Estimated Mask Use and Temporal Relationship to COVID-19 Epidemiology of Black Lives Matter Protests in 12 Cities.

BACKGROUND: There is an increased risk of SARS-CoV-2 transmission during mass gatherings and a risk of asymptomatic infection. We aimed to estimate the use of masks during Black Lives Matter (BLM) protests and whether these protests increased the risk of COVID-19. Two reviewers screened 496 protest images for mask use, with high inter-rater reliability. Protest intensity, use of tear gas, government control measures, and testing rates were estimated in 12 cities. A correlation analysis was conducted to assess the potential effect of mask use and other measures, adjusting for testing rates, on COVID-19 epidemiology 4 weeks (two incubation periods) post-protests. Mask use ranged from 69 to 96% across protests. There was no increase in the incidence of COVID-19 post-protest in 11 cities. After adjusting for testing rates, only Miami, which involved use of tear gas and had high protest intensity, showed a clear increase in COVID-19 after one incubation period post-protest. No significant correlation was found between incidence and protest factors. Our study showed that protests in most cities studied did not increase COVID-19 incidence in 2020, and a high level of mask use was seen. The absence of an epidemic surge within two incubation periods of a protest is indicative that the protests did not have a major influence on epidemic activity, except in Miami. With the globally circulating highly transmissible Alpha, Delta, and Omicron variants, layered interventions such as mandated mask use, physical distancing, testing, and vaccination should be applied for mass gatherings in the future.

Influenza cases in nine aged care facilities in Sydney, Australia over a three-year surveillance period, 2018-2020.

BACKGROUND: Influenza outbreaks in aged care facilities are a major public health concern. In response to the severe 2017 influenza season in Australia, enhanced influenza vaccines were introduced from 2018 onwards for those over 65 and more emphasis was placed on improving vaccination rates among aged care staff. During the COVID-19 pandemic, these efforts were then further escalated to reduce the additional burden that influenza could pose to facilities. METHODS: An observational epidemiological study was conducted from 2018 to 2020 in nine Sydney (Australia) aged care facilities of the same provider. De-identified vaccination data and physical layout data were collected from participating facility managers from 2018 to 2020. Active surveillance of influenza-like illness was carried out from 2018 to 2020 influenza seasons. Correlation and Poisson regression analyses were carried out to explore the relationship between physical layout variables to occurrence of influenza cases. RESULTS: Influenza cases were low in 2018 and 2019, and there were no confirmed influenza cases identified in 2020. Vaccination rates increased among staff by 50.5% and residents by 16.8% over the three-year period of surveillance from 2018 to 2020. For each unit increase in total number of beds, common areas, single rooms, all types of rooms (including double occupancy rooms), the influenza cases increased by 1.02 (95% confidence interval:1.018-1.025), 1.04 (95% confidence interval: 1.019-1.073), 1.03 (95% confidence interval: 1.016-1 0.038) and 1.02 (95% confidence interval:1.005-1.026) times which were found to be statistically significant. For each unit increase in the proportion of shared rooms, influenza cases increased by 1.004 (95% confidence interval:1.0001-1.207) which was found to be statistically significant. CONCLUSIONS: There is a relationship between influenza case counts and aspects of the physical layout such as facility size, and this should be considered in assessing risk of outbreaks in aged care facilities. Increased vaccination rates in staff and COVID-19 prevention and control measures may have eliminated influenza in the studied facilities in 2020.

Factors associated with repeated influenza vaccine uptake among aged care staff in an Australian sample from 2017 to 2019.

BACKGROUND/AIM: Influenza vaccination is strongly recommended every year for aged care staff to protect themselves and minimise risk of transmission to residents. This study aimed to determine the factors associated with repeated annual influenza vaccine uptake among Australian aged care staff from 2017 to 2019. METHODS: Demographic, medical and vaccination data collected from the staff, who participated in an observational study from nine aged care facilities under a single provider in Sydney Australia, were analysed retrospectively. Based on the pattern of repeated influenza vaccination from 2017 to 2019, three groups were identified: (1) unvaccinated all three years; (2) vaccinated occasionally(once or twice) over three years; and (3)vaccinated all threeyears. Multinomial logistic regression analysis was performed to better understand the factors associated with the pattern of repeated influenza vaccination. RESULTS: From a total of 138 staff, between 2017 and 2019, 28.9 % (n = 40) never had a vaccination, while 44.2 % (n = 61) had vaccination occasionally and 26.8 % (n = 37) had vaccination all three years. In the multinomial logistic regression model, those who were<40 years old (OR = 0.57, 95 % CI: 0.19-0.90, p < 0.05) and those who were current smokers (OR = 0.20; 95 % CI: 0.03-0.76, p < 0.05) were less likely to have repeated vaccination for all three years compared to the unvaccinated group. Those who were<40 years old (OR = 0.61; 95 % CI: 0.22-0.68, p < 0.05) and those who were born overseas (OR = 0.50; 95 % CI:0.27-0.69, p < 0.05) were more likely to be vaccinated occasionally compared to the unvaccinated group. CONCLUSION: The significant predictors of repeated vaccine uptake across the three-year study period among aged care staff were age, smoking status and country of birth (Other vs Australia). Targeted interventions towards the younger age group (<40 years old), smokers and those who were born overseas could improve repeated influenza vaccination uptake in the aged care workforce.

Development of a road map to scale up the uptake and utilization of influenza vaccine in 22 countries of Eastern Mediterranean Region.

BACKGROUND: The aim of this project was to develop a road map to support countries in Eastern Mediterranean Region in developing and implementing evidence-based seasonal influenza vaccination policy, strengthen influenza vaccination delivery program and address vaccine misperceptions and hesitancy. METHODS: The road map was developed through consultative meetings with countries' focal points, review of relevant literature and policy documents and analysis of WHO/UNICEF Joint Reporting Form on immunization ((JRF 2015-2020) data. Countries were categorised into three groups, based on the existence of influenza vaccination policy and national regulatory authority, availability of influenza vaccine in the country and number of influenza vaccine doses distributed/ 1000 population. The final road map was shared with representatives of all countries in Eastern Mediterranean Region and other stakeholders during a meeting in September 2021. RESULT: The goal for next 5 years is to increase access to and use of utilization of seasonal influenza vaccine in Eastern Mediterranean Region to reduce influenza-associated morbidity and mortality among priority groups for vaccination. Countries in the Eastern Mediterranean Region are at different stages of implementation of the influenza vaccination program, so activities are planned under four strategic priority areas based on current situations in countries. The consultative body recommended that some countries should establish a new seasonal influenza vaccination programme and ensure the availability of vaccines, while other countries need to reduce vaccine hesitancy and enhance current seasonal influenza vaccination coverage, particularly in all high-risk groups. Countries are also encouraged to leverage COVID-19 adult vaccination programs to improve seasonal influenza vaccine uptake. CONCLUSION: This road map was developed through a consultative process to scale up the uptake and utilization of influenza vaccine in all countries of Eastern Mediterranean Region. The road map proposes activities that should be adopted in the local context to develop/ update national policies and programs.

Recommendations related to occupational infection prevention and control training to protect healthcare workers from infectious diseases: a scoping review of infection prevention and control guidelines.

BACKGROUND: Events such as the COVID-19 pandemic remind us of the heightened risk that healthcare workers (HCWs) have from acquiring infectious diseases at work. Reducing the risk requires a multimodal approach, ensuring that staff have the opportunity to undertake occupational infection prevention and control (OIPC) training. While studies have been done within countries to look at availability and delivery of OIPC training opportunities for HCWs, there has been less focus given to whether their infection prevention and control (IPC) guidelines adhere to recommended best practices. OBJECTIVES: To examine national IPC guidelines for the inclusion of key recommendations on OIPC training for HCWs to protect them from infectious diseases at work and to report on areas of inconsistencies and gaps. METHODS: We applied a scoping review method and reviewed guidelines published in the last twenty years (2000-2020) including the IPC guidelines of World Health Organization and the United States Centers for Disease Control and Prevention. These two guidelines were used as a baseline to compare the inclusion of key elements related to OIPC training with IPC guidelines of four high-income countries /regions i.e., Gulf Cooperation Council, Australia, Canada, United Kingdom and four low-, and middle-income countries (LMIC) i.e. India, Indonesia, Pakistan and, Philippines. RESULTS: Except for the Filipino IPC guideline, all the other guidelines were developed in the last five years. Only two guidelines discussed the need for delivery of OIPC training at undergraduate and/or post graduate level and at workplace induction. Only two acknowledged that training should be based on adult learning principles. None of the LMIC guidelines included recommendations about evaluating training programs. Lastly the mode of delivery and curriculum differed across the guidelines. CONCLUSIONS: Developing a culture of learning in healthcare organizations by incorporating and evaluating OIPC training at different stages of HCWs career path, along with incorporating adult learning principles into national IPC guidelines may help standardize guidance for the development of OIPC training programs. Sustainability of this discourse could be achieved by first updating the national IPC guidelines. Further work is needed to ensure that all relevant healthcare organisations are delivering a package of OIPC training that includes the identified best practice elements.

Examining the discourse regarding the delivery of occupational infection prevention and control training to healthcare workers: a scoping review of pandemic plans of 23 countries.

BACKGROUND: Over the years, countries reformed their pandemic plans but still healthcare systems were unprepared to handle the COVID-19 pandemic. Throughout the COVID-19 pandemic, healthcare workers (HCWs) raised issues around shortage of personal protective equipment (PPE), inadequate occupational infection prevention and control (IPC) training, lack of guidance regarding reuse/extended use of PPE and absence of HCWs. OBJECTIVE: The objective of this scoping review was to compare national and transnational pandemic plans and COVID-19 guidelines for the inclusion of recommendations regarding pandemic-specific occupational IPC training for HCWs, as well as strategies for managing the surge in PPE needs and staffing. INCLUSION CRITERIA: From each of the six WHO defined world regions, four countries with the highest burden of COVID-19 cases (as of mid-2020) were selected and attempted to locate the relevant pandemic plans and COVID-19 guidelines. METHODS: Searches were undertaken of 1: National Guidelines Clearinghouse, 2: websites of international public healthcare agencies such as WHO, the European Centre for Disease Prevention and Control (ECDC) and, 3: in-country health departments/Ministry of Health/Department of Public Health, between June 2020 and July 2021. The data were summarised under six themes drawn from publicly available pandemic plans and COVID-19 (IPC) guidelines of WHO, ECDC and 23 countries. RESULTS: The WHO, ECDC and 14 countries reported pandemic-specific IPC training; however, only four discussed training HCWs on correct PPE use; six countries listed strategies to manage the surge in demand of HCWs, while only five discussed managing the shortage of PPE. None of the COVID-19 guidelines recommended training HCWs for correct reuse or extended use of PPE and only one country's guideline outlined mandatory HCWs attendance and delivery of training in a regional language. CONCLUSION: Pandemic plans should be revised to include guiding principles regarding the delivery of pandemic specific IPC training. There is also a need to provide guidance on when countries should consider reuse and extended use of PPE. This discourse should also be reflected in disease-specific pandemic guidelines, like COVID-19 (IPC) guidelines. The aim of this review is to assist international health agencies in generating evidence-based guideline updates.

Supporting the Delivery of Infection Prevention and Control Training to Healthcare Workers: Insights from the Sector.

Infection prevention and control (IPC) cannot be implemented without healthcare workers (HCWs) being properly trained and competent. The provision of training is essential, yet there is a gap in our understanding of the factors impacting the implementation of IPC training. This paper reports the results from in-depth interviews that explored the current landscape around IPC training delivered across low-, middle-, and high-income countries. Semi-structured interviews were conducted with the key stakeholders involved in policymaking or IPC implementation in Saudi Arabia, Pakistan, India, Indonesia, the Philippines, and Australia. Although the training was mandated for many HCWs, participants indicated that only some training elements were mandatory. Participants spoke about covering various topics, but those in low-resource settings spoke about the challenges of delivering training. Classroom-based training dominated, but online delivery modes were also used in some locations. Whilst HCW's training was postulated to have improved during the COVID-19 pandemic, the capacity to deliver training did not improve in some settings. More research is needed to establish the essential elements that could underpin the development of training packages.

Cross-sectional survey of changes in knowledge, attitudes and practice of mask use in Sydney and Melbourne during the 2020 COVID-19 pandemic.

OBJECTIVES: Since mask uptake and the timing of mask use has the potential to influence the control of the COVID-19 pandemic, this study aimed to assess the changes in knowledge toward mask use in Sydney and Melbourne, Australia, during the 2020 COVID-19 pandemic. DESIGN: An observational study, using a cross-sectional survey, was distributed to adults in Sydney and Melbourne, Australia, during July-August 2020 (survey 1) and September 2020 (survey 2), during the COVID-19 pandemic in Australia. SETTING AND PARTICIPANTS: Participants aged 18 years or older and living in either Sydney or Melbourne. PRIMARY AND SECONDARY OUTCOME MEASURES: Demographics, risk measures, COVID-19 severity and perception, mask attitude and uptake were determined in this study. RESULTS: A total of 700 participants completed the survey. In both Sydney and Melbourne, a consistent decrease was reported in almost all risk-mitigation behaviours between March 2020 and July 2020 and again between March 2020 and September 2020. However, mask use and personal protective equipment use increased in both Sydney and Melbourne from March 2020 to September 2020. There was no significant difference in mask use during the pandemic between the two cities across both timepoints (1.24 (95% CI 0.99 to 1.22; p=0.072)). Perceived severity and perceived susceptibility of COVID-19 infection were significantly associated with mask uptake. Trust in information on COVID-19 from both national (1.77 (95% CI 1.29 to 2.44); p<0.000)) and state (1.62 (95% CI 1.19 to 2.22); p=0.003)) government was a predictor of mask use across both surveys. CONCLUSION: Sydney and Melbourne both had high levels of reported mask wearing during July 2020 and September 2020, consistent with the second wave and mask mandates in Victoria, and cluster outbreaks in Sydney at the time. High rates of mask compliance may be explained by high trust levels in information from national and state government, mask mandates, risk perceptions, current outbreaks and the perceived level of risk of COVID-19 infection at the time.

Airborne or Droplet Precautions for Health Workers Treating Coronavirus Disease 2019?

Cases of coronavirus disease 2019 (COVID-19) have been reported in more than 200 countries. Thousands of health workers have been infected, and outbreaks have occurred in hospitals, aged care facilities, and prisons. The World Health Organization (WHO) has issued guidelines for contact and droplet precautions for healthcare workers caring for suspected COVID-19 patients, whereas the US Centers for Disease Control and Prevention (CDC) has initially recommended airborne precautions. The 1- to 2-meter (≈3-6 feet) rule of spatial separation is central to droplet precautions and assumes that large droplets do not travel further than 2 meters (≈6 feet). We aimed to review the evidence for horizontal distance traveled by droplets and the guidelines issued by the WHO, CDC, and European Centre for Disease Prevention and Control on respiratory protection for COVID-19. We found that the evidence base for current guidelines is sparse, and the available data do not support the 1- to 2-meter (≈3-6 feet) rule of spatial separation. Of 10 studies on horizontal droplet distance, 8 showed droplets travel more than 2 meters (≈6 feet), in some cases up to 8 meters (≈26 feet). Several studies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) support aerosol transmission, and 1 study documented virus at a distance of 4 meters (≈13 feet) from the patient. Moreover, evidence suggests that infections cannot neatly be separated into the dichotomy of droplet versus airborne transmission routes. Available studies also show that SARS-CoV-2 can be detected in the air, and remain viable 3 hours after aerosolization. The weight of combined evidence supports airborne precautions for the occupational health and safety of health workers treating patients with COVID-19.

Supporting the Delivery of Infection Prevention and Control Training to Healthcare Workers: Insights from the Sector

Infection prevention and control (IPC) cannot be implemented without healthcare workers (HCWs) being properly trained and competent. The provision of training is essential, yet there is a gap in our understanding of the factors impacting the implementation of IPC training. This paper reports the results from in-depth interviews that explored the current landscape around IPC training delivered across low-, middle-, and high-income countries. Semi-structured interviews were conducted with the key stakeholders involved in policymaking or IPC implementation in Saudi Arabia, Pakistan, India, Indonesia, the Philippines, and Australia. Although the training was mandated for many HCWs, participants indicated that only some training elements were mandatory. Participants spoke about covering various topics, but those in low-resource settings spoke about the challenges of delivering training. Classroom-based training dominated, but online delivery modes were also used in some locations. Whilst HCW's training was postulated to have improved during the COVID-19 pandemic, the capacity to deliver training did not improve in some settings. More research is needed to establish the essential elements that could underpin the development of training packages.

Factors Associated With SARS-CoV-2 Attack Rates in Aged Care-A Meta-analysis.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has resulted in significant morbidity and mortality in aged-care facilities worldwide. The attention of infection control in aged care needs to shift towards the built environment, especially in relation to using the existing space to allow social distancing and isolation. Physical infrastructure of aged care facilities has been shown to present challenges to the implementation of isolation procedures. To explore the relationship of the physical layout of aged care facilities with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) attack rates among residents, a meta-analysis was conducted. METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P), studies were identified from 5 databases using a registered search strategy with PROSPERO. Meta-analysis for pooled attack rates of SARS-CoV-2 in residents and staff was conducted, with subgroup analysis for physical layout variables such as total number of beds, single rooms, number of floors, number of buildings in the facility, and staff per 100 beds. RESULTS: We included 41 articles across 11 countries, reporting on 90 657 residents and 6521 staff in 757 facilities. The overall pooled attack rate was 42.0% among residents (95% CI, 38.0%-47.0%) and 21.7% in staff (95% CI, 15.0%-28.4%). Attack rates in residents were significantly higher in single-site facilities with standalone buildings than facilities with smaller, detached buildings. Staff-to-bed ratio significantly explains some of the heterogeneity of the attack rate between studies. CONCLUSIONS: The design of aged care facilities should be smaller in size, with adequate space for social distancing.

Factors associated with SARS-COV-2 attack rates in aged care– a meta-analysis

Background The COVID-19 pandemic has resulted in significant morbidity and mortality in aged care facilities worldwide. The attention of infection control in aged care needs to shift towards the built environment, especially with relation to using the existing space to allow social distancing and isolation. Physical infrastructure of aged care facilities has been shown to present challenges to implementation of isolation procedures. To explore the relationship of the physical layout of aged care facilities on SARS-CoV-2 attack rates among residents, a meta-analysis was conducted. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P), studies were identified from five databases using a registered search strategy with PROSPERO. Meta-regression analysis for pooled attack rates of SARS-CoV-2 in residents and staff was conducted, with subgroup analysis for physical layout variables such as total number of beds, single rooms, number of floors, number of buildings in facility and staff per 100 beds Results We included 41 articles across 11 countries, reporting on 90 657 residents and 6521 staff in 757 facilities. The overall pooled attack rate among residents was 42.0% (95% CI: 38.0-47.0%) and 21.7% (95% CI: 15.0-28.4%) in staff. Attack rates in residents were significantly higher in single-site facilities with standalone buildings than facilities with smaller, detached buildings. Staff-to-bed ratio significantly explains some of the heterogeneity of the attack rate between studies. Conclusion The design of aged care facilities should have smaller-sized facilities with adequate space for social distancing.

Trust in government, intention to vaccinate and COVID-19 vaccine hesitancy: A comparative survey of five large cities in the United States, United Kingdom, and Australia.

BACKGROUND: There is widespread hesitancy towards COVID-19 vaccines in the United States, United Kingdom, and Australia. OBJECTIVE: To identify predictors of willingness to vaccinate against COVID-19 in five cities with varying COVID-19 incidence in the US, UK, and Australia. DESIGN: Online, cross-sectional survey of adults from Dynata's research panel in July-September 2020. PARTICIPANTS, SETTING: Adults aged 18 and over in Sydney, Melbourne, London, New York City, or Phoenix. MAIN OUTCOMES AND MEASURES: Willingness to receive a COVID-19 vaccine; reason for vaccine intention. STATISTICAL METHODS: To identify predictors of intention to receive a COVID-19 vaccine, we used Poisson regression with robust error estimation to produce prevalence ratios. RESULTS: The proportion willing to receive a COVID-19 vaccine was 70% in London, 71% NYC, 72% in Sydney, 76% in Phoenix, and 78% in Melbourne. Age was the only sociodemographic characteristic that predicted willingness to receive a COVID-19 vaccine in all five cities. In Sydney and Melbourne, participants with high confidence in their current government had greater willingness to receive the vaccine (PR = 1.24; 95% CI = 1.07-1.44 and PR = 1.38; 95% CI = 1.74-1.62), while participants with high confidence in their current government in NYC and Phoenix were less likely to be willing to receive the vaccine (PR = 0.78; 95% CI = 0.72-0.85 and PR = 0.85; 95% CI = 0.76-0.96). LIMITATIONS: Consumer panels can be subject to bias and may not be representative of the general population. CONCLUSIONS: Success for COVID-19 vaccination programs requires high levels of vaccine acceptance. Our data suggests more than 25% of adults may not be willing to receive a COVID-19 vaccine, but many of them were not explicitly anti-vaccination and thus may become more willing to vaccinate over time. Among the three countries surveyed, there appears to be cultural differences, political influences, and differing experiences with COVID-19 that may affect willingness to receive a COVID-19 vaccine.

The long road of pandemic vaccine development to rollout: A systematic review on the lessons learnt from the 2009 H1N1 influenza pandemic.

BACKGROUND: The 2009 Influenza A(H1N1) pandemic prompted one of the largest public health responses in history. The continuous emergence of new and deadly pathogens has highlighted the need to reflect upon past experiences to improve pandemic preparedness. The aim of this study was to examine the development and rollout of 2009 influenza A(H1N1) pandemic vaccine and knowledge challenges for the effective implementation of vaccination programs for COVID-19 and future influenza pandemics. METHODS: A systematic review was conducted searching EMBASE (inception to current date) and PUBMED (from January 2009 to current date) databases for relevant published studies about influenza A(H1N1) pandemic vaccines. A Google search was conducted to identify relevant documents from gray literature. Selected Studies were reviewed and summarized. RESULTS: A total of 22, comprising of 12 original studies and 10 relevant documents met the inclusion criteria. Fourteen papers reported an initial high demand that outweighed production capacity and caused vaccine shortages. Vaccine procurement and supply were skewed toward high-income countries. Low vaccination rates of about 5%-50% were reported in all studies mainly due to a low-risk perception of getting infected, safety concerns, and the fear of adverse effects. CONCLUSIONS: Safety concerns about the approved H1N1 vaccines resulted in many unsuccessful vaccination campaigns worldwide. Understanding the factors that influence people's decision to accept or refuse vaccination, effective risk communication strategies, adequate resources for vaccine deployment initiatives and building local capacities through shared knowledge and technology transfer may help to improve COVID-19 vaccine uptake and accelerate pandemic control.

COVID-19 outbreaks in aged-care facilities in Australia.

BACKGROUND: Aged-care facilities (ACF's) provide unique challenges when implementing infection control methods for respiratory outbreaks such as COVID-19. Research on this highly vulnerable setting is lacking and there was no national reporting data of COVID-19 cases in ACFs in Australia early in the pandemic. We aimed to estimate the burden of aged-care worker (ACW) infections and outbreaks of COVID-19 in Australian aged-care. METHODS: A line list of publicly available aged-care related COVID-19 reported cases from January 25 to June 10, 2020 was created and was enhanced by matching data extracted from media reports of aged-care related COVID-19 relevant outbreaks and reports. Rate ratios (RR) were used to predict risk of infection in ACW and aged-care residents, and were calculated independently, by comparing overall cases to ACW and aged-care residents' cases. RESULTS: A total of 14 ACFs with COVID-19 cases were recorded by June 2020 nationwide, with a high case fatality rate (CFR) of 50% (n = 34) and 100% (n = 3) seen in two ACFs. Analysis on the resident risk found that the COVID-19 risk is 1.27 times higher (unadjusted RR 1.27 95% confidence interval [CI] 1.00 to1.61; P = 0.047) as compared with the risk of infection in the general population. In over 60% of cases identified in ACFs, the source of infection in the index case was unknown. A total of 28 deaths associated within ACFs were reported, accounting for 54.9% of total deaths in New South Wales and 26.9% of total deaths in Australia. CONCLUSIONS: This high-risk population requires additional prevention and control measures, such as routine testing of all staff and patients regardless of symptoms. Prompt isolation and quarantine as soon as a case is confirmed within a facility is essential.

Mask use, risk-mitigation behaviours and pandemic fatigue during the COVID-19 pandemic in five cities in Australia, the UK and USA: A cross-sectional survey.

OBJECTIVES: To determine patterns of mask wearing and other infection prevention behaviours, over two time periods of the COVID-19 pandemic, in cities where mask wearing was not a cultural norm. METHODS: A cross-sectional survey of masks and other preventive behaviours in adults aged ≥18 years was conducted in five cities: Sydney and Melbourne, Australia; London, UK; and Phoenix and New York, USA. Data were analysed according to the epidemiology of COVID-19, mask mandates and a range of predictors of mask wearing. RESULTS: The most common measures used were avoiding public areas (80.4%), hand hygiene (76.4%), wearing masks (71.8%) and distancing (67.6%). Over 40% of people avoided medical facilities. These measures decreased from March-July 2020. Pandemic fatigue was associated with younger age, low perceived severity of COVID-19 and declining COVID-19 prevalence. Predictors of mask wearing were location (US, UK), mandates, age <50 years, education, having symptoms and knowing someone with COVID-19. Negative experiences with mask wearing and low perceived severity of COVID-19 reduced mask wearing. Most respondents (98%) believed that hand washing and distancing were necessary, and 80% reported no change or stricter adherence to these measures when wearing masks. CONCLUSION: Pandemic mitigation measures were widely reported across all cities, but decreased between March and July 2020. Pandemic fatigue was more common in younger people. Cities with mandates had higher rates of mask wearing. Promotion of mask use for older people may be useful. Masks did not result in a reduction of other hygiene measures.

Experimental Evidence for the Optimal Design of a High-Performing Cloth Mask.

Cloth masks can be an alternative to medical masks during pandemics. Recent studies have examined the performance of fabrics under various conditions; however, the performance against violent respiratory events such as human sneezes is yet to be explored. Accordingly, we present a comprehensive experimental study using sneezes by a healthy adult and a tailored image-based flow measurement diagnostic system evaluating all dimensions of protection of commonly available fabrics and their layered combinations: the respiratory droplet blocking efficiency, water resistance, and breathing resistance. Our results reveal that a well-designed cloth mask can outperform a three-layered surgical mask for such violent respiratory events. Specifically, increasing the number of layers significantly increases the droplet blocking efficiency, on average by ∼20 times per additional fabric layer. A minimum of three layers is necessary to resemble the droplet blocking performance of surgical masks, and a combination of cotton/linen (hydrophilic inner layer)-blends (middle layer)-polyester/nylon (hydrophobic outer layer) exhibited the best performance among overall indicators tested. In an optimum three-layered design, the average thread count should be greater than 200, and the porosity should be less than 2%. Furthermore, machine washing at 60 °C did not significantly impact the performance of cloth masks. These findings inform the design of high-performing homemade cloth masks.

Droplets and Aerosols Generated by Singing and the Risk of Coronavirus Disease 2019 for Choirs.

Choral singing has become a major risk during the coronavirus disease 2019 (COVID-19) pandemic due to high infection rates. Our visualization and velocimetry results reveal that the majority of droplets expelled during singing follow the ambient airflow pattern. These results point toward the possibility of COVID-19 spread by small airborne droplets during singing.