Current knowledge on the presence, biodegradation, and toxicity of discarded face masks in the environment

Disposable surgical/medical face masks and filtering face pieces: Source of microplastics and chemical additives in the environment

The production and consumption of disposable face masks (DFMs) increased intensely during the COVID-19 pandemic, leading to a high amount of them being found in the terrestrial and aquatic environment. The main goal of this research study is to conduct a comparative evaluation of the water-leachability of microplastics (MPs) and chemical additives from various types of disposable surgical/medical face masks (MM DFMs) and filtering face pieces (FFPs). Fourier-Transform Infrared Spectroscopy was used for MPs analysis. Liquid Chromatography/High Resolution Mass Spectrometry was used to analyse analytes presented in the water-leachates of DFMs. FFPs released 3-4 times more microplastic particles compared to MM DFMs. The release of MPs into water from all tested DFMs without mechanical stress suggests potential MP contamination originating from the DFM production process. Our study for the first time identified bisphenol B (0.25-0.42 μg/L) and 1,4-bis(2-ethylhexyl) sulfosuccinate (163.9-115.0 μg/L) as leachables from MM DFMs. MPs in the water-leachates vary in size, with predominant particles <100 μm, and the release order from DFMs is MMIIR > MMII > FFP3>FFP2>MMI. The main type of microplastics identified in the water leachates of the investigated face masks was polypropylene, accounting for 93-97% for MM DFMs and 82-83% for FFPs. Other polymers such as polyethylene, polycarbonate, polyester/polyethylene terephthalate, polyamide/Nylon, polyvinylchloride, and ethylene-propylene copolymer were also identified, but in smaller amounts. FFPs released a wider variety and a higher percentage (17-18%) of other polymers compared to MM DFMs (3-7%). Fragments and fibres were identified in all water-leachate samples, and fragments, particularly debris of polypropylene fibres, were the most common MP morphotype. The findings in this study are important in contributing additional data to develop science-based policy recommendations on the health and environmental impacts of MPs and associated chemical additives originated from DFMs.

Wearing face masks as a potential source for inhalation and oral uptake of inanimate toxins - A scoping review

BACKGROUND

From 2020 to 2023 many people around the world were forced to wear masks for large proportions of the day based on mandates and laws. We aimed to study the potential of face masks for the content and release of inanimate toxins.

METHODS

A scoping review of 1003 studies was performed (database search in PubMed/MEDLINE, qualitative and quantitative evaluation).

RESULTS

24 studies were included (experimental time 17 min to 15 days) evaluating content and/or release in 631 masks (273 surgical, 228 textile and 130 N95 masks). Most studies (63%) showed alarming results with high micro- and nanoplastics (MPs and NPs) release and exceedances could also be evidenced for volatile organic compounds (VOCs), xylene, acrolein, per-/polyfluoroalkyl substances (PFAS), phthalates (including di(2-ethylhexyl)-phthalate, DEHP) and for Pb, Cd, Co, Cu, Sb and TiO2.

DISCUSSION

Of course, masks filter larger dirt and plastic particles and fibers from the air we breathe and have specific indications, but according to our data they also carry risks. Depending on the application, a risk-benefit analysis is necessary.

CONCLUSION

Undoubtedly, mask mandates during the SARS-CoV-2 pandemic have been generating an additional source of potentially harmful exposition to toxins with health threatening and carcinogenic properties at population level with almost zero distance to the airways.

Are we underestimating stormwater? Stormwater as a significant source of microplastics in surface waters

Stormwater represent a critical pathway for transporting microplastics (MPs) to surface waters. Due to complex dynamics of MPs in stormwater, its dispersion, weathering, risk, and transport are poorly understood. This review bridges those gaps by summarizing the latest findings on sources, abundance, characteristics, and dynamics involved in stormwater MP pollution. Weathering starts before or after MPs enter stormwater and is more pronounced on land due to continuous heat and mechanical stress. Land use patterns, rainfall intensity, MPs size and density, and drainage characteristics influence the transport of MPs in stormwater. Tire and road wear particles (TRWPs), littering, and road dust are major sources of MPs in stormwater. The concentrations of MPs varies from 0.38-197,000 particles/L globally. Further MP concentrations showed regional variations, highlighting the importance of local monitoring efforts needed to understand local pollution sources. We observed unique signatures associated with the shape and color of MPs. Fibers and fragments were widely reported, with transparent and black being the predominant colors. We conclude that the contribution of stormwater to MP pollution in surface waters is significantly greater than wastewater treatment plant effluents and demands immediate attention. Field and lab scale studies are needed to understand its behavior in stormwater and the risk posed to the downstream water bodies.

Examining factors influencing public knowledge and practice of proper face mask usage during the COVID-19 pandemic: a cross-sectional study

Background

The COVID-19 pandemic had an enormous impact on people's quality of life worldwide. Appropriate use of facemasks is an important checkpoint in containing the spread of infection, which was believed to provide the desired level of protection and preserve the community. Given the relative novelty of facemask use in the general population, it is imperative to prioritize the promotion of appropriate facemask utilization and identify factors that may contribute to poor adherence.

Aim

This study assessed the factors that determined facemask use among the public.

Methods

A cross-sectional questionnaire-based study was conducted among the residents of the Kingdom of Saudi Arabia between November 2020 and January 2021. The current study explored the factors such as demographic characteristics influencing the knowledge and practice of proper use of facemasks. The study included a total of 198 participants. The results were derived through binomial logistic regression analysis to determine the relationship between the demographic characteristics and responses.

Results

The key findings of the study which are crucial in developing targeted intervention strategies to enhance the responsible use and disposal of facemasks are gender, income and employment. A significant difference was found between male and female participants regarding a positive approach to using facemasks, such as washing their hands (P = 0.042). In addition, homemakers differed significantly from students, regarding the correct usage of facemasks (P = 0.026). The study participants were aware that hand hygiene is essential when putting on and removing facemasks. Despite wearing facemasks properly, adult participants possessed less knowledge about the hazards of reusing facemasks and appropriate disposal (OR = 0.202, 95% CI [0.032-1.298]).

Conclusion

The present research identified gender, income, and employment as the primary attributes that play a pivotal role in the formulation of focused intervention tactics aimed at improving the cautious use and appropriate disposal of facemasks. It is essential to implement nationwide awareness activities, such as information campaigns, to enhance knowledge. Health authorities should establish a functional infrastructure for the collection and disposal of used facemasks by the general public, starting with the dissemination of knowledge. Moreover, the results of the present study have significant implications for health preventive programs aimed at preparing for future pandemics, since they highlight the specific demographic groups that should be prioritized in the development of such policies. Furthermore, it is advisable to integrate these interventional initiatives with national health polices to promote preparedness for handling future pandemics.

Towards environmentally sustainable management: A review on the generation, degradation, and recycling of polypropylene face mask waste

There has been a considerable increase in the use of face masks in the past years. Managing face mask waste has become a global concern, as the current waste management system is insufficient to deal with such a large quantity of solid waste. The drastic increase in quantity, along with the material's inability to degrade plastic components such as polypropylene, has led to a large accumulation of plastic waste, causing a series of environmental and ecological challenges. In addition, the growing use also imposes pressure on waste management methods such as landfill and incineration, raising concerns about high energy consumption, low value-added utilization, and the release of additional pollutants during the process. This article initially reviews the impact of mask-related plastic waste generation and degradation behavior in the natural environment. It then provides an overview of various recently developed methods for recycling face mask plastic waste. The article also offers forward-looking strategies and recommendations on face mask plastic waste management. The review aims to provide guidance on harnessing the complexities of mask waste and other medical plastic pollution issues, as well as improving the current waste management system's deficiencies and inefficiencies in tackling the growing plastic waste problem.

Effect of microfibers induced toxicity in marine sedentary polychaete Hydroides elegans: Insight from embryogenesis axis

Presence of surgical face masks in the environment are more than ever before after the COVID-19 pandemic, and it poses a newer threat to aquatic habitats around the world due to microfibers (MFs) and other contaminants that get discharged when these masks deteriorate. The mechanism behind the developmental toxicity of MFs, especially released from surgical masks, on the early life stages of aquatic organisms are not well understood. Toxicity test were developed to examine the effects of MFs released from surgical facemask upon deterioration using the early gametes and early life stages of marine sedentary polychaete Hydroides elegans. For MFs release, cut pieces of face masks were allowed to degrade in seawater for different time points (1 day, 30 days and 120 days) after which the fibers were obtained for further toxicity studies. The gametes of H. elegans were exposed to the MFs (length < 20 μm) separately for 20 min at a concentration of 50 MFs/ml before fertilization. In addition, we also analyzed the experimental samples for heavy metals and organic substances released from face masks. Our findings demonstrated that gametes exposed to MFs affected the percentage of successful development, considerably slowed down the mitotic cell division and significantly postponed the time of larval hatching and also produced an adverse effect during embryogenesis. When the sperm were exposed fertilization rate was decreased drastically, whereas when the eggs were exposed to MFs fertilization was not inhibited but a delay in early embryonic development observed. In addition the release of heavy metals and other volatile organics from the degrading face masks could also contribute to overall toxicity of these materials in environment. Our study thus shows that inappropriately discarded face masks and MFs and other pollutants released from such face masks could pose long-term hazard to coastal ecosystems.

Facemasks: An insight into their abundance in wetlands, degradation, and potential ecotoxicity

Disposable facemasks represent a new form of environmental contamination worldwide. This study aimed at addressing the abundance of facemasks in an overlooked natural environment with high ecological and economic value - the wetlands (Ria de Aveiro, Portugal, as study case), evaluating their potential biodegradation using naturally occurring fungi and assessing the potential ecotoxicity of released microfibres on local bivalves. All masks collected within 6500 m2 area of Aveiro wetland were 100 % disposable ones (PP-based, confirmed by Fourier transform infrared spectroscopy - FTIR) with an initial abundance of 0.0023 items/m2 in Sept. 2021, which was reduced by ∼40 % in Apr. 2022 and ∼87 % in Sept. 2022, as a reflection of the government policies. Analysis of the carbonyl index (0.03 to 1.79) underlined their state of degradation, primarily due to sun exposure during low tides. In laboratory conditions, 1 mm2 microplastics obtained from new disposable facemasks were prone to biodegradation by Penicillium brevicompactum and Zalerion maritimum inferred from microplastics mass loss (∼22 to -26 % and ∼40 to 50 %, respectively) and FTIR spectra (particularly in the hydroxyl and carbonyl groups). In addition, microfibres released from facemasks induced sublethal effects on the clam, Venerupis corrugata, mostly in their UV-aged form when compared to pristine ones, characterised by a decrease in cellular energy allocation (CEA) and an increase in aerobic energy metabolism (ETS). Concomitantly, clams exposed to 1250 items/L of UV-aged microplastics (similar to field-reported concentrations) expressed greater clearance capacity, indicating a need to compensate for the potential energy unbalance. This study provides the first baseline monitoring of facemasks in wetlands while bringing new evidence on their biodegradation and ecotoxicity, considering environmentally relevant conditions and keystone organisms in such environments. Such studies require scientific attention for rapid regulatory action against this emerging and persistent pollutant, also targeting remediation and mitigation strategies considering these items under pandemic scenarios.

Combined effects of P25 TiO2 nanoparticles and disposable face mask leachate on microalgae Scenedesmus obliquus: analysing the effects of heavy metals

Disposable surgical face masks extensively used during the COVID-19 outbreak would release microplastics into the aquatic environment. The increasing usage of titanium dioxide nanoparticles (nTiO2) in various consumer items has led to its ubiquitous presence in freshwater systems. This study determined the quantity and kind of microplastics discharged from disposable surgical face masks. The mask-leached microplastics were identified to be polypropylene of varying shapes and sizes, spanning from 1 μm to 15 μm. In addition, heavy metals like Cd, Cr, and Hg leached from the face masks were quantified. Four concentrations of nTiO2, 0.5, 1, 2, and 4 mg L-1, were mixed with leached solution from the face masks to perform the combined toxicity test on freshwater algae, Scenedesmus obliquus. A dose-dependent decrease in algal cell viability was observed upon treatment with various concentrations of nTiO2 individually. The mixtures of nTiO2 and the leached solution from the face masks exhibited significantly more toxicity in the algal cells than in their pristine forms. nTiO2 promoted increased production of oxidative stress and antioxidant enzyme activities resulting in cellular damage and decreased photosynthesis. These impacts were elevated when the algal cells were treated with the binary mixture. Furthermore, the heavy metal ions leached from face masks also contributed to the toxic effects. Our study shows that the leachates from disposable surgical face masks, combined with nTiO2, may pose a severe environmental threat.

The safety of telemedicine clinics as an alternative to in-person preoperative assessment for elective laparoscopic cholecystectomy in patients with benign gallbladder disease: a retrospective cohort study

BACKGROUND

The telemedicine clinic for follow up after minor surgical procedures in general surgery is now ubiquitously considered a standard of care. However, this method of consultation is not the mainstay for preoperative assessment and counselling of patients for common surgical procedures such as laparoscopic cholecystectomy. The aim of this study was to evaluate the safety of assessing and counselling patients in the telemedicine clinic without a physical encounter for laparoscopic cholecystectomy.

METHODS

We conducted a retrospective analysis of patients who were booked for laparoscopic cholecystectomy for benign gallbladder disease via general surgery telemedicine clinics from March 2020 to November 2021. The primary outcome was the cancellation rate on the day of surgery. The secondary outcomes were complication and readmission rates, with Clavein-Dindo grade III or greater deemed clinically significant. We performed a subgroup analysis on the cases cancelled on the day of surgery in an attempt to identify key reasons for cancellation following virtual clinic assessment.

RESULTS

We identified 206 cases booked for laparoscopic cholecystectomy from telemedicine clinics. 7% of patients had a cancellation on the day of surgery. Only one such cancellation was deemed avoidable as it may have been prevented by a face-to-face assessment. Severe postoperative adverse events (equal to or greater than Clavien-Dindo grade III) were observed in 1% of patients, and required re-intervention. 30-day readmission rate was 11%.

CONCLUSIONS

Our series showed that it is safe and feasible to assess and counsel patients for laparoscopic cholecystectomy remotely with a minimal cancellation rate on the day of operation. Further work is needed to understand the effect of remote consultations on patient satisfaction, its environmental impact, and possible benefits to healthcare economics to support its routine use in general surgery.