Investigation of the effects of face masks on thermal comfort in Guangzhou, China

A comparison of fit, heat stress, oxygen saturation and comfort between a novel reusable mask and disposable N95 respirator

The effectiveness of face masks in infection prevention depends not only on filtration technology but also on user compliance. However, existing masks suffer from limitations impacting comfort, ease of use, and communication, leading to reduced compliance, especially during prolonged use in healthcare settings. Innovations in mask design are needed to address these issues to ensure effective protection. To provide insights into novel face mask design aimed at enhancing infection prevention in healthcare settings and to introduce new evaluation methods for novel face masks, a fit and usability study was conducted with 22 volunteers, comparing a novel reusable mask, Altus Hero 1 (Hero), to N95 respirators. Subjects performed Occupational Safety and Health Administration (OSHA)-accepted quantitative fit test and usability test, and completed a post-test survey. The survey assessed communication, breathability, humidity retention, eyeglasses fitting, and long-term wear preference. Face temperature and blood oxygen levels were recorded during testing. Hero showed significantly reduced heat retention (p<0.05) compared to N95, aligning with survey responses indicating Hero felt cooler. No significant differences were found in blood oxygen levels between masks. Despite needing design refinements, most subjects preferred Hero for comfort and usability. This study discusses enhancements in design, fit, comfort, and materials to better meet users' needs and ensure compliance. It highlights critical and universal design considerations for future face masks and introduces methodological innovations for evaluating mask fit and usability. The findings offer valuable insights for advancing personal protective equipment for preventing infections and future pandemics.

Efficacy of a moisturizing cream and facial mask for alleviating skin problems associated with medical mask use: A half-face, randomized controlled study

BACKGROUND

Prolonged use of medical masks has increased skin-related issues.

AIM

To evaluate the efficacy of a facial cream and facial mask in mitigating medical mask related skin symptoms.

METHODS

Healthy women were randomly assigned to apply a facial cream (n = 32) or a facial mask plus a facial cream (n = 32) on half-faces after wearing medical masks for 4 h (Tb). Transepidermal water loss (TEWL), dryness score, and redness area were assessed at Tb and 10 min after using the cream (T1) in the facial cream group, and at Tb, 1 h after using the facial mask (T2), and 10 min after using the cream (T3) in the combined use group.

RESULTS

In the facial cream group, the treated half-face showed significantly better improvements from Tb to T1 in TEWL (-2.95 ± 0.38 vs. -0.68 ± 0.35 g/h·cm2, p < 0.001) and skin dryness score (-1.00 ± 0.12 vs. 0.00 ± 0.00, p < 0.001). In the combined use group, the treated half-face showed significantly better improvements from Tb to T2 and T3 in TEWL (T2, -3.46 ± 0.33 vs. -0.09 ± 0.13 g/h·cm2; T3, -4.67 ± 0.31 vs. -0.28 ± 0.22 g/h·cm2) and skin dryness score (T2, -0.63 ± 0.13 vs. 0.03 ± 0.03; T3, -0.94 ± 0.17 vs. 0.19 ± 0.07) (all p < 0.001) then the untreated half-face. The combined use group had significantly lower TEWL at T3 than T2 (p < 0.05). The reduction in redness area was similar between the treated and untreated half-faces in both groups.

CONCLUSIONS

The test facial cream and mask significantly improved skin barrier function and alleviated dryness symptoms associated with medical mask use, with the combined use offering superior benefits.

Surgical masks and filtering facepiece class 2 respirators (FFP2) have no major physiological effects at rest and during moderate exercise at 3000-m altitude: a randomised controlled trial

BACKGROUND

During the COVID-19 pandemic, the use of face masks has been recommended or enforced in several situations; however, their effects on physiological parameters and cognitive performance at high altitude are unknown.

METHODS

Eight healthy participants (four females) rested and exercised (cycling, 1 W/kg) while wearing no mask, a surgical mask or a filtering facepiece class 2 respirator (FFP2), both in normoxia and hypobaric hypoxia corresponding to an altitude of 3000 m. Arterialised oxygen saturation (SaO2), partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2), heart and respiratory rate, pulse oximetry (SpO2), cerebral oxygenation, visual analogue scales for dyspnoea and mask's discomfort were systematically investigated. Resting cognitive performance and exercising tympanic temperature were also assessed.

RESULTS

Mask use had a significant effect on PaCO2 (overall +1.2 ± 1.7 mmHg). There was no effect of mask use on all other investigated parameters except for dyspnoea and discomfort, which were highest with FFP2. Both masks were associated with a similar non-significant decrease in SaO2 during exercise in normoxia (-0.5 ± 0.4%) and, especially, in hypobaric hypoxia (-1.8 ± 1.5%), with similar trends for PaO2 and SpO2.

CONCLUSIONS

Although mask use was associated with higher rates of dyspnoea, it had no clinically relevant impact on gas exchange at 3000 m at rest and during moderate exercise, and no detectable effect on resting cognitive performance. Wearing a surgical mask or an FFP2 can be considered safe for healthy people living, working or spending their leisure time in mountains, high-altitude cities or other hypobaric environments (e.g. aircrafts) up to an altitude of 3000 m.

Multi-scale risk assessment and mitigations comparison for COVID-19 in urban public transport: A combined field measurement and modeling approach

The outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has caused an unparalleled disruption to daily life. Given that COVID-19 primarily spreads in densely populated indoor areas, urban public transport (UPT) systems pose significant risks. This study presents an analysis of the air change rate in buses, subways, and high speed trains based on measured CO2 concentrations and passenger behaviors. The resulting values were used as inputs for an infection risk assessment model, which was used to quantitatively evaluate the effects of various factors, including ventilation rates, respiratory activities, and viral variants, on the infection risk. The findings demonstrate that ventilation has a negligible impact on reducing average risks (less than 10.0%) for short-range scales, but can result in a reduction of average risks by 32.1%-57.4% for room scales. When all passengers wear masks, the average risk reduction ranges from 4.5-folds to 7.5-folds. Based on our analysis, the average total reproduction numbers (R) of subways are 1.4-folds higher than buses, and 2-folds higher than high speed trains. Additionally, it is important to note that the Omicron variant may result in a much higher R value, estimated to be approximately 4.9-folds higher than the Delta variant. To reduce disease transmission, it is important to keep the R value below 1. Thus, two indices have been proposed: time-scale based exposure thresholds and spatial-scale based upper limit warnings. Mask wearing provides the greatest protection against infection in the face of long exposure duration to the omicron epidemic.

Thermal responses of face-masked pedestrians during summer: An outdoor investigation under tree-shaded areas

During the SARS-CoV-2 (COVID-19) pandemic, most citizens were cooperative towards the face-masking policy; however, undeniably, face masking has increased complaints of thermal discomfort to varying degrees and resulted in potential health hazards during summer. Thus, a thermal comfort survey was conducted under tree-shaded areas generally preferred by pedestrians to explore the thermal response of face-masked pedestrians. Thirty-two subjects, with and without masks, participated in walking experiments, and their thermal parameters and physiological indicators were recorded; moreover, the subjects were asked to fill in subjective questionnaires. The results showed that although tree shades significantly reduced the average radiant temperature, dampness in the mask may cause some discomfort symptoms, among which intense sweating (54.55%) and tachycardia (42.18%) accounted for the largest proportion. Based on thermal indices, it could be concluded that face-masking does not significantly affect the thermal comfort of subjects walking in shaded areas. Notably, a 30-min walk in tree-shaded areas with face masking does not adversely affect human health or quality of life. Thus, the present assessment of the thermal safety of humans in shaded environments provides reference data for determining thermal comfort levels during outdoor walking with face masking.

Effect of the cooling clothing integrating with phase change material on the thermal comfort of healthcare workers with personal protective equipment during the COVID-19

Wearing Personal Protective Equipment (PPE) is essential to protect healthcare workers during the COVID-19, but the traditional cooling methods do not meet the requirements of epidemic prevention during the COVID-19. Therefore, the cooling clothing integrated with phase change material (PCM-CC) was proposed for healthcare workers performing nucleic acid sample collection outdoors. Human experiments and subjective questionnaires were used to test the effect of wearing PCM-CC on the thermal sensations of healthcare workers and to analyze the effectiveness of PCM-CC in relieving thermal stress and thereby, improving the thermal comfort of healthcare workers. Results showed that wearing PCM-CC was effective in alleviating various heat symptoms associated with wearing PPE in a hot-temperature environment. Wearing PCM-CC reduced head and facial discomfort by 25% and 41% under the 26 °C thermal environment, while it improved the mean thermal sensation vote (TSV) values by 0.71 and 1.85 under the 26 °C and 32 °C thermal environments, respectively, and made the mean TSV value close to the neutral value. Meanwhile, wearing PCM-CC reduced mean skin temperatures by 0.65 °C, and the pronounced cooling effect was found in the chest. Wearing PCM-CC could be an effective thermoregulation measure to refine the thermal comfort of healthcare workers during the COVID-19 pandemic.

Experimental investigation of the effect of surgical masks on outdoor thermal comfort in Xiamen, China

The COVID-19 pandemic has significantly changed people's lifestyles, and wearing surgical masks in outdoor public spaces has become commonplace. However, few studies have explored the impact of wearing masks on outdoor thermal comfort in different seasons. From May 2021 to February 2022, a series of longitudinal experiments were conducted in Xiamen, China to examine the effect of wearing surgical masks on outdoor thermal comfort. Forty-two participants took part in the experiments with and without masks. During the experiments, the thermal perceptions of the subjects and environmental thermal parameters were collected. Differences in outdoor thermal comfort between subjects wearing masks and those not wearing masks were determined in summer, autumn, and winter. Results showed that 1) the subjects wearing masks had lower neutral temperatures, and this difference was particularly pronounced in summer and exacerbated by walking; 2) in warm environments, masks reduced thermal comfort, and discomfort associated with masks was worse when walking than when sitting; 3) wearing masks significantly worsened facial comfort and increased chest discomfort, as summer turned to winter, the impact of masks on facial comfort decreased; 4) radiation and air temperature were the environmental parameters with the greatest impact on outdoor thermal sensation. Subjects who wore masks preferred lower temperatures, radiation, and humidity, and higher wind speeds.

Comparison of adaptive thermal comfort with face masks in library building in Guangzhou, China

During the COVID-19 pandemic, wearing masks in public spaces has become a protective strategy. Field tests and questionnaire surveys were carried out at a university library in Guangzhou, China, during June 2021 and January 2022. The indoor environmental parameters were observed, thermal sensation votes of students on various environmental parameters were collected, symptoms of students wearing masks were quantified, and the appropriate amount of time to wear masks was established. To identify acceptable and comfortable temperature ranges, the relationship between thermal sensation and thermal index was investigated. During summer and winter, people wearing masks are symptomatic for a certain duration. The most frequently voted symptom was facial heat (62.7 % and 54.6 % during summer and winter, respectively), followed by dyspnea. During summer, more than 80 % of the participants subjects were uncomfortable and showed some symptoms after wearing masks for more than 2 h (3 h during winter). In the summer air conditioning environment in Guangzhou, the neutral T_op was 26.4 °C, and the comfortable T_op range was 25.1–27.7 °C. Under the natural ventilation environment in winter, the neutral T_op was 20.5 °C, and the comfortable T_op range was 18.5–22.5 °C. This study may provide guidance for indoor office work and learning to wear masks in Guangzhou.

Effects of mask wearing duration and relative humidity on thermal perception in the summer outdoor built environment

During the pandemic, face masks are one of the most significant self-protection necessities, but they also cause heat stress. By using the ERA5 (ECMWF Reanalysis 5th Generation) database and the local weather bureau data, the effect of mask wearing on outdoor thermal sensation has been investigated by a survey conducted in the hot summer and cold winter region of eastern China in the summer of 2020. Results show that wearing a face mask for a longer period result in a higher level of discomfort, and the primary source of discomfort is hot and stuffy feelings. The effect of relative humidity is crucial for mask wearers in warm-biased thermal environments, as mean thermal sensation vote (TSV) peaks when environmental relative humidity reaches the range of 70% to 80% and decreases after this range due to the evaporation within the microclimate created by a face mask. Meanwhile, prolonged mask wearing increases participants' hot feelings, especially in warm environments. Specifically, participants wearing face masks for less than 30 min feel hot at a physiological equivalent temperature (PET) value of 34.4 °C, but those who wear them for over 60 min express hot feelings even at a PET value of 24.7 °C. The participants who wear a face mask while walking slowly outdoors have similar thermal sensations to those who do not wear a mask, but are in a higher activity level. The findings demonstrate that mask wearing has a crucial impact on outdoor thermal comfort assessment in a warm-biased outdoor thermal environment.

Indoor thermal comfort in a rural dwelling in southwest China

Recently, indoor thermal comfort has received more scholarly attention than ever due to the COVID-19 pandemic and global warming. However, most studies on indoor thermal comfort in China concentrated on urban buildings in the east and north. The indoor thermal comfort of rural dwellers in southwest China is insufficiently investigated. Hence, this study assesses residents' indoor thermal comfort in a rural dwelling in Linshui, obtains the thermal neutral temperature of the rural area, and analyzes the thermal adaptation behavior of rural dwellers. The results reveal that the thermal neutral temperature of rural dwellers is 29.33°C (operative temperature), higher than that presented in previous studies based on the same climate region. Indoor thermal conditions in rural dwellings are relatively harsh, but various thermal adaptation behavior of rural dwellers significantly improve their ability to withstand the harsh conditions. When people live in an environment with a (relatively) constant climate parameter (e.g., humidity), their perception of that parameter seems compromised. Most rural dwellers are unwilling to use cooling equipment with high energy consumption. Therefore, more passive cooling measures are recommended in the design and renovation of rural dwellings.

Investigation of the Thermal Comfort Properties of Masks Used during the COVID-19 Pandemic

SARS-CoV-2, the causative agent of COVID-19, which was officially declared a pandemic by the World Health Organization (WHO) on 11 March 2020, is transmitted from person to person through respiratory droplets and close contact and can cause severe respiratory failure and pneumonia. Currently, while the worldwide COVID-19 pandemic is still ongoing and countries are taking strict precautions to protect populations against infection, the most effective precautions still seem to be social distancing and wearing a mask. The question of how effective masks were in the early stages of the COVID-19 pandemic has been widely discussed, both in public and scientific circles, and the protection of different mask types has been examined. This study aimed to examine the comfort conditions provided by the different mask types to the user during use. For this purpose, single-ply, double-ply, three-ply, cloth, FFP1, FFP2, and FFP3 masks with different standards were examined, with and without a valve. To conduct the experiments, the novel thermal head measurement system, developed within the scope of this study, was used specifically for mask comfort studies. Thanks to the developed measurement system, the thermal resistance and water vapor resistance values of different masks were measured, and their comfort conditions were evaluated. According to the findings, cloth masks provide a comfortable condition, with lower thermal resistance and water vapor resistance values than other masks. In addition, it was observed that surgical masks offer better thermal comfort conditions, although they have lower protection than FFP masks.

Experimental investigation of the effects of personal protective equipment on thermal comfort in hot environments

Since the outbreak of COVID-19, wearing personal protective equipment (PPE) has become increasingly common, especially for healthcare workers performing nucleic acid sample collection. A field experiment and questionnaire survey were conducted in a semi-open transition space of a university building in Guangzhou, southern China. Thirty-two subjects wore PPE to simulate nucleic acid sample collection, during which thermal parameters were recorded and subjective questionnaires were completed. The relationship between thermal sensation and thermal index was analyzed to determine the neutral temperature and comfort temperature zones. Subjects had higher requirements for thermal environment parameters when wearing PPE than when not wearing PPE, and were found to have statistically significant differences in thermal perception when wearing and not wearing PPE. Wearing PPE significantly raised the subjects' thermal and humidity sensations and restricted their airflow. Wearing PPE resulted in thermal discomfort for the subjects and a high unacceptability rate for environmental thermal parameters. The subjects wore PPE for an acceptable duration of approximately 1.5 h. The neutral operative temperatures were significantly lower when wearing PPE than when not wearing PPE, and the deviation from the neutral temperature was 9.7 °C. The neutral operative temperature was 19.5 °C and the comfort temperature zone was 17.4-21.5 °C when subjects wore PPE, demonstrating that subjects who wore PPE preferred lower temperatures. These results suggest that people who wear PPE for work, especially outdoors, should receive more attention to ensure thermal comfort and safety.

Thermal discomfort caused by personal protective equipment in healthcare workers during the delta COVID-19 pandemic in Guangzhou, China: A case study

Background

In contrast to the previous COVID-19 pandemic, most frontline healthcare workers (HCWs) worked on residents’ nucleic acid tests in outdoor environments, instead of taking care of COVID-19 patients in hospitals during the hot summer of 2021. Therefore, it is necessary to investigate the prevalence and characteristics of thermal discomfort caused by personal protective equipment (PPE).

Methods

A cross-sectional survey was conducted online at hospitals from 11 administrative regions of Guangzhou for the assessment of thermal discomfort among HCWs from June 12–16, 2021. Univariate and logistic regression analyses were used to explore the risk factors associated with thermal discomfort.

Results

A total of 3658 valid responses were collected. The thermal discomfort and humid discomfort levels increased from 2.91 ± 1.19 to 3.61 ± 0.72 and from 0.98 ± 1.36 to 3.06 ± 1.1 after wearing PPE, respectively (p < 0.01). Feelings of being “very hot” and “uncomfortably humid” were the most influenced by wearing PPE, increasing from 31% to 69.1% and from 9.1% to 45.7%, respectively. There were significant increases in the thermal discomfort level (3.75 ± 0.57 vs. 3.33 ± 0.89, p < 0.01) and the humid discomfort level (3.33 ± 0.95 vs. 2.54 ± 1.19, p < 0.01) between the comfortable group and uncomfortable group, accompanied by similar patterns in the feelings of being “very hot” and “uncomfortably humid.” For general thermal-related symptoms, the most common new-onset symptom was profuse sweating (80%) followed by labored breathing (55.2%) and excessive dehydration (46.8%), while facial swelling (74%) was associated with local thermal-related symptoms, followed by hand maceration erosion (56.7%) and visual impairment (49.3%). In the multivariate analysis, the apparent temperature of the environment (≥35 °C), working in negative-pressure ambulances and outdoors, continuing to wear PPE for 1–3 days during this period, being aged >40 years, and previous experiences fighting the pandemic were independently associated with thermal discomfort (p < 0.01). Immediately after PPE removal, 32.3% of respondents considered drinking ice water/another drink, followed by 25% shortening the duration of wearing PPE and 19.1% going to the toilet. A large proportion of the participants looked forward to modifications to the material of the suit (72.9%) and mask (53.4%) for heat dissipation and dehumidification, as well as anti-fogging goggles (60.2%), adding hydration equipment to PPE (53.4%), and using soft materials to reduce pressure (40%).

Conclusions

Thermal discomfort is common and degrades health physiology related to PPE in summer environments. This suggests that modifications to the current working practices are urgently required to improve the resilience of HCWs and enhance their services during pandemics.

Thermal Perception and Physiological Responses under Different Protection States in Indoor Crowded Spaces during the COVID-19 Pandemic in Summer

Currently, people in crowded indoor spaces are required to wear a variety of personal protective equipment to curb the spread of COVID-19. This study aimed to investigate the effects of wearing four types of personal protective equipment (unprotected, wearing masks, wearing face shield and wearing medical protective clothing) on human thermal perception and physiological responses in indoor crowded spaces in summer. The experiment was conducted in a climate chamber designed to simulate the indoor crowded spaces. Environmental parameters of climate chamber (air temperature, relative humidity and wind speed), physiological parameters of subjects (wrist skin temperature and pulse rate), and subjective perceptions (thermal sensation and thermal comfort) were collected during the experiment. The experimental results showed that medical protective clothing has the most obvious blocking effect on heat exchange between human and environment. Thermal sensation in state 4 (wearing medical protective clothing) was significantly (p < 0.05) higher than that in other states. The study of physiological parameters showed that the wrist skin temperature and pulse rate under different protection states increased with the increase of room temperature. Through regression analysis, the thermal sensation estimation model of protective personnel in indoor crowded spaces based on wrist skin temperature and pulse rate was established. The adjusted R2 and RMSE of all models were above 82% and less than 1, indicating that the established thermal sensation model had a good prediction effect.