in healthcare resources.

Impact of the First Phase of the COVID-19 Pandemic on the Acquisition of Goods and Services in the Italian Health System

The emergency caused by the escalation in the COVID-19 pandemic, which became widespread starting on 31 January 2020, put a strain on the Italian National Health System and forced purchasing centres to deviate from the ordinary general principles dictated by current legislation. The aim of this paper is to describe how Spedali Civili Hospital in Brescia challenged the crisis, structured itself optimally, followed simplified procedures, launched new processes, and opened up more Intensive Care Unit beds to accommodate the high number of COVID cases. From an analysis of the equipment variation in terms of increased purchases, subsequent installations, and tests carried out compared with the pre-pandemic period, we report the difficulties that hospitals had to face in the first phase of the pandemic and how they were able to respond to their needs. Our data clearly displayed how the pandemic situation led to a deep internal reorganisation and that the drafting of simpler, effective, and adaptable procedures represents a first key element to ensure receptivity and responsiveness in the management of ordinary and non-ordinary events such as this pandemic condition.

Validation of "Personal Protective Equipment Conservation Strategies Tool" to Predict Consumption of N95s, Facemasks, and Gowns During Pandemic-Related Shortages

We sought to prospectively validate a model to predict the consumption of personal protective equipment in a pediatric emergency department during the COVID-19 pandemic. We developed the Personal Protective Equipment Conservation Strategies Tool, a Monte Carlo simulation model with input parameters defined by members of our emergency department personal protective equipment task force. Inputs include different conservation strategies that reflect dynamic reuse policies. Over the course of 4 consecutive weeks in April and May 2020, we used the model to predict the consumption of N95 respirators, facemasks, and gowns in our emergency department based on values for each input parameter. At the end of each week, we calculated the percent difference between actual consumption and predicted consumption based on model outputs. Actual consumption of personal protective equipment was within 20% of model predictions for each of the 4 consecutive weeks for N95s (range, -16.3% to 16.1%) and facemasks (range, -7.6% to 13.1%), using "maximum conservation" and "high conservation" strategies, respectively. Actual consumption of gowns was 11.8% less than predicted consumption for Week 1, gown resupply data were unavailable on Weeks 2-4. The Personal Protective Equipment Conservation Strategies Tool was prospectively validated for "maximum conservation" and "high conservation" models, with actual consumption within 20% of model predictions.

COVID-19 pandemic in Uttarakhand, India: Environmental recovery or degradation?

The human coronavirus disease-2019 (COVID-19) caused by SARS-CoV-2 is now a global pandemic. Personal hygiene such as hand-washing, the use of personal protective equipment, and social distancing via local and national lockdowns are used to reduce the risk of transmission of SARS-CoV-2. COVID-19 and the associated lockdowns may have significant impacts on environmental quality and ergonomics. However, limited studies exists on the impacts of COVID-19 and the associated lockdowns on environmental quality and ergonomics in low-income settings. Therefore, the present study investigated the impacts of the COVID-19 outbreak on socioeconomics, ergonomics and environment (water quality, air quality and noise) in Uttarakhand, India. Approximately 55% of respondents experienced headaches, and the other common health-related issue was back pain, with 45% of respondents having problems with their backs. Water and air quality significantly improved during the lockdown relative to the pre-lockdown period, but was observed to return to their previous characteristics afterwards. Lockdowns significant increased the concentration of indoor air pollutants while noise pollution levels significantly declined. In summary, lockdowns have adverse impacts on ergonomics, resulting in work-related human health risks. The impacts of lockdowns on environmental quality are mixed: temporary improvements on water and air quality, and noise reduction were observed, but indoor air quality deteriorated. Therefore, during lockdowns there is a need to minimize the adverse environmental and ergonomic impacts of lockdowns while simultaneously enhancing the beneficial impacts.

Filtering Facepiece Respirator Supply Chain Management Framework in a Disaster Such as COVID-19

Due to the lack of vaccines and treatments, filtering facepiece respirators are a primary and effective tool to dampen the spread of COVID-19. To meet the huge and continuous demand for filtering facepiece respirators, this concept paper suggests a supply chain management framework based on the disaster management principle. This concept paper adopts an exploratory and qualitative literature review to provide managerial insights for the supply chain participants. Due to implementation delay and strategic interdependency, the supply chain management strategies need to be systematically integrated. A viable way to integrate strategies is based on the disaster management cycle: mitigation, preparation, response, and recovery phases. Our model integrates innovative and successful but overlooked supply chain management strategies. First, the production capacity should be flexible so that the production mode in emergency and normal situations can be different. Second, the concept paper and development facilities can utilize their capacities for actual production in emergencies. Third, the quality certification process should accommodate the flexible production capacities. Fourth, inventory stockpiling should be renewable. This concept paper contributes to policymakers, healthcare sector decision-makers, stakeholders throughout the FFR supply chain to cope with future crises caused by pandemics by providing a systematic approach to constructing an effective, flexible, and resilient supply chain.

Analysis of Taiwan's Mask Collection and Plan Evasion during the COVID-19 Pandemic

This study established a two-stage dynamic game strategy to analyze how the planned quota and price of masks were set and why mask manufacturing firms on the national mask team (NMT) in Taiwan evaded the plan. Plan evasion occurred when the NMT decided to produce less than the quota set by the government, even though they were incentivized and able to produce more. Taiwan's experience shows that through the collection of masks and the Name-Based Mask Rationing System, the people's right to procure masks can be guaranteed; however, to promote market transaction efficiency, the government should adopt a lower quota for the collection of masks and allow firms to freely sell them in the market after they complete their plans. The self-interest of the government played a key role in inducing plan evasion.

Lesson Learned from the Power of Open Data: Resolving the Mask Shortage Problem Caused by COVID-19 in South Korea

COVID-19 is spreading globally and causing severe damage across different sectors including social culture, politics, and economy. Governments worldwide are responding in various ways to prevent the spread of COVID-19 and to protect the health and safety of citizens. South Korea is escaping the crisis through rapid and early inspection with ICT technology, isolation for confirmed cases, and transparency and communication through public–private partnerships. This paper presents how face mask shortages can be managed through the disclosure of government data and with effective online services. This study shows how South Korea enhances government transparency and that combining open data with ICT technologies can effectively solve social problems during the COVID-19 pandemic.

A Look Behind the Scenes at COVID-19: National Strategies of Infection Control and Their Impact on Mortality

(1) Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began spreading across the globe in December and, as of 9 July 2020, had inflicted more than 550,000 deaths. Public health measures implemented to control the outbreak caused socio-economic havoc in many countries. The pandemic highlighted the quality of health care systems, responses of policymakers in harmony with the population, and socio-economic resilience factors. We suggest that different national strategies had an impact on mortality and case count. (2) Methods: We collected fatality data for 17 countries until 2 June 2020 from public data and associated these with implemented containment measures. (3) Results: The outcomes present the effectiveness of control mechanisms in mitigating the virus for selected countries and the UAE as a special case. Pre-existing conditions defined the needed public health strategies and fatality numbers. Other pre-existing conditions, such as temperature, humidity, median age, and low serum 25-hydroxyvitamin D (25(OH)D) concentrations played minor roles and may have had no direct impact on fatality rates. (4) Conclusions: Prevention, fast containment, adequate public health strategies, and importance of indoor environments were determining factors in mitigating the pandemic. Development of public health strategies adapted to pre-existing conditions for each country and community compliance with implemented policies ensure the successful control of pandemics.