Wearing masks is easy but taking them off is difficult - A situation in Japan during COVID-19 pandemic and after

Background

Masks are well accepted in Japan, where they were already part of daily life even before the COVID-19 pandemic. Unlike many other countries where mask mandates were lifted as soon as the pandemic was under control, Japan was one of the last countries to ease mask-wearing guidelines. Even after the formal announcement to allow masks-off in mid-March 2023, many Japanese still voluntarily wear masks. In this work, possible reasons for this extreme "mask-affinity" of Japanese people were studied by exploring various information sources including tweets (now known as X posts) and subsequent text-analysis, online news, and medical literature.

Methods

An observational study was conducted based on tweets prospectively collected during 5 months from June 26th, 2022 to November 26th, 2022. Tweets with the hashtag "mask (in Japanese)" were collected weekly via the Twitter application programming interface by using R version 4.0.3 to gauge public opinions. The word clouds to allow intuitive understanding of the key words were drawn from the tokenized text.

Results

The data collection period included the 7th flareups of the newly infected cases i.e. "the 7th surge". In total, 161,592 tweets were collected. Word clouds for 1) before the 7th surge based on 18,000 tweets on June 26th and 2) during/after the 7th surge based on 143,592 tweets between July-November were created with the R package "wordcloud2". The results indicated that the people wanted to take off masks due to the heat in summer, then shifted again toward mask-wearing along with the 7th surge but with a certainly growing "no-mask" sentiment.

Conclusions

Subsequent review of domestic information sources suggested that various factors, not only well-known peer pressure, may have contributed the public's mask affinity in Japan. This work revealed an aspect of Japanese struggle toward adaptation to life in an unexpected pandemic by focusing on masks as our closest daily adjunct over the past 3 years of isolation.Trial registration: not applicable.

Estimated public health impact of concurrent mask mandate and vaccinate-or-test requirement in Illinois, October to December 2021

BACKGROUND

Facing a surge of COVID-19 cases in late August 2021, the U.S. state of Illinois re-enacted its COVID-19 mask mandate for the general public and issued a requirement for workers in certain professions to be vaccinated against COVID-19 or undergo weekly testing. The mask mandate required any individual, regardless of their vaccination status, to wear a well-fitting mask in an indoor setting.

METHODS

We used Illinois Department of Public Health's COVID-19 confirmed case and vaccination data and investigated scenarios where masking and vaccination would have been reduced to mimic what would have happened had the mask mandate or vaccine requirement not been put in place. The study examined a range of potential reductions in masking and vaccination mimicking potential scenarios had the mask mandate or vaccine requirement not been enacted. We estimated COVID-19 cases and hospitalizations averted by changes in masking and vaccination during the period covering October 20 to December 20, 2021.

RESULTS

We find that the announcement and implementation of a mask mandate are likely to correlate with a strong protective effect at reducing COVID-19 burden and the announcement of a vaccinate-or-test requirement among frontline professionals is likely to correlate with a more modest protective effect at reducing COVID-19 burden. In our most conservative scenario, we estimated that from the period of October 20 to December 20, 2021, the mask mandate likely prevented approximately 58,000 cases and 1,175 hospitalizations, while the vaccinate-or-test requirement may have prevented at most approximately 24,000 cases and 475 hospitalizations.

CONCLUSION

Our results indicate that mask mandates and vaccine-or-test requirements are vital in mitigating the burden of COVID-19 during surges of the virus.

Facial Dermatoses Associated With Mask-Wearing in the COVID-19 Era: A Nationwide, Cross-Sectional, Multicenter, Questionnaire-based Study

BACKGROUND

Daily usage of facial masks during coronavirus disease 2019 pandemic influenced on facial dermatoses.

OBJECTIVE

This study investigated the impact of mask-wearing habits on facial dermatoses.

METHODS

A nationwide, observational, questionnaire-based survey was conducted from July through August 2021, involving 20 hospitals in Korea.

RESULTS

Among 1,958 facial dermatoses, 75.9% of patients experienced aggravation or development of new-onset facial dermatoses after wearing masks. In aggravated or newly developed acne patients (543 out of 743), associated factors were healthcare provider, female gender, and a long duration of mask-wearing. Irritating symptoms, xerosis, and hyperpigmentation were more frequently observed in this group. Aggravated or newly developed rosacea patients (515 out of 660) were likely to be female, young, and have a long duration of mask-wearing per day. Seborrheic dermatitis patients who experienced aggravation or de novo development (132 out of 184) were younger, and they more frequently involved the chin and jaw in addition to the nasolabial folds and both cheeks. Contact dermatitis patients (132 out of 147) with aggravation or de novo development tended to be female, involve both cheeks, and complain of pruritus. Aggravated or newly developed atopic dermatitis patients (165 out of 224) were more likely to be female, and had a higher baseline investigator global assessment score before mask-wearing.

CONCLUSION

Clinical features and factors related to aggravation were different according to the types of facial dermatoses.

Communication challenges caused by wearing masks and strategies used by pediatric nurses during the COVID-19 pandemic: A qualitative study

PURPOSE

The COVID-19 pandemic and the use of facemasks have caused many communication challenges for pediatric nurses. The purpose of this study was to investigate these challenges and the strategies that nurses use to overcome them during the nursing care of sick children.

DESIGN AND METHODS

This was a qualitative study using conventional content analysis. The nurses were selected by purpose-based sampling and interviewed semi-structurally between April and June 2023 at the Children's Educational Therapy Center in Tabriz, Iran. The sample size was determined by the data saturation principle. The report of this research followed the COREQ guidelines.

RESULTS

Twelve nurses were interviewed. The analysis revealed four main categories: "Disturbances in communication", "Disturbances in trust", "Disturbances in providing care", and "Nurses' strategies to mitigate the challenges of mask usage. To solve the challenges caused by the mask, nurses used solutions such as removing the mask and mitigating the adverse effects of mask usage they used. The central theme of the study was "Humanistic care requires trust-based communication".

CONCLUSIONS

This study highlights the communication challenges faced by pediatric nurses due to mask-wearing during the COVID-19 pandemic. Despite these challenges, nurses have developed innovative strategies to improve communication and build trust with their young patients. Further research is needed to evaluate the effectiveness and feasibility of these strategies.

PRACTICAL IMPLICATIONS

These strategies can be useful for other nurses who work with children in similar conditions. Further research is needed to evaluate the effectiveness and feasibility of these strategies in different settings and populations.

Impact of removing the healthcare mask mandate on hospital-acquired COVID-19 rates

BACKGROUND

Mandatory mask-wearing policies were one of several measures employed to reduce hospital-acquired SARS-CoV-2 infection throughout the pandemic. Many nations have removed healthcare mask mandates, but there remains a risk of new SARS-CoV-2 variants or epidemics of other respiratory viruses.

AIM

To demonstrate the impact of removing the healthcare mask mandate.

METHODS

SARS-CoV-2 infections were analysed in a large teaching hospital for 40 weeks in 2022 using a controlled interrupted time-series design. The intervention was the removal of a staff/visitor surgical mask-wearing policy for the most wards at week 26 (intervention group) with a subset of specific wards retaining the mask policy (control group). The hospital-acquired SARS-CoV-2 infection rate was adjusted by the underlying community infection rate.

FINDINGS

In the context of a surge in SARS-CoV-2 infection, removal of the mask mandate for staff/visitors was not associated with a statistically significant change in the rate of nosocomial SARS-CoV-2 infection in the intervention group (incidence rate ratio: 1.105; 95% confidence interval: 0.523-2.334; P = 0.79) and there was no post-intervention trend (1.013; 0.932-1.100; P = 0.76) to suggest a delayed effect. The control group also showed no immediate or delayed change in infection rate.

CONCLUSION

No evidence was found that removal of a staff/visitor mask-wearing policy had a significant effect on the rate of hospital-acquired SARS-CoV-2 infection. This does not demonstrate that masks were ineffective through the pandemic, but provides some objective evidence to justify the removal of healthcare mask mandates once there was widespread immunity and reduced disease severity.

Effect of face mask on pulmonary artery pressure during echocardiography in children and adolescents

BACKGROUND

Face masks have become an important tool for preventing the spread of respiratory diseases. However, we hypothesized that face masks with reduced nasal airflow may alter pulmonary artery systolic pressure (PASP).

PURPOSE

This study aimed to evaluate the effect of face masks on PASP in children and adolescents.

METHODS

This case-control study was conducted between March 2021 and April 2022 at the Pediatric Cardiovascular Research Center in Isfahan, Iran. Using a convenience sampling method, a total of 120 children and adolescents, boys and girls aged 3-18 years, were allocated into 2 groups of 60 each (case group with congenital heart disease (CHD), control group of healthy subjects). For each patient in the case and control groups, echocardiography (ECHO), heart rate (HR), and blood oxygen saturation (SpO2) were performed and measured twice-once with a surgical mask and once without a surgical mask-by a pediatric cardiologist at 10-min intervals.

RESULTS

A total of 110 participants were analyzed. The mean patient age was 9.58±3.40 years versus 10.20±4.15 years in the case (n=50) and control (n=60) groups, respectively. Approximately 76.0% (n=38) of the participants in the case group versus 60.0% of those in the control group were male. In the case and control groups, there was a statistically significant reduction in the mean changes in tricuspid regurgitation (P=0.001), pulmonary regurgitation (P=0.002), and PASP (P=0.001) after face mask removal. Although this study showed a reduction in pulmonary arterial pressure after face mask removal in patients with CHD and healthy subjects, no significant changes in HR (P=0.535) or SpO2 (P=0.741) were observed in either group.

CONCLUSION

Wearing a face mask increased PASP in healthy children and adolescents with CHD; however, the SPO2 and HR remained unchanged. Therefore, mask removal during ECHO is recommended.

Risk of Severe Acute Respiratory Syndrome Coronavirus 2 Transmission in Seoul, Korea

BACKGROUND

The risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission during the endemic phase may vary from that during the previous pandemic phase. We evaluated the risk of infection in a general population with laboratory-confirmed coronavirus disease 2019 (COVID-19) in a community setting in Korea.

MATERIALS AND METHODS

This study included 1,286 individuals who had been in contact with an index COVID-19 case between January 24, 2020, and June 30, 2022. Variables such as age, sex, nationality, place of contact, level of contact, the status of exposed cases, period, and level of mask-wearing were assessed.

RESULTS

Among 1,286 participants, 132 (10.30%) were confirmed to have COVID-19. With increasing age, the risk of the exposed persons contracting COVID-19 from index cases tended to increase (P <0.001), especially for people in their 70s (odds ratio = 1.24, 95% confidence interval: 1.11 - 1.40, P <0.001). We found an increasing trend in the risk of a COVID-19 exposed case becoming a secondary infection case (P <0.001) in long-term care facilities where the attack rate was high.

CONCLUSION

The risk of COVID-19 transmission is high in long-term care facilities where many older adults reside. Intensive management of facilities at risk of infection and strict mask-wearing of confirmed COVID-19 cases are necessary to prevent the risk of COVID-19 infection.

An Analysis of Studies Pertaining to Masks in Morbidity and Mortality Weekly Report: Characteristics and Quality of Studies through 2023

BACKGROUND

The purpose of this study was to describe and evaluate the nature and methodology of reports and appropriateness of conclusions in The Morbidity and Mortality Weekly Report (MMWR) pertaining to masks. Because MMWR has substantial influence on United States health policy and is not externally peer-reviewed, it is critical to understand the scientific process within the journal. Mask policies have been highly influenced by data published in the MMWR.

METHODS

Retrospective cross-sectional study of MMWR publications pertaining to masks through 2023. Outcomes included study design, whether the study was able to assess mask effectiveness, if results were statistically significant, if masks were concluded to be effective, if randomized evidence or conflicting data were mentioned or cited, and appropriateness of causal statements.

RESULTS

There were 77 studies, all published after 2019, that met our inclusion criteria. The most common study design was observational without a comparator group: 22/77 (28.6%); 0/77 were randomized; 23/77 (29.9%) assessed mask effectiveness; 11/77 (14.3%) were statistically significant, but 58/77 (75.3%) stated that masks were effective. Of these, 41/58 (70.7%) used causal language. One mannequin study used causal language appropriately (1.3%). None cited randomized data; 1/77 (1.3%) cited conflicting evidence.

CONCLUSIONS

MMWR publications pertaining to masks drew positive conclusions about mask effectiveness >75% of the time despite only 30% testing masks and <15% having statistically significant results. No studies were randomized, yet over half drew causal conclusions. The level of evidence generated was low and the conclusions were most often unsupported by the data. Our findings raise concern about the reliability of the journal for informing health policy.

Which alternative well-fit masks can be used in medical procedures?

BACKGROUND

During the COVID-19 pandemic, the WHO and CDC recommended that healthcare personnel (HCPs) performing non-aerosol-generating procedures (AGPs) don a properly fitted mask. We aimed to evaluate the fit factors (FFs) of eight alternative well-fit masks (AWMs) used by Thai HCPs.

METHODS

This comparative descriptive study was conducted on 33 HCPs between October and November 2022, categorized into three facial sizes: small, medium, and large. Each participant wore eight types of AWMs in random order: medical mask under adjustable ear-loop (AEL)-KF94 (MK), medical mask under AEL-KN95 with a hook (MN), medical mask under fabric mask (MF), AEL- KF94 (KF94), AEL-KF94 under fabric masks (KF), AEL-KF94 with a hook (KF94H), AEL-KN95 with a hook (KN95), and AEL-KN95 with a hook under fabric mask (NF). FFs were measured using a quantitative fit test.

RESULTS

The respective number of HCPs wearing small, medium, and large was 12, 12, and 9, and the mean±SD of face width and length was 132.98 ± 10.49 and 114.92 ± 10.10 mm. The highest respective median of FF was KN95 = 200, NF= 200, MN= 185, and KF94H = 171, and the respective passing fit-test rate was 97%, 84.8%, 63.6%, and 60.6%. There was no difference in FFs between the N95 and KN95 (p=0.72), the N95 and NF (p=0.202), and the three face sizes. Moreover, KF94H pass rates were significantly higher for females compared to males (OR = 13.3; p = 0.001) and for small facial sizes compared to either medium or large sizes (OR = 14.7; p = 0.009).

CONCLUSION

The AEL-KN95 with hook and sponge at the nosepiece is an effective respirator for use by HCPs in non-AGPs, as the FF and fit test pass rates were comparable to those of N95, and there were no differences in FFs between facial sizes. However, the female who had a small face size may use a KF94H as an alternative PPE.

[Positioning proposal on the recommendations for the use of masks in health centers after the cessation of the mandatory use in Spain]

Since the beginning of the COVID-19 pandemic in March 2020, the use of masks has been a fundamental pillar for controlling the transmission of SARS-CoV-2 in different areas. Its mandatory nature has been regulated by different regulations, and its effectiveness in reducing the transmission of SARS-CoV-2 and other respiratory viruses has been strongly proven. In this regard, the beneficial impact stands out in healthcare centers where it has been shown to reduce the transmission of respiratory infections, both in patients and healthcare professionals. This document proposes recommendations for the use of masks in health centers at the current time when we find ourselves with an end to the mandatory use of masks in Spain. They are aimed at healthcare professionals, patients and companions/visitors and aim to protect them from acquiring acute respiratory infections as a result of the complex relationships established in the healthcare field.

Exploring the use of masks for protection against the effects of wildfire smoke among people with preexisting respiratory conditions

BACKGROUND

The impact of wildfire smoke is a growing public health issue, especially for those living with preexisting respiratory conditions. Understanding perceptions and behaviors relevant to the use of individual protective strategies, and how these affect the adoption of these strategies, is critical for the development of future communication and support interventions. This study focused on the use of masks by people living in the Australian community with asthma or chronic obstructive pulmonary disease (COPD).

METHODS

Semi-structured phone interviews were undertaken with people living in the community aged 18 years and over. Participants lived in a bushfire-prone area and reported having been diagnosed with asthma or COPD.

RESULTS

Twenty interviews were undertaken between July and September 2021. We found that, during wildfire episodes, there was an overwhelming reliance on closing windows and staying inside as a means of mitigating exposure to smoke. There was limited use of masks for this purpose. Even among those who had worn a mask, there was little consideration given to the type of mask or respirator used. Reliance on sensory experiences with smoke was a common prompt to adopting an avoidance behavior. Participants lacked confidence in the information available from air-quality apps and websites, however they were receptive to the idea of using masks in the future.

CONCLUSIONS

Whilst COVID-19 has changed the nature of community mask use over the last couple of years, there is no guarantee that this event will influence an individual's mask behavior during other events like bushfires. Instead, we must create social support processes for early and appropriate mask use, including the use of air quality monitoring.

The hind information: Exploring the impact of physical damage on mask microbial composition in the aquatic environment

Due to poor management and the lack of environmental awareness, lots of masks (an emerging form of plastic pollution) are discarded into the environment during the COVID-19, thereby jeopardizing the health of humans and the environment. Our study introduces a novel perspective by examining the impact of physical damage on the microbial composition of masks in the water environment. We focus on the variations in biofilm formation on each layer of both damaged and undamaged masks, which allows us to understand more about the biofilm on each layer and the significant changes that occur when masks are physically damaged. Research has shown that the community structure of microorganisms on discarded masks can be altered in just ten days, showing an evolution from undifferentiated pioneer colonizing species ("non-picky") to adaptive dominant species ("picky"). Especially, considering that discarded masks were inevitably damaged, we found that the biomass on the damaged samples is 1.62-2.38 times higher than that of the undamaged samples, respectively. Moreover, the microbial community structure on it was also significantly different. Genes involved in biogeochemical cycles of nutrients are more enriched in damaged masks. When damaged, the colonization process and community structure in the middle layer significantly differ from those in the inner and outer layers and even enrich more pathogenic bacteria. Based on the above, it is evident that the environmental risk of masks cannot be assessed as a whole, and the middle layer carries a higher risk.

Temporal trends in personal protective equipment (PPE) debris during the COVID-19 pandemic in Çanakkale (Turkey)

This study examines trends in PPE (masks, gloves) and disinfecting wipes over three years of the pandemic. The densities of discarded masks, wet wipes, and gloves (personal protective equipment: PPE), were quantified on the streets of Canakkale, Turkey during similar time periods in 2020, 2021 and 2022. Geotagged images of PPE on the streets and sidewalks were documented with a smartphone, while the track of an observer was recorded using a fitness tracker app along a 7.777 km long survey route in the city center, parallel to the Dardanelles Strait. A total of 18 surveys were conducted over three years, and the survey route was subdivided into three zones based on utilization patterns: pedestrian zone, traffic zone and a recreational park zone. The combined densities of all types of PPE density were high in 2020, lower in 2021 and highest in 2022. The within year trend showed an increase over the three study years. The average density of gloves declined from an initially high level in 2020, when the SARS-CoV-2 virus was thought to be transmitted by contact, to near zero in 2021 and to zero in 2022. Densities of wipes were similar in 2020 and 2021 and higher in 2022. Masks were initially difficult to procure in 2020, and their densities progressively increased during that year reaching a plateau in 2021 with similar densities in 2022. PPE densities were significantly lower in the pedestrian route relative to the traffic and park routes, which were not different from each other. The partial curfews implemented by the Turkish government and the effects of prevention measures taken on the PPE concentration in the streets are discussed along with the importance of waste management practices.

Impact of Lifting Mask Mandates on COVID-19 Incidence and Mortality in Portugal: An Ecological Study

INTRODUCTION

The use of face masks in public was one of several COVID-19 non-pharmaceutical interventions adopted to mitigate the pandemic in Portugal. The aim of this study was to evaluate the impact of lifting the mask mandate on the April 22, 2022 on COVID-19 incidence and mortality in mainland Portugal and in the Azores. As a secondary objective, we aimed to evaluate the evolution of COVID-19 cases in a setting without a mask mandate (Azores islands) and in a setting with a mask mandate (Madeira islands).

MATERIAL AND METHODS

Surveillance data on laboratory-confirmed COVID-19 cases and COVID-19 deaths were used to conduct an interrupted time series analysis to estimate changes in daily incidence and deaths during a mask mandate period (28th March - 21st April 2022) and during a post-mask mandate period (22nd April - 15th May 2022), in mainland Portugal and the Azores. In a second phase, for each group of islands, we fitted a negative binomial regression model, with daily COVID-19 incident cases as the primary outcome of interest, and relative frequency of Omicron BA.5 lineage as explanatory variable.

RESULTS

Significant changes in trends were observed for the overall incidence rate and COVID-19 deaths; increasing trends were observed for COVID-19 incidence and deaths in the post mandate period [5.3% per day; incidence rate ratio (IRR): 1.053; 95% confidence interval (CI): 1.029 - 1.078] and [3.2% per day; mortality rate ratio (MRR): 1.032; 95% CI: 1.003 - 1.062], respectively. For every unit increase in the percentage of Omicron BA.5 lineage there was a 1.5% increase per day (IRR: 1.015; 95% CI: 1.006 - 1.024) in COVID-19 incidence rate in the Azores islands, while for Madeira islands an increase of 0.05% COVID-19 cases per day was observed (IRR: 1.005; 95% CI: 1.000 - 1.010).

CONCLUSION

Lifting the mask mandate in Portugal was associated with an increase in COVID-19 incidence and deaths, thus highlighting the positive effect of face mask policies in preventing respiratory virus transmission and saving lives.

How and when is it justified to maintain it?

We address the advantages and disadvantages of maintaining the mandatory use of masks in health centers and nursing homes in the current epidemiological situation in Spain and after the declaration of the World Health Organization on May 5, 2023 of the end of COVID-19 as public health emergency. We advocate for prudence and flexibility, respecting the individual decision to wear a mask and emphasizing the need for its use when symptoms suggestive of a respiratory infection appear, in situations of special vulnerability (such as immunosuppression), or when caring for patients with those infections. At present, given the observed low risk of severe COVID-19 and the low transmission of other respiratory infections, we believe that it is disproportionate to maintain the mandatory use of masks in a general way in health centers and nursing homes. However, this could change depending on the results of epidemiological surveillance and it would be necessary to reconsider returning to the obligation in periods with a high incidence of respiratory infections.

Why elderly in rural China didn't wear masks during the COVID-19 pandemic? A qualitative narrative interview study

BACKGROUND

During the COVID-19 pandemic, ageism and stigmatization towards the elderly have been prominent issues. In addition, there have been debates on Chinese social media as to why elderly people in rural areas are not wearing masks. While some factors that affect the mask-wearing behaviour of the elderly have been analyzed, little attention has been given to the lived experiences and behavioral intentions of rural elderly people who choose not to wear masks, despite government mandates to do so.

METHOD

In this research, 50 semi-structured interviews with 30 elderly individuals in three Chinese villages were carried out using the qualitative method of semi-structured interviews. Following verbatim recording and transcription of the conversations, the subject was analyzed using the Theory of Reasoned Action.

RESULTS

We identified four factors that influence the non-masking behaviour of rural elderly, including past experiences, cultural concepts, cognitive attitudes, and health and safety anxiety, and identified nine sub-themes based on the four overarching themes. Past knowledge, experience, and history have led rural elderly people to distrust the government's mandatory "mask mandate," believing that they do not need to wear masks. Rural cultural concepts and habits make the elderly feel that masks not only fail to provide protection but also become obstacles, resulting in poor daily experiences. Cognitive attitudes and emotions determine the elderly's evaluation of masks, which in turn affects their use of masks. Finally, elderly individuals'chronic diseases directly affect the physical pain and life safety caused by their use of masks, which is a major objective factor for their non-masking.

CONCLUSIONS

Although numerous studies have concluded that Chinese people wore masks out of collectivism and conformity during the pandemic, marginalized groups' opposition to wearing masks also contains distinctive, individualized elements and underlying causes. By exposing these elements and reasons, we can better comprehend the peculiar behavior of particular groups while fighting the pandemic. The needs of marginalized populations should be prioritized by public health policy makers to provide more equitable services.

'A Smaller Mask': Freedom and Authenticity in Autistic Space

Autscape is an autistic-led conference, organised annually in varying locations around England. Governed by a strict set of rules and regulations, Autscape is a social and spatial setup explicitly devised to accommodate the tendencies, sensitivities, and preferences of people on the autism spectrum. It is a design, in other words-as organisers and participants alike often profess-for an altogether autistic space. The uniqueness of the event, and consequently its value to anthropological theory, lies in the shared imagination of the setting by those who inhabit it as one in which neurotypical masks, otherwise worn daily in keeping with hegemonic society's expectation of conformity, can finally be removed. I introduce the concept of un-festival as a means of depicting this event, similar to festival in its goals of defiance and inversion, but different from-and in important ways, opposite to-festival in its style and architecture, in the dispositions it encourages and mobilises, and in its potential implications. The un-festival offers a powerful comment on this moment in history, whereby masks are no longer seen as an item that affords freedom, but as one that stifles it. While Autscape participants remain doubtful as to the actual effect of this event on neurotypical society, they do nevertheless express a desire that this project will have some longstanding effects. That once a space has been designed for autistic people that considers their specific needs and tendencies, autism may then finally cease to be interpreted through a neuro-normative prism and freed to be understood in autistic people's own terms.

Effect of Wearing Different Masks on Acoustic, Aerodynamic, and Formant Parameters

OBJECTIVE

This study aimed to investigate the effects of different types of masks on acoustic, aerodynamic, and formant parameters in healthy people.

METHODS

Our study involved 30 healthy participants, 15 of each gender, aged 20-40 years. The tests were conducted under four conditions: without a mask, after wearing a surgical mask, after wearing a head-mounted N95 mask, and after wearing an ear-mounted N95 mask. Voice recording was done with the mask on. The acoustic parameters include mean fundamental frequency (F0), mean intensity, percentage of jitter (local), percentage of shimmer (local), mean noise to harmonic ratio (NHR), aerodynamic parameter, maximum phonation time (MPT), and formant parameters (/a/, /i/, /u/ three vowels F1, F2).

RESULTS

The main effect of mask type was significant in MPT, mean F0, mean HNR, /a/F1, /a/F2, /i/F2. However, the effect sizes and power in /a/F2, /i/F2 were low. MPT, mean F0 and mean HNR significantly increased and /a/F1 significantly decreased after wearing the head-mounted n95 mask. The mean F0 and mean HNR increased significantly after wearing the ear-mounted n95 mask. No significant changes were observed in parameters after wearing the surgical mask in this study. When the statistics are performed separately for males and females, the results obtained are similar to those previously obtained for unspecified males and females.

CONCLUSION

After wearing the surgical mask, this study found insignificant changes in mean F0, jitter (local), shimmer (local), mean NHR, mean intensity, MPT, and the vowels F1 and F2. This may be due to the looser design of the surgical mask and the relatively small attenuation of sound. N95 masks have a greater effect on vocalization than surgical masks and may cause changes in F0 and HNR after wearing an N95 mask. In the present study, no significant changes in jitter and shimmer were observed after wearing the mask. In addition, there was a significant reduction in /a/F1 after wearing the N95 headgear mask may owing to its high restriction of jaw mobility. In future studies, the change in jaw movement amplitude after wearing the mouthpiece can be added to investigate.

Auxiliary Utensils in Cosmetic and Medical Tattoo Settings

Cosmetic and medical tattooing is miniaturized tattooing of high precision and thus requires many dedicated utensils including advanced devices for marking and anatomical delineation. Symmetry is a special demand, as is aesthetic outcome, building on perfectionated detail. The artist shall master design and strategy along with advanced technical performance helped by having and using the right tools. This article reviews and illustrates the many special utensils involved in good-practice cosmetic and medical tattooing, exemplified by selected tools used for cleansing, disinfection, pre-operative measurement and marking, and special tattoo machines, cartridges, microblades and needles. Personal protective equipment used to prevent infections among technicians and customers are also illustrated. Educational tools, such as face phantoms and eyebrow mats, are displayed. Mastering cosmetic and medical tattooing is a challenge and involves mastering the many auxiliaries along with needle configurations, machines, inks and the whole setting of the activity. This review is an illustrated practical record and a guideline to good professional practice.

Attitudes, Beliefs, and Perceptions Associated with Mask Wearing within Four Racial and Ethnic Groups Early in the COVID-19 Pandemic

BACKGROUND

While previous studies have identified a range of factors associated with mask wearing in the US, little is known about drivers of mask-wearing among racial and ethnic minority groups. This analysis assessed whether factors positively associated with wearing a mask early in the pandemic differed between participants grouped by race/ethnicity (Hispanic, non-Hispanic Black, non-Hispanic Asian, and non-Hispanic White).

METHOD

Data were obtained from a US internet panel survey of 3217 respondents during May-November 2020 (weighted by race/ethnicity, age, gender, and education to the US national population). Within each of the four available racial/ethnic groups, crude and adjusted odds ratios (COR and AOR) were calculated using logistic regression to assess factors positively associated with wearing a mask. Adjusted models were controlled for age, gender, education, county COVID-19 case count, presence of a state-issued mask mandate, and interview month.

RESULTS

The following variables were most strongly positively associated with mask wearing (p<0.05) in each racial/ethnic group: Hispanic-seeing others wearing masks (AOR: 6.7), importance of wearing a mask combined with social distancing (AOR: 3.0); non-Hispanic Black-belief that wearing a mask would protect others from coronavirus (AOR: 5.1), reporting hearing that one should wear a mask (AOR: 3.6); non-Hispanic Asian-belief that people important to them believe they should wear a mask (COR: 5.1, not statistically significant); and non-Hispanic White-seeing others wearing masks (AOR: 3.1), importance of wearing a mask (AOR: 2.3).

CONCLUSION

Public health efforts to encourage mask wearing should consider the diversity of behavioral influences within different population groups.

Mitigation of Respirable Aerosol Particles from Speech and Language Therapy Exercises

INTRODUCTION

Phonation and speech are known sources of respirable aerosol in humans. Voice assessment and treatment manipulate all the subsystems of voice production, and previous work (Saccente-Kennedy et al., 2022) has demonstrated such activities can generate >10 times more aerosol than conversational speech and 30 times more aerosol than breathing. Aspects of voice therapy may therefore be considered aerosol generating procedures and pose a greater risk of potential airborne pathogen (eg, SARS-CoV-2) transmission than typical speech. Effective mitigation measures may be required to ensure safe service delivery for therapist and patient.

OBJECTIVE

To assess the effectiveness of mitigation measures in reducing detectable respirable aerosol produced by voice assessment/therapy.

METHODS

We recruited 15 healthy participants (8 cis-males, 7 cis-females), 9 of whom were voice-specialist speech-language pathologists. Optical Particle Sizers (OPS) (Model 3330, TSI) were used to measure the number concentration of respirable aerosol particles (0.3 µm-10 µm) generated during a selection of voice assessment/therapy tasks, both with and without mitigation measures in place. Measurements were performed in a laminar flow operating theatre, with near-zero background aerosol concentration, allowing us to quantify the number concentration of respiratory aerosol particles produced. Mitigation measures included the wearing of Type IIR fluid resistant surgical masks, wrapping the same masks around the end of straws, and the use of heat and moisture exchange microbiological filters (HMEFs) for a water resistance therapy (WRT) task.

RESULTS

All unmitigated therapy tasks produced more aerosol than unmasked breathing or speaking. Mitigation strategies reduced detectable aerosol from all tasks to a level significantly below, or no different to, that of unmasked breathing. Pooled filtration efficiencies determined that Type IIR surgical masks reduced detectable aerosol by 90%. Surgical masks wrapped around straws reduced detectable aerosol by 96%. HMEF filters were 100% effective in mitigating the aerosol from WRT, the exercise that generated more aerosol than any other task in the unmitigated condition.

CONCLUSIONS

Voice therapy and assessment causes the release of significant quantities of respirable aerosol. However, simple mitigation strategies can reduce emitted aerosol concentrations to levels comparable to unmasked breathing.

Production of singlet oxygen from photosensitizer erythrosine for facile inactivation of coronavirus on mask

The global health crisis caused by the COVID-19 pandemic has led to a surge in demand and use of personal protective equipment (PPE) such as masks, putting great pressure on social production and the environment.It is urgent to find an efficient and non-destructive disinfection method for the safe reuse of PPE. This study proposes a PPE disinfection method that uses erythrosine, a U.S. Food and Drug Administration-approved food dye, as photosensitizer to produce singlet oxygen for virus inactivation, and indicates the completion of disinfection by its photobleaching color change.After spraying 100 μL of 10 μM erythrosine on the surface of the mask for 3 times and light exposure for 25 min, the titer of coronavirus decreased by more than 99.999%, and the color of erythrosine on the mask surface disappeared. In addition, the structure of the mask was intact and the filtration efficiency was maintained at > 95% after 10 cycles of erythrosine treatment.Therefore, this disinfection method can provide at least 10 cycles of reuse with the advantages of high safety and convenient, and the completion of disinfection can be indicated by its photobleaching, which is suitable for hospitals and daily life to reduce the consumption of PPE.

High engagement in nonpharmaceutical interventions and their associations with reduced COVID-19 among US college students

BACKGROUND

Nonpharmaceutical interventions, including face mask-wearing, physical distancing, and avoidance of crowds and poorly ventilated spaces, have been widely recommended to limit the spread of SARS-CoV-2. To date, there is little data available on engagement in nonpharmaceutical interventions and COVID-19 in college students. Using a large sample of college students, we estimate the prevalence of engagement in mask-wearing, physical distancing, and avoidance of crowds/poorly ventilated spaces and their associations with COVID-19.

METHODS

A cross-sectional study was conducted (February-March 2021) using a college-wide online survey among students (n = 2,132) in California. Multiple modified poisson regression models assessed associations between mask-wearing indoors, physical distancing (both indoors or public settings/outdoors), avoidance of crowds/poorly ventilated spaces and COVID-19, controlling for potential confounders.

RESULTS

Fourteen percent (14.4%) reported a previous COVID-19 illness. Most students reported wearing masks consistently indoors (58%), and 78% avoided crowds/poorly ventilated spaces. About half (50%) reported consistent physical distancing in public settings/outdoor and 45% indoors. Wearing a mask indoors was associated with 26% lower risk of COVID-19 disease (RR = 0.74; 95% CI: 0.60,0.92). Physical distancing indoors and in public settings/outdoors was associated with a 30% (RR = 0.70; 95% CI: 0.56,0.88) and 28% (RR = 0.72; 95% CI: 0.58,0.90) decrease risk of COVID-19, respectively. No association was observed with avoidance of crowds/poorly ventilated spaces. The risk of COVID-19 declined as the number of preventive behaviors a student engaged in increased. Compared to those who did not engage in any preventive behaviors (consistently), students who consistently engaged in one behavior had a 25% lower risk (RR = 0.75; 95% CI: 0.53,1.06), those who engaged in two behaviors had 26% lower risk (RR = 0.74; 95% CI: 0.53,1.03), those who engaged in three behaviors had 51% lower risk (RR = 0.49; 95% CI: 0.33,0.74), and those who consistently engaged in all four behaviors had 45% lower risk of COVID-19 (RR = 0.55; 95% CI: 0.40,0.78).

CONCLUSIONS

Wearing face masks and physical distancing were both associated with a lower risk of COVID-19. Students who engaged in more nonpharmaceutical interventions were less likely to report COVID-19. Our findings support guidelines promoting mask-wearing and physical distancing to limit the spread of COVID-19 on campuses and the surrounding communities.

Comparison between discarded facemask and common plastic waste on microbial colonization and physiochemical properties during aging in seawater

Facemasks are indispensable for preventing the spread of COVID-19. However, improper disposal of discarded facemasks has led to their contamination in the marine environment. To understand the environmental risk of this emerging plastic pollution, it's important to clarify the features that distinguish discarded facemasks from common plastic waste during aging. This study compared the microbial colonization, degradation-related enzymes, and physicochemical properties among surgical masks, polystyrene cups, polycarbonate bottles, and polyethylene terephthalate bottles in their aging processes in natural seawater. Compared to the other plastic wastes, surgical masks were colonized by the most diverse microorganisms, reaching 1521 unique prokaryotic OTUs after 21-day exposure in seawater. Moreover, the activity of eukaryotic enzymes associated with plastic degradation was 80-fold higher than that in seawater, indicating that the colonized eukaryotes would be the major microorganisms degrading the surgical masks. Meanwhile, the nano-sized defects (depth between 8 and 61 nm) would evolve into cracks of bigger sizes and result in the breakage of the microfibers and releasing microplastics into the ocean. Overall, our study demonstrated a distinctive plastisphere occurred in surgical masks from both microbial and physiochemical aspects. This work provides new insights for assessing the potential risk of plastic pollution caused by the COVID-19 pandemic.

Physicochemical characterization of reusable facemasks and theoretical adhesion by a challenged bacterium

Background and Objectives

Adhesion of microorganisms on facemask surfaces is a major problem that produces contamination of the mask wearer either by inhalation or by direct contact. Generally, physicochemical properties of the material and the microorganism are responsible for this adhesion and are also reported to influence the filtration efficiency of facemasks. However, theses surface proprieties and their effect on particles attachment on facemask materials remain poorly documented. The purpose of this study was to investigate the physicochemical properties of seven facemasks and evaluate the influence of these characteristics on the adhesion of Sataphylococcus aureus.

Materials and Methods

Physicochemical properties is done by contact angle method and scanning electron microscopy while theoretical adhesion of S. aureus is done according to XDLVO approach.

Results

The obtained results showed that all masks have a hydrophobic character. The electron donor and electron acceptor parameters change depending on each mask. Chemical analysis demonstrates the presence of two chemical elements (carbon and oxygen). Predictive adhesion demonstrate that S. aureus has an attractive behavior towards the masks used but the potential of adhesion is not the same.

Conclusion

Such information is valuable to understand attachment of biological particles and to contribute in the inhibition of this attachment.

COVID-19: Impact on the Musician and Returning to Singing; A Literature Review

OBJECTIVE

The purpose of this study was to review current literature of the impact of COVID-19 on musicians and returning to singing.

METHODS

A comprehensive search of peer-review articles was completed using PubMed, GoogleScholar, Scopus, and Web of Science. The search was completed using many key terms including voice, hoarseness, dysphonia, aphonia, cough, singers, and public speakers. The bibliography from each article found was searched to find additional articles. The search process revealed 56 peer-reviewed articles, 18 primary articles, ranging from the years 2019 to 2020.

CONCLUSION

COVID-19 has had a major impact on singers and other musicians worldwide. It can affect the voice and can lead to paresis/paralysis of laryngeal nerves to long-term changes in respiratory function. There is a risk from aerosolization/droplet formation transmission with singing, and with playing wind and brass instruments that can be mitigated by following COVID-19 guidelines. Ways to reduce possible transmission during singing and instrument play include virtual rehearsals or performances, mask-wearing, instrument covers, smaller choirs, performing outside, excellent ventilation being socially distanced, shorter rehearsals, regularly cleaning commonly touched surfaces and washing hands, avoiding contact with others, and temperature screening.

Disposable surgical masks affect the decomposition of Zostera muelleri

The coronavirus pandemic has caused a surge in the use of both disposable and re-usable mask pollution globally. It is important to understand the potential impact this influx of novel pollution has on key ecological processes, such as detrital dynamics. We aimed to understand the impact mask pollution has on the decomposition of a common coastal seagrass, Zostera muelleri. Using an outdoor mesocosm system with heater chiller units and a gas mixer, we were able to test the impact of both re-usable single-ply homemade cotton masks and disposable surgical masks on samples of Z. muelleri detritus under different environmental conditions. We found that disposable masks, but not re-usable masks, significantly increased decomposition of Z. muelleri detritus. This may be due to the increased surface area available for detritivorous microorganism colonisation, driving further decomposition. This could have negative ramifications for seagrass communities and adjacent ecosystems.

Qualitative fit test outcomes for N95 filtering facepiece respirators in health care workers

BACKGROUND

We analyzed the qualitative fit test results of the filtering facepiece respirators (FFRs) used at our institution to determine their performance and utility.

METHODS

We retrospectively analyzed 12,582 qualitative fit testing results for several FFR models among 8,809 health care workers (HCWs).

RESULTS

The overall failure rate for HCWs was 15.2%. Nearly one-third (2933/8809, 33.3%) had multiple FFRs fit tested. HCW sex was a statistically significant indicator of fit testing failure (χ² = 29.9, df = 1, P < .001), with women having a 44% higher likelihood (OR, 1.4; 95% CI: 1.27-1.65) than men. There were statistically significant differences in the failure rate across FFRs (Fig 4, F[5, 12475] = 8.4, P < .001). Fluidshield 46867S had a significantly higher failure rate (49%) than the 3M 1860 (P = .012), 3M 1860S (P < .001), 3M 8210 (P < .001), and Safelife (P < .001) FFRs.

CONCLUSIONS

There was a large degree of variation in fit testing results for the FFRs tested. Although we were unable to find an FFR that fit more than 95% of the HCWs successfully, we identified poorly functioning FFRs that can help our institution with decision-making and budgeting for acquisition and stocking appropriate FFRs.

Ramped versus sniffing position in the videolaryngoscopy-guided tracheal intubation of morbidly obese patients: a prospective randomized study

BACKGROUND

Ramped positioning is recommended for intubating obese patients undergoing direct laryngoscopy. However, whether the use of the ramped position can provide any benefit in videolaryngoscopy-guided intubation remains unclear. This study assessed intubation time using videolaryngoscopy in morbidly obese patients in the ramped versus sniffing positions.

METHODS

This is a prospective randomized study in patients with morbid obesity (n = 82; body mass index [BMI] ≥ 35 kg/m2). Patients were randomly allocated to either the ramped or the standard sniffing position groups. During the induction of general anesthesia, difficulty in mask ventilation was assessed using the Warters scale. Tracheal intubation was performed using a C-MAC® D-Blade videolaryngoscope, and intubation difficulty was assessed using the intubation difficulty scale (IDS). The primary endpoint was the total intubation time calculated as the sum of the laryngoscopy and tube insertion times.

RESULTS

The percentage of difficult mask ventilation (Warters scale ≥ 4) was significantly lower in the ramped (n = 40) than in the sniffing group (n = 41) (2.5% vs. 34.1%, P < 0.001). The percentage of easy intubation (IDS = 0) was significantly higher in the ramped than in the sniffing group (70.0% vs. 7.3%, P < 0.001). The total intubation time was significantly shorter in the ramped than in the sniffing group (22.5 ± 6.2 vs. 40.9 ± 9.0, P < 0.001).

CONCLUSIONS

Compared with the sniffing position, the ramped position reduced intubation time in morbidly obese patients and effectively facilitated both mask ventilation and tracheal intubation using videolaryngoscopy.

Unraveling the dynamics of the Omicron and Delta variants of the 2019 coronavirus in the presence of vaccination, mask usage, and antiviral treatment

The effectiveness of control interventions against COVID-19 is threatened by the emergence of SARS-CoV-2 variants of concern. We present a mathematical model for studying the transmission dynamics of two of these variants (Delta and Omicron) in the United States, in the presence of vaccination, treatment of individuals with clinical symptoms of the disease and the use of face masks. The model is parameterized and cross-validated using observed daily case data for COVID-19 in the United States for the period from November 2021 (when Omicron first emerged) to March 2022. Rigorous qualitative analysis of the model shows that the disease-free equilibrium of the model is locally-asymptotically stable when the control reproduction number of the model (denoted by R c ) is less than one. This equilibrium is shown to be globally-asymptotically stable for a special case of the model, where disease-induced mortality is negligible and both vaccine-derived immunity in fully-vaccinated individuals and natural immunity do not wane, when the associated reproduction number is less than one. The epidemiological implication of the latter result is that the combined vaccination-boosting strategy can lead to the elimination of the pandemic if its implementation can bring (and maintain) the associated reproduction number to a value less than one. An analytical expression for the vaccine-derived herd immunity threshold is derived. Using this expression, together with the baseline values of the parameters of the parameterized model, we showed that the vaccine-derived herd immunity can be achieved in the United States (so that the pandemic will be eliminated) if at least 68 % of the population is fully-vaccinated with two of the three vaccines approved for use in the United States (Pfizer or Moderna vaccine). Furthermore, this study showed (as of the time of writing in March 2022) that the control reproduction number of the Omicron variant was approximately 3.5 times that of the Delta variant (the reproduction of the latter is computed to be ≈ 0.2782 ), indicating that Delta had practically died out and that Omicron has competitively-excluded Delta (to become the predominant variant in the United States). Based on our analysis and parameterization at the time of writing of this paper (March 2022), our study suggests that SARS-CoV-2 elimination is feasible by June 2022 if the current baseline level of the coverage of fully-vaccinated individuals is increased by about 20 % . The prospect of pandemic elimination is significantly improved if vaccination is combined with a face mask strategy that prioritizes moderately effective and high-quality masks. Having a high percentage of the populace wearing the moderately-effective surgical mask is more beneficial to the community than having low percentage of the populace wearing the highly-effective N95 masks. We showed that waning natural and vaccine-derived immunity (if considered individually) offer marginal impact on disease burden, except for the case when they wane at a much faster rate (e.g., within three months), in comparison to the baseline (estimated to be within 9 months to a year). Treatment of symptomatic individuals has marginal effect in reducing daily cases of SARS-CoV-2, in comparison to the baseline, but it has significant impact in reducing daily hospitalizations. Furthermore, while treatment significantly reduces daily hospitalizations (and, consequently, deaths), the prospects of COVID-19 elimination in the United States are significantly enhanced if investments in control resources are focused on mask usage and vaccination rather than on treatment.

Size-specific filtration efficiency and pressure drop of school-aged children's woven and nonwoven masks at varying face velocities

BACKGROUND

Differences in physiology and breathing patterns between children and adults lead to disparate responses to aerosols of varying sizes. No standardized method exists for measuring the filtration efficiency (FE) of children's masks to reflect such differences.

METHODS

Using an adult N95 mask as a control and two different face velocities (v_f) (9.3 cm/s representing adults and 4.0 cm/s representing school-aged children), we tested the pressure drop (ΔP) through children's nonwoven masks (surgical and KN95) and children's woven masks (100% cotton and partially-cotton-based masks), as well as their size-specific FE between aerodynamic particle diameters of 0.02 and 2.01 μm.

RESULTS

All three types of mask showed a 1 to 9% absolute increase in minimum FE at the lower v_f and a significant decrease in ΔP. For children's surgical masks the increase in FE was significant for most of the examined particle sizes, but for children's woven masks the increase was limited to particles smaller than 0.04 μm.

CONCLUSIONS

Lower v_f for children is likely to lead to a higher FE, lower ΔP, and consequently higher filter qualities in children's masks. For woven masks, the FE for particles larger than 0.04 μm was low (typically <50%) for both v_f's studied.

Masks thermal degradation as an alternative of waste valorization on the COVID-19 pandemic: A kinetic study

The COVID-19 pandemic generated a new dynamic around waste management. Personal protective equipment such as masks, gloves, and face shields were essential to prevent the spread of the disease. However, despite the increase in waste, no technical alternatives were foreseen for the recovery of these wastes, which are made up of materials that can be valued for energy recovery. It is essential to design processes such as waste to energy to promote the circular economy. Therefore, techniques such as pyrolysis and thermal oxidative decomposition of waste materials need to be studied and scaled up, for which kinetic models and thermodynamic parameters are required to allow the design of this reaction equipment. This work develops kinetic models of the thermal degradation process by pyrolysis as an alternative for energy recovery of used masks generated by the COVID-19 pandemic. The wasted masks were isolated for 72 h for virus inactivation and characterized by FTIR-ATR spectroscopy, elemental analysis, and determinate the higher calorific value (HCV). The composition of the wasted masks included polypropylene, polyethylene terephthalate, nylon, and spandex, with higher calorific values than traditional fuels. For this reason, they are susceptible to value as an energetic material. Thermal degradation was performed by thermogravimetric analysis at different heating rates in N₂ atmosphere. The gases produced were characterized by gas chromatography and mass spectrometry. The kinetic model was based on the mass loss of the masks on the thermal degradation, then calculated activation energies, reaction orders, pre-exponential factors, and thermodynamic parameters. Kinetics models such as Coats and Redfern, Horowitz and Metzger, Kissinger-Akahira-Sunose were studied to find the best-fit models between the experimental and calculated data. The kinetic and thermodynamic parameters of the thermal degradation processes demonstrated the feasibility and high potential of recovery of these residues with conversions higher than 89.26% and obtaining long-chain branched hydrocarbons, cyclic hydrocarbons, and CO₂ as products.

Assessment of the awareness about COVID-19 and the following-up of guidelines for biomedical wastes in Jaipur city

In this COVID-19 era, isolating people and reviewing their contacts has proven to be insufficient to control the COVID-19 pandemic as there was a huge gap between exposure to the virus and isolation due to the late onset of symptoms. This led to the spread of infection and people faced the consequences not only of viral infection, but also of financial and occupational crises. People followed best management practices, however, new variants emerged that caused infection. With little information on new COVID-19 variants and their transmission, the disease spread rapidly in humans. Until now, the link between the spread of COVID-19 and the disposal of biomedical waste with household waste has not been established. Therefore, the only way to prevent infection is to make people aware. It is still necessary to open the doors for research to find the possible cause of the appearance of a new variant of COVID-19. To cope with the situation, the level of awareness among the public and their action towards the prevention of spread of infection caused by COVID-19 and its emerging variants must be known. Therefore, a survey was conducted in Jaipur from January to February 2022 to find out the status of awareness. Results of the survey revealed that both people are aware about the infection caused by COVID-19 and its variants. They are also aware about the precautions to be followed to protect themselves from acquiring COVID-19 infection. Most of the people are using masks but not gloves to prevent themselves from the infection. Merely, 71.6% of young, 100% of adults, 40% of old people sanitize their masks and gloves before disposal. Only 66.5% people are using separate bags for the collection of wastes. Despite of awareness about biomedical waste, 25% of young never sanitize, and 26.13% of young seldom sanitizes their waste before disposal. Such types of cases were not observed in adults and old age groups. Similarly, 2.3% of young did not sanitize PPE kit prior to disposal. Results of this study revealed that there is awareness about the different strains of corona virus and biomedical wastes. However, some people showed casual behaviour in the waste disposal practices. The strict implementation of rules to dispose biomedical waste will be useful for dealing with biomedical waste in this pandemic period.

False positive finding on whole-body iodine-131 scan secondary to contaminated face mask: an uncommon peril in current COVID pandemic

Covid-19 has changed the practice of present-day medicine. Social-distancing, hand-sanitation and use of face-mask are important measures taken against its spread. Post-thyroidectomy whole-body diagnostic I-131 scan is an important preliminary investigation for risk stratification and further management in thyroid cancer. False positive findings on diagnostic scan are not uncommon and must be evaluated to avoid unnecessary work-up and treatment. Clinical and biochemical correlation with adjunct SPCET/CT imaging may differentiate true from false-positive lesions. We report a case of unusual false positive linear neck tracer on whole-body diagnostic I-131 scan due to the use of an I-131 contaminated face mask.

Using core values and social influence to increase mask-wearing in non-compliant college students

Determining the best way to increase public health behaviors like mask-wearing in non-compliant individuals remains an important problem. In this two-part study, we examined the correlates of mask non-compliance in undergraduates at a selective East Coast university, and then developed an intervention designed to appeal to individuals with those traits. We found that being politically conservative and favoring the core values of respect for authority and in-group loyalty were associated with mask non-compliance. We then developed two novel public service announcement (PSA) videos. One featured peer campus leaders (e.g. the president of the College Republicans) to appeal to both social influence and the core values of authority and loyalty. The other featured national and local health care authorities. We found that (a) conservative students rated the two videos as equally authoritative, while liberal students rated the health authority PSA to be significantly more authoritative; (b) conservative participants significantly increased their self-reported mask-wearing rates compared to baseline, narrowing the gap in compliance substantially; and (c) the two PSAs were equally effective for conservative students at increasing mask-wearing. This study shows that public health interventions that target the values and beliefs associated with non-compliance may best influence behavior.

Knowledge, practices and compliance related to COVID-19 among Nepalese population in Province 2, Nepal

Aim

The study aimed to access the knowledge, practice, and compliance related to COVID-19 among people residing in Province 2, Nepal.

Materials and methods

A descriptive cross-sectional study was conducted from October 2020 to March 2021. A total of 457 participants of eight districts of Province 2 were enrolled after obtaining consent. Data were collected by face-to-face interviews with participants. A total of 31 validated pre-structured questionnaires were asked to participants in which 11 questions were for knowledge, 12 questions were for practices, and 8 questions were for compliance related to COVID-19. For tool validation, pre-testing was done in 10.0% of individuals of the targeted study population of Mahottari district.

Results

Out of 457 participants, 353(77.2%) were male. The majority of the participants were unmarried (68.3%), had only school-level education (26.5%), Hindu by religion (89.7%), farmers (23.0%), and businessmen (23.0%). More than 75.0% of individuals had knowledge about the causative agent of COVID-19 symptoms and the purpose of isolation. About 53.8% of participants had good knowledge of social distancing, 31.1% had knowledge of masks, and 39.3% knew about sanitizer. Moreover, 94.3% of the respondents had good knowledge of hand-washing practice with soap-water and use of sanitizer, 89.1% had good knowledge of wearing masks and 82.9% followed social distancing. Compliance with standard procedures of sneezing was recorded in 43.1%, washing hands with soap water/sanitizer was 82.3%, and disposal of masks was 53.6%. A significant association was observed between gender with knowledge and compliance (p < 0.05). District-wise association with knowledge, practice and compliance was found to be significant (p < 0.05).

Conclusion

The findings suggest that participants have a good level of knowledge; however, the practice and compliances are considerably low related to COVID-19.

To wear or not to wear? Unpacking the #NoMask discourses and conversations on Twitter

In the context of the COVID-19 health crisis, the use of face masks has been a topic broadly debated. In many Western countries, especially at the heights of the pandemic, discussions on the use of protective facemasks were often linked to what were mainly political considerations, often fueled by health-related misinformation. Our study brings together social sciences and computer science expertise to retrospectively unpack the #NoMask discourses and conversations using both network analysis approaches on big data retrieved from Twitter and qualitative analyses on sub-sets of relevant social media data. By looking comparatively at two dataset gathered at different stages of the health crisis (2020 and 2022), we aim to better understand the role of Twitter in that interesting area where the dissemination of health misinformation became capitalized by the political narrative linking the social discontent caused by the socio-economic impacts of the pandemic to specific political ideologies. Our analyses show that there has never been a unique 'NoMask movement,' nor a defined online community. Rather, we can identify a range of relatively niche, loosely connected, and heterogeneous actors that, in the course of the pandemic, independently pushed diverse (but converging and compatible) discourses. Conversations directly linked to the #NoMask relevant hashtags are overall limited, as twitters using them are not talking to each other; nonetheless, they successfully engaged a larger audience.

Effect of Wearing a Face Mask on Vocal Self-Perception during a Pandemic

OBJECTIVE

To analyze the vocal self-perception of individuals who wore face masks for essential activities and those who wore them for professional and essential activities during the coronavirus disease pandemic.

MATERIALS AND METHODS

This was an observational, descriptive, cross-sectional study. The study included 468 individuals who were stratified into two groups: the Working Group, comprising individuals who wore face masks for professional and essential activities during the pandemic; and the Essential Activities Group, with individuals who wore face masks only for essential activities during the pandemic. The outcome measures tested were self-perception of vocal fatigue, vocal tract discomfort, vocal effort, speech intelligibility, auditory feedback, and coordination between speech and breathing. Descriptive and inferential statistics were performed.

RESULTS

Face masks increased the perception of vocal effort, difficulty in speech intelligibility, auditory feedback, and difficulty in coordinating speech and breathing, irrespective of usage. Individuals who wore face masks for professional and essential activities had a greater perception of symptoms of vocal fatigue and discomfort, vocal effort, difficulties in speech intelligibility, and in coordinating speech and breathing.

CONCLUSION

Use of face masks increases the perception of vocal symptoms and discomfort, especially in individuals who wore it for professional and essential activities.

[Vulnerabilities, ethical responsibility and acceptance of otherness during the first Covid lockdown: A case study of a French Care Centre for Support and Prevention in Addictology]

Le premier confinement de la crise sanitaire Covid 19 a bouleversé les pratiques médicales et soignantes, avec une priorisation des patients positifs à la Covid et une focalisation sur les flux en réanimation. Or, dans les Centres de Soin d’Accompagnement et de Prévention en Addictologie (CSAPA), la dimension relationnelle du soin est centrale. Les professionnels de santé ont été impactés par les protocoles contraignants en matière d’asepsie, avec un risque de rupture de suivi accru chez des patients déjà vulnérables. À partir du cas du CSAPA de Grasse, l’article vise premièrement à analyser rétrospectivement les tensions éthiques rencontrées autour de l’accueil de l’altérité de ces patients aux problématiques complexes et deuxièmement à mettre en lumière l’inventivité des soignants dans leurs pratiques quotidiennes. L’approche développée est philosophique et conceptuelle, centrée sur la philosophie d’E. Levinas et son éthique du « visage » car la crise a exacerbé des tensions éthiques préexistantes autour de l’intersubjectivité. Les soignants ont dû faire face à une « responsabilité pour autrui », elle aussi renforcée. Mais la crise a pu aussi être l’occasion de réinvestir le soin relationnel, en se détachant du primat de la vue: le masque a tantôt aidé tantôt entravé le soin relationnel, mettant au jour la vulnérabilité partagée des soignants et des soignés. La crise sanitaire nous rappelle que la vigilance est toujours de mise vis-à-vis des risques de déshumanisation de la relation de soin.

Assessment of dental health care personnel protocol deviations and self-contamination during personal protective equipment donning and doffing

Background

Dental health care personnel (DHCP) may be at increased risk of exposure to severe acute respiratory syndrome coronavirus 2, the virus that causes COVID-19, as well as other clinically important pathogens. Proper use of personal protective equipment (PPE) reduces occupational exposure to pathogens. The authors performed an assessment of PPE donning and doffing practices among DHCP, using a fluorescent marker as a surrogate for pathogen transmission.

Methods

Participants donned PPE (that is, disposable gown, gloves, face mask, and eye protection) and the fluorescent marker was applied to their palms and abdomen. DHCP then doffed PPE according to their usual practices. The donning and doffing processes were video recorded, areas of fluorescence were noted, and protocol deviations were assessed. Statistical analyses included frequency, type, and descriptions of protocol deviations and factors associated with fluorescence.

Results

Seventy DHCP were enrolled. The donning and doffing steps with the highest frequency of protocol deviations were hand hygiene (66% of donning and 78% of doffing observations involved a deviation) and disposable gown use (63% of donning and 60% of doffing observations involved a deviation). Fluorescence was detected on 69% of DHCP after doffing, most frequently on hands. An increasing number of protocol deviations was significantly associated with increased risk of fluorescence. DHCP with a gown doffing deviation, excluding doffing out of order, were more likely to have fluorescence detected.

Conclusions

DHCP self-contamination was common with both donning and doffing PPE.

Practical Implications

Proper use of PPE is an important component of occupational health.

New Normal Mask-Wearing and Its Impact on Underneath Skin Microbiome: A Cross-Sectional Study in Mild Acne Vulgaris Patients

Introduction

Prolonged mask-wearing could modulate the skin microenvironment resulting in several facial dermatoses. Microbial dysbiosis is proposed to be linked with these changes; however, data regarding the association is still limited. Accordingly, we aimed to explore the impact of face masks on the skin's bacterial microbiota.

Methods

We classified participants into short (<4 h/day) and long (≥4 h/day) mask-wearing time (SMWT and LMWT) groups according to mask-wearing time per day in the previous 2 weeks. Specimens were swabbed from the cheek and forehead of 45 mild acne vulgaris patients, representing mask-covered area (MCA) and mask-uncovered area (MUA), respectively. The 16S rRNA gene sequencing and QIIME2 were used to characterize bacterial communities.

Results

There were 12 (26.7%) and 33 (73.3%) participants in SMWT and LMWT, respectively. There were no significant differences in beta diversity across MCA/MUA or LMWT/SMWT groups. In alpha-diversity, the evenness on MCA was significantly lower in LMWT than in SMWT (p value = 0.049). Among all groups, the relative abundance of bacterial taxa was similar, showing Actinobacteriota and Firmicutes, and Cutibacterium and Staphylococcus as the most predominant phyla and genera, respectively.

Conclusion

Our results showed no significant impact of mask-wearing on the skin microbiota in mild acne vulgaris participants.

Support for mask use as a COVID-19 public health measure among a large sample of Canadian secondary school students

BACKGROUND

Youth voice has been largely absent from deliberations regarding public health measures intended to prevent SARS-CoV-2 transmission, despite being one of the populations most impacted by school-based policies. To inform public health strategies and messages, we examined the level of student support of mask use in public spaces and school mask requirements, as well as factors associated with students' perspectives.

METHODS

We used cross-sectional survey data from 42,767 adolescents attending 133 Canadian secondary schools that participated in the COMPASS study during the 2020/2021 school year. Multinomial regression models assessed support for i) wearing a mask in indoor public spaces and ii) schools requiring students to wear masks, in association with COVID-19 knowledge, concerns, and perceived risk.

RESULTS

Wearing masks in indoor public spaces was supported by 81.9% of students; 8.7% were unsupportive and 9.4% were neutral/undecided. School mask requirements were supported by 67.8%, with 23.1% neutral and 9.1% unsupportive. More females supported mask wearing in public spaces (83.9% vs. 79.1%) and school mask requirements (70.8% vs. 63.5%) than males. Students had increased odds of supporting mask use in public spaces and school mask requirements if they reported concerns about their own or their family's health, had discussions regarding ways to prevent infection, perceived COVID-19 to be a risk to young people, and knew that signs are not always present in COVID-19 cases and that masks prevent SARS-CoV-2 transmission if someone coughs.

CONCLUSIONS

During the year following the beginning of the pandemic, most students supported the required use of masks in schools and wearing masks in indoor public spaces. Improving knowledge around the effectiveness of masks appears likely to have the largest impact on mask support in adolescent populations among the factors studied.

Fate of face masks after being discarded into seawater: Aging and microbial colonization

Billions of discarded masks have entered the oceans since the outbreak of the COVID-19 pandemic. Current reports mostly discuss the potential of masks as plastic pollution, but there has been no study on the fate of this emerging plastic waste in the marine environment. Therefore, we exposed masks in natural seawater and evaluated their aging and effects on the microbial community using a combination of physicochemical and biological techniques. After 30-day exposure in natural seawater, the masks suffered from significant aging. Microbial colonizers such as Rhodobacteraceae Flavobacteriaceae, Vibrionaceae and fouling organisms like calcareous tubeworms Hydroides elegans were massively present on the masks. The roughness and modulus of the mask fiber increased 3 and 5 times, respectively, and the molecular weight decreased 7%. The growth of biofouling organisms caused the masks negatively buoyant after 14-30 days. Our study sheds some light on the fate of discarded masks in a coastal area and provides fundamental data to manage this important plastic waste during COVID-19 pandemic.

Return to school and mask-wearing in class during the COVID-19 pandemic: Student perspectives from a school simulation study

Objectives

This study examined children’s perspectives about returning to in-person school following lockdown due to the pandemic and about mask-wearing in class, as well as the mental health of children and parents during the pandemic.

Methods

This cross-sectional study was part of a 2-day school simulation exercise that randomized students to different masking recommendations. Parent-report of mental health and post-simulation child-report of COVID-19-related anxiety and mask-wearing were analyzed using descriptive and multiple regression analyses. Semi-structured focus groups were conducted with older students to supplement questionnaire data.

Results

Of 190 students in this study, 31% were in grade 4 or lower 95% looked forward to returning to in-person school. Greater child anxiety about COVID-19 was predicted by increased parent/caregiver anxiety (β=0.67; P<0.001), and lower parental educational attainment (β=1.86; P<0.002). Older students were more likely than younger students to report that mask-wearing interfered with their abilities to interact with peers (χ²(1)=31.16; P<0.001) and understand the teacher (χ²(1)=13.97; P<0.001). Students in the group that did not require masks were more likely than students in the masking group to report worries about contracting COVID-19 at school (χ²(1)=10.07; P<0.05), and anticipated difficulty wearing a mask (χ²(1)=18.95; P<0.001).

Conclusions

For children anxious about COVID-19, parental anxiety and education about COVID-19 may be targets for intervention. Future research should examine the impact of prolonged implementation of public health mitigation strategies in school on academic achievement and children’s mental health.

Online survey of university students' perception, awareness and adherence to COVID-19 prevention measures

BACKGROUND

Determining factors correlated with protective measures against COVID-19 is important to improve public health response. This study describes student opinions related to university COVID-19 preventive measures.

METHODS

In fall 2020, 643 US university students completed an online survey on perception, awareness, and adherence to COVID-19 preventive measures. Outcomes included protocol effectiveness (self or others), protocol adherence (self or others), consequences of protocol violation, knowledge of violations, and level of concern for COVID-19. Multiple linear regression models determined correlates of outcome variables. Covariates included gender, race, residence, area of study, class, and knowledge of someone with a positive COVID-19 test.

RESULTS

Overall, students agreed with protective measures (equivalent to higher scores). In adjusted linear models, females (versus males) had significantly higher scores for protocol effectiveness (self) (p < 0.001), consequences of protocol violation (p = 0.005), and concern about COVID-19 (p < 0.001). Asian/Pacific Islander (versus white) had significantly higher scores for protocol effectiveness (self) (p < 0.001), consequences of protocol violation (p = 0.008), and concern about COVID-19 (p = 0.001). Graduate students (versus freshman) had higher scores for protocol effectiveness (self) (p < 0.001), protocol adherence (self) (p = 0.004) and concern about COVID-19 (p < 0.001). In contrast, participants who had a positive COVID-19 test had significantly lower scores for protocol effectiveness (self) (p = 0.02), protocol adherence (self) (p = 0.004), and consequences of protocol violation (p = 0.008).

CONCLUSION

Overall, females, Asian/Pacific Islanders, and graduate students were more likely to agree with or adhere to COVID-19 prevention guidelines but those who tested positive for COVID-19 were less likely to do so. These results may inform future prevention efforts.

Trends of COVID-19 incidence in Manitoba and public health measures: March 2020 to February 2022

OBJECTIVES

The increasing spread of severe acute respiratory syndrome coronavirus-2 has prompted Canada to take unprecedented measures. The objective of this study was to examine the impact of the implemented public health measures on the incidence of COVID-19 in Manitoba.

RESULTS

Using the COVID-19 dataset, we examined the temporal trends of daily reported COVID-19 cases and the coinciding public health measures implemented from March 12, 2020 to February 28, 2022. We calculated the 7-day moving average and crude COVID-19 infection rate/100,000 Manitobans. Due to the restrictions applied, the infection rate decreased from 2.4 (April 1) to 0.07 infections (May 1, 2020). Between May 4 and July 17, 2020, the reported cases stabilized, and some restrictions were lifted. However, in November, the cases peaked with infection rate of 29. Additional restrictions were implemented, and the rate dropped to 3.6 infections on March 31, 2021. As of August 2021, 62.8% of eligible Manitobans received two vaccine doses. The infection rate increased to 128.3 infections on December 31, 2021 and mitigation measures were implemented. This study describes how physical distancing in conjunction with other containment measures can reduce the COVID-19 burden. Future studies into the extent of the implementation of the restrictions are necessary.

Reply to correspondence "Contributing factors towards progression of migraines during the Covid-19 pandemic"

We read Shafeeq Ahmed's letter about our recent article with interest. Stress is one of the most well-known migraine triggers. Early studies have already revealed that stress significantly affects migraine clinical course during the COVID-19 pandemic. Therefore, we also took into account the stress factor in our study. We tried to assess the influence of the COVID-19 pandemic on the psychological state of our patients using the Beck Depression Inventory and the Beck Anxiety Inventory. Due to the COVID-19 pandemic, personal protective equipment and disinfectants have been used so widely and intensively for the first time. Thus, we thought that evaluating the effect of the COVID-19 pandemic on migraine only through stress would be an inadequate approach. Our study demonstrated that in addition to stress, mask types, number of masks, duration of mask use, and disinfectant exposure might affect migraine attacks. Taking these factors into account, treatment and preventative methods may improve migraine sufferers' quality of life.

The contribution of respiratory and hearing protection use to psychological distress in the workplace: a scoping review

OBJECTIVE

Workers from various industries use personal protective equipment (PPE) including masks, respirators, and hearing protection to reduce their exposures to workplace hazards. Many studies have evaluated the physiological impacts of PPE use, but few have assessed the psychological impacts. The aim of the present study was to carry out a scoping review to compile existing evidence and determine the extent of knowledge on workplace mask, respirator or hearing protection use as a psychosocial hazard (stressor) that could result in a stress response and potentially lead to psychological injury.

METHODS

The scoping review followed recognized methods and was conducted using Ovid Emcare, PubMed, Sage Journals, ScienceDirect, Scopus, SpringerLink, Google Scholar and preprint databases (OSF Preprints and medRxiv). Articles on the stressors associated with the use of masks, respirators, and hearing protection were included. The extracted data included author(s) name, year of publication, title of article, study design, population data, stressors assessed, and key findings.

RESULTS

We retrieved 650 articles after removal of duplicates, of which 26 were deemed eligible for inclusion for review. Identified factors associated with PPE use that could potentially create a stress response were identified: communication impacts, physical impacts, psychological illness symptoms, cognitive impacts, and perceived PPE-related impacts. Evidence for respirators suggest that there may be psychological injury associated with their use. However, hearing protection appears to have a protective effect in reducing psychological symptoms such as anxiety, depression, and aggression.

CONCLUSIONS

Mask or respirator use may lead to an increase in work-related stress. Whereas hearing protection may have protective effects against psychological symptoms and improves speech intelligibility. More research is needed to better understand potential psychosocial impacts of mask, respirator and/or hearing protection use.

Investigation of the effects of face masks on thermal comfort in Guangzhou, China

Wearing masks to study and work places has become a daily protective measure during the COVID-19 pandemic. In the summer of 2021, environmental parameters were monitored, and students in a university library in Guangzhou, China, were surveyed to analyze the possible symptoms of wearing masks for a long time, and to assess the sensitivity of various body parts to the environmental parameters. Concurrently, the preference of subjects wearing masks for various environmental parameters was also analyzed. Additionally, the relationship between thermal sensation and thermal index was analyzed to identify acceptable and comfortable temperature ranges. The expected duration of wearing masks was counted. Subjects wearing masks had greater requirements for environmental comfort, and reported increased thermal discomfort of the face and head, compared to those without masks. More than 70% of the subjects wearing masks reported that they experienced discomfort on their faces. Among the subjects who experienced discomfort, 62.7% reported that facial fever was the main symptom; while some reported symptoms of dyspnea (25.4%) and rapid heartbeat (9.1%). More than 75% of the subjects were expected to wear masks for 2.0 h or less. Evaluation of environmental thermal sensation, including overall, facial, and head thermal sensation, differed among subjects who wore and did not wear masks. The indexes of neutral Operative temperature/Standard Effective Temperature (T _op /SET*) and preferred T _op /SET* were lower among subjects with masks than among those without masks. The neutral T _op /SET* deviation was 0.3 °C, and the preferred T _op /SET* deviation was 0.5 °C. Additionally, the acceptable and comfortable temperature zones differed between the two cases. The subjects who wore masks preferred colder temperatures. These findings indicated that the environmental parameters should be adjusted to improve the thermal comfort of the human body while wearing masks in work or study places.