In vivo protective performance of N95 respirator and surgical facemask

How different face mask types affect interpersonal distance perception and threat feeling in social interaction

Due to the easing of the pandemic, public policies no longer mandated people to wear masks. People can choose to no wear or wear different types of masks based on personal preferences and safety perceptions during daily interaction. Available information about the influence of face mask type on interpersonal distance (IPD) by different aging populations is still lacking. Thus, this study aimed to investigate the face mask type (no wear, cloth, medical and N95 mask) and age group effect of avatars (children, adults and older adults) on IPD perception, threat feeling and physiological skin conductance response under active and passive approaching. One hundred participants with a range from 20 to 35 years old were recruited for this study. Twelve avatars (three age groups*four face mask conditions) were created and applied in a virtual reality environment. The results showed that age group, mask type and approach mode had significant effects on IPD and subjective threat feeling. A non-significant effect was found on skin conductance responses. Participants maintained a significantly longer IPD when facing the older adults, followed by adults and then children. In the passive approach condition, people tended to maintain a significantly greater comfort distance than during the active approach. For the mask type effect, people kept a significantly largest and shortest IPD when facing an avatar with no mask or the N95 mask, respectively. A non-significant IPD difference was found between the N95 and medical mask. Additionally, based on the subjective threat feeling, facing an avatar wearing a medical mask generated the lowest threat feeling compared to the others. The findings of this study indicated that wearing medical masks provided a benefit in bringing people closer for interaction during specific situations. Understanding that mask-wearing, especially medical one, brought to shortest IPD when compared to the unmasked condition can be utilized to enhance safety measures in crowded public spaces and health-care settings. This information could guide the development of physical distancing recommendations, taking into account both the type of mask and the age groups involved, to ensure the maintenance of appropriate distances.

Measuring the effects of respiratory protective equipment and other protectors in preventing the scattering of vocalization droplets

This study was conducted to quantitatively examine the effects of respiratory protective equipment (respirators) and various other types of protectors in preventing the scattering of vocalization droplets. Each of 12 adult male volunteers was asked to vocalize intermittently for 1 min at a target intensity of approximately 100 dBA in an experimental room adjusted to a humidity of approximately 60-70%. The subjects vocalized while wearing respirators, other types of protectors, or no protectors at all. The droplet concentration in a particle size range of 0.3 to 10 μm was measured under each experimental condition, and the transmitted particle concentration and penetration were calculated. The concentration and penetration of particles transmitted from the respirators were lower than those transmitted from the other protectors examined. The probability of infection reduction through the use of the protectors was estimated from the data obtained on the effectiveness of the protectors in preventing the scattering of droplets. We concluded that there is no need for additional droplet scattering prevention in various work settings when appropriate respirators are used under optimal conditions.

Water-blocking Asphyxia of N95 Medical Respirator During Hot Environment Work Tasks With Whole-body Enclosed Anti-bioaerosol Suit

Background

During hot environment work tasks with whole-body enclosed anti-bioaerosol suit, the combined effect of heavy sweating and exhaled hot humid air may cause the N95 medical respirator to saturate with water/sweat (i.e., water-blocking).

Methods

32 young male subjects with different body mass indexes (BMI) in whole-body protection (N95 medical respirator + one-piece protective suit + head covering + protective face screen + gloves + shoe covers) were asked to simulate waste collecting from each isolated room in a seven-story building at 27-28°C, and the weight, inhalation resistance (Rf), and aerosol penetration of the respirator before worn and after water-blocking were analyzed.

Results

All subjects reported water-blocking asphyxia of the N95 respirators within 36-67 min of the task. When water-blocking occurred, the Rf and 10-200 nm total aerosol penetration (Pt) of the respirators reached up to 1270-1810 Pa and 17.3-23.3%, respectively, which were 10 and 8 times of that before wearing. The most penetration particle size of the respirators increased from 49-65 nm before worn to 115-154 nm under water-blocking condition, and the corresponding maximum size-dependent aerosol penetration increased from 2.5-3.5% to 20-27%. With the increase of BMI, the water-blocking occurrence time firstly increased then reduced, while the Rf, Pt, and absorbed water all increased significantly.

Conclusions

This study reveals respirator water-blocking and its serious negative impacts on respiratory protection. When performing moderate-to-high-load tasks with whole-body protection in a hot environment, it is recommended that respirator be replaced with a new one at least every hour to avoid water-blocking asphyxia.

A novel N95 respirator with chitosan nanoparticles: mechanical, antiviral, microbiological and cytotoxicity evaluations

BACKGROUND

It is known that some sectors of hospitals have high bacteria and virus loads that can remain as aerosols in the air and represent a significant health threat for patients and mainly professionals that work in the place daily. Therefore, the need for a respirator able to improve the filtration barrier of N95 masks and even inactivating airborne virus and bacteria becomes apparent. Such a fact motivated the creation of a new N95 respirator which employs chitosan nanoparticles on its intermediate layer (SN95 + CNP).

RESULTS

The average chitosan nanoparticle size obtained was 165.20 ± 35.00 nm, with a polydispersity index of 0.36 ± 0.03 and a zeta potential of 47.50 ± 1.70 mV. Mechanical tests demonstrate that the SN95 + CNP respirator is more resistant and meets the safety requisites of aerosol penetration, resistance to breath and flammability, presenting higher potential to filtrate microbial and viral particles when compared to conventional SN95 respirators. Furthermore, biological in vitro tests on bacteria, fungi and mammalian cell lines (HaCat, Vero E6 and CCL-81) corroborate the hypothesis that our SN95 + CNP respirator presents strong antimicrobial activity and is safe for human use. There was a reduction of 96.83% of the alphacoronavirus virus and 99% of H1N1 virus and MHV-3 betacoronavirus after 120 min of contact compared to the conventional respirator (SN95), demonstrating that SN95 + CNP have a relevant potential as personal protection equipment.

CONCLUSIONS

Due to chitosan nanotechnology, our novel N95 respirator presents improved mechanical, antimicrobial and antiviral characteristics.

Fungal contamination of medical masks among forensic healthcare workers in the COVID19 era

Background

Medical masks are widely used in health care settings to protect healthcare workers from respiratory infections, particularly in the context of the recent Covid-19 disease.

Methods

A cross-sectional study of 52 used masks collected from 52 forensic healthcare practitioners was conducted to culture for fungal isolation and identification. A study of fungal contamination was conducted by making an impression of the mouth mask cut piece on Sabouraud agar for selective isolation; each health worker completed a questionnaire, which included age, sex, type of mask, and duration of mask use.

Results

Twenty five of the 52 used masks tested positive for fungal contamination (48,08%). A total of 44% of the contaminated masks belong to health workers between the ages of 21-30 years. Surgical masks (80%), KN95 (8%), and N95 (4%) were the most contaminated protective devices. Usage duration of 1-2 h was associated with 4% of fungal contamination, while a usage duration of 5-6 h was associated with 36% of fungal contamination. Alternaria sp (32%), Penicillium sp (20%), Aspergillus sp (16%) were the most predominant isolated fungi discovered on the inside areas of the masks.

Conclusion

Because fungi are known to cause allergies and serious adverse health effects following recommendations to properly wear a medical mask is critical to preventing fungal contamination, especially among health care workers who are wearing the same mask for a long period during the pandemic.

Face mask performance related to potentially infectious aerosol particles, breathing mode and facial leakage

During the COVID 19 pandemic, wearing certified Respiratory Protective Devices (RPDs) provided important means of protection against direct and indirect infections caused by virus-laden aerosols. Assessing the RPD performance associated with infection prevention in standardised certification tests, however, faces drawbacks, such as the representativeness of the test aerosols used, the protection of third parties during exhalation or the effect of facial leaks. To address these drawbacks, we designed a novel test bench to measure RPD performance, namely the number based total efficiency, size-segregated fractional filtration efficiency and net pressure loss, for 11 types of certified surgical masks and Filtering Face Pieces dependent on breathing mode and facial fit. To be representative for the context of potentially infectious particles, we use a test aerosol based on artificial saliva that is in its size distribution similar to exhaled aerosols. In inhalation mode excluding facial leaks, all investigated samples deposit by count more than 85% of artificial saliva particles, which suggests a high efficiency of certified RPD filter media related to these particles. In exhalation mode most RPDs tend to have similar efficiencies but lower pressure losses. This deviation tends to be significant primarily for the RPDs with thin filter layers like surgical masks or Filtering Face Pieces containing nanofibers and may depend on the RPDs shape. Both the filtration efficiency and pressure loss are strongly inter-dependent and significantly lower when RPDs are naturally fitted including facial leaks, leading to a wide efficiency range of approximately 30-85%. The results indicate a much greater influence of the facial fit than the filter material itself. Furthermore, RPDs tend be more effective in self-protection than in third-party protection, which is inversely correlated to pressure loss. Comparing different types of RPDs, the pressure loss partially differs at similar filtration efficiencies, which points out the influence of the material and the filter area on pressure loss.

A Review of Filtration Performance of Protective Masks

Masks are essential and effective small protective devices used to protect the general public against infections such as COVID-19. However, available systematic reviews and summaries on the filtration performance of masks are lacking. Therefore, in order to investigate the filtration performance of masks, filtration mechanisms, mask characteristics, and the relationships between influencing factors and protective performance were first analyzed through mask evaluations. The summary of filtration mechanisms and mask characteristics provides readers with a clear and easy-to-understand theoretical cognition. Then, a detailed analysis of influencing factors and the relationships between the influencing factors and filtration performance is presented in. The influence of the aerosol size and type on filtration performance is nonlinear and nonconstant, and filtration efficiency decreases with an increase in the gas flow rate; moreover, fitness plays a decisive role in the protective effects of masks. It is recommended that the public should wear surgical masks to prevent COVID-19 infection in low-risk and non-densely populated areas. Future research should focus on fitness tests, and the formulation of standards should also be accelerated. This paper provides a systematic review that will be helpful for the design of masks and public health in the future.

Surfactant-Impregnated MOF-Coated Fabric for Antimicrobial Applications

Since the onset of the SARS-CoV-2 pandemic, the world has witnessed over 617 million confirmed cases and more than 6.54 million confirmed deaths, but the actual totals are likely much higher. The virus has mutated at a significantly faster rate than initially projected, and positive cases continue to surge with the emergence of ever more transmissible variants. According to the CDC, and at the time of this manuscript submission, more than 77% of all current US cases are a result of the B.5 (omicron). The continued emergence of highly transmissible variants makes clear the need for more effective methods of mitigating disease spread. Herein, we have developed an antimicrobial fabric capable of destroying a myriad of microbes including betacoronaviruses. We have demonstrated the capability of this highly porous and nontoxic metal organic framework (MOF), γ-CD-MOF-1, to serve as a host for varied-length benzalkonium chlorides (BACs; active ingredient in Lysol). Molecular docking simulations predicted a binding affinity of up to -4.12 kcal·mol^-1, which is comparable to that of other reported guest molecules for this MOF. Similar Raman spectra and powder X-ray diffraction patterns between the unloaded and loaded MOFs, accompanied by a decrease in the Brunauer-Emmett-Teller surface area from 616.20 and 155.55 m² g^-1 respectively, corroborate the suggested potential for pore occupation with BAC. The MOF was grown on polypropylene fabric, exposed to a BAC-loading bath, washed to remove excess BAC from the external surface, and evaluated for its microbicidal activity against various bacterial and viral classes. Significant antimicrobial character was observed against Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, bacteriophage, and betacoronavirus. This study shows that a common mask material (polypropylene) can be coated with BAC-loaded γ-CD-MOF-1 while maintaining the guest molecule's antimicrobial effects.

Effective use of an extraoral vacuum in preventing the dispersal of particulate matter from metal dental materials

OBJECTIVES

When dentists adjust prostheses at the dental chairside, particulate matter (PM) from the dental material is dispersed. Little is known about the effective use of an extraoral vacuum (EOV) in preventing PM dispersal. This study aimed to evaluate the effective use of an EOV in preventing the dispersal of metal PM in dental offices.

METHODS

The following experimental conditions were planned: the distance from the EOV to the metallic materials (50, 100, 150, and 200 mm), the horizontal angle between the long axis of the micromotor handpiece and EOV (0°, 45°, and 90°), and the operating time of the EOV (during grinding, during grinding and 1 min thereafter, during grinding and the preceding 1 min, 1 min before and after grinding, and during grinding). Carborundum and silicone points were used for grinding and PM dispersal. Diameters (0.3, 0.5, 1.0, and 3.0 μm) were measured using a laser particle counter.

RESULTS

Depending on the instrument used to grind, there were undetectable PMs of different diameters (Carborundum point: 0.3 and 0.5 μm, Silicone point: 0.3 μm). PMNs were reduced as the distance from the EOV to metal materials decreased. Operating the EOV before grinding along the long axis of the micromotor handpiece was effective in reducing the PMNs.

CONCLUSION

PMNs dispersed when grinding metals were effectively reduced by positioning the EOV closer to the grinding surface (within 150 mm) along the long axis of the micromotor handpiece and operating the EOV before grinding.

Thermoplasmonics Decontamination of Respirators Face Masks Using Silver Nanoparticles: A New Weapon in the Fight Against COVID-19 Pandemic

The current COVID-19 pandemic has resulted in an urgent need for methods to decontaminate respirators masks for reuse while keeping them intact and functional. The severe shortage of professional masks such as N95 and FFP2 has necessitated their reuse over long periods. A very promising method is the pasteurization of these masks by thermoplasmonic heat generated by plasmonics nanoparticles when they are irradiated by light. Under illumination at its plasmonic resonance, a metal nanoparticle features enhanced light absorption, turning it into an ideal nano-source of heat, remotely controllable using light. In this work, we propose a numerical study based on the finite element method (FEM) of the thermoplasmonic properties of silver nanoparticles (AgNPs) decorating polypropylene (PP) fibers which is a basic material for the manufacture of these masks. The surface plasmon resonance (SPR) of these nanostructures was investigated through the computation of the complex effective dielectric permittivity and the absorption cross section in the near UV-visible (NUV-Vis) range. First, the SPR characteristics of AgNPs for different morphologies are determined from the absorption spectra, including the SPR-peak position λ_max and the electric field enhancement. Second, we determine the power absorbed by an individual AgNP of different morphologies. From this, we calculate the internal temperature increase of the particle at the plasmonic resonance. The last step is devoted to the determination of the temperature profile in the surrounding medium in order to better understand and design the plasmon-assisted heating processes at the nanometric scale.

Boundary conditions for exhaled airflow from a cough with a surgical or N95 mask

Wearing surgical or N95 masks is effective in reducing the infection risks of airborne infectious diseases. However, in the literature there are no detailed boundary conditions for airflow from a cough when a surgical or N95 mask is worn. These boundary conditions are essential for accurate prediction of exhaled particle dispersion by computational fluid dynamics (CFD). This study first constructed a coughing manikin with an exhalation system to simulate a cough from a person. The smoke visualization method was used to measure the airflow profile from a cough. To validate the setup of the coughing manikin, the results were compared with measured data from subject tests reported in the literature. The validated coughing manikin was then used to measure the airflow boundary conditions for a cough when a surgical mask was worn and when an N95 mask was worn, respectively. Finally, this study applied the developed airflow boundary conditions to calculate person-to-person particle transport from a cough when masks are worn. The calculated exhaled particle patterns agreed well with the smoke pattern in the visualization experiments. Furthermore, the calculated results indicated that, when the index person wore a surgical and a N95 mask, the total exposure of the receptor was reduced by 93.0% and 98.8%, respectively.

Filtration efficiency of N95 filtering facepiece respirators during multi-cycles of “8-hour simulated donning + disinfection”

Background

Aerosol-borne diseases such as COVID-19 may outbreak occasionally in various regions of the world, inevitably resulting in short-term shortage and corresponding reuse of disposable respirators.

Aim

To investigate the effective disinfection methods, reusable duration and frequency of N95 respirators.

Methods

Based on the self-built respirator simulation test system, and under combinations of experimental conditions of three N95 respirators × 0–200 nm NaCl aerosols × three simulated breathing flow rates (15, 50 and 85 L/min) × two disinfection methods (dry heating and ultraviolet (UV) radiation), this study continuously measured the changes in filtration efficiency of all respirators during multi-cycles of ‘8-h simulated donning + disinfection’ until the penetration reached ≥5%.

Findings

Multi-cycles of dry heating and UV radiation treatments on the reused (i.e., multiple 8-h donning) N95 respirators had a minimal effect (<0.5%) on the respirator filtration efficiency, and even at 85 L/min, all tested N95 respirators were able to maintain filtration efficiencies ≥95% for at least 30 h or four reuse cycles of ‘8-h donning + disinfection’, while a lower breathing flow rate (15 L/min) plus the exhalation valve could further extend the N95 respirator's usability duration up to 140 h or 18 reuse cycles of ‘8-h donning + disinfection’. As the respirator wearing time extended, aerosol penetration slowly increased in a quadratic function with a negative second-order coefficient, and the penetration increment during each cycle of 8-h donning was less than 0.9%.

Conclusion

Multi-cycles of N95 respirator reuse in combination with dry heating or UV irradiation disinfection are feasible.

Effective inactivation of Bacillus atrophaeus spores and Escherichia coli on disposable face masks using ultraviolet laser irradiation

Due to the widespread emergence of COVID-19, face masks have become a common tool for reducing transmission risk between people, increasing the need for sterilization methods against mask-contaminated microorganisms. In this study, we measured the efficacy of ultraviolet (UV) laser irradiation (266 nm) as a sterilization technique against Bacillus atrophaeus spores and Escherichia coli on three different types of face mask. The UV laser source demonstrated high penetration of inner mask layers, inactivating microorganisms in a short time while maintaining the particle filtration efficiency of the masks. This study demonstrates that UV laser irradiation is an efficient sterilization method for removing pathogens from face masks.

Adverse Reactions to Facemasks in Health-Care Workers: A Cross-Sectional Survey

Background

Coronavirus disease 2019 (COVID-19) has developed into a worldwide pandemic, which presents several challenges for frontline health-care workers (HCWs). HCWs are highly prone to various skin diseases due to prolonged use of personal protective equipment (PPE). The most frequently used type of PPE is facemasks. To effectively control adverse skin reactions, there is an urgent need for a range of preventive practices.

Methods

This cross-sectional study was conducted at 12 hospitals in Zhejiang province, China. HCWs were invited to participate in the web survey. Data were extracted by two independent reviewers using a predesigned data collection form and analyzed with SPSS 20.0.

Results

A total of 1147 questionnaires were collected, and of these, 1090 (95.03%) were valid and returned. The incidence of chest tightness and shortness of breath and face eczema was significantly higher in HCWs wearing N95 facemasks (41.91%; 31.62%) than in the HCWs wearing medical facemasks (38.05%, P = 0.010; 21.91%, P = 0.012). The incidence of ear pain and indentation was significantly higher in HCWs wearing hang-facemasks (83.81%) than in HCWs wearing strains-facemasks (61.19%, P < 0.001). The incidence of ear pain and indentation was significantly higher in HCWs wearing undiscriminating size code facemasks (79.88%) than in the HCWs wearing discriminating size code facemasks (67.86%, P = 0.031). There was a significant reduction (P  <  0.001) in the incidence of HCWs without adverse reactions (ADRs) with increasing time wearing facemasks.

Conclusion

Incidence of ADRs does not significantly increase with the durations of mask wear where wearing mask time exceeded 4 hours per day. The medical staff generally wore masks for more than 4 hours per day; therefore, we recommend taking 15 min of rest after 2 hours of mask-wearing. Results in this study support the conclusion that the type of strain-facemasks and discriminating size code facemasks has a lower incidence of ADRs than other type of medical facemasks.

Face masks to fight against COVID-19 pandemics: A comprehensive review of materials, design, technology and product development

The outbreak of COVID-19 has created renewed attention on research and large scale manufacturing of face masks. In the last two decades, usage of face masks for respiratory protection has gained increased importance as a measure to control the maladies and fatalities due to exposure to particulate pollutants and toxic pathogens. Numerous variants of surgical and high-performance respirator masks are available in the market, and yet the fibrous materials science researchers, manufacturers and public health agencies are making concerted efforts towards improvising them with respect to self-sterilisability, facial fit, thermo-physiological comfort, reusability and biodegradability, while maintaining or rather enhancing the filtration efficiency. This review article presents a compendium of materials, design and performance standards of existing face masks, as well as elaborates on developments made for their performance enhancement. The criticality of inculcation of good hygiene habits and earnest compliance to correct mask donning and doffing practices has also been highlighted. This review is expected to make valuable contributions in the present COVID-19 scenario when donning a face mask has become mandatory.

Improving the measurement and acoustic performance of transparent face masks and shields

Opaque face masks harm communication by preventing speech-reading (lip-reading) and attenuating high-frequency sound. Although transparent masks and shields (visors) with clear plastic inserts allow speech-reading, they usually create more sound attenuation than opaque masks. Consequently, an iterative process was undertaken to create a better design, and the instructions to make it are published. The experiments showed that lowering the mass of the plastic inserts decreases the high-frequency sound attenuation. A shield with a clear thermoplastic polyurethane (TPU) panel had an insertion loss of (2.0 ± 1.1) dB for 1.25-8 kHz, which improves on previous designs that had attenuations of 11.9 dB and above. A cloth mask with a TPU insert was designed and had an insertion loss of (4.6 ± 2.3) dB for 2-8 kHz, which is better than the 9-22 dB reported previously in the literature. The speech intelligibility index was also evaluated. Investigations to improve measurement protocols that use either mannikins or human talkers were undertaken. Manufacturing variability and inconsistency of human speaking were greater sources of experimental error than fitting differences. It was shown that measurements from a mannikin could match those from humans if insertion losses from four human talkers were averaged.

Enhanced protection face masks do not adversely impact thermophysiological comfort

The World Health Organization has advocated mandatory face mask usage to combat the spread of COVID-19, with multilayer masks recommended for enhanced protection. However, this recommendation has not been widely adopted, with noncompliant persons citing discomfort during prolonged usage of face masks. And yet, a scientific understanding on how face mask fabrics/garment systems affect thermophysiological comfort remains lacking. We aimed to investigate how fabric/garment properties alter the thermal and evaporative resistances responsible for thermophysiological strain. We constructed 12 different layered facemasks (D1-D5, T1-T6, Q1) with various filters using commercially available fabrics. Three approaches were employed: (1) the evaporative and thermal resistances were measured in all the test face masks using the medium size to determine the effect of fabric properties; (2) the effect of face mask size by testing close-fitted (small), fitted (medium) and loose fitted (large) face mask T-6; (3) the effect of face mask fit by donning a large size face mask T-6, both loose and tightened using thermal manikin, Newton. ANOVA test revealed that the additional N95 middle layer filter has no significant effect on the thermal resistances of all the face masks, and evaporative resistances except for face masks T-2 and T-3 (P-values<0.05) whereas size significantly affected thermal and evaporative resistances (P-values<0.05). The correlation coefficient between the air gap size and the thermal and evaporative resistance of face masks T-6 were R² = 0.96 and 0.98, respectively. The tight fit large face mask had superior performance in the dissipation of heat and moisture from the skin (P-values <0.05). Three-layer masks incorporating filters and water-resistant and antimicrobial/antiviral finishes did not increase discomfort. Interestingly, using face masks with fitters improved user comfort, decreasing thermal and evaporative resistances in direct opposition to the preconceived notion that safer masks decrease comfort.

Effectiveness of N95 Masks against SARS-CoV-2: Performance Efficiency, Concerns, and Future Directions

The coronavirus disease 2019 (COVID-19) epidemic, which is caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has continued to spread around the world since December 2019. Healthcare workers and other medical first responders in particular need personal protective equipment to protect their respiratory system from airborne particulates, in addition to liquid splashes to the face. N95 respirator have become a critical component for reducing SARS-CoV-2 transmission and controlling the scale of the COVID-19 pandemic. However, a major dispute concerning the protective performance of N95 respirators has erupted, with a myriad of healthcare workers affected despite wearing N95 masks. This article reviews the most recent updates about the performance of N95 respirators in protecting against the SARS-CoV-2 virus in the present pandemic situation. A brief overview of the manufacturing methods, air filtration mechanisms, stability, and reusability of the mask is provided. A detailed performance evaluation of the mask is studied from an engineering point of view. This Review also reports on a comparative study about the protective performance of all commercially available surgical and respiratory masks used to combat the spread of COVID-19. With the aim of protecting healthcare providers more efficiently, we suggest some potential directions for the development of this respiratory mask that improve the performance efficiency of the mask.

Improvement of performance and function in respiratory protection equipment using nanomaterials

Nanotechnology has become one of key areas for the current development and research. Nanotechnology focuses on matter at the nanoscale and is capable of using different approaches to produce nanomaterials, structures, devices, and systems. One of the concerns that have to be addressed is the adverse effects of exposure to pathogens and pollutants in different workplaces and environments. Respiratory protective equipment (RPE) is one of the personal protective equipment (PPE) utilized to reduce the risk of exposure to environmental or occupational respiratory hazards. Thus, various studies have been conducted for improving the functional properties of sorbents or filters in different kinds of RPE. Different categories of nanomaterials have been reported as effective agents for achieving this goal. The application of these nanomaterials in mask layers or respirators' cartridge could significantly increase the filtration efficiency, breathing comfort, and antibacterial/antiviral properties of the masks and respirators. The present study aimed to comprehensively review the nanomaterials used in different types of face RPE with emphasis on various properties of the utilized nanomaterials. The study also aimed to show an applied perspective for future research on this important subject.

Predicting the spatio-temporal infection risk in indoor spaces using an efficient airborne transmission model

We develop a spatially dependent generalization to the Wells–Riley model, which determines the infection risk due to airborne transmission of viruses. We assume that the infectious aerosol concentration is governed by an advection–diffusion–reaction equation with the aerosols advected by airflow, diffused due to turbulence, emitted by infected people, and removed due to ventilation, inactivation of the virus and gravitational settling. We consider one asymptomatic or presymptomatic infectious person breathing or talking, with or without a mask, and model a quasi-three-dimensional set-up that incorporates a recirculating air-conditioning flow. We derive a semi-analytic solution that enables fast simulations and compare our predictions to three real-life case studies—a courtroom, a restaurant, and a hospital ward—demonstrating good agreement. We then generate predictions for the concentration and the infection risk in a classroom, for four different ventilation settings. We quantify the significant reduction in the concentration and the infection risk as ventilation improves, and derive appropriate power laws. The model can be easily updated for different parameter values and can be used to make predictions on the expected time taken to become infected, for any location, emission rate, and ventilation level. The results have direct applicability in mitigating the spread of the COVID-19 pandemic.

Recent Advances in Facemask Devices for In Vivo Sampling of Human Exhaled Breath Aerosols and Inhalable Environmental Exposures

Since the COVID-19 pandemic, the unprecedented use of facemasks has been requiring for wearing in daily life. By wearing facemask, human exhaled breath aerosols and inhaled environmental exposures can be efficiently filtered and thus various filtration residues can be deposited in facemask. Therefore, facemask could be a simple, wearable, in vivo, onsite and noninvasive sampler for collecting exhaled and inhalable compositions, and gain new insights into human health and environmental exposure. In this review, the recent advances in developments and applications of in vivo facemask sampling of human exhaled bacteria, viruses, proteins, and metabolites, and inhalable facemask contaminants and air pollutants, are reviewed. New features of facemask sampling are highlighted. The perspectives and challenges on further development and potential applications of facemask devices are also discussed.

Assessing face mask littering in urban environments and policy implications: The case of Bangkok

Face mask usage is one of the preventive measures encouraged worldwide to limit the transmission of the SARS-Cov-2 pandemic. Hence, production and mass use of face masks is on the rise due to the pandemic as well as government rules that mandate citizens to wear face masks. However, the improper disposal of face masks has been polluting the environment with enormous hazardous waste. In this study, a face mask littering assessment in an urbanized environment, Bangkok, was carried out. Three streets in the city were selected and observed for face mask littering for 5 h per day for 42 days. Moreover, a questionnaire from 605 participants was recorded to determine mask handling and disposal practices. The study found a total of 170 single-use face masks within a 13.30 km path. Furthermore, the highest (40) and lowest (17) cumulative litter were recorded on Sunday and Monday, respectively. Buffer analysis at 300 m showed 47% of mask litter was found within five mass transit stations, while 15% are within a single street market. Of 605 respondents, 82.15% used a single-use face mask. Surprisingly, most of them (70.58%) disposed of used face masks in regular bins along with their household waste. The results highlight three policy implications to tackle the growing problem: raising awareness, regulation, and provision of bins designed for used face masks in strategic places and supporting innovations and research for eco-friendly face masks.

Nanocoatings: Universal antiviral surface solution against COVID-19

In the current scenario, there is critical global demand for the protection of daily handling surfaces from the viral contamination to limit the spread of COVID-19 infection. The nanotechnologists and material scientists offer sustainable solutions to develop antiviral surface coatings for various substrates including fabrics, plastics, metal, wood, food stuffs etc. to face current pandemic period. They create or propose antiviral surfaces by coating them with nanomaterials which interact with the spike protein of SARS-CoV-2 to inhibit the viral entry to the host cell. Such nanomaterials involve metal/metal oxide nanoparticles, hierarchical metal/metal oxide nanostructures, electrospun polymer nanofibers, graphene nanosheets, chitosan nanoparticles, curcumin nanoparticles, etched nanostructures etc. The antiviral mechanism involves the repletion (depletion) of the spike glycoprotein that anchors to surfaces by the nanocoating and makes the spike glycoprotein and viral nucleotides inactive. The nature of interaction between the nanomaterial and virus depends on the type nanostructure coating over the surface. It was found that functional coating materials can be developed using nanomaterials as their polymer nanocomposites. The various aspects of antiviral nanocoatings including the mechanism of interaction with the Corona Virus, the different type of nanocoatings developed for various substrates, future research areas, new opportunities and challenges are reviewed in this article.

Efficacy of facemasks in mitigating respiratory exposure to submicron aerosols

We designed a novel experimental set-up to pseudo-simultaneously measure size-segregated filtration efficiency (η_F), breathing resistance (η_P) and potential usage time (t_B) for 11 types of face protective equipment (FPE; four respirators; three medical; and four handmade) in the submicron range. As expected, the highest η_F was exhibited by respirators (97 ± 3%), followed by medical (81 ± 7%) and handmade (47 ± 13%). Similarly, the breathing resistance was highest for respirators, followed by medical and handmade FPE. Combined analysis of efficiency and breathing resistance highlighted trade-offs, i.e. respirators showing the best overall performance across these two indicators, followed by medical and handmade FPE. This hierarchy was also confirmed by quality factor, which is a performance indicator of filters. Detailed assessment of size-segregated aerosols, combined with the scanning electron microscope imaging, revealed material characteristics such as pore density, fiber thickness, filter material and number of layers influence their performance. η_F and η_P showed an inverse exponential decay with time. Using their cross-over point, in combination with acceptable breathability, allowed to estimate t_B as 3.2-9.5 h (respirators), 2.6-7.3 h (medical masks) and 4.0-8.8 h (handmade). While relatively longer t_B of handmade FPE indicate breathing comfort, they are far less efficient in filtering virus-laden submicron aerosols compared with respirators.

Masks for COVID-19

Sustainable solutions on fabricating and using a face mask to block the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread during this coronavirus pandemic of 2019 (COVID-19) are required as society is directed by the World Health Organization (WHO) toward wearing it, resulting in an increasingly huge demand with over 4 000 000 000 masks used per day globally. Herein, various new mask technologies and advanced materials are reviewed to deal with critical shortages, cross-infection, and secondary transmission risk of masks. A number of countries have used cloth masks and 3D-printed masks as substitutes, whose filtration efficiencies can be improved by using nanofibers or mixing other polymers into them. Since 2020, researchers continue to improve the performance of masks by adding various functionalities, for example using metal nanoparticles and herbal extracts to inactivate pathogens, using graphene to make masks photothermal and superhydrophobic, and using triboelectric nanogenerator (TENG) to prolong mask lifetime. The recent advances in material technology have led to the development of antimicrobial coatings, which are introduced in this review. When incorporated into masks, these advanced materials and technologies can aid in the prevention of secondary transmission of the virus.

Quantifying face mask comfort

Face mask usage is one of the most effective ways to limit SARS-CoV-2 transmission, but a mask is only useful if user compliance is high. Through anonymous surveys (n = 679), it was shown that mask discomfort is the primary source of noncompliance in mask wearing. Further, through these surveys, three critical predicting variables that dictate mask comfort were identified: air resistance, water vapor permeability, and face temperature change. To validate these predicting variables in a physiological context, experiments (n = 9) were performed to measure the respiratory rate and change in face temperature while wearing different types of three commonly used masks. Finally, using values of these predicting variables from experiments and the literature, and surveys asking users to rate the comfort of various masks, three machine learning algorithms were trained and tested to generate overall comfort scores for those masks. Although all three models performed with an accuracy of approximately 70%, the multiple linear regression model provides a simple analytical expression to predict the comfort scores for common face masks provided the input predicting variables. As face mask usage is crucial during the COVID-19 pandemic, the goal of this quantitative framework to predict mask comfort is hoped to improve user experience and prevent discomfort-induced noncompliance.

Polyacrylonitrile Nanofibers Containing Viroblock as Promising Material for Protective Clothing

Antimicrobial viroblock/polyacrylonitrile nanofiber webs fabricated using the electrospinning method were assessed in terms of the antimicrobial activity against infectious agents as a potential material used in mask production. Viroblock (VB) is an amalgam of lipid vesicle and silver. Lipid vesicle depletes the virus outer membrane, which contains cholesterol, while silver ions penetrate the virus, interact with sulfur-bearing moieties, and possess the virus bactericidal property. VB, having anti-coronavirus and anti-influenza properties, was prepared in four different concentrations, 0.5 wt%, 1 wt%, 1.5 wt%, and 2 wt%, in regard to nanofiber weight. The resultant nanofibers were characterized by scanning electron microscope (SEM), Fourier transform infrared (FTIR), thermogravimetric analysis (TGA), water contact angle, water content, and thermogravimetric analysis (TGA). Moreover, all nanofibrous samples were evaluated for cell proliferation assay and ATCC antibacterial tests. Based on characterization results and cytotoxicity, the developed composite nanofibers-based webs showed good promise for utilization in anti-viral masks. Particularly, 2 wt% VB/PAN nanofibers have the highest antibacterial properties against negative and positive bacteria along with excellent cell viability.

Impact of asymptomatic COVID-19 carriers on pandemic policy outcomes

This paper provides a mathematical model that makes it clearly visible why the underestimation of r, the fraction of asymptomatic COVID-19 carriers in the general population, may lead to a catastrophic reliance on the standard policy intervention that attempts to isolate all confirmed infectious cases. The SE(A+O)R model with infectives separated into asymptomatic and ordinary carriers, supplemented by a model of the data generation process, is calibrated to standard early pandemic datasets for two countries. It is shown that certain fundamental parameters, critically r, are unidentifiable with this data. A general analytical framework is presented that projects the impact of different types of policy intervention. It is found that the lack of parameter identifiability implies that some, but not all, potential policy interventions can be correctly predicted. In an example representing Italy in March 2020, a hypothetical optimal policy of isolating confirmed cases that aims to reduce the basic reproduction number R₀ of the outbreak from 4.4 to 0.8 assuming r = 0, only achieves 3.8 if it turns out that r = 40%.

What We Are Learning from COVID-19 for Respiratory Protection: Contemporary and Emerging Issues

Infectious respiratory diseases such as the current COVID-19 have caused public health crises and interfered with social activity. Given the complexity of these novel infectious diseases, their dynamic nature, along with rapid changes in social and occupational environments, technology, and means of interpersonal interaction, respiratory protective devices (RPDs) play a crucial role in controlling infection, particularly for viruses like SARS-CoV-2 that have a high transmission rate, strong viability, multiple infection routes and mechanisms, and emerging new variants that could reduce the efficacy of existing vaccines. Evidence of asymptomatic and pre-symptomatic transmissions further highlights the importance of a universal adoption of RPDs. RPDs have substantially improved over the past 100 years due to advances in technology, materials, and medical knowledge. However, several issues still need to be addressed such as engineering performance, comfort, testing standards, compliance monitoring, and regulations, especially considering the recent emergence of pathogens with novel transmission characteristics. In this review, we summarize existing knowledge and understanding on respiratory infectious diseases and their protection, discuss the emerging issues that influence the resulting protective and comfort performance of the RPDs, and provide insights in the identified knowledge gaps and future directions with diverse perspectives.

Toward nanotechnology-enabled face masks against SARS-CoV-2 and pandemic respiratory diseases

Wearing a face mask has become a necessity following the outbreak of the coronavirus (COVID-19) disease, where its effectiveness in containing the pandemic has been confirmed. Nevertheless, the pandemic has revealed major deficiencies in the ability to manufacture and ramp up worldwide production of efficient surgical-grade face masks. As a result, many researchers have focused their efforts on the development of low cost, smart and effective face covers. In this article, following a short introduction concerning face mask requirements, the different nanotechnology-enabled techniques for achieving better protection against the SARS-CoV-2 virus are reviewed, including the development of nanoporous and nanofibrous membranes in addition to triboelectric nanogenerators based masks, which can filter the virus using various mechanisms such as straining, electrostatic attraction and electrocution. The development of nanomaterials-based mask coatings to achieve virus repellent and sterilizing capabilities, including antiviral, hydrophobic and photothermal features are also discussed. Finally, the usability of nanotechnology-enabled face masks is discussed and compared with that of current commercial-grade N95 masks. To conclude, we highlight the challenges associated with the quick transfer of nanomaterials-enabled face masks and provide an overall outlook of the importance of nanotechnology in counteracting the COVID-19 and future pandemics.

Using face masks with spectacles versus contact lenses

PURPOSE

To test the hypothesis that various subjective ocular and task-related parameters associated with wearing a face mask would be better in neophyte contact lens (CL) wear compared to habitual spectacle (Sp) wear.

METHODS

Thirty participants were randomised to continue in Sp (n = 15) or wear somofilcon A daily disposable CL (n = 15) ('group'). A surgical face mask (Type II R) was worn for at least one hour per day on four or more days per week. After two weeks, participants completed the Quality of Life Impact of Refractive Correction Questionnaire (QIRC), a two-part face mask usability questionnaire and graded ocular-related symptoms using 0-100 visual analogue scales.

RESULTS

There was no difference between groups for overall QIRC score but some individual question scores reflected better quality of life in the CL: 'outdoor activities', 'keep fit' and 'able to do things' (all p < 0.05). Differences in favour of the CL were seen for the following in the face mask usability questionnaire: 'breathing', 'heat', 'comfort on ears', 'overall comfort', 'walking', 'driving', 'reading', 'computer use', 'exercising' and 'socialising' (all p < 0.05). Significant differences were also seen for the 0-100 VAS symptoms probing vision quality in favour of the CL: glare, distance and near vision, fogging, restricted field of view and peripheral blur.

CONCLUSION

This work supports anecdotal reports that CL are a better vision correction option than Sp when used in conjunction with a face mask. Participants reported a range of benefits to the CL/face mask combination for vision-related symptoms, breathing and heat-related symptoms and a number of day-to-day activities including walking, driving and exercising. All of the benefits relating to the CL are likely to result in improved adherence to face mask use. Overall, the findings of this work suggest that where possible, CL should be the preferred vision correction option for people using face masks.

The Possibility of Reuse of Nanofiber Mats by Machine Washing at Different Temperatures

The worldwide spread of coronavirus COVID-19 infections demonstrates the great need for personal protective equipment and, in particular, hygiene masks. These masks are essential for the primary protection of the respiratory tract against pathogens such as viruses and bacteria that are infectious and transmitted through the air as large droplets or via small airborne particles. The use of protective masks will continue to accompany humans for an indefinite period of time, and therefore there is an urgent need for a safe method to extend their usability by reusing them under perspective with minimal loss of protective properties. Nanofiber mats are widely used in masks and in this study the reusability of nanofiber mats is investigated by washing them at different temperatures. This paper shows the first measurements of the washability of nanofiber mats. Furthermore, the air permeability is measured, and the evaporation resistance is evaluated. According to the results of this study, the air permeability performance of nanofiber mats does not change significantly after washing, confirming the possibility of reuse.

Assessment of mask efficiency for preventing transmission of airborne illness through aerosols and water vapor

Background: Currently the Center for Disease Control has advised the use of face coverings to prevent transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to those who are unvaccinated. This study seeks to evaluate if cloth masks have increased efficiency with the addition of a filter material. Methods: An adult airway and test lung model were exposed to nebulized ‘coarse’ aerosol droplets (0.5-11 µm) and humidified ‘fine’ water vapor particles (0.03-0.05 µm). Aerosol was quantified based on particles deposited on the face, airway and lung model. Tracheal humidity levels characterized fine particle permeability. Both phases of testing were conducted by evaluating the following testing conditions: 1) no mask; 2) cloth mask; 3) cloth mask with Swiffer™ filter; 4) cloth mask with Minimum Efficiency Reporting Value (MERV) 15 filter; 4) cloth mask with PM2.5 filter 5) surgical mask and 6) N95 respirator. Results: All mask conditions provided greater filtration from coarse particles when compared to no mask (P<0.05). All cloth mask with filter combinations were better at stopping fine particles in comparison to no mask. A cloth mask without a filter and surgical mask performed similarly to no mask with fine particles (P<0.05). The cloth mask with MERV 15 filter and the surgical mask performed similarly to the N95 with course particles, while the cloth mask with Swiffer™ performed similarly to the N95 with the fine particles (P<0.05). Conclusions: Respiratory viruses including SARS-CoV-2 and influenza are spread through exposure to respiratory secretions that are aerosolized by infected individuals. The findings from this study suggest that a mask can filter these potentially infectious airborne particles.

Does wearing double surgical masks during the COVID-19 pandemic reduce maternal oxygen saturation in term pregnant women?: A prospective study

Purpose

This study aimed to compare the effects of using single and double surgical masks (SM) on maternal oxygen saturation in pregnant women.

Methods

In this prospective study, single or double SM were worn by term pregnant women who applied for routine controls. The vital signs of the participants such as oxygen saturation, pulse, respiratory rate, fever, systolic and diastolic blood pressure were measured at admission and 30 min later.

Results

There were 223 participants in the single SM group and 231 participants in the double SM group. Thirty minutes after putting on the mask, there was no significant difference in the proportion of patients whose oxygen saturation fell below 95 (3.6 vs 5.6%, p = 0.301). No significant difference was observed between the admission and 30 min oxygen saturation levels of the pregnant women in the single SM group. However, maternal oxygen saturation after 30 min of the pregnant women in the double SM group was significantly lower (97.4 ± 1.1 vs 96.6 ± 1.3, p < 0.001). No significant changes were observed in the vital signs of either groups.

Conclusion

When using double SM, oxygen saturation is significantly reduced compared to pre-mask values. Nevertheless, it seems difficult to say that these decreases have clinical significance.

Expiratory aerosol particle escape from surgical masks due to imperfect sealing

Wearing surgical masks or other similar face coverings can reduce the emission of expiratory particles produced via breathing, talking, coughing, or sneezing. Although it is well established that some fraction of the expiratory airflow leaks around the edges of the mask, it is unclear how these leakage airflows affect the overall efficiency with which masks block emission of expiratory aerosol particles. Here, we show experimentally that the aerosol particle concentrations in the leakage airflows around a surgical mask are reduced compared to no mask wearing, with the magnitude of reduction dependent on the direction of escape (out the top, the sides, or the bottom). Because the actual leakage flowrate in each direction is difficult to measure, we use a Monte Carlo approach to estimate flow-corrected particle emission rates for particles having diameters in the range 0.5-20 μm. in all orientations. From these, we derive a flow-weighted overall number-based particle removal efficiency for the mask. The overall mask efficiency, accounting both for air that passes through the mask and for leakage flows, is reduced compared to the through-mask filtration efficiency, from 93 to 70% for talking, but from only 94-90% for coughing. These results demonstrate that leakage flows due to imperfect sealing do decrease mask efficiencies for reducing emission of expiratory particles, but even with such leakage surgical masks provide substantial control.

The efficacy of ultraviolet light-emitting technology against coronaviruses: a systematic review

The ongoing pandemic of COVID-19 has underlined the importance of adopting effective infection prevention and control (IPC) measures in hospital and community settings. Ultraviolet (UV)-based technologies represent promising IPC tools: their effective application for sanitation has been extensively evaluated in the past but scant, heterogeneous and inconclusive evidence is available on their effect on SARS-CoV-2 transmission. With the aim of pooling the available evidence on the efficacy of UV technologies against coronaviruses, we conducted a systematic review following PRISMA guidelines, searching Medline, Embase and the Cochrane Library, and the main clinical trials' registries (WHO ICTRP, ClinicalTrials.gov, Cochrane and EU Clinical Trial Register). Quantitative data on studies' interventions were summarized in tables, pooled by different coronavirus species and strain, UV source, characteristics of UV light exposure and outcomes. Eighteen papers met our inclusion criteria, published between 1972 and 2020. Six focused on SARS-CoV-2, four on SARS-CoV-1, one on MERS-CoV, three on seasonal coronaviruses, and four on animal coronaviruses. All were experimental studies. Overall, despite wide heterogenicity within included studies, complete inactivation of coronaviruses on surfaces or aerosolized, including SARS-CoV-2, was reported to take a maximum exposure time of 15 min and to need a maximum distance from the UV emitter of up to 1 m. Advances in UV-based technologies in the field of sanitation and their proved high virucidal potential against SARS-CoV-2 support their use for IPC in hospital and community settings and their contribution towards ending the COVID-19 pandemic. National and international guidelines are to be updated and parameters and conditions of use need to be identified to ensure both efficacy and safety of UV technology application for effective infection prevention and control in both healthcare and non-healthcare settings.

Disposal Behavior of Used Masks during the COVID-19 Pandemic in the Moroccan Community: Potential Environmental Impact

The spread of coronavirus disease-2019 (COVID-19) levied on the Moroccan authorities to increase their mask production capacity, which reached up to 12 million facemask units produced per day. This increase in personal protective equipment (PPE) production and consumption is an efficient tool to address the spread of COVID-19. However, this results in more plastic and microplastic debris being added into the land and marine environments, which will harm the ecosystem, wildlife, and public health. Such a situation needs deep individual behavior observation and tracking, as well as an assessment of the potential environmental impact of this new type of waste. For this reason, we assessed the Moroccan population's behavior regarding the use and disposal of facemasks and gloves. An exploratory survey was prepared and shared via social media and email with the population of Rabat-Salé-Kénitra and Casablanca-Settat regions. Additionally, we calculated the estimated number and weight of daily and weekly PPE used and generated by the studied regions. The survey showed that 70% of the respondents threw their discarded masks and gloves in house trash or trash bins after their first use, whereas nearly 30% of respondents admitted that they did not wear masks because they did not leave their homes during the lockdown, while from the 70% of facemask users, more than five million (equivalent to 40,000 kg) of facemasks would be generated and disposed of daily by the community of these regions, which presents 35% of the total engendered facemask waste in Morocco. Accordingly, the environment impact of facemasks showed that the greenhouse gas footprint is about 640 kT CO2 eq./year for the whole of Morocco, while the energy footprint is around 60,000 GWh/year. Furthermore, an urgent multidisciplinary environmental assessment of the potential impact of PPE must be conducted among the 12 Moroccan regions. This study demonstrated the real impact of the COVID-19 PPE on human behavior and the environment and suggests a need for providing new didactic management of facemasks and gloves.

Respiratory mask using a combination of spunbond, meltblown, and activated carbon materials for reducing exposure to CO: an in vivo study

Air pollution is a serious health problem in almost all developing and developed countries around the world. One component of air pollution dangerous for health is carbon monoxide (CO). The largest source of carbon monoxide is the burning of fossil fuels and peatland fires. The government continues to control pollution through both environmental management and summer pollution control. However, the resulting impact is less than optimal. We conducted a study to test the material used as an alternative respiratory protector in absorbing CO gas. The protective material comprised of a combination of spunbond, meltblown, and activated carbon materials. We carried the study out on a laboratory scale using experimental animals that were subjected to different stages of treatment. The results showed that respiratory protective masks with a combination of activated carbon and spunbond/meltblown materials were better able to inhibit CO exposure (p ≤ 0.001) than respiratory masks without activated carbon. The combination material is thus effective in absorbing CO; it can carry further research out on other harmful gases such as NO and NO₂.

Efficacy of face coverings in reducing transmission of COVID-19: Calculations based on models of droplet capture

In the COVID-19 pandemic, among the more controversial issues is the use of masks and face coverings. Much of the concern boils down to the question-just how effective are face coverings? One means to address this question is to review our understanding of the physical mechanisms by which masks and coverings operate-steric interception, inertial impaction, diffusion, and electrostatic capture. We enquire as to what extent these can be used to predict the efficacy of coverings. We combine the predictions of the models of these mechanisms which exist in the filtration literature and compare the predictions with recent experiments and lattice Boltzmann simulations, and find reasonable agreement with the former and good agreement with the latter. Building on these results, we explore the parameter space for woven cotton fabrics to show that three-layered cloth masks can be constructed with comparable filtration performance to surgical masks under ideal conditions. Reusable cloth masks thus present an environmentally friendly alternative to surgical masks so long as the face seal is adequate enough to minimize leakage.

Efficacy of Face Masks Used in Uganda: A Laboratory-Based Inquiry during the COVID-19 Pandemic

With shortages of face masks being reported worldwide, it is critical to consider alternatives to commercially manufactured face masks. This study aimed to test and compare the efficacy of various makes of locally made or homemade cloth face masks obtained from face-mask vendors in Kampala, Uganda, during the COVID-19 pandemic. The testing was performed to assess the bacterial filtration efficiency (BFE), breathability, distance-dependent fitness, and reusability of the locally made or homemade cloth face masks, while considering the most commonly used non-published face-mask decontamination approaches in Uganda. During laboratory experimentation, modified protocols from various face-mask testing organizations were adopted. Ten different face-mask types were experimented upon; each face-mask type was tested four times for every single test, except for the decontamination protocols involving washing where KN95 and surgical face masks were not included. Among the locally made or homemade cloth face masks, the double-layered cloth face masks (described as F) had better BFE and distance-dependent fitness characteristics, they could be reused, and had good breathability, than the other locally made or homemade cloth face masks. Despite these good qualities, the certainty of these face masks protecting wearers against COVID-19 remains subject to viral filtration efficiency testing.

An overview of filtration efficiency through the masks: Mechanisms of the aerosols penetration

The masks have always been mentioned as an effective tool against environmental threats. They are considered as protective equipment to preserve the respiratory system against the non-desirable air droplets and aerosols such as the viral or pollution particles. The aerosols can be pollution existence in the air, or the infectious airborne viruses initiated from the sneezing, coughing of the infected people. The filtration efficiency of the different masks against these aerosols are not the same, as the particles have different sizes, shapes, and properties. Therefore, the challenge is to fabricate the filtration masks with higher efficiency to decrease the penetration percentage at the nastiest conditions. To achieve this concept, knowledge about the mechanisms of the penetration of the aerosols through the masks at different effective environmental conditions is necessary. In this paper, the literature about the different kinds of face masks and respiratory masks, common cases of their application, and the advantages and disadvantages of them in this regard have been reviewed. Moreover, the related mechanisms of the penetration of the aerosols through the masks are discussed. The environmental conditions affecting the penetration as well as the quality of the fabrication are studied. Finally, special attention was given to the numerical simulation related to the different existing mechanisms.

Literature review to integrate information to assist workers to select masks even at workplaces without occupational health personnel

BACKGROUND

With the COVID-19 pandemic, the idea of universal mask wearing to prevent infecting others when one becomes infected has prevailed among people. In general, any workplace is not exempt and workers are required to wear a mask while working at the sites.

OBJECTIVES

This study aims to integrate information to assist workers to select effective protectors for the prevention of droplet infection even at workplaces without occupational health personnel.

METHODS

A total of 94 studies were included in this study: 91 studies were identified in MEDLINE, which was used for the literature search, and an additional three studies were identified from other information sources. The studies were checked to eliminate duplication and narrowed down to 31 based on the titles and abstracts. The contents of the 31 studies were read through and then 19 studies were extracted for careful reading.

RESULTS AND CONCLUSIONS

Regarding the protectors used at workplaces, it was suggested that (1) workers continue to use respiratory protectors as needed at sites where respiratory protectors such as an N95 respirator had to be used even before the spread of COVID-19 and (2) wear surgical masks, multi-layer cloth masks, or hybrid fabric masks made of several types of fabrics that are recommended in terms of preventing dissemination of droplets and protecting against inhalation of droplets, selected according to the working conditions, taking account of air permeability, breathability, and durability.

Decontamination interventions for the reuse of surgical mask personal protective equipment: a systematic review

BACKGROUND

The high demand for personal protective equipment during the novel coronavirus outbreak has prompted the need to develop strategies to conserve supply. Little is known regarding decontamination interventions to allow for surgical mask reuse.

AIM

To identify and synthesize data from original research evaluating interventions to decontaminate surgical masks for the purpose of reuse.

METHODS

MEDLINE, Embase, CENTRAL, Global Health, the WHO COVID-19 database, Google Scholar, DisasterLit, preprint servers, and prominent journals from inception to April 8^th, 2020, were searched for prospective original research on decontamination interventions for surgical masks. Citation screening was conducted independently in duplicate. Study characteristics, interventions, and outcomes were extracted from included studies by two independent reviewers. Outcomes of interest included impact of decontamination interventions on surgical mask performance and germicidal effects.

FINDINGS

Seven studies met eligibility criteria: one evaluated the effects of heat and chemical interventions applied after mask use on mask performance, and six evaluated interventions applied prior to mask use to enhance antimicrobial properties and/or mask performance. Mask performance and germicidal effects were evaluated with heterogeneous test conditions. Safety outcomes were infrequently evaluated. Mask performance was best preserved with dry heat decontamination. Good germicidal effects were observed in salt-, N-halamine-, and nanoparticle-coated masks.

CONCLUSION

There is limited evidence on the safety or efficacy of surgical mask decontamination. Given the heterogeneous methods used in studies to date, we are unable to draw conclusions on the most efficacious and safe intervention for decontaminating surgical masks.

Rationale for American Society of Retina Specialists Best Practice Recommendations for Conducting Vitreoretinal Surgery during the COVID-19 Era

PURPOSE

To detail the rationale behind recommendations recently published by the American Society of Retina Specialists (ASRS) outlining best practices for safety of vitreoretinal surgeons and staff while performing vitreoretinal surgery during the coronavirus disease (COVID)-19 pandemic.

METHODS

The committee for ASRS Best Practices for Retinal Surgery during the COVID-19 Pandemic reviewed existing evidence and information on SARS-CoV-2 transmission, and risk factors during vitreoretinal surgery. Recommendations were based on best available published data, cumulative clinical experiences, and recommendations and policies from other organizations. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the strength of recommendations and confidence in the evidence. These serve as interim recommendations which are routinely updated given gaps of knowledge and lack of high-quality data on this evolving subject.

RESULTS

Relevant existing literature related to methods of transmission, and ocular manifestations of SARS-CoV-2 are summarized. The data and clinical experiences driving recommendations for pre-operative, intraoperative and post-operative surgical considerations, anesthesia choice, as well as considerations for intravitreal injections are provided.

CONCLUSION

Recommendations are provided with the goal of protecting vitreoretinal surgeons and associated personnel from exposure to SARS-CoV-2 during interventional vitreoretinal procedures. This is a rapidly evolving topic with numerous remaining gaps in our current knowledge. As such, recommendations will evolve and the current manuscript is intended to serve as a foundation for continued dialogue on best practices.

Decontamination interventions for the reuse of surgical mask personal protective equipment: a systematic review

BACKGROUND

The high demand for personal protective equipment during the novel coronavirus outbreak has prompted the need to develop strategies to conserve supply. Little is known regarding decontamination interventions to allow for surgical mask reuse.

AIM

To identify and synthesize data from original research evaluating interventions to decontaminate surgical masks for the purpose of reuse.

METHODS

MEDLINE, Embase, CENTRAL, Global Health, the WHO COVID-19 database, Google Scholar, DisasterLit, preprint servers, and prominent journals from inception to April 8^th, 2020, were searched for prospective original research on decontamination interventions for surgical masks. Citation screening was conducted independently in duplicate. Study characteristics, interventions, and outcomes were extracted from included studies by two independent reviewers. Outcomes of interest included impact of decontamination interventions on surgical mask performance and germicidal effects.

FINDINGS

Seven studies met eligibility criteria: one evaluated the effects of heat and chemical interventions applied after mask use on mask performance, and six evaluated interventions applied prior to mask use to enhance antimicrobial properties and/or mask performance. Mask performance and germicidal effects were evaluated with heterogeneous test conditions. Safety outcomes were infrequently evaluated. Mask performance was best preserved with dry heat decontamination. Good germicidal effects were observed in salt-, N-halamine-, and nanoparticle-coated masks.

CONCLUSION

There is limited evidence on the safety or efficacy of surgical mask decontamination. Given the heterogeneous methods used in studies to date, we are unable to draw conclusions on the most efficacious and safe intervention for decontaminating surgical masks.

A novel reusable anti-COVID-19 transparent face respirator with optimized airflow

This novel face mask is designed to be a reusable respirator with a small and highly efficient disposable fabric filter. Respirator material requirements are reduced by 75% compared to traditional designs and allow repeated cleaning or sterilization. The probability of virus particle inhalation is reduced using novel air filtration pathways, through square-waveform design to increase filter airflow. Air enters the mask from right and left side filters, while the area in front of the mouth is isolated. Clear epoxy is used for a transparent frame, allowing lip-reading, and mask edges contain a silicone seal preventing bypass of the filters. The mask is manufactured using silicone molds, eliminating electricity requirements making it economical and viable in developing countries. Computational fluid dynamics numerical studies and Fluent ANSYS software were used to simulate airflow through the filter to optimize filter air path geometry and validate mask design with realistic human requirements. The breathing cycle was represented as a transient function, and N95 filter specifications were selected as a porous medium. The novel design achieved 1.2 × 10⁻³ kg s⁻¹, 20% higher than human requirements, with air streamlines velocity indicating local high speed, forcing and trapping virus particles against filter walls through centrifugal forces.

A laboratory-based study examining the properties of silk fabric to evaluate its potential as a protective barrier for personal protective equipment and as a functional material for face coverings during the COVID-19 pandemic

The worldwide shortage of single-use N95 respirators and surgical masks due to the COVID-19 pandemic has forced many health care personnel to use their existing equipment for as long as possible. In many cases, workers cover respirators with available masks in an attempt to extend their effectiveness against the virus. Due to low mask supplies, many people instead are using face coverings improvised from common fabrics. Our goal was to determine what fabrics would be most effective in both practices. Under laboratory conditions, we examined the hydrophobicity of fabrics (cotton, polyester, silk), as measured by their resistance to the penetration of small and aerosolized water droplets, an important transmission avenue for the virus causing COVID-19. We also examined the breathability of these fabrics and their ability to maintain hydrophobicity despite undergoing repeated cleaning. Laboratory-based tests were conducted when fabrics were fashioned as an overlaying barrier for respirators and when constructed as face coverings. When used as material in these two situations, silk was more effective at impeding the penetration and absorption of droplets due to its greater hydrophobicity relative to other tested fabrics. We found that silk face coverings repelled droplets in spray tests as well as disposable single-use surgical masks, and silk face coverings have the added advantage over masks such that they can be sterilized for immediate reuse. We show that silk is a hydrophobic barrier to droplets, can be more breathable than other fabrics that trap humidity, and are re-useable via cleaning. We suggest that silk can serve as an effective material for making hydrophobic barriers that protect respirators, and silk can now be tested under clinical conditions to verify its efficacy for this function. Although respirators are still the most appropriate form of protection, silk face coverings possess properties that make them capable of repelling droplets.