The Face Mask at the Intersection of Preventive Science, Domestic Politics, and International Diplomacy: A Historical Perspective.

Background: The face mask has been used to protect against airborne diseases throughout history. We conducted a historical review of the literature on the origin of the face mask, the scientific evidence of its benefits, and its implications for domestic and international politics. Material and Methods: We performed a comprehensive search for peer- and nonpeer- reviewed literature published between 1905 and 2020. Results: Face mask wearing in hospital settings to prevent disease transmission from health care workers to their patients originates with the first use of the mask in surgery in 1897 by German surgeon Johann von Mikulicz. During the first half of the 20th century, various scientific investigators focused on determining the most effective type of medical mask. The role of the face mask in the general population as a preventive intervention during public health emergencies is supported by historical reports spanning from the European Bubonic Plague in 1619, to the Great Manchurian Plague of 1910-1911, the influenza pandemic of 1918, and the current coronavirus disease in 2019 (COVID-19) pandemic. Although the face mask has helped against airborne disease transmission, its benefits during pandemics have been filtered through the prism of political leanings and geopolitical interests. Conclusions: Our review suggests that while face mask alone cannot stop pandemics, in conjunction with other nonpharmacologic interventions it can be useful in mitigating them. When cooperation rather than division becomes the norm in the global response to pandemics, the face mask can then unite rather than divide us.

Unmasking the unmasked.

Facial maskings have been part of the human story since time began, and the reasons for their needs and the materials that went into their making would vary according to the reasons and materials available. The health-related needs took centuries to become established, but not until the germ theory of disease became recognized. The facial mask, seen as an essential defensive tool for prevention of respiratory transmitted disease continues to be the prime personal protective piece of equipment. With air-born contaminations, such as the present pandemic SARS- CoV-2 viral infestation, why would there be opposition to the use of this personal protective cover of our airways, when until an immunologic answer is available, it is the best single prevention we have. When supported with other measures, like distancing, washing and non-crowding, society would be much safer and secure, with probable less acute and drastic outcomes due to the spread of this virus.

Face Masks: Their History and the Values They Communicate.

Masks, now recommended and worn by a growing proportion of the world's population, have reflected various perceived meaning across time. This paper provides a brief history of the socio-cultural perceptions attached to wearing a mask by surveying how masks were perceived in ancient Greece and Rome, the origins of medical masks, and the ascribed socio-cultural meaning of masks during the COVID-19 pandemic. The use of a mask has historically diverse perceived meanings; currently, wearing a mask communicates a bipolar socio-cultural meaning and a nuanced, divisive symbology. To some, masks communicate a belief in medical science and a desire to protect one's neighbor from contagion. To others, a mask communicates oppression, government overreach, and a skepticism toward established scientific principles. It is the mask's ability to signal a deception, or extrapolated more broadly, a value system, that is highly relevant to current public health guidelines encouraging mask use to decrease the transmission of SARS-CoV-2, the novel coronavirus responsible for the COVID-19 pandemic. Public health officials and providers should utilize evidence-based health communication strategies when findings warrant a reversed recommendation of a symbol (such as masks) with a legacy of socio-cultural underpinnings that are deep-seated, complex, and emotional.

Protective face masks through centuries, from XVII century plague doctors to current health care professionals managing the COVID-19 pandemic.

The adoption of items similar to face masks by human beings dates back to the remote past. With specific regard to the use of face protections for medical purposes, from the beginning of the XVII century onwards in Europe physicians in charge of curing patients with plague wore a complicated, and subsequently typical, costume. The face mask included eye sockets of glass and leather headdresses with long, pointed beaks. These beaks were filled with scented spices, aromatic substances and perfumes to filter out the plague and to mask "bad air", which was considered to be the vehicle of the disease. In the XVIII and XIX centuries a number of advances regarding personal protection devices in health care were achieved. In the course of the 1918 influenza pandemic (Spanish flu), health care professionals began to use face masks in a routine way to protect themselves and their patients. From the sixties (XX century) onwards, the explosion of health care technology has led to a continuous refinement in the study of individual protection devices, also because, even in the presence of an increasing number of powerful antimicrobial agents, infectious diseases have remained dominant during these last decades. It is not by chance, therefore, that one of the consequences of the 2020 ongoing COVID-19 pandemic should be the fact that face masks have become essential again both inside and outside health care environments. Even if more than a century has passed from Fluegge's historical definition of bacteria-laden droplets, the role of certain medical-preventive achievements of the past, including the paradigmatic model of protective face masks, continues to remain pivotal in this third millennium.

The history and value of face masks.

In the human population, social contacts are a key for transmission of bacteria and viruses. The use of face masks seems to be critical to prevent the transmission of SARS-CoV-2 for the period, in which therapeutic interventions are lacking. In this review, we describe the history of masks from the middle age to modern times.

COVID-19 and Other Pandemics: How Might They Be Prevented?

Pandemics such as influenza, smallpox, and plague have caused the loss of hundreds of millions of lives and have occurred for many centuries. Fortunately, they have been largely eliminated by the use of vaccinations and drugs. More recently, Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and now Coronavirus Disease 2019 (COVID-19) have arisen, and given the current absence of highly effective approved vaccines or drugs, brute-force approaches involving physical barriers are being used to counter virus spread. A major basis for physical protection from respiratory infections is eye, nose, and mouth protection. However, eye protection with goggles is problematic due to "fogging", while nose/mouth protection is complicated by the breathing difficulties associated with non-valved respirators. Here, we give a brief review of the origins and development of face masks and eye protection to counter respiratory infections on the basis of experiments conducted 100 years ago, work that was presaged by the first use of personal protective equipment, "PPE", by the plague doctors of the 17th Century. The results of the review lead to two conclusions: first, that eye protection using filtered eye masks be used to prevent ocular transmission; second, that new, pre-filtered, valved respirators be used to even more effectively block viral transmission.