How do the general population behave with facemasks to prevent COVID-19 in the community? (preprint)

IMPORTANCE The appropriate use of facemasks, recommended or mandated by authorities, is critical to protect the community and prevent the spread of COVID-19. OBJECTIVE To evaluate the frequency and quality of facemask use in general populations of different socio-spatial backgrounds. DESIGN A multi-site observational study carried out from 25 June 2020 to 21 July 2020. SETTING The observations were carried out in 43 different locations in a region in the west of France, representing various areas: rural and urban, indoor and outdoor, and in areas where masks were mandated or not. An observer was positioned at a predetermined place, facing a landmark, and collected information about the use of facemasks and socio-demographic data. PARTICIPANTS All individual passing between the observer and the landmark were included. EXPOSURE The observer collected information on whether a mask was worn, the type of mask used, the quality of the positioning, gender, and the age category of each individual. MAIN OUTCOMES AND MEASURES The main outcomes were the use of a facemask and the quality of the positioning. Factors associated with these outcomes were identified. RESULTS A total of 3354 observations were recorded. A facemask was worn by 56.4% (n=1892) of individuals, varying from 49% (n=1359) in non-mandatory areas and 91.7% (n=533) in mandatory areas, including surgical facemasks (56.8%, n=1075) and cloth masks (43.2%, n=817). The facemask was correctly positioned in 75.2% (n=1422) of cases. The factors independently associated with wearing a facemask were being indoors (adjusted odds ratio [aOR], 0.37; 95% confidence interval [CI], 0.31-0.44), being in a mandatory area (aOR, 0.14; 95%CI, 0.10-0.20), female gender (aOR, 0.57; 95%CI, 0.49-0.66), and age >40 years (aOR, 0.54; 95%CI, 0.46-0.63). The factors independently associated with correct mask position were rural location (aOR, 0.76; 95%CI, 0.97-0.98), being in an indoor area (aOR, 0.49; 95%CI, 0.38-0.65), use of a cloth mask (aOR, 0.65; 95%CI, 0.52-0.81), and age >40 years (aOR, 0.61; 95%CI 0.49-0.76). CONCLUSIONS AND RELEVANCE Information campaigns should promote the use of cloth masks. Young people in general and men in particular are the priority targets. Simplifying the rules to require universal mandatory masking seems to be the best approach for health authorities.

Impact of Doxycycline on COVID-19 Patients with Risk Factors: DYNAMIC, a Multi-Centre, Randomised, Placebo-Controlled, Double-Blind Trial (preprint)

Background: The DYNAMIC study is based on three properties of tetracyclines. (1) Tetracyclines are known to chelate zinc from matrix metalloproteinases. It is possible their chelating activity may help inhibit COVID-19 infection by limiting its ability to replicate in the host. (2) As seen with dengue virus, tetracyclines may also be able to inhibit the replication of positive polarity single-stranded RNA viruses, such as COVID-19. (3) Tetracyclines are also modulators of innate immunity (anti-inflammatory activity), a property that has been used to treat inflammatory skin diseases for many years. They could therefore participate in limiting the cytokine storm induced by COVID-19. Moreover, the lipophilic nature of tetracyclines and their strong pulmonary penetration could allow them to inhibit viral replication at this level. Among the tetracyclines, doxycycline has three advantages: its long safety history (side effects are uncommon with no notable risks), its short treatment duration and its low cost.Methods: The trial will involve 330 patients who are positive for SARS-CoV-2 infection and have one or more risk factors for worsening the disease. These patients will be included as outpatients for early treatment of illness. For logistical reasons and in order to be able to standardise the study as much as possible, recruitment will take place in 6 hospital departments covering the whole of France. For 14 days they will be given either 200mg of doxycycline a day or placebo. Our hypothesis is a considerable reduction in the number of patients hospitalised due to COVID-19 thanks to the treatment of doxycycline.Discussion: This study could have an impact on the overcrowding of patients with COVID-19 at the hospital which is one of the major world-wide problems of this pandemic. This treatment would therefore contribute to supporting the deconfinement strategy by blocking the viral infection early and reducing the infectious period.Trial Registration: On ClinicalTrials.gov, registration number NCT04371952, first published on 30 April 2020.