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MMWR. Morbidity and Mortality Weekly... Feb 2021Universal masking is one of the prevention strategies recommended by CDC to slow the spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1)....
Universal masking is one of the prevention strategies recommended by CDC to slow the spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1). As of February 1, 2021, 38 states and the District of Columbia had universal masking mandates. Mask wearing has also been mandated by executive order for federal property* as well as on domestic and international transportation conveyances. Masks substantially reduce exhaled respiratory droplets and aerosols from infected wearers and reduce exposure of uninfected wearers to these particles. Cloth masks and medical procedure masks fit more loosely than do respirators (e.g., N95 facepieces). The effectiveness of cloth and medical procedure masks can be improved by ensuring that they are well fitted to the contours of the face to prevent leakage of air around the masks' edges. During January 2021, CDC conducted experimental simulations using pliable elastomeric source and receiver headforms to assess the extent to which two modifications to medical procedure masks, 1) wearing a cloth mask over a medical procedure mask (double masking) and 2) knotting the ear loops of a medical procedure mask where they attach to the mask's edges and then tucking in and flattening the extra material close to the face (knotted and tucked masks), could improve the fit of these masks and reduce the receiver's exposure to an aerosol of simulated respiratory droplet particles of the size considered most important for transmitting SARS-CoV-2. The receiver's exposure was maximally reduced (>95%) when the source and receiver were fitted with modified medical procedure masks. These laboratory-based experiments highlight the importance of good fit to optimize mask performance. Until vaccine-induced population immunity is achieved, universal masking is a highly effective means to slow the spread of SARS-CoV-2** when combined with other protective measures, such as physical distancing, avoiding crowds and poorly ventilated indoor spaces, and good hand hygiene. Innovative efforts to improve the fit of cloth and medical procedure masks to enhance their performance merit attention.
Topics: COVID-19; Centers for Disease Control and Prevention, U.S.; Humans; Masks; United States
PubMed: 33600386
DOI: 10.15585/mmwr.mm7007e1 -
JAMA Network Open Mar 2021Face masks have been associated with effective prevention of diffusion of viruses via droplets. However, the use of face masks among children, especially those aged...
IMPORTANCE
Face masks have been associated with effective prevention of diffusion of viruses via droplets. However, the use of face masks among children, especially those aged younger than 3 years, is debated, and the US Centers for Disease Control and American Academy of Physicians recommend the use of face mask only among individuals aged 3 years or older.
OBJECTIVE
To examine whether the use of surgical facial masks among children is associated with episodes of oxygen desaturation or respiratory distress.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study was conducted from May through June 2020 in a secondary-level hospital pediatric unit in Italy. Included participants were 47 healthy children divided by age (ie, group A, aged ≤24 months, and group B, aged >24 months to ≤144 months). Data were analyzed from May through June 2020.
INTERVENTIONS
All participants were monitored every 15 minutes for changes in respiratory parameters for the first 30 minutes while not wearing a surgical face mask and for the next 30 minutes while wearing a face mask. Children aged 24 months and older then participated in a walking test for 12 minutes.
MAIN OUTCOMES AND MEASURES
Changes in respiratory parameters during the use of surgical masks were evaluated.
RESULTS
Among 47 children, 22 children (46.8%) were aged 24 months or younger (ie, group A), with 11 boys (50.0%) and median (interquartile range [IQR]) age 12.5 (10.0-17.5) months, and 25 children (53.2%) were aged older than 24 months to 144 months or younger, with 13 boys (52.0%) and median (IQR) age 100.0 (72.0-120.0) months. During the first 60 minutes of evaluation in the 2 groups, there was no significant change in group A in median (IQR) partial pressure of end-tidal carbon dioxide (Petco2; 33.0 [32.0-34.0] mm Hg; P for Kruskal Wallis = .59), oxygen saturation (Sao2; 98.0% [97.0%-99.0%]; P for Kruskal Wallis = .61), pulse rate (PR; 130.0 [115.0-140.0] pulsations/min; P for Kruskal Wallis = .99), or respiratory rate (RR; 30.0 [28.0-33.0] breaths/min; P for Kruskal Wallis = .69) or for group B in median (IQR) Petco2 (36.0 [34.0-38.0] mm Hg; P for Kruskal Wallis = .97), Sao2 (98.0% [97.0%-98.0%]; P for Kruskal Wallis = .52), PR (96.0 [84.0-104.5] pulsations/min; P for Kruskal Wallis test = .48), or RR (22.0 [20.0-25.0] breaths/min; P for Kruskal Wallis = .55). After the group B walking test, compared with before the walking test, there was a significant increase in median (IQR) PR (96.0 [84.0-104.5] pulsations/min vs 105.0 [100.0-115.0] pulsations/min; P < .02) and RR (22.0 [20.0-25.0] breaths/min vs 26.0 [24.0-29.0] breaths/min; P < .05).
CONCLUSIONS AND RELEVANCE
This cohort study among infants and young children in Italy found that the use of facial masks was not associated with significant changes in Sao2 or Petco2, including among children aged 24 months and younger.
Topics: COVID-19; Carbon Dioxide; Child, Preschool; Female; Humans; Infant; Italy; Male; Masks; Oxygen; Pandemics; Partial Pressure; Respiration; Respiratory Function Tests; Respiratory Insufficiency; Respiratory Rate; SARS-CoV-2
PubMed: 33651109
DOI: 10.1001/jamanetworkopen.2021.0414 -
The Laryngoscope May 2016This study aims to: 1) determine the current consumer trends of over-the-counter (OTC) and custom-made face mask usage among National Collegiate Athletic Association... (Review)
Review
OBJECTIVES/HYPOTHESIS
This study aims to: 1) determine the current consumer trends of over-the-counter (OTC) and custom-made face mask usage among National Collegiate Athletic Association (NCAA) Division I athletic programs; and 2) provide a literature review of OTC face guards and a classified database.
STUDY DESIGN
Literature review and survey.
METHODS
Consumer trends were obtained by contacting all 352 NCAA Division I programs. Athletic trainers present in the office when called answered the following questions: 1) "When an athlete breaks his or her nose, is a custom or generic face guard used?" and 2) "What brand is the generic face guard that is used?" Data was analyzed to determine trends among athletic programs. Also, a database of OTC devices available was generated using PubMed, Google, and manufacturer Web sites.
RESULTS
Among the 352 NCAA Division I athletic programs, 254 programs participated in the survey (72% response rate). The majority preferred custom-made guards (46%). Disadvantages included high cost and slow manufacture turnaround time. Only 20% of the programs strictly used generic brands. For the face mask database, 10 OTC products were identified and classified into four categories based on design, with pricing ranging between $35.99 and $69.95.
CONCLUSION
Only a handful of face masks exist for U.S. consumers, but none of them have been reviewed or classified by product design, sport application, price, and collegiate consumer use. This project details usage trends among NCAA Division I athletic programs and provides a list of available devices that can be purchased to protect the nose and face during sports.
LEVEL OF EVIDENCE
NA. Laryngoscope, 126:1054-1060, 2016.
Topics: Athletes; Basketball; Consumer Behavior; Humans; Masks; Nose; Sports Equipment; Surveys and Questionnaires; Universities
PubMed: 26344194
DOI: 10.1002/lary.25584 -
Neurology(R) Neuroimmunology &... Jan 2022To investigate whether children receiving immunosuppressive therapies for neuroimmunologic disorders had (1) increased susceptibility to SARS-CoV2 infection or to...
BACKGROUND AND OBJECTIVES
To investigate whether children receiving immunosuppressive therapies for neuroimmunologic disorders had (1) increased susceptibility to SARS-CoV2 infection or to develop more severe forms of COVID-19; (2) increased relapses or autoimmune complications if infected; and (3) changes in health care delivery during the pandemic.
METHODS
Patients with and without immunosuppressive treatment were recruited to participate in a retrospective survey evaluating the period from March 14, 2020, to March 30, 2021. Demographics, clinical features, type of immunosuppressive treatment, suspected or confirmed COVID-19 in the patients or cohabitants, and changes in care delivery were recorded.
RESULTS
One hundred fifty-three children were included: 84 (55%) female, median age 13 years (interquartile range [8-16] years), 79 (52%) on immunosuppressive treatment. COVID-19 was suspected or confirmed in 17 (11%) (all mild), with a frequency similar in patients with and without immunosuppressive treatment (11/79 [14%] vs 6/74 [8%], = 0.3085). The frequency of neurologic relapses was similar in patients with (18%) and without (21%) COVID-19. Factors associated with COVID-19 included having cohabitants with COVID-19 ( < 0.001) and lower blood levels of vitamin D ( = 0.039). Return to face-to-face schooling or mask type did not influence the risk of infection, although 43(28%) children had contact with a classmate with COVID-19. Clinic visits changed from face to face to remote for 120 (79%) patients; 110 (92%) were satisfied with the change.
DISCUSSION
In this cohort of children with neuroimmunologic disorders, the frequency of COVID-19 was low and not affected by immunosuppressive therapies. The main risk factors for developing COVID-19 were having cohabitants with COVID-19 and low vitamin D levels.
Topics: Adolescent; COVID-19; Child; Delivery of Health Care; Female; Humans; Immunocompromised Host; Immunosuppressive Agents; Male; Masks; Nervous System Diseases; Pandemics; Recurrence; Retrospective Studies; SARS-CoV-2; Vitamin D
PubMed: 34759018
DOI: 10.1212/NXI.0000000000001101 -
Journal of Preventive Medicine and... Jan 2021Non-traditional materials are used for mask construction to address personal protective equipment shortages during the coronavirus disease 2019 (COVID-19) pandemic....
OBJECTIVES
Non-traditional materials are used for mask construction to address personal protective equipment shortages during the coronavirus disease 2019 (COVID-19) pandemic. Reusable masks made from surgical sterilization wrap represent such an innovative approach with social media frequently referring to them as "N95 alternatives." This material was tested for particle filtration efficiency and breathability to clarify what role they might have in infection prevention and control.
METHODS
A heavyweight, double layer sterilization wrap was tested when new and after 2, 4, 6, and 10 autoclave sterilizing cycles and compared with an approved N95 respirator and a surgical mask via testing procedures using a sodium chloride aerosol for N95 efficiency testing similar to 42 CFR 84.181. Pressure testing to indicate breathability was also conducted.
RESULTS
The particle filtration efficiency for the sterilization wrap ranged between 58% to 66%, with similar performance when new and after sterilizing cycles. The N95 respirator and surgical mask performed at 95% and 68% respectively. Pressure drops for the sterilization wrap, N95 and surgical mask were 10.4 mmH2O, 5.9 mmH2O, and 5.1 mmH2O, respectively, well below the National Institute for Occupational Safety and Health limits of 35 mmH2O during initial inhalation and 25 mmH2O during initial exhalation.
CONCLUSIONS
The sterilization wrap's particle filtration efficiency is much lower than a N95 respirator, but falls within the range of a surgical mask, with acceptable breathability. Performance testing of non-traditional mask materials is crucial to determine potential protection efficacy and for correcting misinterpretation propagated through popular media.
Topics: Filtration; Humans; Masks; Occupational Exposure; Pandemics; Personal Protective Equipment; Sterilization
PubMed: 33618497
DOI: 10.3961/jpmph.20.394 -
PloS One 2021Wearing a facial mask can limit COVID-19 transmission. Measurements of communities' mask use behavior have mostly relied on self-report. This study's objective was to...
Prevalence of unmasked and improperly masked behavior in indoor public areas during the COVID-19 pandemic: Analysis of a stratified random sample from Louisville, Kentucky.
Wearing a facial mask can limit COVID-19 transmission. Measurements of communities' mask use behavior have mostly relied on self-report. This study's objective was to devise a method to measure the prevalence of improper mask use and no mask use in indoor public areas without relying on self-report. A stratified random sample of retail trade stores (public areas) in Louisville, Kentucky, USA, was selected and targeted for observation by trained surveyors during December 14-20, 2020. The stratification allowed for investigating mask use behavior by city district, retail trade group, and public area size. The total number of visited public areas was 382 where mask use behavior of 2,080 visitors and 1,510 staff were observed. The average prevalence of mask use among observed visitors was 96%, while the average prevalence of proper use was 86%. In 48% of the public areas, at least one improperly masked visitor was observed and in 17% at least one unmasked visitor was observed. The average prevalence of proper mask use among staff was 87%, similar to the average among visitors. However, the percentage of public areas where at least one improperly masked staff was observed was 33. Significant disparities in mask use and its proper use were observed among both visitors and staff by public area size, retail trade type, and geographical area. Observing unmasked and improperly masked visitors was more common in small (less than 1500 square feet) public areas than larger ones, specifically in food and grocery stores as compared to other retail stores. Also, the majority of the observed unmasked persons were male and middle-aged.
Topics: COVID-19; Disease Transmission, Infectious; Humans; Kentucky; Masks; Pandemics; Prevalence; Public Facilities; Public Health; SARS-CoV-2
PubMed: 34319978
DOI: 10.1371/journal.pone.0248324 -
Pediatrics Feb 2022Masking is an essential coronavirus 2019 mitigation tool assisting in the safe return of kindergarten through 12th grade children and staff to in-person instruction;...
OBJECTIVES
Masking is an essential coronavirus 2019 mitigation tool assisting in the safe return of kindergarten through 12th grade children and staff to in-person instruction; however, masking adherence, compliance evaluation methods, and potential consequences of surveillance are currently unknown. We describe 2 school districts' approaches to promote in-school masking and the consequent impact on severe acute respiratory syndrome coronavirus 2 secondary transmission.
METHODS
Two North Carolina school districts developed surveillance programs with daily versus weekly interventions to monitor in-school masking adherence. Safety teams recorded the proportion of students and staff appropriately wearing masks and provided real-time education after observation of improper masking. Primary infections, within-school transmission, and county-level severe acute respiratory syndrome coronavirus 2 infection rates were assessed.
RESULTS
Proper mask use was high in both intervention groups and districts. There were variations by grade level, with lower rates in elementary schools, and proper adherence being higher in the weekly surveillance group. Rates of secondary transmission were low in both districts with surveillance programs, regardless of intervention frequency.
CONCLUSIONS
Masking surveillance interventions are effective at ensuring appropriate masking at all school levels. Creating a culture of safety within schools led by local leadership is important and a feasible opportunity for school districts with return to in-person school. In our study of schools with high masking adherence, secondary transmission was low.
Topics: Adolescent; COVID-19; Child; Child, Preschool; Communicable Disease Control; Humans; Masks; North Carolina; Schools
PubMed: 34737177
DOI: 10.1542/peds.2021-054268I -
CMAJ : Canadian Medical Association... May 2016Conflicting recommendations exist related to which facial protection should be used by health care workers to prevent transmission of acute respiratory infections,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Conflicting recommendations exist related to which facial protection should be used by health care workers to prevent transmission of acute respiratory infections, including pandemic influenza. We performed a systematic review of both clinical and surrogate exposure data comparing N95 respirators and surgical masks for the prevention of transmissible acute respiratory infections.
METHODS
We searched various electronic databases and the grey literature for relevant studies published from January 1990 to December 2014. Randomized controlled trials (RCTs), cohort studies and case-control studies that included data on health care workers wearing N95 respirators and surgical masks to prevent acute respiratory infections were included in the meta-analysis. Surrogate exposure studies comparing N95 respirators and surgical masks using manikins or adult volunteers under simulated conditions were summarized separately. Outcomes from clinical studies were laboratory-confirmed respiratory infection, influenza-like illness and workplace absenteeism. Outcomes from surrogate exposure studies were filter penetration, face-seal leakage and total inward leakage.
RESULTS
We identified 6 clinical studies (3 RCTs, 1 cohort study and 2 case-control studies) and 23 surrogate exposure studies. In the meta-analysis of the clinical studies, we found no significant difference between N95 respirators and surgical masks in associated risk of (a) laboratory-confirmed respiratory infection (RCTs: odds ratio [OR] 0.89, 95% confidence interval [CI] 0.64-1.24; cohort study: OR 0.43, 95% CI 0.03-6.41; case-control studies: OR 0.91, 95% CI 0.25-3.36); (b) influenza-like illness (RCTs: OR 0.51, 95% CI 0.19-1.41); or (c) reported workplace absenteeism (RCT: OR 0.92, 95% CI 0.57-1.50). In the surrogate exposure studies, N95 respirators were associated with less filter penetration, less face-seal leakage and less total inward leakage under laboratory experimental conditions, compared with surgical masks.
INTERPRETATION
Although N95 respirators appeared to have a protective advantage over surgical masks in laboratory settings, our meta-analysis showed that there were insufficient data to determine definitively whether N95 respirators are superior to surgical masks in protecting health care workers against transmissible acute respiratory infections in clinical settings.
Topics: Cross Infection; Humans; Masks; Occupational Diseases; Occupational Exposure; Respiratory Protective Devices; Respiratory Tract Infections
PubMed: 26952529
DOI: 10.1503/cmaj.150835 -
Environmental Science and Pollution... Apr 2022A massive increase in the use and production of masks worldwide has been seen in the current COVID-19 pandemic, which has contributed to reducing the transmission of the...
A massive increase in the use and production of masks worldwide has been seen in the current COVID-19 pandemic, which has contributed to reducing the transmission of the virus globally. This paper aims to evaluate the life cycle environmental impacts of disposable medical masks to identify the life cycle stages that cause the highest impact on the environment. A further goal is to estimate the total environmental impacts at the global level in 2020. The inventory data was constructed directly from the industry. The system boundary of the study is from cradle to grave comprising raw material extraction and processing, production, packaging, distribution, use, and disposal as well as transport and waste management along the supply chain. Eleven environmental impacts have been estimated. The results suggest that the global warming potential of a disposable medical mask is 0.02 g CO-eq. for which the main contributor is the raw material supply (40.5%) followed by the packaging (30.0%) and production (15.5%). Sensitivity analysis was carried out to test the environmental impacts. In total, 52 billion disposable medical masks used worldwide consumes 22 TJ of energy in 2020. The global warming potential of disposable medical masks supplied in a year of the COVID-19 pandemic is 1.1 Mt CO eq. This paper assessed the hotspots in the medical mask. The findings of this study will be of interest to policymakers, global mask manufacturers, and users, allowing them to make more informed decisions about the medical mask industry.
Topics: Animals; COVID-19; Carbon Dioxide; Environment; Humans; Life Cycle Stages; Masks; Pandemics
PubMed: 34841484
DOI: 10.1007/s11356-021-17430-5 -
Revista Gaucha de Enfermagem 2021To describe a proposal for making and distributing masks for population in risk, with guidance on the stages of making them and the care in handling them based on the...
OBJECTIVE
To describe a proposal for making and distributing masks for population in risk, with guidance on the stages of making them and the care in handling them based on the development of educational video and infographic.
METHOD
Experience report on the stages of the process of training people to make fabric masks for the population at risk, between March and June 2020, in a city in the interior of São Paulo.
RESULTS
1,650 masks were made and distributed to vulnerable population groups from different contexts and tutorial video and infographic were elaborated and released to enable people to make their own masks with resources available at home.
FINAL CONSIDERATIONS
It was possible to manufacture and distribute masks for the population at risk and develop educational actions to contain the disease, given the advance of confirmed cases and deaths by Covid-19, corroborating the role of nursing in health education.
Topics: Brazil; COVID-19; Containment of Biohazards; Health Education; Health Promotion; Humans; Masks; Textiles; Video Recording; Vulnerable Populations
PubMed: 34037184
DOI: 10.1590/1983-1447.2021.20200276