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1.
Appl Physiol Nutr Metab ; 46(7): 753-762, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1571437

ABSTRACT

We sought to determine the impact of wearing cloth or surgical masks on the cardiopulmonary responses to moderate-intensity exercise. Twelve subjects (n = 5 females) completed three, 8-min cycling trials while breathing through a non-rebreathing valve (laboratory control), cloth, or surgical mask. Heart rate (HR), oxyhemoglobin saturation (SpO2), breathing frequency, mouth pressure, partial pressure of end-tidal carbon dioxide (PetCO2) and oxygen (PetO2), dyspnea were measured throughout exercise. A subset of n = 6 subjects completed an additional exercise bout without a mask (ecological control). There were no differences in breathing frequency, HR or SpO2 across conditions (all p > 0.05). Compared with the laboratory control (4.7 ± 0.9 cmH2O [mean ± SD]), mouth pressure swings were smaller with the surgical mask (0.9 ± 0.7; p < 0.0001), but similar with the cloth mask (3.6 ± 4.8 cmH2O; p = 0.66). Wearing a cloth mask decreased PetO2 (-3.5 ± 3.7 mm Hg) and increased PetCO2 (+2.0 ± 1.3 mm Hg) relative to the ecological control (both p < 0.05). There were no differences in end-tidal gases between mask conditions and laboratory control (both p > 0.05). Dyspnea was similar between the control conditions and the surgical mask (p > 0.05) but was greater with the cloth mask compared with laboratory (+0.9 ± 1.2) and ecological (+1.5 ± 1.3) control conditions (both p < 0.05). Wearing a mask during short-term moderate-intensity exercise may increase dyspnea but has minimal impact on the cardiopulmonary response. Novelty: Wearing surgical or cloth masks during exercise has no impact on breathing frequency, tidal volume, oxygenation, and heart rate However, there are some changes in inspired and expired gas fractions that are physiologically irrelevant. In young healthy individuals, wearing surgical or cloth masks during submaximal exercise has few physiological consequences.


Subject(s)
Exercise/physiology , Heart Rate , Masks , Oxyhemoglobins/metabolism , Respiratory Rate , Adult , COVID-19/prevention & control , Carbon Dioxide/physiology , Dyspnea/physiopathology , Equipment Design , Exercise Test , Face , Female , Humans , Male , Mouth/physiology , Oxygen/physiology , Partial Pressure , Pressure , Skin Temperature , Tidal Volume , Young Adult
2.
MMWR Morb Mortal Wkly Rep ; 70(21): 779-784, 2021 May 28.
Article in English | MEDLINE | ID: covidwho-1395448

ABSTRACT

To meet the educational, physical, social, and emotional needs of children, many U.S. schools opened for in-person learning during fall 2020 by implementing strategies to prevent transmission of SARS-CoV-2, the virus that causes COVID-19 (1,2). To date, there have been no U.S. studies comparing COVID-19 incidence in schools that varied in implementing recommended prevention strategies, including mask requirements and ventilation improvements* (2). Using data from Georgia kindergarten through grade 5 (K-5) schools that opened for in-person learning during fall 2020, CDC and the Georgia Department of Public Health (GDPH) assessed the impact of school-level prevention strategies on incidence of COVID-19 among students and staff members before the availability of COVID-19 vaccines.† Among 169 K-5 schools that participated in a survey on prevention strategies and reported COVID-19 cases during November 16-December 11, 2020, COVID-19 incidence was 3.08 cases among students and staff members per 500 enrolled students.§ Adjusting for county-level incidence, COVID-19 incidence was 37% lower in schools that required teachers and staff members to use masks, and 39% lower in schools that improved ventilation, compared with schools that did not use these prevention strategies. Ventilation strategies associated with lower school incidence included methods to dilute airborne particles alone by opening windows, opening doors, or using fans (35% lower incidence), or in combination with methods to filter airborne particles with high-efficiency particulate absorbing (HEPA) filtration with or without purification with ultraviolet germicidal irradiation (UVGI) (48% lower incidence). Multiple strategies should be implemented to prevent transmission of SARS-CoV-2 in schools (2); mask requirements for teachers and staff members and improved ventilation are important strategies that elementary schools could implement as part of a multicomponent approach to provide safer, in-person learning environments. Universal and correct mask use is still recommended by CDC for adults and children in schools regardless of vaccination status (2).


Subject(s)
COVID-19/prevention & control , Masks/statistics & numerical data , Schools , Ventilation/standards , COVID-19/epidemiology , Child , Georgia/epidemiology , Humans , Incidence
3.
PLoS One ; 16(2): e0247414, 2021.
Article in English | MEDLINE | ID: covidwho-1388900

ABSTRACT

BACKGROUND: Facemasks are recommended to reduce the spread of SARS-CoV-2, but concern about inadequate gas exchange is an often cited reason for non-compliance. RESEARCH QUESTION: Among adult volunteers, do either cloth masks or surgical masks impair oxygenation or ventilation either at rest or during physical activity? STUDY DESIGN AND METHODS: With IRB approval and informed consent, we measured heart rate (HR), transcutaneous carbon dioxide (CO2) tension and oxygen levels (SpO2) at the conclusion of six 10-minute phases: sitting quietly and walking briskly without a mask, sitting quietly and walking briskly while wearing a cloth mask, and sitting quietly and walking briskly while wearing a surgical mask. Brisk walking required at least a 10bpm increase in heart rate. Occurrences of hypoxemia (decrease in SpO2 of ≥3% from baseline to a value of ≤94%) and hypercarbia (increase in CO2 tension of ≥5 mmHg from baseline to a value of ≥46 mmHg) in individual subjects were collected. Wilcoxon signed-rank was used for pairwise comparisons among values for the whole cohort (e.g. walking without a mask versus walking with a cloth mask). RESULTS: Among 50 adult volunteers (median age 33 years; 32% with a co-morbidity), there were no episodes of hypoxemia or hypercarbia (0%; 95% confidence interval 0-1.9%). In paired comparisons, there were no statistically significant differences in either CO2 or SpO2 between baseline measurements without a mask and those while wearing either kind of mask mask, both at rest and after walking briskly for ten minutes. INTERPRETATION: The risk of pathologic gas exchange impairment with cloth masks and surgical masks is near-zero in the general adult population.


Subject(s)
COVID-19/prevention & control , Masks , Oxygen/metabolism , Pulmonary Ventilation/physiology , Adult , COVID-19/psychology , COVID-19/transmission , Carbon Dioxide/metabolism , Exercise/physiology , Female , Heart Rate/physiology , Humans , Hypoxia/etiology , Hypoxia/metabolism , Male , Masks/adverse effects , N95 Respirators/adverse effects , Rest/physiology , SARS-CoV-2/isolation & purification , Walking/physiology
4.
Infect Dis Now ; 51(5): 410-417, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1349451

ABSTRACT

SARS-CoV-2 mainly infects the respiratory tract, and presents significantly higher active replication in the upper airways. To remain viable and infectious, the SARS-CoV-2 virion must be complete and integral, which is not easily demonstrated in the environment by positive reverse transcriptase PCR results. Real-life conditions in healthcare settings may be conducive to SARS-CoV-2 RNA dissemination in the environment but without evidence of its viability and infectiveness in air. Theoretically, SARS-CoV-2 shedding and dissemination nonetheless appears to be air-mediated, and a distinction between "air" and "droplet" transmission is too schematic to reflect the reality of the respiratory particles emitted by patients, between which a continuum exists. Airborne transmission is influenced by numerous environmental conditions that are not transposable between different viral agents and situations in healthcare settings or in the community. Even though international guidelines on "droplet" versus "air" precautions and personal protective equipment (surgical versus respirator masks) are under discussion, the existing literature underscores the effectiveness of "droplet" precautions as a means of protecting healthcare workers. Differentiation in guidelines between healthcare venues, community settings and, more generally, confined environments is of paramount importance, especially insofar as it underlines the abiding pandemic-related need for systematic mask wearing by the general population.


Subject(s)
Air Microbiology , COVID-19/transmission , Health Personnel , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Occupational Diseases/prevention & control , Occupational Diseases/virology , SARS-CoV-2 , Humans
5.
Ital J Dermatol Venerol ; 156(2): 220-225, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1302863

ABSTRACT

BACKGROUND: During the recent COVID-19 outbreak, masks became mandatory and shortages frequent, therefore the prevalence of non-CE (European Conformity Mark) approved masks increased in the general population. We aimed to quantify the prevalence of mask-related cutaneous side effects and the differences between CE and non-CE approved masks. METHODS: In this multicenter prospective observational study conducted from March 20, 2020 to May 12, 2020(during and after quarantine), patients attending emergency departments for a dermatological consult were clinically assessed and their masks were inspected to detect CE marks and UNI (Italian National Unification Entity) norms. Patients with history of facial dermatoses or under current treatment for facial dermatoses were excluded. RESULTS: We enrolled 412 patients (318 during quarantine and 94 after quarantine). CE-approved masks were observed 52.8% vs. 24.5%, whilst subsets of non-CE approved masks were 9.7% vs. 14.9% (Personal protective equipment (PPE)-masks), 16.4% vs. 12.8% (surgical masks [SM]), and 21.1% vs. 47.9%(non-PPE) and (non-SM masks), respectively during and after quarantine. Remarkably, non-CE-approved masks resulted in patients displaying a statistically significant higher incidence of facial dermatoses and irritant contact dermatitis compared to CE-approved masks, and these differences were mainly driven by non-PPE non-SM masks. Comparing quarantine and after quarantine periods, no statistically significant differences were found for CE-approved masks, whilst differences were detected in non-CE-approved masks regarding incidence of facial dermatoses (P<0.0001)and irritant contact dermatitis (P=0.0041). CONCLUSIONS: Masks are essential to prevent COVID-19 but at the same time higher awareness regarding mask specifications should be promoted in the general population. Non-PPE and non-SM masks should undergo more rigorous testing to prevent the occurrence of cutaneous side effects and future patients' lawsuit damages.


Subject(s)
COVID-19 , Dermatitis, Occupational/etiology , Disease Outbreaks , Facial Dermatoses/etiology , Masks/adverse effects , Personal Protective Equipment/adverse effects , COVID-19/epidemiology , Humans , Italy/epidemiology , Masks/standards , Personal Protective Equipment/standards , Prospective Studies
6.
Ear Hear ; 42(4): 772-781, 2021.
Article in English | MEDLINE | ID: covidwho-1280144

ABSTRACT

OBJECTIVE: The purpose of this study was to assess the speech recognition in noise when using a transparent mask that allows greater visibility of the talker's face compared to an opaque mask in persons with normal and impaired hearing via an online format. DESIGN: A repeated-measures design was used to evaluate the auditory-visual recognition of sentences recorded in background noise with transparent and opaque face masks, and without a mask (N = 154). In a smaller follow-up study (N = 29), the same files were presented via auditory-only presentation to determine if differences observed in the transparent and opaque mask conditions were attributable to additional visual cues or to acoustic differences between the recordings of the two mask types. Listeners completed the 40-minute online session on a computer, laptop, or tablet in a quiet room via their personal listening devices (earbuds or hearing assistive device). The adult volunteers who used English as their first language were recruited through social media links and email and categorized into three groups: normal hearing and confirmed or suspected hearing loss either with or without the use of assistive listening devices. RESULTS: Auditory-visual recognition of sentences recorded with the transparent mask was significantly better (M = 68.9%) than for sentences recorded with the opaque mask (M = 58.9%) for all participants. There was a trend for those who used hearing assistive technology to score lower than the other two groups who had similar performance across all conditions regardless of the mask type. Subjective ratings of confidence and concentration followed the expected pattern based on objective scores. Results of the auditory-only presentation of the sentences to listeners with normal hearing suggested that the transparent mask benefits were not attributable to an acoustic advantage but rather to the addition of the visual cues of the talker's face available through the transparent mask. In fact, performance in the auditory-only presentation was significantly lower with the transparent mask (M = 40.7%) compared to the opaque mask (M = 58.2%). CONCLUSIONS: Use of transparent masks can significantly facilitate speech recognition in noise even for persons with normal hearing and thus may reduce stressful communication challenges experienced in medical, employment, and educational settings during the global pandemic. To mitigate the spread of COVID-19 and facilitate communication, safety-approved transparent masks are strongly encouraged over opaque masks.


Subject(s)
COVID-19 , Communication , Masks , Speech Perception , Adult , Humans , SARS-CoV-2
7.
West J Emerg Med ; 22(3): 547-551, 2021 Apr 19.
Article in English | MEDLINE | ID: covidwho-1266883

ABSTRACT

INTRODUCTION: The coronavirus 2019 pandemic caused a shortage of disposable N95 respirators, prompting healthcare entities to extend the use of these masks beyond their intended single-use manufacturer recommendation with a paucity of supporting research. METHODS: We performed a prospective cohort study of ED healthcare workers (HCW) ("subjects") required to use respirators at an academic, Level I trauma center. Subjects had been previously fit tested and assigned an appropriately sized N95 mask per hospital protocol. Per study protocol, subjects were fit tested periodically throughout their shifts and on multiple shifts over the eight-week study period. Data points collected included the age of the mask, subjective assessment of mask seal quality, and fit test results. We analyzed the data using Fisher's exact test, and calculated odds ratios (OR) to determine the failure rate of disposable N95 masks following reuse. RESULTS: A total of 130 HCWs underwent fit testing and 127 were included for analysis. Mask failure rate climbed after day 2 of use, with 33.3% of masks failing at day 3, 42.9% at day 4, and 50% at ≥ day 5. Categorizing the masks into those being used for two or fewer days vs those in use for three or more, failure was more common on day 3 of use or older compared to those in the first two days of use (41.8% vs 8.3%, P < 0.0001) with an OR of failure with an older mask of 7.9 (confidence interval [CI], 2.8-22.3). The healthcare workers' assessment of poor seal was 33.3% sensitive (CI, 18.6-51.9) and 95.7% specific (CI, 88.8-98.6) for fit test failure. CONCLUSION: Disposable N95 masks have significant failure rates following reuse in clinical practice. Healthcare personnel also performed poorly in assessing the integrity of the seal of their disposable respirators.


Subject(s)
Equipment Failure/statistics & numerical data , Equipment Reuse , N95 Respirators , COVID-19/epidemiology , COVID-19/prevention & control , Disposable Equipment , Emergency Service, Hospital , Humans , Pandemics , Prospective Studies
8.
Eur J Orthop Surg Traumatol ; 31(5): 989-993, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1263148

ABSTRACT

INTRODUCTION: Personal protective equipment (PPE) may protect health-care workers from COVID-19 infection and limit nosocomial spread to vulnerable hip fracture patients. METHODS: We performed a cross-sectional survey amongst orthopaedic trainees to explore PPE practice in 19 hospitals caring for hip fracture patients in the North West of England. RESULTS: During the second wave of the pandemic, 14/19 (74%) hospitals experienced an outbreak of COVID-19 amongst staff or patients on the orthopaedic wards. An FFP3 respirator mask was used by doctors in only 6/19 (32%) hospitals when seeing patients with COVID-19 and a cough and in 5/19 (26%) hospitals when seeing asymptomatic patients with COVID-19. A COVID-19 outbreak was reported in 11/13 (85%) orthopaedic units where staff wore fluid resistant surgical masks compared to 3/6 (50%) units using an FFP3 respirator mask (RR 1.69, 95% CI 0.74-3.89) when caring for symptomatic patients with COVID-19. Similarly, a COVID-19 outbreak was reported in more orthopaedic units caring for asymptomatic patients with COVID-19 where staff wore fluid resistant surgical masks (12/14 (86%)) as compared to an FFP3 respirator mask (2/5 (40%)) (RR 2.14, 95% CI 0.72-6.4). CONCLUSION: Urgent re-evaluation of PPE use is required to reduce nosocomial spread of COVID-19, amongst highly vulnerable patients with hip fracture.


Subject(s)
COVID-19/transmission , Cross Infection/transmission , Hip Fractures/complications , Orthopedics , Cross-Sectional Studies , England , Humans , Masks , Personal Protective Equipment , Ventilators, Mechanical
9.
Int J Environ Res Public Health ; 18(11)2021 May 28.
Article in English | MEDLINE | ID: covidwho-1256515

ABSTRACT

The use of face masks has assumed a leading spot among nonspecific prevention measures during the coronavirus pandemic. The effectiveness of this protective measure depends on the specifics of individual use. The purpose of our study was to analyze the use of respiratory protective equipment (RPE) by medical students during the COVID-19 pandemic. The evaluation of face mask use was based on the results of a survey of medical students at Sechenov University. There were 988 participants in the study: 97.5% used RPE during the pandemic, 89.1% used disposable medical and hygienic face masks, 27.4% used reusable cloth face masks, and 13.2% used respirators. The majority of respondents (75.2%) were found to wear face masks correctly. However, 17.0% of the respondents were found to cover only their mouths with a face mask, while 7.8% reported often shifting their face mask under the chin due to perceived discomfort. Only 25.1% of respondents changed their disposable face mask after 2-3 h of wearing, while 13.0% decontaminated and used it several times. Most cloth face mask users (93.7%) decontaminated their marks, but only 55.7% of respondents did so daily. Face masks were most often worn in medical organizations (91.5%), and 1.4% of respondents did not use respiratory protection anywhere. In conclusion, we consider it necessary to introduce a special module on nonspecific prevention in the discipline of hygiene.


Subject(s)
COVID-19 , Respiratory Protective Devices , Students, Medical , Humans , Pandemics/prevention & control , SARS-CoV-2
10.
J Korean Med Sci ; 36(21): e140, 2021 May 31.
Article in English | MEDLINE | ID: covidwho-1249650

ABSTRACT

BACKGROUND: For protection against coronavirus disease 2019 (COVID-19), the Korean government recommended the KF94 mask or that a mask at the same level as the KF94 should be worn when contacting a patient with COVID-19. Furthermore, adequately fitted N95 respirators and KF94 masks are essential. We investigated the fit tests to determine whether healthcare workers had adequate protection with N95 respirators and KF94 masks. METHODS: In this prospective single-center simulation study, five N95 respirators (two made in the USA by 3M and three made in Korea) and six KF94 masks, the Korean standard medical masks, were tested. The fit factor (FF) and leakage rate were evaluated using a two-fit test device. Adequate protection (defined as FF ≥ 100 or leakage rate ≤ 5) rates were compared between N95 respirators and KF94 masks, and between made in Korea and the 3M N95 respirators. For KF94 masks, adequate protection rates were compared before and after ear strap fixation. RESULTS: Overall, 30 participants were enrolled, and 330 fit tests were performed for FF and leakage rate. Adequate protection rates of all tested N95 respirators and KF94 masks were 22.7% (n = 75) by FF and 20.6% (n = 68) by leakage rate. N95 respirators showed a significantly higher adequate protection rate than KF94 masks for FF (48.7% vs. 1.1%, P < 0.001) and leakage rate (42.0% vs. 2.8%, P < 0.001). Adequate protection rate of 3M-made N95 respirators was significantly higher than that of those made in Korea (83.3% vs. 25.6% in FF, P < 0.001; 73.3% vs. 21.1% in leakage rate, P < 0.001). In KF94 masks, after fixation of ear strap with a hook, adequate protection rate improved significantly (1.1% vs. 12.8% in FF, P < 0.001; 2.8% vs. 11.1%, P < 0.001). CONCLUSION: Although adequate protection rate of N95 respirators was higher than that of KF94 masks, N95 respirator protection rate was not optimum. Thus, it is necessary to minimize exposure to risk by selecting an appropriate mask or respirator that adequately fits each person, and by wearing respirators or masks appropriately, before contacting the patients. With their superior protection rate, wearing N95 respirators is recommended instead of KF94 masks, especially when performing aerosol-generating procedures.


Subject(s)
COVID-19/prevention & control , Health Personnel , Masks , N95 Respirators , SARS-CoV-2 , Adult , Computer Simulation , Female , Humans , Male , Prospective Studies
11.
J Appl Clin Med Phys ; 22(6): 274-280, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1239974

ABSTRACT

Thermoplastic masks, used along with surgical masks, enable immobilization methods to reduce the risk of infection in patients undergoing intracranial stereotactic radiosurgery and stereotactic radiotherapy (SRS/SRT) during the COVID-19 crisis. The purpose of this study was to investigate the feasibility of thermoplastic mask immobilization with a surgical mask using an ExacTrac system. Twelve patients each with brain metastases were immobilized using a thermoplastic mask and a surgical mask and only a thermoplastic mask. Two x-ray images were acquired to correct (XC) and verify (XV) the patient's position at a couch angle of 0°. Subsequently, the XC and XV images were acquired at each planned couch angle for non-coplanar beams. When the position errors were detected after couch rotation for non-coplanar beams, the errors were corrected at each planned couch angle until a clinically acceptable tolerance was attained. The position errors in the translational and rotational directions (vertical, lateral, longitudinal, pitch, roll, and yaw) were retrospectively investigated using data from the ExacTrac system database. A standard deviation of XC translational and rotational position errors with and without a surgical mask in the lateral (1.52 vs 2.07 mm), longitudinal (1.59 vs 1.87 mm), vertical (1.00 vs 1.73 mm), pitch (0.99 vs 0.79°), roll (1.24 vs 0.68°), and yaw (1.58 vs 0.90°) directions were observed at a couch angle of 0°. Most of patient positioning errors were less than 1.0 mm or 1.0° after the couch was rotated to the planned angle for non-coplanar beams. The overall absolute values of the translational and rotational XV position errors with and without the surgical mask were less than 0.5 mm and 0.5°, respectively. This study showed that a thermoplastic mask with a surgical mask is a feasible immobilization technique for brain SRS/SRT patients using the ExacTrac system.


Subject(s)
Brain Neoplasms , COVID-19 , Radiosurgery , Brain Neoplasms/radiotherapy , Brain Neoplasms/surgery , Humans , Immobilization , Masks , Patient Positioning , Radiotherapy Planning, Computer-Assisted , Radiotherapy Setup Errors/prevention & control , Retrospective Studies , SARS-CoV-2 , Uncertainty
12.
J Expo Sci Environ Epidemiol ; 31(6): 953-960, 2021 11.
Article in English | MEDLINE | ID: covidwho-1233697

ABSTRACT

BACKGROUND: Globally, a large percentage of men keep a beard at least occasionally. Workplace regulations prohibit beards with N95 respirators, but there is little information on the effect of beards with face masks worn by the public for protection against SARS-CoV-2. METHODS AND FINDINGS: We examined the fitted filtration efficiency (FFE) of five commonly worn protective face masks as a function of beard length following the US Occupational Safety and Health Administration Quantitative Fit Test: N95 (respirator), KF94 and KN95, surgical/procedure, and cloth masks. A comparison using N95 respirators was carried out in shaven and bearded men. A detailed examination was conducted for beard lengths between 0 and 10 mm (0.5 mm increments). The effect of an exercise band covering the beard on FFE was also tested. Although N95 respirators showed considerable variability among bearded men, they had the highest FFE for beard lengths up to 10 mm. KF94 and KN95 masks lost up to 40% of their FFE. Procedure and cotton masks had poor performance even on bare skin (10-30% FFE) that did not change appreciably with beard length. Marked performance improvements were observed with an exercise band worn over the beard. CONCLUSIONS: Though variable, N95 respirators offer the best respiratory protection for bearded men. While KF94 and KN95 FFE is compromised considerably by increasing beard length, they proved better options than procedure and cotton face masks. A simple exercise band improves FFE for face masks commonly used by bearded men during the COVID-19 pandemic.


Subject(s)
COVID-19 , Respiratory Protective Devices , Humans , Male , Masks , Pandemics/prevention & control , Personal Protective Equipment , SARS-CoV-2
13.
J Drugs Dermatol ; 19(9): 858-864, 2020 Sep 01.
Article in English | MEDLINE | ID: covidwho-1231667

ABSTRACT

As the coronavirus epidemic continues, a host of new cutaneous complications is seen on the faces of frontline healthcare workers wearing personal protective equipment on a daily basis. To minimize the risk of COVID-19 infection, healthcare workers wear tight-fitting masks that lead to an excessive amount of pressure on the facial skin. Mechanical pressure, mask materials, and perspiration can all lead to various types of cutaneous lesions such as indentations of the face, skin tears, post-inflammatory hyperpigmentation, ulceration, crusting, erythema, and infection. The objective of this article is to provide effective and straightforward recommendations to those health care providers using facial masks in order to prevent skin-related complications. J Drugs Dermatol. 2020;19(9):858-864. doi:10.36849/JDD.2020.5259.


Subject(s)
Coronavirus Infections/prevention & control , Facial Dermatoses/etiology , Facial Injuries/etiology , Masks/adverse effects , Pandemics/prevention & control , Personal Protective Equipment/adverse effects , Pneumonia, Viral/prevention & control , COVID-19 , Coronavirus Infections/epidemiology , Erythema/etiology , Erythema/physiopathology , Exanthema/etiology , Exanthema/physiopathology , Facial Dermatoses/physiopathology , Facial Injuries/epidemiology , Facial Injuries/physiopathology , Female , Global Health , Health Personnel/statistics & numerical data , Humans , Male , Occupational Exposure/prevention & control , Occupational Health , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Risk Assessment
14.
Am J Emerg Med ; 48: 273-275, 2021 10.
Article in English | MEDLINE | ID: covidwho-1230338

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has forced health care workers to explore alternative personal protective equipment (PPE) strategies due to traditional product shortages in the setting of increased global demand. Some physicians have chosen to use elastomeric face masks (EFMs), traditionally used in non-healthcare industries. METHODS: We performed a prospective cohort study of Emergency Medicine (EM) physicians working at a Level 1 Trauma Center who chose to use self-supplied EFMs for PPE. All subjects used commercial EFMs with disposable filters (N95, P95, or P100). All subjects chose their mask size independently with no input from employee health regarding appropriate fit. Per study protocol, subjects were fit tested periodically during clinical shifts over the course of the 6-week study period. All investigators performing fit testing underwent OSHA qualitative fit testing training. Data collected included mask/filters age, subjective assessment of mask seal quality, and fit test results. The data were analyzed using descriptive statistics. RESULTS: 105 fit tests were performed on physicians wearing EFMs over the course of 49 shifts. Physicians felt their fit was adequate for all tests performed. There were no fit test failures in any subjects. CONCLUSIONS: EFMs have an extremely low failure rate. Physicians are able to assess the adequacy of fit and accurately choose EFM size.


Subject(s)
Air Filters , COVID-19/prevention & control , Emergency Medicine , Masks/standards , Physicians , COVID-19/transmission , Cohort Studies , Cross-Sectional Studies , Elastomers , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , N95 Respirators , Prospective Studies , SARS-CoV-2 , United States , United States Occupational Safety and Health Administration
15.
BMC Psychiatry ; 21(1): 237, 2021 05 05.
Article in English | MEDLINE | ID: covidwho-1216891

ABSTRACT

BACKGROUND: Maintaining the therapeutic care of psychiatric patients during the first wave of the COVID-19 pandemic in Switzerland required changes to the way in which sessions were conducted, such as telepsychiatric interventions or using face masks during on-site sessions. While little is known about how face masks affect the therapeutic experience of patients and therapists, the effectiveness of telepsychiatry is well documented for several psychiatric disorders. However, research on the benefits of telepsychiatry in adult patients with attention-deficit/hyperactivity disorder (ADHD) remains scarce. This seems problematic since the symptoms typically associated with ADHD, such as attention problems and distractibility, may lessen the utility of telepsychiatry for this particular group. The present study's aim was to explore how adult patients with ADHD and their therapists experienced therapy sessions during the COVID-19 pandemic in three different settings: face-to-face with the therapist wearing a face mask, via telephone, or via videoconferencing. METHODS: In this exploratory, quantitatively driven mixed-method study (quantitative questionnaire data and qualitative data from open-ended responses), we assessed patients' evaluation of the session, their treatment satisfaction, and patients' and therapists' ratings of therapeutic alliance. We also collected qualitative comments on both sides' experience of the session. Overall, 97 therapist and 66 patient questionnaires were completed. Results are reported for the N = 60 cases for which data from both parties were available. Sequential multiple regressions adjusted for therapist and number of sessions were used for the main quantitative analyses. RESULTS: No statistically significant differences regarding session flow, post-session positivity, satisfaction and therapeutic alliance were observed. The only exception was that telepsychiatric sessions were rated as significantly less deep than face-to-face sessions, an effect that may decline over time, especially in the videoconferencing group. Patients and therapists identified similar facilitating and complicating aspects, but differed in their emphasis of specific elements. CONCLUSIONS: Both settings, on-site with the therapist wearing a face mask and telepsychiatric, seem to be valid options to continue treatment of adults with ADHD during a situation such as the COVID-19 pandemic. Aspects such as patient preference, session content, and therapeutic methods may be useful to identify the most suitable modality.


Subject(s)
Attention Deficit Disorder with Hyperactivity , COVID-19 , Adult , Humans , Masks , Pandemics , SARS-CoV-2 , Switzerland
16.
Ann Intern Med ; 174(4): 472-483, 2021 04.
Article in English | MEDLINE | ID: covidwho-1201212

ABSTRACT

BACKGROUND: Colleges in the United States are determining how to operate safely amid the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE: To examine the clinical outcomes, cost, and cost-effectiveness of COVID-19 mitigation strategies on college campuses. DESIGN: The Clinical and Economic Analysis of COVID-19 interventions (CEACOV) model, a dynamic microsimulation model, was used to examine alternative mitigation strategies. The CEACOV model tracks infections accrued by students and faculty, accounting for community transmissions. DATA SOURCES: Data from published literature were used to obtain parameters related to COVID-19 and contact-hours. TARGET POPULATION: Undergraduate students and faculty at U.S. colleges. TIME HORIZON: One semester (105 days). PERSPECTIVE: Modified societal. INTERVENTION: COVID-19 mitigation strategies, including social distancing, masks, and routine laboratory screening. OUTCOME MEASURES: Infections among students and faculty per 5000 students and per 1000 faculty, isolation days, tests, costs, cost per infection prevented, and cost per quality-adjusted life-year (QALY). RESULTS OF BASE-CASE ANALYSIS: Among students, mitigation strategies reduced COVID-19 cases from 3746 with no mitigation to 493 with extensive social distancing and masks, and further to 151 when laboratory testing was added among asymptomatic persons every 3 days. Among faculty, these values were 164, 28, and 25 cases, respectively. Costs ranged from about $0.4 million for minimal social distancing to about $0.9 million to $2.1 million for strategies involving laboratory testing ($10 per test), depending on testing frequency. Extensive social distancing with masks cost $170 per infection prevented ($49 200 per QALY) compared with masks alone. Adding routine laboratory testing increased cost per infection prevented to between $2010 and $17 210 (cost per QALY gained, $811 400 to $2 804 600). RESULTS OF SENSITIVITY ANALYSIS: Results were most sensitive to test costs. LIMITATION: Data are from multiple sources. CONCLUSION: Extensive social distancing with a mandatory mask-wearing policy can prevent most COVID-19 cases on college campuses and is very cost-effective. Routine laboratory testing would prevent 96% of infections and require low-cost tests to be economically attractive. PRIMARY FUNDING SOURCE: National Institutes of Health.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control/methods , Pneumonia, Viral/prevention & control , Universities , Adult , COVID-19/epidemiology , COVID-19 Testing , Communicable Disease Control/economics , Cost-Benefit Analysis , Female , Humans , Male , Masks , Mass Screening/economics , Pandemics , Physical Distancing , Pneumonia, Viral/epidemiology , SARS-CoV-2 , United States/epidemiology
17.
PLoS One ; 16(4): e0250432, 2021.
Article in English | MEDLINE | ID: covidwho-1197392

ABSTRACT

BACKGROUND: Since the beginning of the COVID-19 pandemics, masking policies have been advocated. While masks are known to prevent transmission towards other individuals, it is unclear if different types of facial masks can protect the user from inhalation. The present study compares in-vitro different commercial and custom-made facial masks at different distances and breathing patterns. METHODS: Masks were placed on a head mannequin connected to a lung simulator, using a collecting filter placed after the mannequin airway. Certified, commercial and custom-made masks were tested at three different distances between the emitter and the mannequin: 40 cm, 80 cm and 120 cm. Two patterns of breathing were used, simulating normal and polypneic respiration. A solution of methylene blue was nebulized with a jet nebulizer and different mask-distance-breathing pattern combinations were tested. The primary endpoint was the inhaled fraction, defined as the amount of methylene blue detected with spectrophotometry expressed as percent of the amount detected in a reference condition of zero distance and no mask. FINDINGS: We observed a significant effect of distance (p < 0.001), pattern of breathing (p = 0.040) and type of mask (p < 0.001) on inhaled fraction. All masks resulted in lower inhaled fraction compared to breathing without mask (p < 0.001 in all comparisons), ranging from 41.1% ± 0.3% obtained with a cotton mask at 40 cm distance with polypneic pattern to <1% for certified FFP3 and the combination of FFP2 + surgical mask at all distances and both breathing pattern conditions. DISCUSSION: Distance, type of device and breathing pattern resulted in highly variable inhaled fraction. While the use of all types of masks resulted relevantly less inhalation compared to distancing alone, only high-grade certified devices (FFP3 and the combination of FFP2 + surgical mask) ensured negligible inhaled fraction in all conditions.


Subject(s)
COVID-19/prevention & control , Masks , Physical Distancing , Equipment Design , Humans , Manikins , Respiration , SARS-CoV-2/isolation & purification
18.
S Afr Med J ; 111(3): 227-233, 2021 03 02.
Article in English | MEDLINE | ID: covidwho-1178552

ABSTRACT

BACKGROUND: Evidence on mask use in the general population is needed to inform SARS-CoV-2 responses. OBJECTIVES: To assess the effectiveness of cloth and medical masks for preventing SARS-CoV-2 transmission in community settings. METHODS: Two rapid reviews were conducted searching three electronic databases (PubMed, Embase, Cochrane Library) and two clinical trials registries on 30 and 31 March 2020. RESULTS: We screened 821 records and assessed nine full-text articles for eligibility. One and seven RCTs were included for cloth and medical mask reviews, respectively. No SARS-CoV-2-specific RCTs and no cloth mask RCTs in community settings were identified. A single hospital-based RCT provided indirect evidence that, compared with medical masks, cloth masks probably increase clinical respiratory illnesses (relative risk (RR) 1.56; 95% confidence interval (CI) 0.98 - 2.49) and laboratory-confirmed respiratory virus infections (RR 1.54; 95% CI 0.88 - 2.70). Evidence for influenza-like illnesses (ILI) was uncertain (RR 13.00; 95% CI 1.69 - 100.03). Two RCTs provide low-certainty evidence that medical masks may make little to no difference to ILI infection risk versus no masks (RR 0.98; 95% CI 0.81 - 1.19) in the community setting. Five RCTs provide low-certainty evidence that medical masks may slightly reduce infection risk v. no masks (RR 0.81; 95% CI 0.55 - 1.20) in the household setting. CONCLUSIONS: Direct evidence for cloth and medical mask efficacy and effectiveness in the community is limited. Decision-making for mask use may consider other factors such as feasibility and SARS-CoV-2 transmission dynamics; however, well-designed comparative effectiveness studies are required.


Subject(s)
COVID-19/prevention & control , Infection Control/methods , Masks , Pneumonia, Viral/prevention & control , Humans , Influenza, Human/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/virology , SARS-CoV-2 , Textiles
19.
PLoS One ; 16(4): e0249201, 2021.
Article in English | MEDLINE | ID: covidwho-1170003

ABSTRACT

INTRODUCTION: During viral pandemics, filtering facepiece (FFP) masks together with eye protection form the essential components of personal protective equipment (PPE) for healthcare workers. There remain concerns regarding insufficient global supply and imperfect protection offered by currently available PPE strategies. A range of full-face snorkel masks were adapted to accept high grade medical respiratory filters using bespoke-designed 3D-printed connectors. We compared the protection offered by the snorkel to that of standard PPE using a placebo-controlled respirator filtering test as well as a fluorescent droplet deposition experiment. Out of the 56 subjects tested, 42 (75%) passed filtering testing with the snorkel mask compared to 31 (55%) with a FFP3 respirator mask (p = 0.003). Amongst the 43 subjects who were not excluded following a placebo control, 85% passed filtering testing with the snorkel versus to 68% with a FFP3 mask (p = 0.008). Following front and lateral spray of fluorescence liquid particles, the snorkel mask also provided superior protection against droplet deposition within the subject's face, when compared to a standard PPE combination of FFP3 masks and eye protection (3.19x108 versus 6.81x108 fluorescence units, p<0.001). The 3D printable adaptors are available for free download online at https://www.ImperialHackspace.com/COVID-19-Snorkel-Respirator-Project/. CONCLUSION: Full-face snorkel masks adapted as particulate respirators performed better than a standard PPE combination of FFP3 mask and eye protection against aerosol inhalation and droplet deposition. This adaptation is therefore a promising PPE solution for healthcare workers during highly contagious viral outbreaks.


Subject(s)
COVID-19/prevention & control , Health Personnel , Masks , Occupational Exposure , Respiratory Protective Devices , Adult , Female , Humans , Male
20.
Indian J Otolaryngol Head Neck Surg ; 73(4): 486-493, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1163163

ABSTRACT

Covid-19 due to Sars-Cov-2 infection has reached pandemic proportion. Many healthcare workers are involved in managing both COVID-suspected and confirmed cases. It is mandatory for healthcare workers to have droplet and contact precautions by means of Personal protective equipment (PPE), facemask, face shield or eye protection. Prolonged usage of medical mask results in various adverse effects. This study is an attempt to know the common effects of prolonged face mask in healthcare workers and its resultant quality-of-life (QOL). To study the common effects of prolonged face mask and its impact on QOL of healthcare workers during the COVID 19 crisis. This was a prospective cross-sectional study conducted over 6 months among 2750 healthcare workers. A questionnaire requesting demographic details and most common side effects after prolonged usage of face mask was circulated. We also attached a short form-12 (sf-12) questionnaire to assess its impact on QOL. Out of 2750 personnel, 299 were excluded. Male preponderance was noted. Study was conducted on candidates using 3ply mask or above. Age range was between 18 and 65 years with mean age being 37.61 ± 15.23 in mask users < 5 h per day, 32.2 ± 10.02 in 5-10 h group and 30.19 ± 8.15 in 10 h group. 8.48% (n = 174) had comorbidities. QOL impacted. The complaints with face mask use definitely are troublesome with increase in severity with duration of mask usage. This definitely has a proportional impact on the healthcare workers' QOL.

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