Face masks against COVID-19: Standards, efficacy, testing and decontamination methods

Concerns about Wearing Masks to Avoid COVID-19 Infection in China: Assessment of an Internet-based Cross-sectional Study

BACKGROUND

The novel coronavirus disease of 2019 (COVID-19) is likely to spread from person to person in close contact settings. The Chinese Center for Disease Control and Prevention has released a handbook on COVID-19 which introduced health information to the public, specifically related to wearing masks correctly and adopting preventive measures to avoid the COVID-19 infection.

OBJECTIVE

The current study aimed to assess the level of mask knowledge, behavior related to mask usage, and major information channels in China.

METHODS

An Internet-based survey was conducted primarily using the DingXiang Doctor WeChat public accounts. The data about mask knowledge and behavior were recollected and analyzed. Besides descriptive statistical analysis, logistic regression was used to analyze significant risk factor.

RESULTS

There were a total of 10,304 respondents to the survey, more than half were under 30 years old, and nearly three-quarters were women. Over 80% of participants had a bachelor's degree or higher, as well as the largest amounts of respondents were business/service workers (40.80%). Over half of the study participants got married (51.46%). The findings revealed that 67.49% of the participants practiced protective mask behavior, 97.93% believed that wearing masks is effective against COVID-19, 96.85% chose the mask that has two or more layers of washable, breathable fabric, 70.57% wore masks correctly. Gender, age, occupation, and education level had significant effects on behavior, while marital and infection status of family members were not significant. In addition, it was found that WeChat public accounts (89.55%) were the most prominent source of health information for Chinese netizens after the break of COVID-19.

CONCLUSIONS

This study elucidated that the Chinese netizens' protective mask behavior was far lower than mask knowledge. Improved information channels and adequate information on wearing masks are necessary to improve the public's protective mask behavior, particularly among the males, elderly, and people with less education.

CLINICALTRIAL

Carbon Nanotube prepared by catalytic pyrolysis as the electrode for supercapacitors from polypropylene wasted face masks

The massive global consumption and discarded face masks drove by the ongoing spread of COVID-19. Meantime, incineration and landfill discarded face masks would result in severe environmental pollution and infectious hazards. Herein a suggestion to recycle polypropylene waste masks into CNTs by an environmentally friendly and high-added value disposal process was proposed, and which was prepared as supercapacitor electrode materials for energy storage attempting. The CNTs were prepared from waste masks by catalysis pyrolysis with Ni-Fe bimetallic catalysts. Especially, the bamboo-like structure CNT was obtained with Ni/Fe molar ratio is 3. This structure owned a high specific capacitance compared to other standard CNTs. Its specific capacitance could reach 56.04 F/g (1 A/g) and has excellent cycling stability with a capacitance retention rate of the material is 85.41% after 10,000 cycles. Besides, the assembled capacitor possesses a good energy density of 4.78 Wh/kg at a power density of 900 W/kg. Thus, this work provides a sustainable and cost-effective strategy for disposing waste masks into high-valuable CNT, and their potential application for supercapacitors was also studied and exploited. It would provide a new idea for recycling and utilizing other polypropylene wastes such as medical devices.

Graphical abstract

Environmental risks of polymer materials from disposable face masks linked to the COVID-19 pandemic

The indispensable role of plastic products in our daily life is highlighted by the COVID-19 pandemic again. Disposable face masks, made of polymer materials, as effective and cheap personal protective equipment (PPE), have been extensively used by the public to slow down the viral transmission. The repercussions of this have generated million tons of plastic waste being littered into the environment because of the improper disposal and mismanagement amid. And plastic waste can release microplastics (MPs) with the help of physical, chemical and biological processes, which is placing a huge MPs contamination burden on the ecosystem. In this work, the knowledge regarding to the combined effects of MPs and pollutants from the release of face masks and the impacts of wasted face masks and MPs on the environment (terrestrial and aquatic ecosystem) was systematically discussed. In view of these, some green technologies were put forward to reduce the amounts of discarded face masks in the environment, therefore minimizing MPs pollution at its source. Moreover, some recommendations for future research directions were proposed based on the remaining knowledge gaps. In a word, MPs pollution linked to face masks should be a focus worldwide.

Epidemiological Study on Mycoplasma pneumoniae and Chlamydia pneumoniae Infection of Hospitalized Children in a Single Center During the COVID-19 Pandemic

Background

Since the outbreak of COVID-19, a series of preventive and control measures in China have been used to effectively curb the spread of COVID-19. This study aimed to analyze the epidemiological characteristics of Mycoplasma pneumoniae (MP) and Chlamydia pneumoniae (CP) in hospitalized children with acute respiratory tract infection during the COVID-19 pandemic.

Methods

MP IgM antibody and CP IgM antibody were detected in all hospitalized children due to acute respiratory tract infection in the Children’s Hospital Affiliated to Zhejiang University from January 2019 to December 2020. These data were compared between 2019 and 2020 based on age and month.

Results

The overall detection rate of MP and CP in 2020 was significantly lower than that in 2019 (MP: 21.5% vs 32.9%, P<0.001; CP: 0.3% vs 0.9%, P<0.001). This study found a 4-fold reduction in the number of children positive for MP and a 7.5-fold reduction in the number of children positive for CP from 2019 to 2020. The positive cases were concentrated in children aged >1 year old. In 2019, the positive rate of MP was detected more commonly in children 3 years of age or older than in younger children. In 2020, the higher positive rate of MP reached a peak in the 3- to 6-year age group (35.3%). CP was detected predominantly in children aged 6 years older in 2019 and 2020, with positive rates of 4.8% and 2.6%, respectively. Meanwhile, the positive rates of MP in 2019 were detected more commonly in July, August and September, with 47.2%, 46.7% and 46.3%, respectively. Nevertheless, the positive rates of MP from February to December 2020 apparently decreased compared to those in 2019. The positive rates of CP were evenly distributed throughout the year, with 0.5%-1.6% in 2019 and 0.0%-2.1% in 2020.

Conclusions

A series of preventive and control measures for SARS-CoV-2 during the COVID-19 pandemic can not only contain the spread of SARS-CoV-2 but also sharply improve the infection of other atypical pathogens, including MP and CP.

An Experimental Analysis of Five Household Equipment-Based Methods for Decontamination and Reuse of Surgical Masks

The current coronavirus pandemic has increased worldwide consumption of individual protective devices. Single-use surgical masks are one of the most used devices to prevent the transmission of the COVID-19 virus. Nevertheless, the improper management of such protective equipment threatens our environment with a new form of plastic pollution. With the intention of contributing to a responsible policy of recycling, in the present work, five decontamination methods for used surgical masks that can be easily replicated with common household equipment are described. The decontamination procedures were hot water at 40 °C and 80 °C; autoclave; microwave at 750 W; and ultraviolet germicidal irradiation. After each decontamination procedure, the bacterial load reduction of Staphylococcus aureus ATCC 6538 was recorded to verify the effectiveness of these methods and, moreover, bacterial filtration efficiency and breathability tests were performed to evaluate mask performances. The best results were obtained with the immersion in 80 °C water and the microwave-assisted sterilization. Both methods achieved a high degree of mask decontamination without altering the filtration efficiency and breathability, in accordance with the quality standard. The proposed decontamination methods represent a useful approach to reduce the environmental impact of this new waste material. Moreover, these procedures can be easily reproduced with common household equipment to increase the recycling efforts.

Anti-COVID-19 Nanomaterials: Directions to Improve Prevention, Diagnosis, and Treatment

Following the announcement of the outbreak of COVID-19 by the World Health Organization, unprecedented efforts were made by researchers around the world to combat the disease. So far, various methods have been developed to combat this "virus" nano enemy, in close collaboration with the clinical and scientific communities. Nanotechnology based on modifiable engineering materials and useful physicochemical properties has demonstrated several methods in the fight against SARS-CoV-2. Here, based on what has been clarified so far from the life cycle of SARS-CoV-2, through an interdisciplinary perspective based on computational science, engineering, pharmacology, medicine, biology, and virology, the role of nano-tools in the trio of prevention, diagnosis, and treatment is highlighted. The special properties of different nanomaterials have led to their widespread use in the development of personal protective equipment, anti-viral nano-coats, and disinfectants in the fight against SARS-CoV-2 out-body. The development of nano-based vaccines acts as a strong shield in-body. In addition, fast detection with high efficiency of SARS-CoV-2 by nanomaterial-based point-of-care devices is another nanotechnology capability. Finally, nanotechnology can play an effective role as an agents carrier, such as agents for blocking angiotensin-converting enzyme 2 (ACE2) receptors, gene editing agents, and therapeutic agents. As a general conclusion, it can be said that nanoparticles can be widely used in disinfection applications outside in vivo. However, in in vivo applications, although it has provided promising results, it still needs to be evaluated for possible unintended immunotoxicity. Reviews like these can be important documents for future unwanted pandemics.

A Physical Analog to Assess Surgical Face Mask Air Flow Resistance During Tidal Ventilation

A large variety of disposable face masks have been produced since the onset of the COVID-19 pandemic. Decreased resistance to inspiration improves adherence to the use of the mask; the so called breathability is usually estimated by the measurement of air flow across a section of the tissue under a given pressure difference. We hypothesized that the mask pressure—flow relationship studied in conditions that mimic tidal breathing could allow a more comprehensive characterization of airflow resistance, a major determinant of mask comfort. A physical analog was made of a plaster cast dummy head connected through a pneumotachograph to a series of bellows inflated/deflated by a respirator. Pressure was measured at the mock airway opening over which the mask was carefully secured. The precision of the measurement equipment was quantified using two estimates of measurement error: repeatability coefficient (RC) and within-mask coefficient of variation (CV_wm). The airflow resistance of 10 surgical masks was tested on 4 different days. Resistance means did not differ significantly among four repeated measures (0.34 hPa.s.L⁻¹; 0.37 hPa.s.L⁻¹; 0.37 hPa.s.L⁻¹; and 0.37 hPa.s.L⁻¹; p = 0.08), the estimated RC was 0.08 hPa.s.L⁻¹ [95%CI: 0.06–0.10 hPa.s.L⁻¹], and CV_wm was 8.7% [95%CI: 1.5–12.2%]. Multiple comparisons suggest the presence of a learning effect by which the operator reduced the error over the course of repetitive resistance measurements. Measurement precision improved considerably when the first set of measures was not taken into account [RC ~ 0.05 hPa.s.L⁻¹ (95%CI: 0.03–0.06 hPa.s.L⁻¹); CV_wm~4.5% (95%CI: 1.9–6.1%)]. The testing of the face mask resistance (R) appears simple and highly repeatable in conditions that resemble tidal breathing, once operator training was assured. The procedure adds further to the current standard assessment of breathability and allows estimating the maximal added respiratory load, about 10–20% of the respiratory resistance reported in heathy adult subjects.

Technological scouting of bi-material face masks: simulation of adherence using 3D Facial Norms

During the COVID-19 pandemic started in March 2020, the need for personal protective equipment rapidly grew as it became mandatory. The availability of a set of faces can be of great utility in designing a face mask with proper adherence and comfortability in wearing and breathing. A 3D geometry of a face with user-defined anthropometric measures was generated with Blender, a powerful development tool for creating 3D images. Using 3D Facial Norms, a free online database, it was possible to compute the mean anthropometric measures for the age groups of 17-20, 20-30, and 30-40 years old and then generate the respective faces for both genders. The adherence of an innovative face mask was then simulated with the reverse engineering software considering both the face mask and the faces rigid.

Technological scouting of bi-material face masks: experimental analysis on real faces

The need for personal protective equipment rapidly grew during the COVID-19. Companies had to face problems related to their products' sustainability, adherence, and comfortability. Designing a face mask with proper adherence and comfortability in wearing and breathing became a matter of great importance. In this work, the adherence of an innovative face mask and its comfortability were experimentally tested with real faces, considering the deformation of the mask and the soft facial tissues. A stereophotogrammetric acquisition was made of the face with the face mask during these tests. A comparison between the geometries of the face and the mask, undeformed and deformed, gave the respective deformations. The force applied by the mask to the face was calculated, measuring the elastic strain of the mask bands during wearing and the deformation.

Occupational facial dermatoses related to mask use in healthcare professionals

Background

Mask use can lead to facial dermatoses due to factors, such as hyperhydration, seborrhea, high humidity caused by sweating, and the occlusive effect of the mask.

Aim

We investigated mask‐related facial dermatoses in healthcare personnel who, since the beginning of the COVID‐19 pandemic, had to wear a mask for long hours.

Methods

In this study, healthcare professionals working at Medipol Mega University Hospital since the beginning of the pandemic were screened for facial dermatoses between December 2020 and February 2021 with a dermatological examination and interview.

Results

Of the 101 healthcare professionals, 51 (50.5%) were doctors and 50 (49.5%) nurses, and 36 (35.6%) were male and 65 (64.4%) were female. All the participants had been actively working at the hospital for 35–46 weeks since the beginning of the pandemic and wearing N95 or surgical masks for an average of 6–13 h a day. During the dermatological examination, the most common facial dermatosis was acne, which was observed in 55.4% (n = 56) of the cases. Of the 56 acne cases, 41.1% (n = 23) had acne in their history, while 58.9% (n = 33) had new‐onset acne. Being female, using a N95 surgical mask compared to surgical mask, and the daily average duration of mask use were determined as risk factors for acne development due to mask use.

Conclusions

The use of masks, more frequently N95, caused both an increase in existing acne and the development of new acne.

Could Nanotechnology Help to End the Fight Against COVID-19? Review of Current Findings, Challenges and Future Perspectives

A serious viral infectious disease was introduced to the globe by the end of 2019 that was seen primarily from China, but spread worldwide in a few months to be a pandemic. Since then, accurate prevention, early detection, and effective treatment strategies are not yet outlined. There is no approved drug to counter its worldwide transmission. However, integration of nanostructured delivery systems with the current management strategies has promised a pronounced opportunity to tackle the pandemic. This review addressed the various promising nanotechnology-based approaches for the diagnosis, prevention, and treatment of the pandemic. The pharmaceutical, pharmacoeconomic, and regulatory aspects of these systems with currently achieved or predicted beneficial outcomes, challenges, and future perspectives are also highlighted.

A study to quantify surgical plume and survey the efficiency of different local exhaust ventilations

This study aimed to compare the concentration of surgical smoke produced by different tissues and electric diathermy modes and to measure the effectiveness of various local exhaust ventilations. We compared the surgical plume concentration from different tissues and settings with a porcine tissue model. We also compared the efficiency of three local exhaust ventilations: (1) a desktop unit (Medtronic Rapid Vac), (2) a central evacuation system with ENT suction, and (3) a central evacuation system with a urethral catheter (PAHSCO Urethral Catheter). In the cutting setting, the skin tissue had a higher concentration of total suspended particulates (TPS), which were 1990 ± 2000 (mean ± SD, μg/m³), 6440 ± 3000 and 9800 ± 2300 at 15, 30 and 45 s, respectively (p < 0.05). In the coagulation setting, the adipose tissue had a higher concentration of TPS, which were 3330 ± 2600, 11,200 ± 5500 and 15,800 ± 7300, respectively (p < 0.05). We found that all three smoke extractors had more than 96% efficiency in clearing surgical smoke. With electric diathermy, skin tissue in the cutting model and adipose tissue in the coagulation mode will produce higher concentration of particles within surgical plumes. An electric surgical scalpel adapted with a urethral catheter is a simple and effective way to exhaust smoke in surgical operations.