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Yoo SJ, Oh J, Hong SJ, Kim MG, Hwang J, Kim YJ. Microfluidics-based condensation bioaerosol sampler for multipoint airborne virus monitoring. Biosens Bioelectron 2024; 264:116658. [PMID: 39137520 DOI: 10.1016/j.bios.2024.116658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/26/2024] [Accepted: 08/08/2024] [Indexed: 08/15/2024]
Abstract
To facilitate rapid monitoring of airborne viruses, they must be collected with high efficiency and concentrated in a small volume of a liquid sample. In addition, the development of low-cost miniaturized samplers is essential for multipoint monitoring. Thus, in an attempt to fulfill these requirements, this study developed a microfluidic condensation bioaerosol sampler (MCBS). The developed sampler comprised two parts: a virus growth section and a virus droplet-to-liquid sample conversion section, each of which was fabricated on a chip using microfluidic technology. The condensation nucleus growth technique used in the virus growth section grew nanometer-sized airborne viruses into micro-sized droplets, making it possible to collection of viruses easier and with high efficiency. In addition, the virus droplet-to-liquid sample conversion section controlled the transport of droplets based on electrowetting technology. This enabled the collected airborne viruses to be concentrated in tens of microliters of the liquid sample. To evaluate the performance of both the sections, the virus dropletization, virus collection efficiency, and virus droplet-to-liquid sample conversion efficiency were evaluated through quantitative experiments. H1N1 and HCOV-229E viruses were used to conduct quantitative experiments on MCBS. We could obtain virus liquid samples with at 72.8- and 89.9-times higher concentration through 1:1 evaluation with a commercial sampler. Thus, the developed sampler facilitated efficient collection and concentration of airborne viruses in a compact, cost-effective manner. This is expected to facilitate rapid and accurate multipoint monitoring of viral aerosols.
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Affiliation(s)
- Seong-Jae Yoo
- School of Mechanical Engineering, Yonsei University, Seoul, 03722, South Korea
| | - Jaeho Oh
- School of Mechanical Engineering, Yonsei University, Seoul, 03722, South Korea
| | - Seung-Jae Hong
- School of Mechanical Engineering, Yonsei University, Seoul, 03722, South Korea
| | - Min-Gu Kim
- Department of Medical Engineering, College of Medicine, Yonsei University, Seoul, 03722, South Korea
| | - Jungho Hwang
- School of Mechanical Engineering, Yonsei University, Seoul, 03722, South Korea
| | - Yong-Jun Kim
- School of Mechanical Engineering, Yonsei University, Seoul, 03722, South Korea.
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2
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Klimek P, Ledebur K, Thurner S. Epidemic modelling suggests that in specific circumstances masks may become more effective when fewer contacts wear them. COMMUNICATIONS MEDICINE 2024; 4:134. [PMID: 38971886 PMCID: PMC11227579 DOI: 10.1038/s43856-024-00561-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 06/25/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND The effectiveness of non-pharmaceutical interventions to control the spread of SARS-CoV-2 depends on many contextual factors, including adherence. Conventional wisdom holds that the effectiveness of protective behaviours, such as wearing masks, increases with the number of people who adopt them. Here we show in a simulation study that this is not always true. METHODS We use a parsimonious network model based on the well-established empirical facts that adherence to such interventions wanes over time and that individuals tend to align their adoption strategies with their close social ties (homophily). RESULTS When these assumptions are combined, a broad dynamic regime emerges in which the individual-level reduction in infection risk for those adopting protective behaviour increases as adherence to protective behaviour decreases. For instance, at 10 % coverage, we find that adopters face nearly a 30 % lower infection risk than at 60 % coverage. Based on surgical mask effectiveness estimates, the relative risk reduction for masked individuals ranges from 5 % to 15 %, or a factor of three. This small coverage effect occurs when the outbreak is over before the pathogen is able to invade small but closely knit groups of individuals who protect themselves. CONCLUSIONS Our results confirm that lower coverage reduces protection at the population level while contradicting the common belief that masking becomes ineffective at the individual level as more people drop their masks.
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Affiliation(s)
- Peter Klimek
- Section for Science of Complex Systems, Medical University of Vienna, Vienna, Austria.
- Complexity Science Hub Vienna, Vienna, Austria.
- Supply Chain Intelligence Institute Austria, Vienna, Austria.
- Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Katharina Ledebur
- Section for Science of Complex Systems, Medical University of Vienna, Vienna, Austria
- Complexity Science Hub Vienna, Vienna, Austria
| | - Stefan Thurner
- Section for Science of Complex Systems, Medical University of Vienna, Vienna, Austria
- Complexity Science Hub Vienna, Vienna, Austria
- Santa Fe Institute, Santa Fe, NM, USA
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3
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Dörr T, Güsewell S, Flury D, Süveges M, Gaza Valera CB, Botero-Mesa S, Zanella MC, Iten A, Balmelli C, Troillet N, Tschudin-Sutter S, W Schreiber P, Jent P, Damonti L, Sommerstein R, Portmann L, Vuichard-Gysin D, Cusini A, Nussbaumer-Ochsner Y, Heininger U, Berger C, Zimmermann P, Gardiol C, Keiser O, Schlegel M, Kohler P, P Kuster S. Association of institutional masking policies with healthcare-associated SARS-CoV-2 infections in Swiss acute care hospitals during the BA.4/5 wave (CH-SUR study): a retrospective observational study. Antimicrob Resist Infect Control 2024; 13:64. [PMID: 38886813 PMCID: PMC11184728 DOI: 10.1186/s13756-024-01422-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/05/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND In the initial phase of the SARS-CoV-2 pandemic, masking has been widely accepted in healthcare institutions to mitigate the risk of healthcare-associated infection. Evidence, however, is still scant and the role of masks in preventing healthcare-associated SARS-CoV-2 acquisition remains unclear.We investigated the association of variation in institutional mask policies with healthcare-associated SARS-CoV-2 infections in acute care hospitals in Switzerland during the BA.4/5 2022 wave. METHODS SARS-CoV-2 infections in hospitalized patients between June 1 and September 5, 2022, were obtained from the "Hospital-based surveillance of COVID-19 in Switzerland"-database and classified as healthcare- or community-associated based on time of disease onset. Institutions provided information regarding institutional masking policies for healthcare workers and other prevention policies. The percentage of healthcare-associated SARS-CoV-2 infections was calculated per institution and per type of mask policy. The association of healthcare-associated SARS-CoV-2 infections with mask policies was tested using a negative binominal mixed-effect model. RESULTS We included 2'980 SARS-CoV-2 infections from 13 institutions, 444 (15%) were classified as healthcare-associated. Between June 20 and June 30, 2022, six (46%) institutions switched to a more stringent mask policy. The percentage of healthcare-associated infections subsequently declined in institutions with policy switch but not in the others. In particular, the switch from situative masking (standard precautions) to general masking of HCW in contact with patients was followed by a strong reduction of healthcare-associated infections (rate ratio 0.39, 95% CI 0.30-0.49). In contrast, when compared across hospitals, the percentage of health-care associated infections was not related to mask policies. CONCLUSIONS Our findings suggest switching to a more stringent mask policy may be beneficial during increases of healthcare-associated SARS-CoV-2 infections at an institutional level.
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Affiliation(s)
- Tamara Dörr
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, Rorschacher Strasse 95, St. Gallen, CH-9007, Switzerland
| | - Sabine Güsewell
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, Rorschacher Strasse 95, St. Gallen, CH-9007, Switzerland
| | - Domenica Flury
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, Rorschacher Strasse 95, St. Gallen, CH-9007, Switzerland
| | - Maria Süveges
- Faculté de Médecine de l'Université de Genève, Institut de Santé Globale, 24 rue du Général- Dufour, Genève 4, 1211, Switzerland
| | - Camille Beatrice Gaza Valera
- Faculté de Médecine de l'Université de Genève, Institut de Santé Globale, 24 rue du Général- Dufour, Genève 4, 1211, Switzerland
| | - Sara Botero-Mesa
- Faculté de Médecine de l'Université de Genève, Institut de Santé Globale, 24 rue du Général- Dufour, Genève 4, 1211, Switzerland
| | - Marie-Céline Zanella
- Service de prévention et contrôle de l'infection, Direction médicale et qualité, Hôpitaux universitaires Genève, Rue Gabrielle-Perret-Gentil 4, Genève, 1205, Switzerland
- Infection Control Program and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, Genève, 1205, Switzerland
| | - Anne Iten
- Service de prévention et contrôle de l'infection, Direction médicale et qualité, Hôpitaux universitaires Genève, Rue Gabrielle-Perret-Gentil 4, Genève, 1205, Switzerland
| | - Carlo Balmelli
- Infection Control Programme, EOC Hospitals, Viale Officina 3, Bellinzona, 6500, Switzerland
| | - Nicolas Troillet
- Service of Infectious Diseases, Central Institute, Valais Hospitals, Av. Grand-Champsec 80, Sion, 1951, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Petersgraben 4, Basel, 4031, Switzerland
| | - Peter W Schreiber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Philipp Jent
- Department of Infectious Diseases, Bern University Hospital (Inselspital), University of Bern, Länggassstrasse 122, Bern, 3012, Switzerland
| | - Lauro Damonti
- Department of Infectious Diseases, Bern University Hospital (Inselspital), University of Bern, Länggassstrasse 122, Bern, 3012, Switzerland
| | - Rami Sommerstein
- Department of Infectious Diseases, Bern University Hospital (Inselspital), University of Bern, Länggassstrasse 122, Bern, 3012, Switzerland
- Faculty of Health Sciences and Medicine, Clinic St. Anna, University of Lucerne, Alpenquai 4, Lucerne, 6005, Switzerland
| | - Lea Portmann
- Faculty of Health Sciences and Medicine, Clinic St. Anna, University of Lucerne, Alpenquai 4, Lucerne, 6005, Switzerland
| | - Danielle Vuichard-Gysin
- Department of Infectious Diseases, Thurgau Cantonal Hospital, Spitalcampus 1, Muensterlingen, 8596, Switzerland
| | - Alexia Cusini
- Department of Infectious Diseases, Cantonal Hospital Graubuenden, Loëstrasse 170, Chur, 7000, Switzerland
| | - Yvonne Nussbaumer-Ochsner
- Klinik für Innere Medizin, Kantonsspital Spitäler Schaffhausen, Geissbergstrasse 81, Schaffhausen, 8208, Switzerland
| | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Spitalstrasse 33, Basel, 4056, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Children's Research Centre, University Children's Hospital Zurich, Steinwiesstrasse 75, Zurich, 8032, Switzerland
| | - Petra Zimmermann
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Chemin du Musée 8, Fribourg, 1700, Switzerland
- Department of Paediatrics, Fribourg Hospital HFR, Chemin des Pensionnats 2-6, Fribourg, Villars-sur-Glâne, 1752, Switzerland
| | - Céline Gardiol
- Swiss Federal Office of Public Health, Schwarzenburgstrasse 157, Bern, 3003, Switzerland
| | - Olivia Keiser
- Faculté de Médecine de l'Université de Genève, Institut de Santé Globale, 24 rue du Général- Dufour, Genève 4, 1211, Switzerland
| | - Matthias Schlegel
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, Rorschacher Strasse 95, St. Gallen, CH-9007, Switzerland
| | - Philipp Kohler
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, Rorschacher Strasse 95, St. Gallen, CH-9007, Switzerland
| | - Stefan P Kuster
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, Rorschacher Strasse 95, St. Gallen, CH-9007, Switzerland.
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Floriano I, Silvinato A, Bacha HA, Barbosa AN, Tanni S, Bernardo WM. Effectiveness of wearing masks during the COVID-19 outbreak in cohort and case-control studies: a systematic review and meta-analysis. J Bras Pneumol 2024; 49:e20230003. [PMID: 38198343 PMCID: PMC10760436 DOI: 10.36416/1806-3756/e20230003] [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: 03/01/2023] [Accepted: 09/06/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE To evaluate the efficacy of wearing a mask to prevent COVID-19 infection. METHODS This was a systematic review and meta-analysis of cohort and case-control studies, considering the best level of evidence available. Electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Clinical Trials.gov) were searched to identify studies that evaluated the effectiveness of wearing masks compared with that of not wearing them during the COVID-19 pandemic. Risk of bias and quality of evidence were assessed using the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation. RESULTS Of the 1,028 studies identified, 9 met the inclusion criteria (2 cohort studies and 7 case-control studies) and were included in the analysis. The meta-analysis using cohort studies alone showed statistically significant differences, wearing a cloth mask decreased by 21% [RD = -0.21 (95% CI, -0.34 to -0.07); I2 = 0%; p = 0,002] the risk of COVID-19 infection, but the quality of evidence was low. Regarding case-control studies, wearing a surgical mask reduced the chance of COVID-19 infection [OR = 0.51 (95% CI, 0.37-0.70); I2 = 47%; p = 0.0001], as did wearing an N95 respirator mask [OR = 0.31 (95% CI, 0.20-0.49); I2 = 0%; p = 0.00001], both with low quality of evidence. CONCLUSIONS In this systematic review with meta-analysis, we showed the effectiveness of wearing masks in the prevention of SARS-CoV-2 infection regardless of the type of mask (disposable surgical mask, common masks, including cloth masks, or N95 respirators), although the studies evaluated presented with low quality of evidence and important biases.
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Affiliation(s)
- Idevaldo Floriano
- . Cooperativa Baixa Mogiana, Medicina Baseada em Evidências, Mogi-Guaçu (SP) Brasil
| | - Antônio Silvinato
- . Cooperativa Baixa Mogiana, Medicina Baseada em Evidências, Mogi-Guaçu (SP) Brasil
- . Associação Médica Brasileira, Medicina Baseada em Evidências, São Paulo (SP) Brasil
| | | | - Alexandre Naime Barbosa
- . Disciplina de Moléstias Infecciosas e Parasitárias, Departamento de Infectologia, Dermatologia, Diagnóstico por Imagem e Radioterapia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
| | - Suzana Tanni
- . Disciplina de Pneumologia, Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
| | - Wanderley Marques Bernardo
- . Associação Médica Brasileira, Medicina Baseada em Evidências, São Paulo (SP) Brasil
- . Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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Elgersma IH, Fretheim A, Elstrøm P, Aavitsland P. Association between face mask use and risk of SARS-CoV-2 infection: Cross-sectional study. Epidemiol Infect 2023; 151:e194. [PMID: 37952983 PMCID: PMC10728967 DOI: 10.1017/s0950268823001826] [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: 06/07/2023] [Revised: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023] Open
Abstract
We examined the association between face masks and risk of infection with SARS-CoV-2 using cross-sectional data from 3,209 participants in a randomized trial exploring the effectiveness of glasses in reducing the risk of SARS-CoV-2 infection. Face mask use was based on participants' response to the end-of-follow-up survey. We found that the incidence of self-reported COVID-19 was 33% (aRR 1.33; 95% CI 1.03-1.72) higher in those wearing face masks often or sometimes, and 40% (aRR 1.40; 95% CI 1.08-1.82) higher in those wearing face masks almost always or always, compared to participants who reported wearing face masks never or almost never. We believe the observed increase in the incidence of infection associated with wearing a face mask is likely due to unobservable and hence nonadjustable differences between those wearing and not wearing a mask. Observational studies reporting on the relationship between face mask use and risk of respiratory infections should be interpreted cautiously, and more randomized trials are needed.
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Affiliation(s)
- Ingeborg Hess Elgersma
- Centre for Epidemic Intervention Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Atle Fretheim
- Centre for Epidemic Intervention Research, Norwegian Institute of Public Health, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Petter Elstrøm
- Centre for Epidemic Intervention Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Preben Aavitsland
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
- Pandemic Centre, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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6
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Smith DRM, Chervet S, Pinettes T, Shirreff G, Jijón S, Oodally A, Jean K, Opatowski L, Kernéis S, Temime L. How have mathematical models contributed to understanding the transmission and control of SARS-CoV-2 in healthcare settings? A systematic search and review. J Hosp Infect 2023; 141:132-141. [PMID: 37734676 DOI: 10.1016/j.jhin.2023.07.028] [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: 03/24/2023] [Accepted: 07/04/2023] [Indexed: 09/23/2023]
Abstract
Since the onset of the COVID-19 pandemic, mathematical models have been widely used to inform public health recommendations regarding COVID-19 control in healthcare settings. The objective of this study was to systematically review SARS-CoV-2 transmission models in healthcare settings, and to summarize their contributions to understanding nosocomial COVID-19. A systematic search and review of published articles indexed in PubMed was carried out. Modelling studies describing dynamic inter-individual transmission of SARS-CoV-2 in healthcare settings, published by mid-February 2022 were included. Models have mostly focused on acute-care and long-term-care facilities in high-income countries. Models have quantified outbreak risk, showing great variation across settings and pandemic periods. Regarding surveillance, routine testing rather than symptom-based was highlighted as essential for COVID-19 prevention due to high rates of silent transmission. Surveillance impacts depended critically on testing frequency, diagnostic sensitivity, and turn-around time. Healthcare re-organization also proved to have large epidemiological impacts: beyond obvious benefits of isolating cases and limiting inter-individual contact, more complex strategies (staggered staff scheduling, immune-based cohorting) reduced infection risk. Finally, vaccination impact, while highly effective for limiting COVID-19 burden, varied substantially depending on assumed mechanistic impacts on infection acquisition, symptom onset and transmission. Modelling results form an extensive evidence base that may inform control strategies for future waves of SARS-CoV-2 and other viral respiratory pathogens. We propose new avenues for future models of healthcare-associated outbreaks, with the aim of enhancing their efficiency and contributions to decision-making.
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Affiliation(s)
- D R M Smith
- Anti-infective Evasion and Pharmacoepidemiology Team, CESP, Université Paris-Saclay, UVSQ, INSERM U1018, Montigny-le-Bretonneux, France; Institut Pasteur, Université Paris-Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE), F-75015 Paris, France; Laboratoire Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire National des Arts et Métiers, F-75003 Paris, France
| | - S Chervet
- Anti-infective Evasion and Pharmacoepidemiology Team, CESP, Université Paris-Saclay, UVSQ, INSERM U1018, Montigny-le-Bretonneux, France; Institut Pasteur, Université Paris-Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE), F-75015 Paris, France; Université Paris-Cité, INSERM, IAME, F-75018, Paris, France
| | - T Pinettes
- Laboratoire Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire National des Arts et Métiers, F-75003 Paris, France; Unité PACRI, Institut Pasteur, Conservatoire National des Arts et Métiers, Paris, France
| | - G Shirreff
- Anti-infective Evasion and Pharmacoepidemiology Team, CESP, Université Paris-Saclay, UVSQ, INSERM U1018, Montigny-le-Bretonneux, France; Institut Pasteur, Université Paris-Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE), F-75015 Paris, France; Laboratoire Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire National des Arts et Métiers, F-75003 Paris, France
| | - S Jijón
- Laboratoire Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire National des Arts et Métiers, F-75003 Paris, France; Unité PACRI, Institut Pasteur, Conservatoire National des Arts et Métiers, Paris, France
| | - A Oodally
- Anti-infective Evasion and Pharmacoepidemiology Team, CESP, Université Paris-Saclay, UVSQ, INSERM U1018, Montigny-le-Bretonneux, France; Institut Pasteur, Université Paris-Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE), F-75015 Paris, France; Laboratoire Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire National des Arts et Métiers, F-75003 Paris, France
| | - K Jean
- Laboratoire Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire National des Arts et Métiers, F-75003 Paris, France; Unité PACRI, Institut Pasteur, Conservatoire National des Arts et Métiers, Paris, France
| | - L Opatowski
- Anti-infective Evasion and Pharmacoepidemiology Team, CESP, Université Paris-Saclay, UVSQ, INSERM U1018, Montigny-le-Bretonneux, France; Institut Pasteur, Université Paris-Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE), F-75015 Paris, France
| | - S Kernéis
- Université Paris-Cité, INSERM, IAME, F-75018, Paris, France; Equipe de Prévention du Risque Infectieux (EPRI), AP-HP, Hôpital Bichat, F-75018 Paris, France.
| | - L Temime
- Laboratoire Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire National des Arts et Métiers, F-75003 Paris, France; Unité PACRI, Institut Pasteur, Conservatoire National des Arts et Métiers, Paris, France
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Heron L, Buitrago-Garcia D, Ipekci AM, Baumann R, Imeri H, Salanti G, Counotte MJ, Low N. How to update a living systematic review and keep it alive during a pandemic: a practical guide. Syst Rev 2023; 12:156. [PMID: 37660117 PMCID: PMC10474670 DOI: 10.1186/s13643-023-02325-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 08/17/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND The covid-19 pandemic has highlighted the role of living systematic reviews. The speed of evidence generated during the covid-19 pandemic accentuated the challenges of managing high volumes of research literature. METHODS In this article, we summarise the characteristics of ongoing living systematic reviews on covid-19, and we follow a life cycle approach to describe key steps in a living systematic review. RESULTS We identified 97 living systematic reviews on covid-19, published up to 7th November 2022, which focused mostly on the effects of pharmacological interventions (n = 46, 47%) or the prevalence of associated conditions or risk factors (n = 30, 31%). The scopes of several reviews overlapped considerably. Most living systematic reviews included both observational and randomised study designs (n = 45, 46%). Only one-third of the reviews has been updated at least once (n = 34, 35%). We address practical aspects of living systematic reviews including how to judge whether to start a living systematic review, methods for study identification and selection, data extraction and evaluation, and give recommendations at each step, drawing from our own experience. We also discuss when it is time to stop and how to publish updates. CONCLUSIONS Methods to improve the efficiency of searching, study selection, and data extraction using machine learning technologies are being developed, their performance and applicability, particularly for reviews based on observational study designs should improve, and ways of publishing living systematic reviews and their updates will continue to evolve. Finally, knowing when to end a living systematic review is as important as knowing when to start.
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Affiliation(s)
- Leonie Heron
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Diana Buitrago-Garcia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Aziz Mert Ipekci
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Rico Baumann
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Hira Imeri
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Jacobs Center for Productive Youth Development, University of Zurich, Zürich, Switzerland
| | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Michel Jacques Counotte
- Wageningen Bioveterinary Research, Wageningen University & Research, Lelystad, The Netherlands
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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8
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Plachouras D, Kacelnik O, Rodríguez-Baño J, Birgand G, Borg MA, Kristensen B, Kubele J, Lyytikäinen O, Presterl E, Reilly J, Voss A, Zingg W, Suetens C, Monnet DL. Revisiting the personal protective equipment components of transmission-based precautions for the prevention of COVID-19 and other respiratory virus infections in healthcare. Euro Surveill 2023; 28:2200718. [PMID: 37561052 PMCID: PMC10416576 DOI: 10.2807/1560-7917.es.2023.28.32.2200718] [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: 08/30/2022] [Accepted: 05/10/2023] [Indexed: 08/11/2023] Open
Abstract
The COVID-19 pandemic highlighted some potential limitations of transmission-based precautions. The distinction between transmission through large droplets vs aerosols, which have been fundamental concepts guiding infection control measures, has been questioned, leading to considerable variation in expert recommendations on transmission-based precautions for COVID-19. Furthermore, the application of elements of contact precautions, such as the use of gloves and gowns, is based on low-quality and inconclusive evidence and may have unintended consequences, such as increased incidence of healthcare-associated infections and spread of multidrug-resistant organisms. These observations indicate a need for high-quality studies to address the knowledge gaps and a need to revisit the theoretical background regarding various modes of transmission and the definitions of terms related to transmission. Further, we should examine the implications these definitions have on the following components of transmission-based precautions: (i) respiratory protection, (ii) use of gloves and gowns for the prevention of respiratory virus infections, (iii) aerosol-generating procedures and (iv) universal masking in healthcare settings as a control measure especially during seasonal epidemics. Such a review would ensure that transmission-based precautions are consistent and rationally based on available evidence, which would facilitate decision-making, guidance development and training, as well as their application in practice.
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Affiliation(s)
| | | | - Jesús Rodríguez-Baño
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases and Microbiology division, Hospital Universitario Virgen Macarena and Department of Medicine, University of Seville/CSIC, Biomedicine Institute of Seville, Seville, Spain
| | - Gabriel Birgand
- Health Protection Research Unit, Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, United Kingdom
- Regional Centre for Infection Prevention and Control, Region of Pays de la Loire, Nantes, France
| | - Michael A Borg
- Infection Control Department, Mater Dei Hospital, Msida, Malta
| | | | - Jan Kubele
- Clinical Microbiology and ATB centre, Na Homolce Hospital, Prague, Czechia
| | | | - Elisabeth Presterl
- Department for Hospital Epidemiology and Infection Control, Medical University of Vienna, Vienna, Austria
| | - Jacqui Reilly
- Research Centre for Health, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Andreas Voss
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, Groningen, the Netherlands
| | - Walter Zingg
- Charité Universitätsmedizin, Berlin, Germany
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Carl Suetens
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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9
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Chou R, Dana T. Major Update: Masks for Prevention of SARS-CoV-2 in Health Care and Community Settings-Final Update of a Living, Rapid Review. Ann Intern Med 2023; 176:827-835. [PMID: 37186920 PMCID: PMC10234287 DOI: 10.7326/m23-0570] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Optimal use of masks for preventing COVID-19 is unclear. PURPOSE To update an evidence synthesis on N95, surgical, and cloth mask effectiveness in community and health care settings for preventing SARS-CoV-2 infection. DATA SOURCES MEDLINE, EMBASE, medRxiv (3 June 2022 to 2 January 2023), and reference lists. STUDY SELECTION Randomized trials of interventions to increase mask use and risk for SARS-CoV-2 infection and observational studies of mask use that controlled for potential confounders. DATA EXTRACTION Two investigators sequentially abstracted study data and rated quality. DATA SYNTHESIS Three randomized trials and 21 observational studies were included. In community settings, mask use may be associated with a small reduced risk for SARS-CoV-2 infection versus no mask use, on the basis of 2 randomized trials and 7 observational studies. In routine patient care settings, surgical masks and N95 respirators may be associated with similar risk for SARS-CoV-2 infection, on the basis of 1 new randomized trial with some imprecision and 4 observational studies. Evidence from observational studies was insufficient to evaluate other mask comparisons due to methodological limitations and inconsistency. LIMITATION Few randomized trials, studies had methodological limitations and some imprecision, suboptimal adherence and pragmatic aspects of randomized trials potentially attenuated benefits, very limited evidence on harms, uncertain applicability to Omicron variant predominant era, meta-analysis not done due to heterogeneity, unable to formally assess for publication bias, and restricted to English-language articles. CONCLUSION Updated evidence suggests that masks may be associated with a small reduction in risk for SARS-CoV-2 infection in community settings. Surgical masks and N95 respirators may be associated with similar infection risk in routine patient care settings, but a beneficial effect of N95 respirators cannot be ruled out. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Roger Chou
- Pacific Northwest Evidence-based Practice Center and the Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.C., T.D.)
| | - Tracy Dana
- Pacific Northwest Evidence-based Practice Center and the Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.C., T.D.)
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10
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Martín Sánchez FJ, Martínez-Sellés M, Molero García JM, Moreno Guillén S, Rodríguez-Artalejo FJ, Ruiz-Galiana J, Cantón R, De Lucas Ramos P, García-Botella A, García-Lledó A, Hernández-Sampelayo T, Gómez-Pavón J, González Del Castillo J, Martín-Delgado MC, Bouza E. Insights for COVID-19 in 2023. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2023. [PMID: 36510683 DOI: 10.3701/req/059.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Predictions for a near end of the pandemic by the World Health Organization should be interpreted with caution. Current evidence indicates that the efficacy of a fourth dose of classical mRNA vaccines (BT162b2 or mRNA-1273) is low and short-lived in preventing SARS-CoV-2 infection in its predominant variant (Omicron). However, its efficacy is high against severe symptomatic infection, hospitalization and death. The new vaccines being introduced are bivalent and active against the Omicron variants. Potential new vaccines to be introduced in the coming year include a vaccine based on a recombinant protein that emulates the receptor binding domain of the Spike protein under development by the Spanish company Hipra, as well as vaccines for nasal or oral administration. Available information suggests that vaccines against COVID-19 can be administered in association with influenza vaccination without particular complications. New drugs against COVID-19, both antiviral and anti-inflammatory, are under investigation, but this does not seem to be the case with monoclonal antibodies. The indication to use masks in some circumstances will be maintained next year in view of the accumulation of scientific data on their efficacy. Finally, the long COVID or Post-COVID syndrome may continue to affect a very high proportion of patients who have had the disease, requiring combined diagnostic and therapeutic resources.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas del Hospital General Universitario Gregorio Marañón, Universidad Complutense. CIBERES. Ciber de Enfermedades Respiratorias. Madrid, Spain.
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11
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Evaluation of the bacterial contamination of face masks worn by personnel in a center of COVID 19 hospitalized patients: A cross-sectional study. New Microbes New Infect 2023; 52:101090. [PMID: 36744172 PMCID: PMC9883076 DOI: 10.1016/j.nmni.2023.101090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/29/2023] Open
Abstract
Background During the Coronavirus Pandemic, the use of masks has increased significantly. The lack of control on hygiene protocols and the need to use PPE properly increases the spread of bacterial infection. The purpose of this study was to investigate the degree of contamination and frequency of bacterial species isolated from surgical and N95 masks used by hospital personnel. Methods A total number of 175 masks were collected from staff working in Sina hospital (Hamadan province, Iran) during the first six months of 2022. The bacterial contamination of masks were evaluated and identified using biochemical kits. Antimicrobial susceptibility testing of the isolates were done using Kirby-Bauer methods and MIC were assessed for each isolate against different disinfectants (Sodium hypochlorite 5%, Hydrogen Peroxide 3%, Ethanol 70% and Deconex). Results Of 175 masks, 471 bacterial isolates were detected including 9 species. The most prevalent strain were Coagulase negative Staphylococcus (28%) followed by Acinetobacter (20.8%) and Pseudomonas (13.8%), while, Klebsiealla and Enterococcus were the least frequent species with the rate of 3.8% and 1.2%, respectively. The results of MIC methods indicated that all 471 strains were resistant to ehtanol70% and sensitive to hydrogen peroxide 3%. Furthermore, the mean average of Deconex inhibitory effect is lower than Sodium hypochlorite 5%. Conclusions According to the results of this study, there was a high prevalence of CoNS, Acinetobacter and Pseudomonas in hospital with a high resistance pattern against antibiotics especially Ampicillin and disinfectants.
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12
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Francis NA, Becque T, Willcox M, Hay AD, Lown M, Clarke R, Stuart B, Yardley L, Moore M, Houriet J, Little P. Non-pharmaceutical interventions and risk of COVID-19 infection: survey of U.K. public from November 2020 - May 2021. BMC Public Health 2023; 23:389. [PMID: 36829127 PMCID: PMC9951136 DOI: 10.1186/s12889-023-15209-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 02/03/2023] [Indexed: 02/26/2023] Open
Abstract
INTRODUCTION Non-pharmaceutical interventions (NPIs), such as handwashing, social distancing and face mask wearing, have been widely promoted to reduce the spread of COVID-19. This study aimed to explore the relationship between self-reported use of NPIs and COVID-19 infection. METHODS We conducted an online questionnaire study recruiting members of the UK public from November 2020 to May 2021. The association between self-reported COVID-19 illness and reported use of NPIs was explored using logistic regression and controlling for participant characteristics, month of questionnaire completion, and vaccine status. Participants who had been exposed to COVID-19 in their household in the previous 2 weeks were excluded. RESULTS Twenty-seven thousand seven hundred fifty-eight participants were included and 2,814 (10.1%) reported having a COVID-19 infection. The odds of COVID-19 infection were reduced with use of a face covering in unadjusted (OR 0.17 (95% CI: 0.15 to 0.20) and adjusted (aOR 0.19, 95% CI 0.16 to 0.23) analyses. Social distancing (OR 0.27, 95% CI: 0.22 to 0.31; aOR 0.35, 95% CI 0.28 to 0.43) and handwashing when arriving home (OR 0.57, 95% CI 0.46 to 0.73; aOR 0.63, 95% CI: 0.48 to 0.83) also reduced the odds of COVID-19. Being in crowded places of 10-100 people (OR 1.89, 95% CI: 1.70 to 2.11; aOR 1.62, 95% CI: 1.42 to 1.85) and > 100 people (OR 2.33, 95% CI: 2.11 to 2.58; aOR 1.73, 95% CI: 1.53 to 1.97) were both associated with increased odds of COVID-19 infection. Handwashing before eating, avoiding touching the face, and cleaning things with virus on were all associated with increased odds of COVID-19 infections. CONCLUSIONS This large observational study found evidence for strong protective effects for individuals from use of face coverings, social distancing (including avoiding crowded places) and handwashing on arriving home on developing COVID-19 infection. We also found evidence for an increased risk associated with other behaviours, possibly from recall bias.
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Affiliation(s)
- Nick A Francis
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, NIHR School for Primary Care Research, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, UK.
| | - Taeko Becque
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, NIHR School for Primary Care Research, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, UK
| | - Merlin Willcox
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, NIHR School for Primary Care Research, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Bristol Medical School: Population Health Sciences, NIHR School for Primary Care Research, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Mark Lown
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, NIHR School for Primary Care Research, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, UK
| | - Richard Clarke
- School of Natural and Social Sciences, University of Gloucestershire, Francis Close Hall, Swindon Road, Cheltenham, GL50 4AZ, UK
| | - Beth Stuart
- Pragmatic Clinical Trials Unit, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Lucy Yardley
- School of Psychology, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK.,School of Psychological Science, University of Bristol, 12A Priory Road, Bristol, BS8 1TR, UK
| | - Michael Moore
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, NIHR School for Primary Care Research, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, UK
| | - Joëlle Houriet
- Antenna Foundation, Avenue de La Grenade 24, 1207, Geneva, Switzerland
| | - Paul Little
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, NIHR School for Primary Care Research, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, UK
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13
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Borg MG, Borg MA. A Trendline and Predictive Analysis of the First-Wave COVID-19 Infections in Malta. EPIDEMIOLOGIA (BASEL, SWITZERLAND) 2023; 4:33-50. [PMID: 36648777 PMCID: PMC9844502 DOI: 10.3390/epidemiologia4010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/26/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023]
Abstract
Following the first COVID-19 infected cases, Malta rapidly imposed strict lockdown measures, including restrictions on international travel, together with national social distancing measures, such as prohibition of public gatherings and closure of workplaces. The study aimed to elucidate the effect of the intervention and relaxation of the social distancing measures upon the infection rate by means of a trendline analysis of the daily case data. In addition, the study derived a predictive model by fitting historical data of the SARS-CoV-2 positive cases within a two-parameter Weibull distribution, whilst incorporating swab-testing rates, to forecast the infection rate at minute computational expense. The trendline analysis portrayed the wave of infection to fit within a tri-phasic pattern, where the primary phase was imposed with social measure interventions. Following the relaxation of public measures, the two latter phases transpired, where the two peaks resolved without further escalation of national measures. The derived forecasting model attained accurate predictions of the daily infected cases, attaining a high goodness-of-fit, utilising uncensored government-official infection-rate and swabbing-rate data within the first COVID-19 wave in Malta.
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Affiliation(s)
- Mitchell G. Borg
- Department of Mechanical Engineering, Faculty of Engineering, University of Malta, MSD 2080 Msida, Malta
- Department of Naval Architecture, Ocean, and Marine Engineering, University of Strathclyde, Glasgow G4 0LZ, UK
| | - Michael A. Borg
- Infection Control Department, Mater Dei Hospital, MSD 2090 Msida, Malta
- Department of Microbiology, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta
- Correspondence:
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14
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Muacevic A, Adler JR, Balappanavar AY, Rijhwani K, Chahar P, Gupta R. Self-Perceived Halitosis and Related Factors Among the Mask-Wearing Population During the COVID-19 Pandemic in Delhi, India: A Cross-Sectional Study. Cureus 2022; 14:e32507. [PMID: 36654644 PMCID: PMC9840413 DOI: 10.7759/cureus.32507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Halitosis (oral malodor) is a common health condition throughout the world. In India, data on self-reported halitosis and related factors is limited. Mouth mask usage has been made compulsory after the coronavirus disease 2019 (COVID-19) pandemic. This could possibly alter oral microflora and environment and contribute to halitosis. The aim of the study was to determine the prevalence of self-perceived halitosis (SPH) among mask-wearing patients visiting a tertiary care dental hospital in Delhi, India. Methods A cross‑sectional study was conducted among a convenience sample of 300 patients visiting a tertiary care dental hospital in the capital of India. SPH status was measured using a self-designed and structured questionnaire containing socio-demographic factors, mask-related habits, and self-perceived oral health status. Statistical analysis was done using Jamovi software (The jamovi project, Sydney, Australia) version 1.8. Descriptive analysis followed by a chi-square test and a multivariate logistic regression test was applied. Results Bad breath was perceived by 86 study subjects. Of the participants, 16.7% felt that they had bad breath before the pandemic, and 38% of the participants had an increased perception or feeling of bad breath since regular mask usage. Of the participants, 42.7% felt that they had an increased feeling of dryness in the mouth post-pandemic. SPH status was associated with mask usage frequency (p<0.001), change (p<0.001) and type of mask (p=0.004), increased feeling of dryness (p<0.001), frequency of toothbrushing (p<0.001), self-reported oral disease (p=0.007), and dental treatment in the past 12 months (p=0.005). Conclusion The SPH status of the study population was associated with mask-related habits and self-reported oral health status. The findings highlight the importance of possible amendments in preventive and curative care for patients with halitosis post-COVID-19 pandemic.
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15
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Chou R. Comparative Effectiveness of Mask Type in Preventing SARS-CoV-2 in Health Care Workers: Uncertainty Persists. Ann Intern Med 2022; 175:1763-1764. [PMID: 36442057 PMCID: PMC9707439 DOI: 10.7326/m22-3219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Two and a half years after the emergence of the COVID-19 pandemic, Loeb and colleagues reported the first randomized trial of N95 respirators versus medical masks in health care workers. The editorialist discusses the findings and highlights remaining areas of uncertainty about optimal mask type.
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Affiliation(s)
- Roger Chou
- Oregon Health & Science University, Portland, Oregon
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16
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Gunay BO, Akalin I, Kalkisim A, Esenulku CM, Turkoglu EB. Effect of FFP2/N95 facemask wear on retinal and choroidal thickness profile in healthy subjects. Int J Ophthalmol 2022; 15:1821-1828. [PMID: 36404981 PMCID: PMC9631179 DOI: 10.18240/ijo.2022.11.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 09/08/2022] [Indexed: 12/12/2022] Open
Abstract
AIM To investigate the influence of non-oil 95 (N95)/filtering facepiece 2 (FFP2) facemask wear on retinal thickness, choroidal thickness (CT), retinal nerve fiber layer thickness (RNFLT), and ganglion cell layer thickness (GCLT) in healthy subjects. METHODS In this prospective study, 53 healthy participants who used FFP2/N95 facemask were enrolled. Participants underwent optical coherence tomography imaging before and at 1 and 4h following FFP2/N95 facemask wear. The last imaging session was performed 1h after FFP2/N95 removal. Retinal thickness, CT, RNFLT, and GCLT were assessed at each session. Vital parameters were also assessed. RESULTS The pulse rate of the subjects significantly decreased at 1 and 4h compared to baseline values (P<0.05). No significant changes in retinal thickness, RNFLT, and GCLT were observed in the study. CT profile showed a significant increase at all measured locations except 1-mm temporal, 1-mm inferior and 2-mm inferior points following FFP2/N95 wear which turned to baseline values after FFP2/N95 removal. Pulse rate and CT changes at 4h were significantly correlated (P<0.05). CONCLUSION Parasympathetic activation during FFP2/N95 facemask wear might have a role on elevated CT measurements in healthy individuals by virtue of increased choroidal blood flow.
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Affiliation(s)
- Betul Onal Gunay
- Department of Ophthalmology, University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Trabzon 61040, Turkey
| | - Irfan Akalin
- Department of Ophthalmology, University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Trabzon 61040, Turkey
| | - Ahmet Kalkisim
- Department of Ophthalmology, University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Trabzon 61040, Turkey
| | - Cenap Mahmut Esenulku
- Department of Ophthalmology, University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Trabzon 61040, Turkey
| | - Elif Betul Turkoglu
- Department of Ophthalmology, Akdeniz University Hospital, Antalya 07070, Turkey
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Stanford V, Gresh L, Toledo J, Méndez J, Aldighieri S, Reveiz L. Evidence in decision-making in the context of COVID-19 in Latin America. THE LANCET REGIONAL HEALTH - AMERICAS 2022; 14:100322. [PMID: 35879980 PMCID: PMC9299752 DOI: 10.1016/j.lana.2022.100322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background The pace of the COVID-19 pandemic poses an unprecedented challenge to the evidence-to-decision process. Latin American countries have responded to COVID-19 by introducing interventions to both mitigate the risk of infection and to treat cases. Understanding how evidence is used to inform government-level decision-making at a national scale is crucial for informing country and regional actors in ongoing response efforts. Objectives This study was undertaken between February-May 2021 and aims to characterise the best available evidence (BAE) and assess the extent to which it was used to inform decision-making in 21 Latin American countries, in relation to pharmaceutical (PI) and non-pharmaceutical interventions (NPI) related to COVID-19, including the use of therapeutics (corticosteroids, hydroxychloroquine/chloroquine and ivermectin), facemask use in the community setting and the use of diagnostic tests as a requirement for international travel. Method A three-phase methodology was used to; (i) characterise the BAE for each intervention using an umbrella review, (ii) identify government-level decisions for each intervention through a document review and (iii) assess the use of evidence to inform decisions using a novel adapted framework analysis. Findings The BAE is characterized by 17 living and non-living systematic reviews as evolving, and particularly uncertain for NPIs. 107 country-level documents show variation in both content and timing of decision outcomes across intervention types, with the majority of decisions taken at a time of evidence uncertainty, with only 5 documents including BAE. Seven out of eight key indicators of an evidence-to-decision process were identified more frequently among PIs than either NPI of facemask use or testing prior to travel. Overall evidence use was reported more frequently among PIs than either NPI of facemask use or travel testing (92%, 28% and 29%, respectively). Interpretation There are limitations in the extent to which evidence use in decision-making is reported across the Latin America region. Institutionalising this process and grounding it in existing and emerging methodologies can facilitate the rapid response in an emergency setting. Funding No funding was sourced for this work.
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Affiliation(s)
- Victoria Stanford
- Evidence and Intelligence for Action in Health Department, Pan American Health Organization, Washington, DC, USA
| | - Lionel Gresh
- Incident Management System for the Covid-19 Response. Pan American Health Organization, Washington, DC, USA
- Department of Health Emergencies, Pan American Health Organization, Washington, DC, USA
| | - Joao Toledo
- Incident Management System for the Covid-19 Response. Pan American Health Organization, Washington, DC, USA
- Department of Health Emergencies, Pan American Health Organization, Washington, DC, USA
| | - Jairo Méndez
- Incident Management System for the Covid-19 Response. Pan American Health Organization, Washington, DC, USA
- Department of Health Emergencies, Pan American Health Organization, Washington, DC, USA
| | - Sylvain Aldighieri
- Incident Management System for the Covid-19 Response. Pan American Health Organization, Washington, DC, USA
- Department of Health Emergencies, Pan American Health Organization, Washington, DC, USA
| | - Ludovic Reveiz
- Evidence and Intelligence for Action in Health Department, Pan American Health Organization, Washington, DC, USA
- Incident Management System for the Covid-19 Response. Pan American Health Organization, Washington, DC, USA
- Corresponding author at: Pan American Health Organization, 525 23rd St, NW, Washington DC 20037-2895, USA.
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Using the concept of circular economy to reduce the environmental impact of COVID-19 face mask waste. SUSTAINABLE MATERIALS AND TECHNOLOGIES 2022. [PMCID: PMC9355742 DOI: 10.1016/j.susmat.2022.e00475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
COVID-19 pandemic has posed severe threats to the society globally. World Health Organization (WHO) guidelines suggest that people wear face masks as a precautionary measure daily. This has resulted in the generation of massive amounts of mask-associated waste in the environment. Owing to the criticality of the epidemic, there has not been a large-scale investigation on where to discard masks, making this situation daunting. As the pandemic continues, the use of masks continues to increase; repeated use and disposal of masks has become an imperative issue. Most disposable masks comprise chemical fibers in the filter layer. Without proper treatment and disposal, these large amounts of chemical waste will eventually flow into rivers or oceans, leading to serious pollution. Therefore, to reduce the negative effects on the marine environment, it is crucial that we produce reusable masks and reduce disposable wearing habits. This study aimed to resolve this challenge using textile materials created by recycling fish-scale waste. Functional and comfortable masks manufactured without chemical additives to achieve multiple functions can increase the willingness to wear and be reused. Hence, product use can be prolonged, and the use of disposable masks can be curtailed. The product manufactured herein is biodegradable in nature, thus conforming to the green sustainable initiative.
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19
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Chou R, Dana T, Jungbauer R. Update Alert 8: Masks for Prevention of Respiratory Virus Infections, Including SARS-CoV-2, in Health Care and Community Settings. Ann Intern Med 2022; 175:W108-W109. [PMID: 35878407 PMCID: PMC9380719 DOI: 10.7326/l22-0272] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Roger Chou
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon
| | - Tracy Dana
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon
| | - Rebecca Jungbauer
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon
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20
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Faudrait-il garder les masques en milieu de travail ? ARCH MAL PROF ENVIRO 2022. [PMCID: PMC9482429 DOI: 10.1016/j.admp.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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21
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Varela AR, Gurruchaga AP, Restrepo SR, Martin JD, Landazabal YDC, Tamayo-Cabeza G, Contreras-Arrieta S, Caballero-Díaz Y, Florez LJH, González JM, Santos-Barbosa JC, Pinzón JD, Yepes-Nuñez JJ, Laajaj R, Buitrago Gutierrez G, Florez MV, Fuentes Castillo J, Quinche Vargas G, Casas A, Medina A, Behrentz E, Guevara YPR, Sanchez DR, Guevara-Suarez M, Hidalgo M, Betancourt P. Effectiveness and adherence to closed face shields in the prevention of COVID-19 transmission: a non-inferiority randomized controlled trial in a middle-income setting (COVPROSHIELD). Trials 2022; 23:698. [PMID: 35987694 PMCID: PMC9391623 DOI: 10.1186/s13063-022-06606-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The use of respiratory devices can mitigate the spread of diseases such as COVID-19 in community settings. We aimed to determine the effectiveness of closed face shields with surgical face masks to prevent SARS-CoV-2 transmission in working adults during the COVID-19 pandemic in Bogotá, Colombia.
Methods
An open-label non-inferiority randomized controlled trial that randomly assigned participants to one of two groups: the intervention group was instructed to wear closed face shields with surgical face masks, and the active control group was instructed to wear only surgical face masks. The primary outcome was a positive reverse transcription polymerase chain reaction test, IgG/IgM antibody test for SARS-CoV-2 detection, or both during and at the end of the follow-up period of 21 days. The non-inferiority limit was established at − 5%.
Results
A total of 316 participants were randomized, 160 participants were assigned to the intervention group and 156 to the active control group. In total, 141 (88.1%) participants in the intervention group and 142 (91.0%) in the active control group completed the follow-up. Primary outcome: a positive SARS-CoV-2 test result was identified in one (0.71%) participant in the intervention group and three (2.1%) in the active control group. In the intention-to-treat analysis, the absolute risk difference was − 1.40% (95% CI [− 4.14%, 1.33%]), and in the per-protocol analysis, the risk difference was − 1.40% (95% CI [− 4.20, 1.40]), indicating non-inferiority of the closed face shield plus face mask (did not cross the non-inferiority limit).
Conclusions
The use of closed face shields and surgical face masks was non-inferior to the surgical face mask alone in the prevention of SARS-CoV-2 infection in highly exposed groups. Settings with highly active viral transmission and conditions such as poor ventilation, crowding, and high mobility due to occupation may benefit from the combined use of masks and closed face shields to mitigate SARS-CoV-2 transmission.
Trial registration
ClinicalTrials.gov NCT04647305. Registered on November 30, 2020
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22
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Tong T, Tang W, Xiao S, Liang J. Antiviral Effects of Heparan Sulfate Analogue‐Modified Two‐Dimensional MXene Nanocomposites on PRRSV and SARS‐CoV‐2. ADVANCED NANOBIOMED RESEARCH 2022; 2:2200067. [PMID: 36249178 PMCID: PMC9538433 DOI: 10.1002/anbr.202200067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/03/2022] [Indexed: 01/09/2023] Open
Abstract
Due to the worldwide impact of viruses such as SARS‐CoV‐2, researchers have paid extensive attention to antiviral reagents against viruses. Despite extensive research on two‐dimensional (2D) transition metal carbides (MXenes) in the field of biomaterials, their antiviral effects have received little attention. In this work, heparan sulfate analogue (sodium 3‐mercapto‐1‐propanesulfonate, MPS) modified 2D MXene nanocomposites (Ti3C2‐Au‐MPS) for prevention of viral infection are prepared and investigated using severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pseudovirus and porcine reproductive and respiratory syndrome virus (PRRSV) as two model viruses. Ti3C2‐Au‐MPS nanocomposites are shown to possess antiviral properties in the different stages of PRRSV proliferation, such as direct interaction with PRRS virions and inhibiting their adsorption and penetration in the host cell. Additionally, Ti3C2‐Au‐MPS nanocomposites can strongly inhibit the infection of SARS‐CoV‐2 pseudovirus as shown by the contents of its reporter gene GFP and luciferase. These results demonstrate the potential broad‐spectrum antiviral property of Ti3C2‐Au‐MPS nanocomposites against viruses with the receptor of heparin sulfate. This work sheds light on the specific antiviral effects of MXene‐based nanocomposites against viruses and may facilitate further exploration of their antiviral applications.
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Affiliation(s)
- Ting Tong
- College of Science College of Resource and Environment State Key Laboratory of Agricultural Microbiology Huazhong Agricultural University Wuhan 430070 P. R. China
| | - Wantao Tang
- College of Science College of Resource and Environment State Key Laboratory of Agricultural Microbiology Huazhong Agricultural University Wuhan 430070 P. R. China
| | - Shaobo Xiao
- College of Veterinary Medicine State Key Laboratory of Agricultural Microbiology Key Laboratory of Preventive Veterinary Medicine in Hubei Province Huazhong Agricultural University Wuhan 430070 P. R. China
| | - Jiangong Liang
- College of Science College of Resource and Environment State Key Laboratory of Agricultural Microbiology Huazhong Agricultural University Wuhan 430070 P. R. China
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Diurnal changes of noninvasive parameters of ocular surface in healthy subjects before and after continuous face mask wearing during the COVID-19 pandemic. Sci Rep 2022; 12:12998. [PMID: 35906320 PMCID: PMC9334741 DOI: 10.1038/s41598-022-17486-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022] Open
Abstract
To investigate whether diurnal changes in noninvasive ocular surface parameters and subjective symptoms occur in healthy subjects wearing face mask who were analyzed before and after 8 h of continuous use. In this prospective cross-sectional study, healthy volunteers attending the same workplace environment underwent a noninvasive ocular surface workup by means of Keratograph 5 M (Oculus, Wetzlar, Germany) in the same day at 2 different time points: (i) in the early morning before wearing face mask (T0); (ii) after 8 h of continuous face mask use (T1). Noninvasive break-up time (NIBUT), tear meniscus height (TMH), ocular redness and meibomian gland dropout were measured. All subjects were asked to complete the Ocular Surface Disease Index (OSDI) questionnaire before and after 8 h of face mask wearing. Data from 20 healthy subjects (10 males and 10 females, mean age 25.1 ± 3.9 years) were included. Mean value of TMH decreased significantly from 0.29 ± 0.07 at T0 to 0.23 ± 0.07 mm at T1 (P < 0.001); conversely, mean values of NIBUT, redness score and meibomian gland dropout did not change significantly after continuous face mask wearing (always P > 0.532). Concerning ocular discomfort symptoms, mean value of OSDI score worsened significantly at T1 compared to T0 (from 12.9 ± 12.6 to 19.4 ± 12.0; P = 0.017). Continuous face mask wearing for 8 h led to decreased TMH associated with the onset of ocular discomfort symptoms in young healthy subjects.
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Arno A, Thomas J, Wallace B, Marshall IJ, McKenzie JE, Elliott JH. Accuracy and Efficiency of Machine Learning-Assisted Risk-of-Bias Assessments in "Real-World" Systematic Reviews : A Noninferiority Randomized Controlled Trial. Ann Intern Med 2022; 175:1001-1009. [PMID: 35635850 DOI: 10.7326/m22-0092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Automation is a proposed solution for the increasing difficulty of maintaining up-to-date, high-quality health evidence. Evidence assessing the effectiveness of semiautomated data synthesis, such as risk-of-bias (RoB) assessments, is lacking. OBJECTIVE To determine whether RobotReviewer-assisted RoB assessments are noninferior in accuracy and efficiency to assessments conducted with human effort only. DESIGN Two-group, parallel, noninferiority, randomized trial. (Monash Research Office Project 11256). SETTING Health-focused systematic reviews using Covidence. PARTICIPANTS Systematic reviewers, who had not previously used RobotReviewer, completing Cochrane RoB assessments between February 2018 and May 2020. INTERVENTION In the intervention group, reviewers received an RoB form prepopulated by RobotReviewer; in the comparison group, reviewers received a blank form. Studies were assigned in a 1:1 ratio via simple randomization to receive RobotReviewer assistance for either Reviewer 1 or Reviewer 2. Participants were blinded to study allocation before starting work on each RoB form. MEASUREMENTS Co-primary outcomes were the accuracy of individual reviewer RoB assessments and the person-time required to complete individual assessments. Domain-level RoB accuracy was a secondary outcome. RESULTS Of the 15 recruited review teams, 7 completed the trial (145 included studies). Integration of RobotReviewer resulted in noninferior overall RoB assessment accuracy (risk difference, -0.014 [95% CI, -0.093 to 0.065]; intervention group: 88.8% accurate assessments; control group: 90.2% accurate assessments). Data were inconclusive for the person-time outcome (RobotReviewer saved 1.40 minutes [CI, -5.20 to 2.41 minutes]). LIMITATION Variability in user behavior and a limited number of assessable reviews led to an imprecise estimate of the time outcome. CONCLUSION In health-related systematic reviews, RoB assessments conducted with RobotReviewer assistance are noninferior in accuracy to those conducted without RobotReviewer assistance. PRIMARY FUNDING SOURCE University College London and Monash University.
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Affiliation(s)
- Anneliese Arno
- EPPI-Centre, University College London, London, United Kingdom, and School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.A.)
| | - James Thomas
- EPPI-Centre, University College London, London, United Kingdom (J.T.)
| | - Byron Wallace
- College of Computer and Information Science, Northeastern University, Boston, Massachusetts (B.W.)
| | - Iain J Marshall
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom (I.J.M.)
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.E.M., J.H.E.)
| | - Julian H Elliott
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.E.M., J.H.E.)
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Arnaldo P, Mabunda N, Young PW, Tran T, Sitoe N, Chelene I, Nhanombe A, Isamael N, Júnior A, Cubula B, Inlamea OF, Gudo E, Jani IV. Prevalence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Antibodies in the Mozambican Population: A Cross-Sectional Serologic Study in 3 Cities, July-August 2020. Clin Infect Dis 2022; 75:S285-S293. [PMID: 35748663 PMCID: PMC9278262 DOI: 10.1093/cid/ciac516] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The extent of population exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was uncertain in many African countries during the onset of the pandemic. METHODS We conducted a cross-sectional study and randomly selected and surveyed general population and occupational groups from 6 July to 24 August 2020, in 3 cities in Mozambique. Anti-SARS-CoV-2-specific immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies were measured using a point-of-care rapid test. The prevalence was weighted for population (by age, sex, and city) and adjusted for test sensitivity and specificity. RESULTS A total of 21 183 participants, including 11 143 from the general population and 10 040 from occupational groups, were included across all 3 cities. General population seropositivity (IgM or IgG) prevalence was 3.0% (95% confidence interval [CI], 1.0%-6.6%) in Pemba, 2.1% (95% CI, 1.2%-3.3%) in Maputo City, and 0.9% (95% CI, .1%-1.9%) in Quelimane. The prevalence in occupational groups ranged from 2.8% (95% CI, 1.3%-5.2%) to 5.9% (95% CI, 4.3%-8.0%) in Pemba, 0.3% (95% CI, .0%-2.2%) to 4.0% (95% CI, 2.6%-5.7%) in Maputo City, and 0.0% (95% CI, .0%-.7%) to 6.6% (95% CI, 3.8%-10.5%) in Quelimane, and showed variations between the groups tested. CONCLUSIONS In the first representative COVID-19 serosurveys in Mozambique, in mid-2020, weighted and assay-adjusted seroprevalence in 3 provincial capitals of anti-SARS-CoV-2 ranged from 0.9% to 3.0%, whereas adjusted prevalence in occupational groups ranged from 0.0% to 6.6% with variation between groups. Exposure to SARS-CoV-2 was extensive during the first pandemic wave, and transmission may have been more intense among occupational groups. These data have been of utmost importance to inform public health intervention to control and respond to the pandemic in Mozambique.
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Affiliation(s)
- Paulo Arnaldo
- Corresponding author contact information Paulo Arnaldo INSTITUTO NACIONAL DE SAÚDE (INS) EN1, Bairro da Vila - Parcela n°3943 Distrito de Marracuene Província de Maputo-Moçambique E-mail:
| | - Nédio Mabunda
- Departamento de Regulação e Promoção da Investigação em Saúde, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Peter Wesley Young
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention (CDC), Maputo, Mozambique
| | - Tiffany Tran
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention (CDC), Maputo, Mozambique
| | - Nádia Sitoe
- Departamento de Plataformas Tecnológicas, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Imelda Chelene
- Departamento de Plataformas Tecnológicas, Instituto Nacional de Saúde, Maputo, Mozambique
| | | | - Nália Isamael
- Departamento de Plataformas Tecnológicas, Instituto Nacional de Saúde, Maputo, Mozambique
| | - António Júnior
- Departamento de Gestão e Coordenação da Investigação em Saúde, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Basílio Cubula
- Departamento de Métodos, Instituto Nacional de Estatística, Maputo, Mozambique
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Kunstler B, Newton S, Hill H, Ferguson J, Hore P, Mitchell BG, Dempsey K, Stewardson AJ, Friedman D, Cole K, Sim MR, Ferguson B, Burns P, King N, McGloughlin S, Dicks M, McCarthy S, Tam B, Hazelton B, McGurgan C, McDonald S, Turner T. P2/N95 respirators & surgical masks to prevent SARS-CoV-2 infection: Effectiveness & adverse effects. Infect Dis Health 2022; 27:81-95. [PMID: 35151628 PMCID: PMC8769935 DOI: 10.1016/j.idh.2022.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Millions of people have acquired and died from SARS-CoV-2 infection during the COVID-19 pandemic. Healthcare workers (HCWs) are required to wear personal protective equipment (PPE), including surgical masks and P2/N95 respirators, to prevent infection while treating patients. However, the comparative effectiveness of respirators and masks in preventing SARS-CoV-2 infection and the likelihood of experiencing adverse events (AEs) with wear are unclear. METHODS Searches were carried out in PubMed, Europe PMC and the Cochrane COVID-19 Study Register to 14 June 2021. A systematic review of comparative epidemiological studies examining SARS-CoV-2 infection or AE incidence in HCWs wearing P2/N95 (or equivalent) respirators and surgical masks was performed. Article screening, risk of bias assessment and data extraction were duplicated. Meta-analysis of extracted data was carried out in RevMan. RESULTS Twenty-one studies were included, with most having high risk of bias. There was no statistically significant difference in respirator or surgical mask effectiveness in preventing SARS-CoV-2 infection (OR 0.85, [95%CI 0.72, 1.01]). Healthcare workers experienced significantly more headaches (OR 2.62, [95%CI 1.18, 5.81]), respiratory distress (OR 4.21, [95%CI 1.46, 12.13]), facial irritation (OR 1.80, [95%CI 1.03, 3.14]) and pressure-related injuries (OR 4.39, [95%CI 2.37, 8.15]) when wearing respirators compared to surgical masks. CONCLUSION The existing epidemiological evidence does not enable definitive assessment of the effectiveness of respirators compared to surgical masks in preventing infection. Healthcare workers wearing respirators may be more likely to experience AEs. Effective mitigation strategies are important to ensure the uptake and correct use of respirators by HCWs.
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Affiliation(s)
- Breanne Kunstler
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton, Melbourne, VIC, 3800, Australia.
| | - Skye Newton
- Adelaide Health Technology Assessment (AHTA), School of Public Health, University of Adelaide, Australia
| | - Hayley Hill
- Adelaide Health Technology Assessment (AHTA), School of Public Health, University of Adelaide, Australia
| | - John Ferguson
- Division of Medicine, John Hunter Hospital, Newcastle Regional Mail Centre, NSW, 2310, Australia
| | - Phillipa Hore
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Brett G. Mitchell
- The University of Newcastle, School of Nursing and Midwifery, Level 9, 77a Holden St, Gosford Hospital, Gosford, NSW, Australia, 2250
| | - Kathy Dempsey
- The Clinical Excellence Commission, 1 Reserve Road, St Leonards, NSW, Australia, 2065
| | - Andrew J. Stewardson
- Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, 85 Commercial Rd, Melbourne, VIC, Australia, 3004
| | - Deborah Friedman
- Deputy Chief Health Officer, Victorian Department of Health Melbourne, VIC, Australia, 3004
| | - Kate Cole
- Cole Health Pty Ltd, Balmain, NSW, Australia, 2041
| | - Malcolm R. Sim
- Monash Centre for Occupational & Environmental Health (MonCOEH), School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Rd, Melbourne, VIC, Australia, 3004
| | - Bridget Ferguson
- Central Queensland University, School of Nursing, Midwifery and Social Sciences; 554-700 Yaamba Rd, Norman Gardens, QLD, 4701, Australia
| | - Penelope Burns
- Academic Unit of General Practice, ANU Medical School, The Australian National University, Building 4, Hospital Road, Garran, ACT, 2605, Australia
| | - Nicole King
- North Shore Private Hospital, 3 Westbourne St, St Leonard's, 2065, Australia
| | - Steven McGloughlin
- Alfred Health and School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, Australia, 3004
| | - Melanie Dicks
- Ernst & Young, 121 Marcus Clarke Street, Canberra, ACT, Australia, 2601
| | - Sally McCarthy
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Barry Tam
- Health Infrastructure NSW, 60 Day Road, Cheltenham, NSW, 2119, Australia
| | - Briony Hazelton
- PathWest Laboratory Medicine, QEII Medical Centre, Hospital Avenue, Nedlands, WA, Australia, 6009
| | - Cherylynn McGurgan
- Royal Melbourne Hospital Emergency Department, 300 Grattan Street, Parkville, VIC, Australia, 3050
| | - Steve McDonald
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Tari Turner
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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27
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Chou R, Dana T, Jungbauer R. Update Alert 7: Masks for Prevention of Respiratory Virus Infections, Including SARS-CoV-2, in Health Care and Community Settings. Ann Intern Med 2022; 175:W58-W59. [PMID: 35344376 PMCID: PMC8966624 DOI: 10.7326/l21-0783] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Roger Chou
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon
| | - Tracy Dana
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon
| | - Rebecca Jungbauer
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon
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Zhao H, Jatana S, Bartoszko J, Loeb M. Nonpharmaceutical interventions to prevent viral respiratory infection in community settings: an umbrella review. ERJ Open Res 2022; 8:00650-2021. [PMID: 35651370 PMCID: PMC9149389 DOI: 10.1183/23120541.00650-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/29/2022] [Indexed: 01/08/2023] Open
Abstract
BackgroundRespiratory viruses pose an important public health threat to most communities. Nonpharmaceutical interventions (NPIs) such as masks, hand hygiene or physical distancing, among others, are believed to play an important role in reducing transmission of respiratory viruses. In this umbrella review, we summarise the evidence of the effectiveness of NPIs for the prevention of respiratory virus transmission in the community setting.ObservationsA systematic search of PubMed, Embase, Medline and Cochrane reviews resulted in a total of 24 studies consisting of 11 systematic reviews and meta-analyses, 12 systematic reviews without meta-analyses and one standalone meta-analysis. The current evidence from these data suggests that hand hygiene is protective against respiratory viral infection. The use of hand hygiene and facemasks, facemasks alone and physical distancing were interventions with inconsistent evidence. Interventions such as school closures, oral hygiene or nasal saline rinses were shown to be effective in reducing the risk of influenza; however, the evidence is sparse and mostly of low and critically low quality.ConclusionsStudies on the effectiveness of NPIs for the prevention of respiratory viral transmission in the community vary in study design, quality and reported effectiveness. Evidence for the use of hand hygiene or facemasks is the strongest; therefore, the most reasonable suggestion is to use hand hygiene and facemasks in the community setting.
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Minoguchi K, Isii A, Nakamura T, Sato H, Abe T, Kawakami H, Nakamura K, Goto T. Effects of wearing surgical masks on fraction of inspired oxygen in spontaneously breathing patients: improving safety for frontline healthcare professionals under pandemic situations. BMC Anesthesiol 2022; 22:108. [PMID: 35436860 PMCID: PMC9014278 DOI: 10.1186/s12871-022-01649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During pandemic situations, many guidelines recommend that surgical masks be worn by both healthcare professionals and infected patients in healthcare settings. The purpose of this study was to clarify the levels and changes of oxygen concentration over time while oxygen was administered over a surgical mask. METHODS Patients scheduled to undergo general anesthesia (n = 99) were enrolled in this study. First, patients were administered oxygen at 6 L/min via an oxygen mask over a surgical mask for 5 min. The patients removed the surgical mask and then took a 3-min break; thereafter, the same amount of oxygen was administered for another 5 min via the oxygen mask. We measured the fraction of inspired oxygen (FiO2), the end-tidal CO2 (EtCO2), and respiratory frequency every minute for 5 min, both while administering oxygen with and without a surgical mask. The FiO2 was measured at the beginning of inspiration and the EtCO2 was measured at the end of expiration. RESULTS The FiO2 at 5 min was significantly lower when breathing with a surgical mask than that without it (mean difference: 0.08 [95% CI: 0.067-0.10]; p < 0.001). In contrast, the EtCO2 at 5 min was significantly higher when breathing with a surgical mask than that without it (mean difference: 11.9 mmHg [95% CI: 10.9-12.9]; p < 0.001). CONCLUSION The FiO2 was lower when oxygen was administered over surgical masks than when patients did not wear surgical masks. Oxygen flow may need to be adjusted in moderately ill patients requiring oxygen administration.
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Affiliation(s)
- Kazuhiro Minoguchi
- Department of Anesthesiology, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Akira Isii
- Department of Anesthesiology, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Toshiki Nakamura
- Department of Anesthesiology, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Hitoshi Sato
- Department of Anesthesiology, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan. .,Department of Clinical Quality Management, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan. .,Department of Quality and Safety in Healthcare, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Takeru Abe
- Department of Quality and Safety in Healthcare, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Hiromasa Kawakami
- Department of Anesthesiology, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Kyota Nakamura
- Department of Clinical Quality Management, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.,Department of Quality and Safety in Healthcare, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Takahisa Goto
- Department of Anesthesiology and Intensive Care Unit, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
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Grainger R, Kim AHJ, Conway R, Yazdany J, Robinson PC. COVID-19 in people with rheumatic diseases: risks, outcomes, treatment considerations. Nat Rev Rheumatol 2022; 18:191-204. [PMID: 35217850 PMCID: PMC8874732 DOI: 10.1038/s41584-022-00755-x] [Citation(s) in RCA: 89] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 02/06/2023]
Abstract
The COVID-19 pandemic has brought challenges for people with rheumatic disease in addition to those faced by the general population, including concerns about higher risks of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and poor outcomes of COVID-19. The data that are now available suggest that rheumatic disease is associated with a small additional risk of SARS-CoV-2 infection, and that outcomes of COVID-19 are primarily influenced by comorbidities and particular disease states or treatments. Despite considerable advances in our knowledge of which therapeutic agents provide benefits in COVID-19, and of what constitutes effective vaccination strategies, the specific considerations that apply to people with rheumatic disease are yet to be definitively addressed. An overview of the most important COVID-19 studies to date that relate to people with rheumatic disease can contribute to our understanding of the clinical-care requirements of this population.
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Affiliation(s)
- Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Alfred H J Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Richard Conway
- Department of Rheumatology, St James's Hospital, Dublin, Ireland
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Philip C Robinson
- University of Queensland School of Clinical Medicine, Faculty of Medicine, Herston, Queensland, Australia.
- Royal Brisbane & Women's Hospital, Metro North Hospital & Health Service, Herston Road, Herston, Queensland, Australia.
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Motallebi S, Cheung RCY, Mohit B, Shahabi S, Alishahi Tabriz A, Moattari S. Modeling COVID-19 Mortality Across 44 Countries: Face Covering May Reduce Deaths. Am J Prev Med 2022; 62:483-491. [PMID: 35305777 PMCID: PMC8580811 DOI: 10.1016/j.amepre.2021.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Despite ongoing efforts to vaccinate communities against COVID-19, the necessity of face mask use in controlling the pandemic remains subject to debate. Several studies have investigated face masks and COVID-19, covering smaller and less diverse populations than this study's sample. This study examines a hypothesized association of face-covering mandates with COVID-19 mortality decline across 44 countries in 2 continents. METHODS In a retrospective cohort study, changes in COVID-19‒related daily mortality rate per million population from February 15 to May 31, 2020 were compared between 27 countries with and 17 countries without face mask mandates in nearly 1 billion (911,446,220 total) people. Longitudinal mixed effect modeling was applied and adjusted for over 10 relevant demographic, social, clinical, and time-dependent confounders. RESULTS Average COVID-19 mortality per million was 288.54 in countries without face mask policies and 48.40 in countries with face mask policies. In no mask countries, adjusted average daily increase was 0.1553 - 0.0017 X (days since the first case) log deaths per million, compared with 0.0900 - 0.0009 X (days since the first case) log deaths per million in the countries with a mandate. A total of 60 days into the pandemic, countries without face mask mandates had an average daily increase of 0.0533 deaths per million, compared with the average daily increase of 0.0360 deaths per million for countries with face mask mandates. CONCLUSIONS This study's significant results show that face mask mandates were associated with lower COVID-19 deaths rates than the rates in countries without mandates. These findings support the use of face masks to prevent excess COVID-19 deaths and should be advised during airborne disease epidemics.
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Affiliation(s)
- Sahar Motallebi
- Department of Social Medicine and Global Health, Lund University, Lund, Sweden
| | - Rex C Y Cheung
- Department of Decision Sciences, San Francisco State University, San Francisco, California
| | - Babak Mohit
- Sleep Disorders Center, University of Maryland Medical Center, Baltimore, Maryland.
| | - Shahram Shahabi
- Southwest College of Naturopathic Medicine & Health Sciences, Tempe, Arizona
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Syamak Moattari
- Health Sciences Department, Worcester State University, Worcester, Massachusetts
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Surface Functionalization of Non-Woven Fabrics Using a Novel Silica-Resin Coating Technology: Antiviral Treatment of Non-Woven Fabric Filters in Surgical Masks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063639. [PMID: 35329324 PMCID: PMC8952221 DOI: 10.3390/ijerph19063639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/08/2022] [Accepted: 03/12/2022] [Indexed: 11/16/2022]
Abstract
Masks are effective for preventing the spread of COVID-19 and other respiratory infections. If antimicrobial properties can be applied to the non-woven fabric filters in masks, they can become a more effective countermeasure against human-to-human and environmental infections. We investigated the possibilities of carrying antimicrobial agents on the fiber surfaces of non-woven fabric filters by applying silica-resin coating technology, which can form silica-resin layers on such fabrics at normal temperature and pressure. Scanning electron microscopy and electron probe microanalysis showed that a silica-resin layer was formed on the fiber surface of non-woven fabric filters. Bioassays for coronavirus and quantitative reverse transcription-polymerase chain reactions (RT-PCR) revealed that all antimicrobial agents tested loaded successfully onto non-woven fabric filters without losing their inactivation effects against the human coronavirus (inhibition efficacy: >99.999%). These results indicate that this technology could be used to load a functional substance onto a non-woven fabric filter by vitrifying its surface. Silica-resin coating technology also has the potential of becoming an important breakthrough not only in the prevention of infection but also in various fields, such as prevention of building aging, protection of various cultural properties, the realization of a plastic-free society, and prevention of environmental pollution.
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Effectiveness of Mask-Wearing on Respiratory Illness Transmission in Community Settings: A Rapid Review. Disaster Med Public Health Prep 2022; 17:e96. [PMID: 35249589 PMCID: PMC9623601 DOI: 10.1017/dmp.2021.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Respiratory illnesses, including coronavirus disease 2019 (COVID-19), have resulted in millions of deaths globally. Guidance on mask-wearing in community settings has been inconsistent. This review examined the effectiveness of mask-wearing on respiratory virus transmission in community settings. METHODS A search was conducted for English language reports of randomized controlled trials of mask-wearing in the community and effect on laboratory-confirmed respiratory infections or influenza-like illness. Investigators abstracted study characteristics and assessed bias. Meta-analysis was conducted to calculate pooled risk estimates. RESULTS Eleven studies were included. In 7 studies that evaluated influenza-like illness symptoms as an outcome (3029 participants), this study found mask-wearing associated with a decreased risk of influenza-like illness (overall risk ratio [RR], 0.83; 95% confidence interval [CI], 0.71 to 0.96). Studies examining laboratory-confirmed respiratory infections as an outcome (10,531 participants) showed no statistically significant association between mask-wearing and infections (RR, 1.04; 95% CI, 0.60-1.80). However, masking combined with enhanced hand hygiene was associated with a decreased risk for both influenza-like illness symptoms (RR, 0.88; 95% CI, 0.51-1.51) and laboratory-confirmed respiratory infection (RR, 0.79; 95% CI, 0.52-1.18). CONCLUSIONS Masking in community settings decreases transmission of influenza-like illness. Mask-wearing combined with enhanced hand hygiene reduces transmission of influenza-like illness and laboratory-confirmed respiratory infection.
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Transport Safety Concerning a Patient Infected With SARS-CoV-2 and Emergency Service Officers in an Ambulance Accident-A Case Study. Disaster Med Public Health Prep 2022; 17:e139. [PMID: 35241209 PMCID: PMC9002143 DOI: 10.1017/dmp.2022.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The manifestation of a new pathogen, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), constitutes a new problem for modern health care systems. Developing updated standards for all emergency services working at an accident site during the pandemic has been a continuous challenge. The principal method of preventing the transmission of the SARS-CoV-2 virus is the use of personal protective equipment, such as protective suits, masks and goggles, or face shields. The study aims to present the recommended on-site procedures during the coronavirus pandemic based on the description of an accident of an ambulance transporting a patient with confirmed SARS-CoV-2 infection, emphasizing the actions taken by the emergency services sent to the accident site.
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35
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Advances in the Prophylaxis of Respiratory Infections by the Nasal and the Oromucosal Route: Relevance to the Fight with the SARS-CoV-2 Pandemic. Pharmaceutics 2022; 14:pharmaceutics14030530. [PMID: 35335905 PMCID: PMC8953301 DOI: 10.3390/pharmaceutics14030530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/19/2022] [Accepted: 02/23/2022] [Indexed: 11/22/2022] Open
Abstract
In this time of COVID-19 pandemic, the strategies for prevention of the infection are a primary concern. Looking more globally on the subject and acknowledging the high degree of misuse of protective face masks from the population, we focused this review on alternative pharmaceutical developments eligible for self-defense against respiratory infections. In particular, the attention herein is directed to the nasal and oromucosal formulations intended to boost the local immunity, neutralize or mechanically “trap” the pathogens at the site of entry (nose or mouth). The current work presents a critical review of the contemporary methods of immune- and chemoprophylaxis and their suitability and applicability in topical mucosal dosage forms for SARS-CoV-2 prophylaxis.
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Kim MS, Seong D, Li H, Chung SK, Park Y, Lee M, Lee SW, Yon DK, Kim JH, Lee KH, Solmi M, Dragioti E, Koyanagi A, Jacob L, Kronbichler A, Tizaoui K, Cargnin S, Terrazzino S, Hong SH, Abou Ghayda R, Radua J, Oh H, Kostev K, Ogino S, Lee IM, Giovannucci E, Barnett Y, Butler L, McDermott D, Ilie PC, Shin JI, Smith L. Comparative effectiveness of N95, surgical or medical, and non-medical facemasks in protection against respiratory virus infection: A systematic review and network meta-analysis. Rev Med Virol 2022; 32:e2336. [PMID: 35218279 PMCID: PMC9111143 DOI: 10.1002/rmv.2336] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 12/25/2022]
Abstract
The aim of this systematic review and network meta‐analysis is to evaluate the comparative effectiveness of N95, surgical/medical and non‐medical facemasks as personal protective equipment against respiratory virus infection. The study incorporated 35 published and unpublished randomized controlled trials and observational studies investigating specific mask effectiveness against influenza virus, SARS‐CoV, MERS‐CoV and SARS‐CoV‐2. We searched PubMed, Google Scholar and medRxiv databases for studies published up to 5 February 2021 (PROSPERO registration: CRD42020214729). The primary outcome of interest was the rate of respiratory viral infection. The quality of evidence was estimated using the GRADE approach. High compliance to mask‐wearing conferred a significantly better protection (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.23–0.82) than low compliance. N95 or equivalent masks were the most effective in providing protection against coronavirus infections (OR, 0.30; CI, 0.20–0.44) consistently across subgroup analyses of causative viruses and clinical settings. Evidence supporting the use of medical or surgical masks against influenza or coronavirus infections (SARS, MERS and COVID‐19) was weak. Our study confirmed that the use of facemasks provides protection against respiratory viral infections in general; however, the effectiveness may vary according to the type of facemask used. Our findings encourage the use of N95 respirators or their equivalents (e.g., P2) for best personal protection in healthcare settings until more evidence on surgical and medical masks is accrued. This study highlights a substantial lack of evidence on the comparative effectiveness of mask types in community settings.
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Affiliation(s)
- Min Seo Kim
- Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
| | - Dawon Seong
- College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Han Li
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Seo Kyoung Chung
- College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Youngjoo Park
- College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Minho Lee
- College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Seung Won Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, Republic of Korea.,Department of Precision Medicine, Sungkyunkwan University School of medicine, Suwon, Republic of Korea
| | - Dong Keon Yon
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Jae Han Kim
- College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Keum Hwa Lee
- College of Medicine, Yonsei University, Seoul, Republic of Korea.,Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ontario, Canada.,Department of Mental Health, The Ottawa Hospital, Ontario, Canada.,Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Elena Dragioti
- Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, CIBERSAM, Barcelona, Spain.,ICREA, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, CIBERSAM, Barcelona, Spain.,Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | | | - Kalthoum Tizaoui
- Department of Basic Sciences, Medicine Faculty of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Sarah Cargnin
- Department of Pharmaceutical Sciences, Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale, Novara, Italy
| | - Salvatore Terrazzino
- Department of Pharmaceutical Sciences, Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale, Novara, Italy
| | - Sung Hwi Hong
- Severance Hospital, Yonsei University Health Systems, Seoul, Republic of Korea
| | - Ramy Abou Ghayda
- Urology Institute, University Hospitals System, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Mental Health Research Networking Center, CIBERSAM, Barcelona, Spain.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institute, Stockholm, Sweden
| | - Hans Oh
- School of Social Work, University of Southern California, California, USA
| | | | - Shuji Ogino
- Cancer Immunology and Cancer Epidemiology Programs, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - I-Min Lee
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Edward Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Yvonne Barnett
- School of Life Sciences, Faculty of Science and Engineering, Anglia Ruskin University, East Road, Cambridge, UK
| | - Laurie Butler
- Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, UK
| | - Daragh McDermott
- NTU Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | | | - Jae Il Shin
- College of Medicine, Yonsei University, Seoul, Republic of Korea.,Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Lee Smith
- Center for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
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Kessler SE, Aunger R. The evolution of the human healthcare system and implications for understanding our responses to COVID-19. Evol Med Public Health 2022; 10:87-107. [PMID: 35284079 PMCID: PMC8908543 DOI: 10.1093/emph/eoac004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 01/14/2022] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic has revealed an urgent need for a comprehensive, multidisciplinary understanding of how healthcare systems respond successfully to infectious pathogens-and how they fail. This study contributes a novel perspective that focuses on the selective pressures that shape healthcare systems over evolutionary time. We use a comparative approach to trace the evolution of care-giving and disease control behaviours across species and then map their integration into the contemporary human healthcare system. Self-care and pro-health environmental modification are ubiquitous across animals, while derived behaviours like care for kin, for strangers, and group-level organizational responses have evolved via different selection pressures. We then apply this framework to our behavioural responses to COVID-19 and demonstrate that three types of conflicts are occurring: (1) conflicting selection pressures on individuals, (2) evolutionary mismatches between the context in which our healthcare behaviours evolved and our globalized world of today and (3) evolutionary displacements in which older forms of care are currently dispensed through more derived forms. We discuss the significance of understanding how healthcare systems evolve and change for thinking about the role of healthcare systems in society during and after the time of COVID-19-and for us as a species as we continue to face selection from infectious diseases.
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Affiliation(s)
- Sharon E Kessler
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Robert Aunger
- Environmental Health Group, London School of Hygiene and Tropical Medicine, London, UK
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38
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Li H, Yuan K, Sun YK, Zheng YB, Xu YY, Su SZ, Zhang YX, Zhong Y, Wang YJ, Tian SS, Gong YM, Fan TT, Lin X, Gobat N, Wong SYS, Chan EYY, Yan W, Sun SW, Ran MS, Bao YP, Shi J, Lu L. Efficacy and practice of facemask use in general population: a systematic review and meta-analysis. Transl Psychiatry 2022; 12:49. [PMID: 35105851 PMCID: PMC8804079 DOI: 10.1038/s41398-022-01814-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 12/14/2021] [Accepted: 01/18/2022] [Indexed: 11/17/2022] Open
Abstract
In recent decades, respiratory infections, including SARS, HINI and the currently spreading COVID-19, caused by various viruses such as influenza and coronavirus have seriously threatened human health. It has generated inconsistent recommendations on the mandatory use of facemasks across countries on a population level due to insufficient evidence on the efficacy of facemask use among the general population. This meta-analysis aimed to explore (1) the efficacy of facemask use on preventing respiratory infections, and (2) the perceptions, intentions, and practice about facemask use among the general population worldwide. We searched PubMed, MEDLINE, Web of Science, Cochrane, bioRxiv, and medRxiv databases since inception to August 17, 2020. From 21,341 records identified, eight RCTs on facemask in preventing infections and 78 studies on perception, intention, and practice of facemask use among the general population were included in the analysis. The meta-analysis of RCTs found a significant protective effect of facemask intervention (OR = 0.84; 95% CI = 0.71-0.99; I2 = 0%). This protective effect was even more pronounced when the intervention duration was more than two weeks (OR = 0.76; 95% CI = 0.66-0.88; I2 = 0%). The meta-analysis of observational studies on perception, intention, and practice on facemask use showed that 71% of respondents perceived facemasks to be effective for infection prevention, 68% of respondents would wear facemasks, and 54% of respondents wore facemasks for preventing respiratory infections. Differences in perception, intention, and practice behavior of facemask use in different regions may be related to the impact of respiratory infections, regional culture, and policies. The governments and relevant organizations should make effort to reduce the barriers in the use of facemasks.
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Affiliation(s)
- Hui Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No.2018RU006), Peking University, 100191, Beijing, China
| | - Kai Yuan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No.2018RU006), Peking University, 100191, Beijing, China
| | - Yan-Kun Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No.2018RU006), Peking University, 100191, Beijing, China
| | - Yong-Bo Zheng
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No.2018RU006), Peking University, 100191, Beijing, China
| | - Ying-Ying Xu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, 100191, Beijing, China
- School of Public Health, Peking University, 100191, Beijing, China
| | - Si-Zhen Su
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No.2018RU006), Peking University, 100191, Beijing, China
| | - Yu-Xin Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No.2018RU006), Peking University, 100191, Beijing, China
- School of Public Health, Peking University, 100191, Beijing, China
| | - Yi Zhong
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No.2018RU006), Peking University, 100191, Beijing, China
- Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Yi-Jie Wang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No.2018RU006), Peking University, 100191, Beijing, China
- Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Shan-Shan Tian
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No.2018RU006), Peking University, 100191, Beijing, China
| | - Yi-Miao Gong
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No.2018RU006), Peking University, 100191, Beijing, China
- Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Teng-Teng Fan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No.2018RU006), Peking University, 100191, Beijing, China
| | - Xiao Lin
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No.2018RU006), Peking University, 100191, Beijing, China
- Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Nina Gobat
- Nuffield Dept of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Samuel Yeung Shan Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Emily Ying Yang Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, School of Public Health and Primary Care, Prince of Wales Hospital, Sha tin, Hong Kong
| | - Wei Yan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No.2018RU006), Peking University, 100191, Beijing, China
| | - Si-Wei Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No.2018RU006), Peking University, 100191, Beijing, China
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Yan-Ping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, 100191, Beijing, China.
- School of Public Health, Peking University, 100191, Beijing, China.
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, 100191, Beijing, China.
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No.2018RU006), Peking University, 100191, Beijing, China.
- Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China.
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The Thought of Death in a Pandemic Era: Can Anxiety Determine the Nexus between the Accessibility, Availability and Use of Personal Protective Equipment (PPE) for COVID-19 and Work Behaviour among Aviation Workers? Healthcare (Basel) 2022; 10:healthcare10020215. [PMID: 35206830 PMCID: PMC8872227 DOI: 10.3390/healthcare10020215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/21/2021] [Accepted: 01/17/2022] [Indexed: 12/15/2022] Open
Abstract
Since the emergence of COVID-19, the aviation sector has been one of the numerous industries which have been affected the most. In this present paper, the thought of death among aviation workers as an indicator of anxiety at a time when the availability, access to, and use of Personal Protective Equipment (PPE) remains paramount to the survival of work in the line of duties and its influence on different work behaviors was assessed. The theoretical foundation of the study was built on the process efficiency theory, attentional interference theory, and the terror management theory (TMT), which focuses on both the psychological and emotional responses exhibited by people due to fear or worry about a specific situation. The study adopted an exploratory study design that incorporates a cross-sectional and self-reported survey among 646 frontline workers across 12 international airlines and the Ghana Airport Company Limited (GACL), Accra, Ghana using simple random sampling and convenient sampling techniques. After all the preliminary tests were performed, the path analysis estimated by Structural Equation Modelling (SEM) indicated that anxiety has a significant influence on workers’ stress-adaptive performance and task performance, but recorded no significant causal link with interpersonal performance. The findings indicated that all three proxies of employee work behaviours, which focus on both adaptive and task performance, were significantly related to workers’ access, availability, and use of PPE (APPE). The association between anxiety and APPE was also found to be significant. Bootstrapping mediation analysis shows that anxiety partially mediates the influence APPE has on both stress-adaptive performance and task performance, but did not show any mediating effect on the association between APPE and interpersonal performance. Among the three dimensions of death anxiety, both the fear of death (FDE) and death intrusion (DINT) indicated a significant partial mediating effect on the influence APPE has on all three multidimensional constructs of work behaviours. The findings literally prove that worrying about the fatality risk associated with COVID-19 is highly predictive.
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40
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El Hassan M, Assoum H, Bukharin N, Al Otaibi H, Mofijur M, Sakout A. A review on the transmission of COVID-19 based on cough/sneeze/breath flows. EUROPEAN PHYSICAL JOURNAL PLUS 2022; 137:1. [PMID: 34909366 PMCID: PMC8660964 DOI: 10.1140/epjp/s13360-021-02162-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/08/2021] [Indexed: 05/17/2023]
Abstract
COVID-19 pandemic has recently had a dramatic impact on society. The understanding of the disease transmission is of high importance to limit its spread between humans. The spread of the virus in air strongly depends on the flow dynamics of the human airflows. It is, however, known that predicting the flow dynamics of the human airflows can be challenging due to different particles sizes and the turbulent aspect of the flow regime. It is thus recommended to present a deep analysis of different human airflows based on the existing experimental investigations. A validation of the existing numerical predictions of such flows would be of high interest to further develop the existing numerical model for different flow configurations. This paper presents a literature review of the experimental and numerical studies on human airflows, including sneezing, coughing and breathing. The dynamics of these airflows for different droplet sizes is discussed. The influence of other parameters, such as the viscosity and relative humidity, on the germs transmission is also presented. Finally, the efficacy of using a facemask in limiting the transmission of COVID-19 is investigated.
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Affiliation(s)
- Mouhammad El Hassan
- Mechanical Engineering Department, Prince Mohammad Bin Fahd University, Al Khobar, Kingdom of Saudi Arabia
| | - Hassan Assoum
- Mechanical Engineering Department, Beirut Arab University, Tripoli, Lebanon
| | - Nikolay Bukharin
- School of Manufacturing and Automation, Southern Alberta Institute of Technology, Calgary, Canada
| | - Huda Al Otaibi
- Mechanical Engineering Department, Prince Mohammad Bin Fahd University, Al Khobar, Kingdom of Saudi Arabia
| | - Md Mofijur
- Mechanical Engineering Department, Prince Mohammad Bin Fahd University, Al Khobar, Kingdom of Saudi Arabia
- Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW 2007 Australia
| | - Anas Sakout
- LASIE, University of La Rochelle, La Rochelle, France
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41
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Landry SA, Subedi D, Barr JJ, MacDonald MI, Dix S, Kutey DM, Mansfield D, Hamilton GS, Edwards BA, Joosten SA. OUP accepted manuscript. J Infect Dis 2022; 226:199-207. [PMID: 35535021 PMCID: PMC9400421 DOI: 10.1093/infdis/jiac195] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background Healthcare workers (HCWs) are at risk from aerosol transmission of severe acute respiratory syndrome coronavirus 2. The aims of this study were to (1) quantify the protection provided by masks (surgical, fit-testFAILED N95, fit-testPASSED N95) and personal protective equipment (PPE), and (2) determine if a portable high-efficiency particulate air (HEPA) filter can enhance the benefit of PPE. Methods Virus aerosol exposure experiments using bacteriophage PhiX174 were performed. An HCW wearing PPE (mask, gloves, gown, face shield) was exposed to nebulized viruses (108 copies/mL) for 40 minutes in a sealed clinical room. Virus exposure was quantified via skin swabs applied to the face, nostrils, forearms, neck, and forehead. Experiments were repeated with a HEPA filter (13.4 volume-filtrations/hour). Results Significant virus counts were detected on the face while the participants were wearing either surgical or N95 masks. Only the fit-testPASSED N95 resulted in lower virus counts compared to control (P = .007). Nasal swabs demonstrated high virus exposure, which was not mitigated by the surgical/fit-testFAILED N95 masks, although there was a trend for the fit-testPASSED N95 mask to reduce virus counts (P = .058). HEPA filtration reduced virus to near-zero levels when combined with fit-testPASSED N95 mask, gloves, gown, and face shield. Conclusions N95 masks that have passed a quantitative fit-test combined with HEPA filtration protects against high virus aerosol loads at close range and for prolonged periods of time.
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Affiliation(s)
- Shane A Landry
- Correspondence: Shane Landry, PhD, Monash University BASE facility, 264 Ferntree Gully Road, Ground Floor, Notting Hill, 3168, VIC, Australia ()
| | - Dinesh Subedi
- School of Biological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jeremy J Barr
- School of Biological Sciences, Monash University, Clayton, Victoria, Australia
| | - Martin I MacDonald
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, Victoria, Australia
| | - Samantha Dix
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Donna M Kutey
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Darren Mansfield
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, Victoria, Australia
- School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
- Monash Partners–Epworth, Victoria, Victoria, Australia
| | - Garun S Hamilton
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, Victoria, Australia
- School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
- Monash Partners–Epworth, Victoria, Victoria, Australia
| | - Bradley A Edwards
- Department of Physiology, School of Biomedical Sciences and Biomedical Discovery Institute, Monash University, Melbourne, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Simon A Joosten
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, Victoria, Australia
- School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
- Monash Partners–Epworth, Victoria, Victoria, Australia
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Change in Pediatric Health Care Spending and Drug Utilization during the COVID-19 Pandemic. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121183. [PMID: 34943379 PMCID: PMC8699860 DOI: 10.3390/children8121183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 11/26/2021] [Accepted: 12/09/2021] [Indexed: 12/23/2022]
Abstract
Objective: To evaluate how the restrictive measures implemented during the SARS-CoV-2 pandemic have influenced the incidence of the most common children’s diseases and the consumption of medications in 2020 compared to 2019. Methods: We involved all family pediatricians of the local health authority of Latina, from which we requested data of monthly visits in 2019 and 2020 for six common diseases disseminated through droplets and contact, and the territorial and integrative pharmaceutical unit of the area, from which we requested data of the net expenditure regarding the most commonly used drugs at pediatric age. Results: There was significant reduction in the incidence of the evaluated diseases and in the consumption of investigated drugs between 2019 and 2020 in the months when the restrictive measures were in place, with an attenuation of this effect during the months of the gradual loosening of those measures. Conclusion: Nonpharmaceutical intervention measures have caused changes in the diffusion of common pediatric diseases. We believe that the implementation of a reasonable containment strategy, even outside of the pandemic, could positively influence the epidemiology of infectious and allergic diseases in children, and healthcare system spending.
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Atzema CL, Mostarac I, Button D, Austin PC, Javidan AP, Wintraub L, Li A, Patel RV, Lee DD, Latham NP, Latham EA, Brown PCM, Somogyi RD, Chang A, Nguyen H, Buerk S, Chen B, Zimmerman T, Funari T, Colbert C, Kea B. Assessing effective mask use by the public in two countries: an observational study. BMJ Open 2021; 11:e049389. [PMID: 34887270 PMCID: PMC8662585 DOI: 10.1136/bmjopen-2021-049389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 10/29/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES During the COVID-19 pandemic wearing a mask in public has been recommended in some settings and mandated in others. How often this advice is followed, how well, and whether it inadvertently leads to more disease transmission opportunities due to a combination of improper use and physical distancing lapses is unknown. DESIGN Cross-sectional observational study performed in June-August 2020. SETTING Eleven outdoor and indoor public settings (some with mandated mask use, some without) each in Toronto, Ontario, and in Portland, Oregon. PARTICIPANTS All passers-by in the study settings. OUTCOME MEASURES Mask use, incorrect mask use, and number of breaches (ie, coming within 2 m of someone else where both parties were not properly masked). RESULTS We observed 36 808 persons, the majority of whom were estimated to be aged 31-65 years (49%). Two-thirds (66.7%) were wearing a mask and 13.6% of mask-wearers wore them incorrectly. Mandatory mask-use settings were overwhelmingly associated with mask use (adjusted OR 79.2; 95% CI 47.4 to 135.1). Younger age, male sex, Torontonians, and public transit or airport settings (vs in a store) were associated with lower adjusted odds of wearing a mask. Mandatory mask-use settings were associated with lower adjusted odds of mask error (OR 0.30; 95% CI 0.14 to 0.73), along with female sex and Portland subjects. Subjects aged 81+ years (vs 31-65 years) and those on public transit and at the airport (vs stores) had higher odds of mask errors. Mask-wearers had a large reduction in adjusted mean number of breaches (rate ratio (RR) 0.19; 95% CI 0.17 to 0.20). The 81+ age group had the largest association with breaches (RR 7.77; 95% CI 5.32 to 11.34). CONCLUSIONS Mandatory mask use was associated with a large increase in mask-wearing. Despite 14% of them wearing their masks incorrectly, mask users had a large reduction in the mean number of breaches (disease transmission opportunities). The elderly and transit users may warrant public health interventions aimed at improving mask use.
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Affiliation(s)
- Clare L Atzema
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ivona Mostarac
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Dana Button
- Oregon Health & Science University, School of Medicine, Portland, Oregon, USA
| | - Peter C Austin
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Arshia P Javidan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Wintraub
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Allen Li
- University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Raumil V Patel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Dongjoo Lee
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Eric A Latham
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Patrick C M Brown
- Oregon Health & Science University, School of Medicine, Portland, Oregon, USA
| | - Rita D Somogyi
- Oregon Health & Science University, School of Medicine, Portland, Oregon, USA
| | - Alex Chang
- Oregon Health & Science University, School of Medicine, Portland, Oregon, USA
| | - Huong Nguyen
- Oregon Health & Science University, School of Medicine, Portland, Oregon, USA
| | - Sara Buerk
- Oregon Health & Science University, School of Medicine, Portland, Oregon, USA
| | - Bin Chen
- Oregon Health & Science University, School of Medicine, Portland, Oregon, USA
| | - Tristen Zimmerman
- Oregon Health & Science University, School of Medicine, Portland, Oregon, USA
| | - Trevor Funari
- Oregon Health & Science University, School of Medicine, Portland, Oregon, USA
| | - Cameron Colbert
- Oregon Health & Science University, School of Medicine, Portland, Oregon, USA
| | - Bory Kea
- Oregon Health & Science University, School of Medicine, Portland, Oregon, USA
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Abstract
Jin-Ling Tang and Li-Ming Li argue that despite the lure of vaccines and new drugs, established public health measures will remain our best tool to control covid-19 and future epidemics
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Affiliation(s)
- Jin-Ling Tang
- Shenzhen Institute of Advanced Technology of the Chinese Academy of Sciences, Shenzhen, China
- Guangzhou Women and Children's Medical Centre, Guangzhou, Guangdong Province, China
| | - Li-Ming Li
- School of Public Health, Peking University, Beijing, China
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Fu M, Guo J, Zhang Y, Zhao Y, Zhang Y, Wang Z, Hou Z. Effect of Wearing Medical Masks on Perioperative Respiratory Complications in Older Adults with Hip Fracture: A Retrospective Cohort Study. Clin Interv Aging 2021; 16:1967-1974. [PMID: 34824528 PMCID: PMC8610772 DOI: 10.2147/cia.s333238] [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: 08/09/2021] [Accepted: 11/06/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Respiratory complication is one of the major challenges in the treatment of older adults with hip fractures. However, no study so far has investigated the effect of wearing medical masks on the prevention of perioperative respiratory complications in these patients. Patients and Methods In this retrospective cohort study, 1016 consecutive patients aged ≥65 years with hip fractures were included and assigned to two groups: the control group and the observation group. The two groups received the same perioperative management modalities. In addition, patients in the observation group were asked to wear medical masks for protection. Data of patients’ demographics, fracture type, surgical methods, comorbidities, the incidence of perioperative respiratory and other complications, and hospital outcomes were collected and compared between the two groups. Subgroup analyses were also performed stratified by fracture types. Results A total of 1016 patients (292 females and 724 males) with a mean age of 79.4±7.3 years were analyzed in the study, including 533 in the control group and 483 in the observation group. The overall incidence of perioperative respiratory complication, and the incidence of pulmonary infection, respiratory failure and arrhythmia in the observation group were significantly lower than the control group, especially in winter and spring. There was no difference in other complications, hospital length of stay, and total hospital costs. Further subgroup analyses showed that the incidence of heart failure and arrhythmia in the observation group was lower than that in the control group for patients with femoral neck fractures, which was different from patients with intertrochanteric fractures. Conclusion The incidence of perioperative respiratory complications, including pulmonary infection and respiratory failure, could be reduced in older adults with hip fractures by strengthening personal protection, including wearing medical masks, especially in winter and spring. Wearing medical masks could also effectively reduce the incidence of perioperative heart failure and arrhythmia in femoral neck fracture patients and do not increase the incidence of other complications and the burden of hospitalization.
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Affiliation(s)
- Mingming Fu
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Junfei Guo
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Yaqian Zhang
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yuqi Zhao
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China.,Chinese Academy of Engineering, Beijing, 100088, People's Republic of China
| | - Zhiqian Wang
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China
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46
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Kollepara PK, Siegenfeld AF, Taleb NN, Bar-Yam Y. Unmasking the mask studies: why the effectiveness of surgical masks in preventing respiratory infections has been underestimated. J Travel Med 2021; 28:taab144. [PMID: 34490465 PMCID: PMC8499874 DOI: 10.1093/jtm/taab144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Pre-pandemic empirical studies have produced mixed statistical results on the effectiveness of masks against respiratory viruses, leading to confusion that may have contributed to organizations such as the WHO and CDC initially not recommending that the general public wear masks during the coronavirus disease 2019 pandemic. METHODS A threshold-based dose-response curve framework is used to analyse the effects of interventions on infection probabilities for both single and repeated exposure events. Empirical studies on mask effectiveness are evaluated with a statistical power analysis that includes the effect of adherence to mask usage protocols. RESULTS When the adherence to mask usage guidelines is taken into account, the empirical evidence indicates that masks prevent disease transmission: all studies we analysed that did not find surgical masks to be effective were under-powered to such an extent that even if masks were 100% effective, the studies in question would still have been unlikely to find a statistically significant effect. We also provide a framework for understanding the effect of masks on the probability of infection for single and repeated exposures. The framework demonstrates that masks can have a disproportionately large protective effect and that more frequently wearing a mask provides super-linearly compounding protection. CONCLUSIONS This work shows (1) that both theoretical and empirical evidence is consistent with masks protecting against respiratory infections and (2) that non-linear effects and statistical considerations regarding the percentage of exposures for which masks are worn must be taken into account when designing empirical studies and interpreting their results.
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Affiliation(s)
- Pratyush K Kollepara
- New England Complex Systems Institute, Cambridge, MA, USA
- Department of Physics, BITS Pilani K K Birla Goa Campus, Goa, India
| | - Alexander F Siegenfeld
- New England Complex Systems Institute, Cambridge, MA, USA
- Department of Physics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Yaneer Bar-Yam
- New England Complex Systems Institute, Cambridge, MA, USA
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47
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Effects of N95 Mask Use on Pulmonary Function in Children. J Pediatr 2021; 237:143-147. [PMID: 34043996 DOI: 10.1016/j.jpeds.2021.05.050] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess whether use of an N95 mask by children is associated with episodes of desaturation or respiratory distress. STUDY DESIGN Twenty-two healthy children were assigned at random to 1 of 2 groups: one group wearing N95 masks without an exhalation valve and the other group wearing N95 masks with an exhalation valve. We tracked changes in partial pressure of end-tidal carbon dioxide (PETCO2), oxygen saturation, pulse rate, and respiratory rate over 72 minutes of mask use. All subjects were monitored every 15 minutes, the first 30 minutes while not wearing a mask and the next 30 minutes while wearing a mask. They then performed a 12-minute walking test. RESULTS The children did not experience a statistically significant change in oxygen saturation or pulse rate during the study. There were significant increases in respiratory rate and PETCO2 in the children wearing an N95 mask without an exhalation valve, whereas these increases were seen in the children wearing a mask with an exhalation valve only after the walking test. CONCLUSIONS The use of an N95 mask could potentially cause breathing difficulties in children if the mask does not have an exhalation valve, particularly during a physical activity. We believe that wearing a surgical mask may be more appropriate for children.
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48
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Partridge DG, Sori A, Green DJ, Simpson R, Poller B, Raza M, Kaur H, Jessop H, Colton B, Nield A, Evans CM, Lee A. Universal use of surgical masks is tolerated and prevents respiratory viral infection in stem cell transplant recipients. J Hosp Infect 2021; 119:182-186. [PMID: 34543704 PMCID: PMC8447542 DOI: 10.1016/j.jhin.2021.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 12/14/2022]
Abstract
Prevention of respiratory viral infection in stem cell transplant patients is important due to its high risk of adverse outcome. This single-centre, mixed methods study, conducted before the severe acute respiratory syndrome coronavirus-2 pandemic, explored the barriers and facilitators to a policy of universal mask use by visitors and healthcare workers, and examined the impact of the first year of introduction of the policy on respiratory viral infection rates compared with preceding years, adjusted for overall incidence. Education around universal mask use was highlighted as being particularly important in policy implementation. A significant decrease in respiratory viral infection was observed following introduction.
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Affiliation(s)
- D G Partridge
- Department of Microbiology, Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, UK; Florey Institute for Host-Pathogen Interaction, University of Sheffield, Sheffield, UK.
| | - A Sori
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - D J Green
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - R Simpson
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - B Poller
- Department of Laboratory Medicine, NHS Lothian, Edinburgh, UK
| | - M Raza
- Department of Virology, Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, UK
| | - H Kaur
- Department of Haematology, Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, UK
| | - H Jessop
- Department of Haematology, Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, UK
| | - B Colton
- Department of Haematology, Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, UK
| | - A Nield
- Department of Haematology, Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, UK
| | - C M Evans
- Florey Institute for Host-Pathogen Interaction, University of Sheffield, Sheffield, UK; Department of Virology, Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, UK
| | - A Lee
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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49
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Cagna DR, Donovan TE, McKee JR, Eichmiller F, Metz JE, Albouy JP, Marzola R, Murphy KG, Troeltzsch M. Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2021; 126:276-359. [PMID: 34489050 DOI: 10.1016/j.prosdent.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 11/26/2022]
Abstract
The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2020 professional literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to this work to cover this broad topic. Specific subject areas addressed include prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders (TMDs); sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence day-to-day dental treatment decisions with a keen eye on future trends in the profession. With the tremendous volume of dentistry and related literature being published today, this review cannot possibly be comprehensive. The purpose is to update interested readers and provide important resource material for those interested in pursuing greater detail. It remains our intent to assist colleagues in navigating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the dental patients they encounter.
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Affiliation(s)
- David R Cagna
- Professor, Associate Dean, Chair and Residency Director, Department of Prosthodontics, University of Tennessee Health Sciences Center College of Dentistry, Memphis, Tenn.
| | - Terence E Donovan
- Professor, Department of Comprehensive Oral Health, University of North Carolina School of Dentistry, Chapel Hill, NC
| | | | - Frederick Eichmiller
- Vice President and Science Officer, Delta Dental of Wisconsin, Stevens Point, Wis
| | | | - Jean-Pierre Albouy
- Assistant Professor of Prosthodontics, Department of Restorative Sciences, University of North Carolina School of Dentistry, Chapel Hill, NC
| | | | - Kevin G Murphy
- Associate Clinical Professor, Department of Periodontics, University of Maryland College of Dentistry, Baltimore, Md; Private practice, Baltimore, Md
| | - Matthias Troeltzsch
- Associate Professor, Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians University of Munich, Munich, Germany; Private practice, Ansbach, Germany
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50
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Chou R, Dana T, Jungbauer R. Update Alert 6: Masks for Prevention of Respiratory Virus Infections, Including SARS-CoV-2, in Health Care and Community Settings. Ann Intern Med 2021; 174:W68. [PMID: 34251900 PMCID: PMC8280537 DOI: 10.7326/l21-0393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Roger Chou
- Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon
| | - Tracy Dana
- Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon
| | - Rebecca Jungbauer
- Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon
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