An evidence review of face masks against COVID-19

Innovative biosensing smart masks: unveiling the future of respiratory monitoring

Real-time monitoring of respiratory health is increasingly critical, particularly in addressing global health challenges such as Corona Virus Disease 2019 (COVID-19). Smart masks equipped with biosensing mechanisms revolutionize respiratory health monitoring by enabling real-time detection of respiratory parameters and biomarkers. In recent years, significant advancements have been achieved in the development of smart masks based on different sensor types with high sensitivity and accuracy, flexible functionality, and portability, providing new approaches for remote and real-time monitoring of respiratory parameters and biomarkers. In this review, we aim to provide a comprehensive overview of the current state of development and future potential of biosensing smart masks in various domains. This review outlines a systematic categorization of smart masks according to diverse sensing principles, classifying them into six categories: electrochemical sensors, optical sensors, piezoelectric sensors, and others. This review discusses the basic sensing principles and mechanisms of smart masks and describes the existing research developments of their different biosensors. Additionally, it explores the innovative applications of smart masks in health monitoring, protective functions, and expanding application scenarios. This review also identifies the current challenges faced by smart masks, including issues with sensor accuracy, environmental interference, and the need for better integration of multifunctional features. Proposed solutions to these challenges are discussed, along with the anticipated role of smart masks in early disease detection, personalized medicine, and environmental protection.

Intensity of public health and social measures are associated with effectiveness of SARS-CoV-2 vaccine in test-negative study

The intensity and duration of exposure can influence vaccine effectiveness (VE). For "leaky" vaccines such as SARS-CoV-2 vaccines, which reduce but do not entirely prevent infections, repeated or prolonged exposures may increase breakthrough infection likelihood. To test this hypothesis, we conducted a systematic review and meta-analysis of 76 test-negative design studies reporting VE against SARS-CoV-2 infection or severe disease. Exposure intensity was approximated using Oxford COVID-19 Government Response Tracker indices: Stringency Index (SI), Containment and Health Index (CHI), and Government Response Index (GRI). Based on 1,419 VE estimates, pooled VE against infection was significantly higher in settings with higher index values (lower exposure intensity): 82% (95% CI: 80-83%) in high-SI settings versus 39% (95% CI: 35-43%) in low-SI settings. Similar patterns appeared for other indices and severe disease outcomes. These associations persisted in meta-regression models adjusting for viral variant, vaccine type, time since vaccination, prior infection status, and enrollment criteria. Correlation analyses showed moderate-to-strong positive correlations between VE estimates and exposure indices (Spearman's correlation: 0.50-0.62). These findings establish exposure intensity as a critical effect modifier of SARS-CoV-2 VE, demonstrating the leaky nature of COVID-19 vaccines and explaining heterogeneity in real-world effectiveness estimates. Future VE evaluations and vaccination strategies should account for exposure intensity to ensure accurate, context-specific estimates.

Prevalence of COVID-19 Complications during a Program of Homeopathic Camphora Officinalis Distribution to City Populations of Santa Catarina, Brazil: An Ecological Study

BACKGROUND

 Coronavirus disease 2019 (COVID-19), a disease caused by the SARS-CoV-2 coronavirus, was declared a pandemic in March 2020, posing significant challenges globally. Homeopathy has historical relevance in epidemic management. In response, the government of the state of Santa Catarina, Brazil, distributed Camphora 1M as a potential prophylactic intervention for COVID-19.

OBJECTIVE

 This study aimed to investigate the possible effects of Camphora 1M as an adjunctive prophylactic measure in managing COVID-19, focusing on mortality and hospitalization rates, during the period April 28 to July 31, 2020, within designated COVID-19 in-patient units in Santa Catarina.

METHODS

 An ecological study design was applied to this epidemiological research. Five case municipalities (Itajaí, Atalanta, Entre Rios, Rio do Campo, Trombudo Central) were compared with five control municipalities (São José, Galvão, Pedras Grandes, Grão-Pará, Ascurra).

RESULTS

 No statistically significant differences were observed in predictor variables between municipalities that received Camphora 1M and the respective controls. Similarly, no statistically significant differences were observed in outcomes: deaths (p = 0.879), hospitalized cases (p = 0.537), daily ward admissions (p = 0.730) and ICU admissions (p = 0.072).

CONCLUSION

 For the first wave of the pandemic in the state of Santa Catarina, Brazil, city-wide distribution of Camphora 1M was not associated with reduced numbers, severity or mortality among the population hospitalized in designated public hospitals for COVID-19.

Aerosol emission, transmission, and mitigation from performing singing and wind instruments

During the COVID-19 pandemic, concerns about potential airborne virus transmission and exposure during musical performances were raised. Past studies suggest that aerosols are emitted from exhaling and talking with varying magnitudes. Meanwhile, little was known about aerosol emissions from singing and playing wind instruments. The objective of this study was to examine the spatial and temporal build-up of aerosol concentration in a typical studio room where singing, talking, and playing wind instruments are involved, to represent musical practicing and teaching scenarios at the University of Cincinnati College-Conservatory of Music (CCM). Four condensation particle counters were strategically placed throughout a room at various distances from the performer. Besides singing, musical professionals played seven instruments (clarinet, flute, French horn, saxophone, trombone, trumpet, and tuba). Two types of tests were conducted for each instrument: 10 min of playing and 10 min of combined playing and talking to mimic the teaching session. The results show that singing increased aerosol concentration to 3.9 × 103 cm-3 at the performing point, more than double the background (1.2 × 103 cm-3). Most wind instruments had minimal but detectable emission of aerosols over time, suggesting instruments could provide wall deposition for aerosols compared to singing. Particle concentrations decreased further from the performing point; however, they were still detectable over the background level at 10 feet away. Use of a portable high-efficiency particulate air (HEPA) filtration reduced aerosol concentrations developed during musical performances to below background level. These findings suggest that there are risks associated with aerosolized transmission of infectious agents such as SARS-CoV-2 from musical performance if the performer is infected. Distancing beyond the 6 ft distancing recommendation and proper room and local ventilation combined with disinfecting procedures are needed to minimize the risk of exposure to infectious aerosols.

Is trust a zero-sum game? What happens when institutional sources get it wrong

Trust in mainstream institutions is declining while people are increasingly turning to alternative media and conspiracy theories. Previous research has suggested that these trends may be linked, but the dynamics of trust across multiple sources has received little investigation. Is trust a neutral process, where each source is judged independently, is it a zero-sum competition, where a loss for one side is a gain for the other, or does losing trust in one source in foster a more generalized sense of distrust? Across three experimental studies (N = 2,951) we examined how people react when a source makes a serious error, testing four potential models of trust dynamics. We found that regardless of whether the outlet is mainstream, counter-mainstream, or neutral, trust drops for the erring source but does not rise for its competitors. This was the case in the context of both food regulations and COVID-19 precautions. Such a pattern suggest that each source may be judged independently of others. However, in several cases, an error made by one source led to a loss of trust in all sources, suggesting that rather than choosing sides between competing sources, people are also judging the media landscape as a whole to discern if it is feasible to find trustworthy information. However, correlational data did also find that the more people saw a source as politicized, the less they trusted that source and the more they trusted its competitors.

Global spatiotemporal dynamics of Mycoplasma pneumoniae re-emergence after COVID-19 pandemic restrictions: an epidemiological and transmission modelling study

BACKGROUND

Mycoplasma pneumoniae is a major cause of respiratory tract infections. We aimed to investigate the spatiotemporal dynamics, antimicrobial resistance, and severity of the delayed re-emergence of infections with M pneumoniae after the implementation of non-pharmaceutical interventions (NPIs) against COVID-19.

METHODS

Epidemiological data (positive and total test numbers, and macrolide-resistant M pneumoniae detections) and clinical data (hospitalisations, intensive care unit [ICU] admissions, and deaths) were collected through our global surveillance from April 1, 2017 to March 31, 2024. The moving epidemic method (MEM) was used to establish epidemic periods, and the time-series susceptible-infected-recovered (TSIR) model to investigate the delayed re-emergence.

FINDINGS

The dataset included 65 sites in 29 countries from four UN regions: Europe, Asia, the Americas, and Oceania. A global re-emergence of M pneumoniae cases by PCR detection was noted from the second half of 2023. The mean global detection rate was 11·47% (SD 15·82) during the re-emergence (April, 2023-March, 2024). By use of MEM, the re-emergence was identified as epidemic in all four UN regions, simultaneously in ten countries at calendar week 40 (early October, 2023). Macrolide-resistant M pneumoniae rates from Europe and Asia were 2·02% and 71·22%, respectively, and did not differ between the re-emergence and pre-COVID-19 pandemic periods. During the re-emergence, some countries reported increased hospitalisations (in adults, two of ten countries; and in children, two of 14 countries) and ICU admissions (in adults, one of nine countries; and in children, two of 14 countries). Overall, 65 (0·11%) deaths were reported, without statistical difference between pre-COVID-19 pandemic and re-emergence. The TSIR model accurately predicted, considering a 3-week generation time of M pneumoniae and a 90% reduction in transmission through NPIs, the observed delayed re-emergence.

INTERPRETATION

This large global dataset for M pneumoniae detections shows that although there was an unprecedented high number of detections across many countries in late 2023, the severity and number of deaths remained low. Our results suggest that the delayed re-emergence was related to the long incubation period of M pneumoniae infection.

FUNDING

None.

Wearing a surgical mask during chemotherapy session is safe

Surgical masks(SM) have become essential to our daily lives with the COVID-19 pandemic. It is recommended as the cheapest, most effective preventive method. The effects of SM on patients receiving chemotherapy are unknown. Our study aimed to investigate the effects of SM on oxygenation and CO2 retention in cancer patients receiving chemotherapy and to examine its possible clinical consequences. Patients diagnosed with cancer and receiving chemotherapy were included in the study. Venous blood gas, SO2 by pulse oximeter, and vital signs were recorded before and after treatment. Acute toxicities encountered during treatment were recorded. One hundred twenty-six patients with a median age of 60 (33-85) were evaluated in the study. The comparison of pre-post treatment parameters showed statistically significant changes in Ph (7.37 vs. 7.35, p < 0.01), pCO2 (44.2 vs. 45.8, p = 0.049), HCO3 (25.7 vs. 25.3, p = 0.003), SpO2 (97.0 vs. 96.0, p = 0.08), fever (36.4 vs. 36.3, p = 0.023). All the changes were clinically insignificant and in normal ranges. Chemotherapy-related acute toxicity was noted in 4 (3.2%) of the patients. Lung morbidity, cancer type, lung metastasis status, treatment applied, duration of therapy, and acute toxicity do not affect the current parameters. In our study, it was shown that constantly wearing a SM in patients receiving chemotherapy caused CO2 retention and a tendency to hypoxemia. However, the current changes were clinically insignificant and within the normal range. Surgical masks can be used safely in cancer patients receiving systemic treatment.

Assessing the impact of COVID-19 on middle-aged and older females in China: a comparative study of urban-rural disparities

BACKGROUND

The impact of COVID-19 has been long-lasting and severe. Middle-aged and older females, as a vulnerable group, need special attention. China is a typical urban-rural dualistic society, and the impact of the urban-rural gap on middle-aged and older females is unknown. The purpose of this study was to explore the influence of COVID-19 on middle-aged and older females in Chinese urban and rural areas.

METHODS

This study used CHARLS (China Health and Retirement Longitudinal Study) database. A total of 10,063 participants were included in this study (3,680 in urban and 6,383 in rural). The chi-square test and t-test were used to analyze differences between urban and rural participants, and binary logistic regression (forward: conditional) was used to analyze differences in the factors influencing the two groups in terms of mask wearing.

RESULTS

During the epidemic, there were significant differences between urban and rural middle-aged and older females in terms of demographic characteristics, prevention knowledge, attitude, identification, isolation, personal activities, mental health, containment measures in residential areas and individual preventive behavior. Rural middle-aged and older females had poorer preventive behavior. Age, marital status, preventive knowledge, calling and messaging, internet contact, containment measures in residential areas were the common influencing factors affecting mask wearing behavior of the participants. The mask-wearing behavior of urban participants was also influenced by the attitude towards government's measures, COVID-19 test and fear.

CONCLUSIONS

Middle-aged and older females in Chinese urban and rural areas faced different situations during the epidemic and required targeted measures.

Screening and monitoring patients at high risk for mental health issues in COVID-19: a multicenter pre-post assessment study

PURPOSE

This study aimed to present the methods for screening, monitoring, and intervening with patients at high risk for mental health issues with COVID-19 at residential treatment centers, which are isolation treatment facilities for COVID-19 patients.

METHODS

We evaluated the mental health status of COVID-19 patients in three residential treatment centers. At admission and one day before discharge, patients received via their mobile a questionnaire containing one question each on anxiety, subjective psychological distress, post-traumatic stress symptoms, depression and suicidal ideation to identify those at high risk for mental health issues. High-risk patients and normal-risk participants who requested consultation were referred for psychological counseling. We evaluated the participants' clinical and mental health characteristics and performed a logistic regression analysis to identify factors associated with worsened depression and suicide risk at discharge.

RESULTS

Of 5,163 qualifying patients, 1,941 patients (37.6%) had their mental health assessed both at admission and discharge. In total, 661 persons (34.1%) required mental health support at admission and 648 persons (33.4%) at discharge. The patients at high risk for mental health issues at admission had an odds ratio of 5.31 (95% CI: 4.23-6.66) for depression at discharge, compared to those with normal mental health status at admission. The group that requested professional psychological counseling at admission showed an odds ratio of 2.33 (95% CI: 1.31-4.13) for depression at discharge.

CONCLUSIONS

Repeated mental health monitoring is crucial for COVID-19 patients. Additionally, a flexible intervention strategy should be developed to implement different screening methods for patients at high risk for mental health issues, depending on the status of the COVID-19 epidemic and available resources.

Impact of face masks on empathy and communication in head and neck cancer patients: a case-control study

Background

The COVID-19 pandemic necessitated the widespread use of face masks in medical settings. In the treatment of patients with head and neck tumors or other malignancies, where non-verbal communication and emotional expression are critical, face masks may potentially impair the physician-patient relationship. This study aimed to assess the impact of face masks on perceived empathy and the quality of physician-patient communication in this patient cohort.

Methods

A prospective case-control study as part of the postoperative follow-up consultations was conducted at the Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, utilizing the Consultation and Relational Empathy (CARE) measure. Patients were divided into two groups: in the case group, clinicians wore face masks throughout the entire consultation, while in the control group, masks were worn only during the clinical examination. The primary outcome was the difference in CARE scores, reflecting the perceived empathy of the clinician.

Results

No significant difference in mean CARE scores was observed between the two groups (p=0.454), indicating that wearing a face mask did not significantly affect patients' perception of clinician empathy. However, a significant positive correlation was found between patients' familiarity with the clinician and higher CARE scores (p=0.003). Other variables, such as patient health status and consultation duration, did not significantly influence CARE scores.

Conclusion

Wearing face masks does not significantly impair perceived empathy in the context of physician-patient communication. Familiarity with the clinician emerged as a key factor in enhancing the quality of the interaction. These findings underscore the importance of fostering long-term, trust-based physician-patient relationships, particularly during periods of pandemic-related protective measures such as mask mandates.

COVID-19 related complications

The COVID-19 pandemic has significantly impacted global healthcare systems, revealed vulnerabilities and prompted a re-evaluation of medical practices. Acute complications from the virus, including cardiovascular and neurological issues, have underscored the necessity for timely medical interventions. Advances in diagnostic methods and personalized therapies have been pivotal in mitigating severe outcomes. Additionally, Long COVID has emerged as a complex challenge, affecting various body systems and leading to respiratory, cardiovascular, neurological, psychological, and musculoskeletal problems. This broad spectrum of complications highlights the importance of multidisciplinary management approaches that prioritize therapy, rehabilitation, and patient-centered care. Vulnerable populations such as paediatric patients, pregnant women, and immunocompromised individuals face unique risks and complications, necessitating continuous monitoring and tailored management strategies to reduce morbidity and mortality associated with COVID-19.

Smart filtering facepiece respirator with self-adaptive fit and wireless humidity monitoring

The widespread emergence of airborne diseases has transformed our lifestyle, and respirators have become an essential part of daily life. Nevertheless, finding respirators that fit well can be challenging due to the variety of human facial sizes and shapes, potentially compromising protection. In addition, the current respirators do not inform the user of the air quality in case of continuous long-term use. Here, we introduce a smart filtering facepiece respirator incorporating a humidity sensor and pressure sensory feedback for self-fit adjusting and maintaining an adequate fit. The humidity detection sensor uses laser-induced graphene, and the pressure sensor array based on the dielectric elastomeric sponge monitors the respirator contact on the user's face, providing real-time closed-loop feedback and the wearer's fitting status. Those membrane sensors show outstanding performance, such as a low humidity hysteresis of 0.131 % and a precise pressure detection limit of 0.23 ± 0.02 kPa. As a result of the self-fit adjusting mode, the overall fit factor is increased by 10 % on average compared to the commercial respirator. This significant improvement in fit factor, coupled with the innovative design, has the potential to develop next-generation facepiece respirators as essential personal protective equipment.

Face mask mandates alter major determinants of adherence to protective health behaviours in Australia

Face mask wearing is a protective health behaviour that helps mitigate the spread of infectious diseases such as influenza and COVID-19. Understanding predictors of face mask wearing can help refine public health messaging and policy in future pandemics. Government mandates influence face mask wearing, but how mandates change predictors of face mask wearing has not been explored. We investigate how mandates changed predictors of face mask wearing and general protective behaviours within Australia during the COVID-19 pandemic using cross-sectional survey data. We compared four machine learning models to predict face mask wearing and general protective behaviours before and after mandates started in Australia; ensemble, tree-based models (XGBoost and random forests) performed best. Other than state, common predictors before and after mandates included age, survey week, average number of contacts, wellbeing, and perception of illness threat. Predictors that only appeared in the top ten before mandates included trust in government, and employment status; and after mandates were willingness to isolate. These distinct predictors are possible targets for future public health messaging at different stages of a new pandemic.

A novel framework for modeling quarantinable disease transmission

The COVID-19 pandemic has significantly challenged traditional epidemiological models due to factors such as delayed diagnosis, asymptomatic transmission, isolation-induced contact changes, and underreported mortality. In response to these complexities, this paper introduces a novel CURNDS model prioritizing compartments and transmissions based on contact levels, rather than merely on symptomatic severity or hospitalization status. The framework surpasses conventional uniform mixing and static rate assumptions by incorporating adaptive power laws, dynamic transmission rates, and spline-based smoothing techniques. The CURNDS model provides accurate estimates of undetected infections and undocumented deaths from COVID-19 data, uncovering the pandemic's true impact. Our analysis challenges the assumption of homogeneous mixing between infected and non-infected individuals in traditional epidemiological models. By capturing the nuanced transmission dynamics of infection and confirmation, our model offers new insights into the spread of different COVID-19 strains. Overall, CURNDS provides a robust framework for understanding the complex transmission patterns of highly contagious, quarantinable diseases.

Who Cares If Not Supposed To? Moral Foundations, Consideration of Immediate Consequences, and Mask-Wearing Intentions After Revocation of the Legal Obligation To Do So

After two years of obligation to wear masks during the pandemic, in March 2022, the legal requirement was revoked for public spaces (except for medical facilities) in Poland. The aim of the study was to find out how individualizing moral foundations (focused on avoiding harm to others and concern for justice) shaped the intention to wear masks despite the revocation and how binding moral foundations (concentrated on respect for authorities, loyalty to the ingroup, and purity) and consideration of immediate consequences modify this relationship. For exploratory purposes, the same model was also tested for a retrospective declaration about the refusal to wear protective masks when legally required to do so. In both models, gender was controlled. N = 557 people from the general population participated in the online survey. Results showed that in the case of intention to wear masks after the obligation was revoked, individualizing moral foundations and female gender were positive predictors. The lower the binding moral foundations and consideration of immediate consequences, the higher the effect of individualizing moral foundations. No interaction effects were found for a retrospective declaration of participants refusing to wear masks during the pandemic. However, positive predictors were male gender, binding moral foundations, and consideration of immediate consequences, whereas individualizing moral foundations were a negative predictor. The results suggest morality plays a role in forming health-related communication. Men should be targeted in order to enhance their acceptance of preventive measures.

From node to network: weaving a global perspective on efficacy and costs of non-pharmaceutical interventions

Non-pharmaceutical intervention (NPI) policies, ranging from mild measures to total isolation, were implemented worldwide during the COVID-19 pandemic. We adopt a systematic approach to guide policymakers in deploying NPI policies to mitigate the pandemic's effects while balancing their social and economic impacts. Our results show that each NPI has an optimal duration, beyond which its effectiveness plateaus. Stricter policies require longer durations, and when sustained for the optimal period, earlier implementation is more effective. However, when this duration is unattainable, timing becomes critical, as both early and late implementation reduce efficacy. Stringent policies with insufficient durations may perform worse than less restrictive measures applied over the same period, and an NPI policy aimed at minimizing overall healthcare burden under a fixed policy duration may significantly intensify peak-time strains. Finally, as the virus becomes more transmissible and less lethal, the effectiveness gap between stringent and less restrictive policies narrows, with targeted interventions for vulnerable groups outperforming universal strict measures.

Impact of mask wearing time on fluid consumption and physical activity during the COVID-19 pandemic

Purpose

To examine the associations between mask-wearing on fluid consumption and physical activity behaviors during the COVID-19 pandemic.

Methods

137 college students (female, 72.5%; age, 26 ± 9 y) completed a survey detailing their fluid intake, physical activity behaviors, and time spent wearing a mask throughout the day during the previous month in the Fall 2020 academic semester.

Results

Increased daily mask wearing time was not associated with total fluid intake (p > 0.05). Participants had greater odds of being 'somewhat active' compared to 'inactive' with an increase in mask wearing time (OR = 1.23 [1.03, 1.47], p = 0.022).

Conclusion

Wearing a mask during the COVID-19 pandemic did not influence fluid intake behaviors, however, it increased the likelihood of reported greater levels of physical activity. These factors may be related to an individual being more likely to globally adopt healthier behaviors, however, this needs further exploration.

Sterilization and Filter Performance of Nano- and Microfibrous Facemask Filters - Electrospinning and Restoration of Charges for Competitive Sustainable Alternatives

Facemask materials have been under constant development to optimize filtration performance, wear comfort, and general resilience to chemical and mechanical stress. While single-use polypropylene meltblown membranes are the established go-to material for high-performing mask filters, they are neither sustainable nor particularly resistant to sterilization methods. Herein an in-depth analysis is provided of the sterilization efficiency, filtration efficiency, and breathing resistance of selected aerosol filters commonly implemented in facemasks, with a particular focus on the benefits of nanofibrous filters. After establishing a general overview over face mask filters and machine washing parameters required for successful decontamination, respective changes in filter performance and structure are presented. Sustainably manufactured, highly efficient, but also more fragile electrospun membranes not only offer competitive performance as well as a more environment-friendly production and degradation process, but also support a subsequent sterilization and recharging approach via alcohol exposition and drying in an electric field. It is further elaborated on the prospective sustainability of each material to offer a clear outlook on electrospun membranes as the most promising filter membranes of the future.

AutoML-Driven Insights into Patient Outcomes and Emergency Care During Romania's First Wave of COVID-19

BACKGROUND

The COVID-19 pandemic severely impacted healthcare systems, affecting patient outcomes and resource allocation. This study applied automated machine learning (AutoML) to analyze key health outputs, such as discharge conditions, mortality, and COVID-19 cases, with the goal of improving responses to future crises.

METHODS

AutoML was used to train and validate models on an ICD-10 dataset covering the first wave of COVID-19 in Romania (January-September 2020).

RESULTS

For discharge outcomes, Light Gradient Boosted models achieved an F1 score of 0.9644, while for mortality 0.7545 was reached. A Generalized Linear Model blender achieved an F1 score of 0.9884 for "acute or emergency" cases, and an average blender reached 0.923 for COVID-19 cases. Older age, specific hospitals, and oncology wards were less associated with improved recovery rates, while mortality was linked to abnormal lab results and cardiovascular/respiratory diseases. Patients admitted without referral, or patients in hospitals in the central region and the capital region of Romania were more likely to be acute cases. Finally, counties such as Argeş (South-Muntenia) and Brașov (Center) showed higher COVID-19 infection rates regardless of age.

CONCLUSIONS

AutoML provided valuable insights into patient outcomes, highlighting variations in care and the need for targeted health strategies for both COVID-19 and other health challenges.

Ideological Consistency and News Sharing as Predictors of Masking Among College Students

During the COVID-19 pandemic, the United States Centers for Disease Control and Prevention (CDC) recommended the use of well-fitting face masks or respirators as a strategy to reduce respiratory transmission; however, acceptance and utilization of face masks quickly became a contentious, politically charged matter. Given the effectiveness of masking against respiratory viruses, it is critical to understand the various normative factors and personal values associated with mask wearing. To this end, this study reports the findings of an online, cross-sectional survey (n = 1231) of college students during the COVID-19 pandemic. Findings show that ideological consistency, sharing news to create awareness, and sharing unverified news significantly predict masking behaviors, though ideological consistency most substantially explained variance in self-reported masking behaviors. Participants with more liberal political ideologies reported greater adherence to masking policies while those with more conservative ideologies reported less mask-wearing behavior. A better understanding of the predictors of masking behaviors, particularly how political ideologies continue to shape public health responses, is essential for designing more effective communication strategies to control disease spread and help inform strategies for future outbreaks. Study implications and limitations are discussed.

Efficacy of powered air-purifying respirators (PAPRs) for source control of simulated respiratory aerosols

BACKGROUND

Loose-fitting powered air-purifying respirators (PAPRs) are a popular alternative to the use of filtering facepiece respirators for health care workers. Although PAPRs protect the wearer from aerosol particles, their ability to block infectious aerosol particles exhaled by the wearer from being released into the environment (called source control) is unclear.

METHODS

The source control performance of 4 PAPRs with loose-fitting facepieces were tested using a manikin that exhales aerosol particles. The PAPRs were tested by themselves and in combination with a face-worn product intended to provide source control (either a surgical mask or an N95 filtering facepiece respirator).

RESULTS

Two PAPR facepieces with filtration panels significantly reduced the release of exhaled aerosols into the environment, while 3 facepieces without such panels did not. Wearing a surgical mask or respirator under the facepiece significantly improved the source control performance.

CONCLUSIONS

Most PAPR facepieces do not block aerosols exhaled by the wearer. Facepieces designed to filter exhaled particles can prevent aerosols from being released into the environment. Wearing a surgical mask or a filtering facepiece respirator under the facepiece can also provide source control, but PAPRs are not typically certified for use with masks and respirators.

Microfibre pollution: An emerging contaminant, alarming threat to the global environment

Microfibres, mostly obtained from home laundry, textiles, industrial materials, sewage effluents, and sludge, are considered the main source of environmental pollution, which has become a prevalent threat to terrestrial and aquatic creatures. Global population growth and industrialization have led to a rise in fibre consumption and production, which spread its network in drinking water, beer, and seafood. Focusing on the alarming threat of microfibre towards the natural environment, we have penned an extensive review article about microfibre pollution. The manuscript is divided into various subparts, such as the introductory portion, which briefly summarizes the sources and presence of various hazardous pollutants in the environment, followed by a detailed discussion about microfibre. The second part elaborates on the sources and distribution of microfibreous pollutants and the third portion discloses the toxic chemicals utilized or produced from functionalization, as well as the negative implications of microfibre on the environment. The fourth part discloses the leading application strategies to diminish microfibre pollution by controlling the sources and the development of various remediations. The last portion deals with the future and critical aspects of microfibre contamination. The authors hope this review article will boost its domain in environmental chemistry, sustainable development and environmental engineering from academic to industrial level as it helps researchers in particular and academics in general.

Trajectories of health behaviors during the COVID-19 pandemic: a longitudinal analysis of handwashing, mask wearing, social contact limitations, and physical distancing

AIM

This study aimed to investigate the associations between health behavior adherence and psychological factors during the COVID-19 pandemic, with a particular focus on identifying trajectories of handwashing, mask wearing, social contact limitations, and physical distancing.

METHODS

We employed a multi-trajectory group-based approach to analyze data from 6026 Belgian residents, including 60% women, with an average age of 52.65. Data were collected over six waves spanning from April 2021 to December 2021.

RESULTS

Participants were categorized into trajectory groups based on persistently low (11.9%), moderate-low (20.9%), moderate-high (39.1%), and high (28.1%) levels of adherence to the specified health behaviors. Our findings indicate a declining trend in health behavior adherence over the study period. Additionally, we observed that females, older individuals, and those with prior COVID-19 infection had a higher likelihood of belonging to trajectory groups characterized by the highest levels of health behavior adherence. Similarly, individuals with positive vaccination intentions, a heightened perception of consequences, and increased health anxiety demonstrated greater adherence to health behaviors over time. Furthermore, our investigation into the relationship between health behaviors and mental health revealed that participants in trajectory groups with higher levels of adherence to social contact limitations and physical distancing reported increased feelings of loneliness and decreased life satisfaction.

CONCLUSIONS

The COVID-19 pandemic has reshaped our lives, and while vaccines have marked progress, maintaining health behaviors is crucial for virus prevention. To address potential mental health challenges from sanitary measures, policies and communication should promote health behaviors while acknowledging their psychological impact.

Face mask use and viral load in patients with mild symptoms of COVID-19

OBJECTIVE

Previous studies indicated that face masks reduce the probability of infection by SARS-CoV-2 but did not examine the relationship between SARS-CoV-2 viral load and mask usage. This study analyzed this relationship.

METHODS

This cross-sectional study evaluated patients admitted to a public Emergency Care Unit in Belo Horizonte, MG, Brazil, between October 2020 and March 2021. Convenience samples were recruited during the study period. Adult patients with COVID-19 symptoms were invited to participate after being examined by a physician according to the Emergency Care Unit routine. This study included 441 adults with mild symptoms diagnosed with COVID-19 via RT-PCR, who were tested until the 14th day after symptom onset. Participants were interviewed about mask usage, oropharyngeal swabs were collected, and the SARS-CoV-2 viral load was measured using RT-PCR. The difference between the SARS-CoV-2 viral load in the groups of individuals who regularly used and did not use masks was subjected to a hypothesis test.

RESULTS

Of the patients who had swabs collected 1-5 days after symptom onset, 64.9% of those not using masks regularly and 45.5% of those using masks regularly presented a high SARS-CoV-2 viral load. This difference was statistically significant (p=0.0073). Considering only the patients who had swabs collected 4-8 days after symptom onset, 44.1% of those not using masks regularly and 30.8% of those using masks regularly presented a high SARS-CoV-2 viral load; this difference was statistically significant (p=0.0364).

CONCLUSION

When people who regularly wear a face mask contract COVID-19, they have a significantly lower probability of having a high viral load of SARS-CoV-2 compared to those who do not regularly wear masks.

A generalized multinomial probabilistic model for SARS-COV-2 infection prediction and public health intervention assessment in an indoor environment

SARS-CoV-2 Omicron and its sub-lineages have become the predominant variants globally since early 2022. As of January 2023, over 664 million confirmed cases and over 6.7 million deaths had been reported globally. Current infection models are limited by the need for large datasets or calibration to specific contexts, making them difficult to apply to different settings. This study aims to develop a generalized multinomial probabilistic model of airborne infection to assist public health decision-makers in evaluating the effectiveness of public health interventions (PHIs) across a broad spectrum of scenarios. The proposed model systematically incorporates group characteristics, epidemiology, viral loads, social activities, environmental conditions, and PHIs. Assumptions about social distance and contact duration that estimate infectivity during short-term group gatherings have been made. The study is differentiated from earlier works on probabilistic infection modeling in the following ways: (1) predicting new cases arising from more than one infectious person in a gathering, (2) incorporating additional key infection factors, and (3) evaluating the effectiveness of multiple PHIs on SARS-CoV-2 infection simultaneously. Although the results show that limiting group size has an impact on infection, improving ventilation has a much greater positive health impact. The proposed model is versatile and can flexibly accommodate other scenarios or airborne diseases by modifying the parameters allowing new factors to be added.

Mask wearing on an HBCU campus during the COVID-19 pandemic

Objective: Young adults of age 18-29 years old account for the most COVID-19 cases in the US, and ethnic groups were affected disproportionately. Correctly wearing a face mask remains a critical intervention for COVID-19 mitigation. The study aimed to examine how well Historically Black Colleges and Universities (HBCUs) residents adhered to mask wearing during the pandemic. Methods: We conducted an observational study on an urban HBCU campus and the neighborhoods in Maryland for 13 weeks in spring 2021. Results: Of 1926 (1126 on campus; 800 off campus) persons observed, 89.8% wore masks, with 83.5% covering their mouths and noses. The HBCU campus showed better mask adherence than neighborhoods (92.0% vs. 86.7%). The most common improper mask wearing was nose out, followed by only-on-chin. Cloth and surgical masks were worn the most. Conclusion: The HBCU campus and neighborhood settings presented a high rate of facemask use during the pandemic.

Knowledge, attitudes, and behaviors with mask use and vaccines for COVID-19 prevention at 13 colleges and universities, April 2021

Objectives: To understand college and university student knowledge, attitudes, and behaviors (KAB) regarding COVID-19 prevention strategies. Methods: Thirteen colleges and universities volunteered to conduct an anonymous electronic survey in April 2021 to assess students' KAB about mask use and vaccination to prevent COVID-19. Results: Three-quarters of students indicated they "Always" wore a mask correctly when in public indoor places. Of those not yet vaccinated, 55% expressed concern about unknown side effects. Over half of students were unsure or believe they do not need to continue wearing masks after vaccination and older students more likely to be vaccinated. There was a significant inverse correlation between intention of getting vaccinated and intention to attend a large indoor party without a mask. Conclusions: Colleges and universities are important to community efforts to slow the COVID-19 pandemic. The KAB findings can inform approaches to increase overall mask use and vaccination uptake among young students.

Increasing Face Mask Wearing in Autistic Individuals Using Behavior Analytic Interventions: A Systematic Review and Meta-analysis

The current review aimed to evaluate the effectiveness of behavior-analytic procedures in increasing face mask-wearing in autistic individuals. This comes following recommended guidance during the COVID-19 pandemic. A systematic review and meta-analysis were completed of peer-reviewed and grey literature. Six databases were searched and seven studies using single-case experimental designs met the eligibility criteria which were then quality appraised. Data were extracted on participant characteristics, study design, independent and dependent variables, fidelity, generalization, maintenance, and social validity outcomes. Both the non-overlap of all pairs and Baseline Corrected TAU were used to estimate effect size. Two studies were rated strong and borderline strong quality and five were rated as adequate or below. All studies showed positive outcomes for mask-wearing, with an average of 0.92 for non-overlap of all pairs and 0.47 for Baseline Corrected Tau effect sizes. The most common and effective procedures for increasing mask-wearing were graded exposure and differential and positive reinforcement. Factors such as mode of delivery, implementer, and setting did not appear to influence study outcomes. Procedures were found to be rated as acceptable by parents and professionals in five of the studies. The existing literature on increasing face mask-wearing in autistic individuals provides promising findings to add to existing literature around increasing tolerance to medical equipment and hygiene practices in autistic populations. However, these findings are based on a small sample size, with six of the studies taking place in the United States with varying study quality.

Biodegradable Poly (L-Lactic acid) Fibrous Membrane with Ribbon-Structured Fibers and Ultrafine Nanofibers Enhances Air Filtration Performance

Here, the poly (l-lactic acid) (PLLA) membrane with multi-structured networks (MSN) is successfully prepared by electrospinning technology for the first time. It is composed of micron-sized ribbon-structured fibers and ultrafine nanofibers with a diameter of tens of nanometers, and they are connected to form the new network structure. Thanks to the special fiber morphology and structure, the interception and electrostatic adsorption ability for against atmospheric particulate matter (PM) are significantly enhanced, and the resistance to airflow is reduced due to the "slip effect" caused by ultrafine nanofibers. The PLLA MSN membrane shows excellent filtration performance with ultra-high filtration efficiency (>99.9% for PM2.5 and >99.5% for PM0.3) and ultra-low pressure drop (≈20 Pa). It has demonstrated filtration performance that even exceeds current non-biodegradable polymer materials, laying the foundation for future applications of biodegradable PLLA in the field of air filtration. In addition, this new structure also provides a new idea for optimizing the performance of other polymer materials.

Predictors of seropositivity to SARS-CoV-2 among employees at a large urban medical center

BACKGROUND

Before SARS-CoV-2 vaccination availability, medical center employees were at high risk of COVID-19. However, risk factors for SARS-CoV-2 infection in medical center employees, both healthcare and non-healthcare workers, are poorly understood.

METHODS

From September-December 2020, free IgG antibody testing was offered to all employees at a large urban medical center. Participants were asked to complete a questionnaire on work and non-work related risk factors for COVID-19 infection.

RESULTS

SARS-CoV-2 seropositivity was found in 4.7%. Seropositivity was associated with close contact with COVID-19 cases with or without the use of adequate personal protective equipment (PPE), (OR 3.1 [95% CI 1.4-6.9] and OR 4.7 [95% CI 2.0-11.0] respectively), never wearing a mask outside of work (OR 10.1 [95% CI 1.9-57]), and Native Hawaiian/Pacific Islander race (OR 6.3 95% CI (1.6-25)].

CONCLUSIONS

Among workers in a large urban medical center, SARS-CoV-2 seropositivity was associated with work-related COVID-19 close contacts and low mask use outside of work, suggesting that non-workplace close contacts are also relevant routes of COVID-19 spread among healthcare workers.

Exploring pathogen population density as a metric for understanding post-COVID infectious disease surges

After the easing of COVID-19 restrictions, peaks of common infectious diseases surpassed pre-pandemic levels, raising questions about causes and ways to monitor these changes. A proposed measure, the Pathogen Population Density (PPD) score, could help track these shifts. PPD refers to the concentration of infectious agents within a population at a given time and location, serving as a potential indicator of infection levels in susceptible individuals at the population level. It is likely that PPD remains relatively stable within a specific community, as an equilibrium forms between infections and susceptibility. During the pandemic, nonpharmaceutical interventions (NPIs) led to a reduction in infectious diseases, possibly lowering population immunity and decreasing the PPD score. Once NPIs were lifted, the PPD score likely increased sharply due to a larger pool of susceptible individuals, causing more primary infections and stronger recurrent infections, faster transmission, and more severe pathogenic outcomes at the individual level. Monitoring the PPD score over time could help predict when infection peaks will occur. PPD is influenced by factors such as public health strategies, vaccination programs, and the behavior of high-risk individuals. As a quantitative measure, PPD has the potential to serve as a valuable predictive and monitoring tool, helping public health officials anticipate and track changes in infectious disease dynamics. It could be an effective tool for managing future outbreaks or pandemics and serve as a communication tool between scientists and the public to understand the emergence of new disease peaks.

Comparative study on the incidence of non-COVID-19 viral pneumonia before and after the COVID-19 pandemic: A retrospective analysis based on respiratory non-COVID viral nucleic acid results

Background

The impact of the coronavirus disease 2019 (COVID-19) pandemic on the etiology of non-COVID-19 viral pneumonia remains to be identified. We investigated the evolution of non-COVID-19 viral pneumonia in hospitalized patients before and after the COVID-19 pandemic.

Methods

This is a single-center retrospective study. Patients who came to West China Hospital of Sichuan University diagnosed with non-COVID-19 viral pneumonia from January 1, 2016 to December 31, 2021, were included and divided into pre- and post-COVID-19 groups according to the date of the COVID-19 outbreak in China. The results of 13 viral nucleic acid tests were compared between the two groups.

Results

A total of 5937 patients (3954 in the pre-COVID-19 group and 1983 in the post-COVID-19 group) were analyzed. Compared with the pre-COVID-19 group, the proportion of patients tested for respiratory non-COVID-19 viral nucleic acid was significantly increased in the post-COVID-19 group (14.78% vs. 22.79%, P <0.05). However, the non-COVID-19 virus-positive rates decreased from 37.9% to 14.6% after the COVID-19 outbreak (P < 0.001). Notably, non-COVID-19 viral pneumonia caused by the influenza A virus H1N1 (InfAH1N1) (2009) dropped to 0% after the pandemic. The top three viruses were InfAH1N1 (2009) (13.9%), human rhinovirus (7.4%), and human adenovirus (3.4%) in the pre-COVID-19 group, and human rhinovirus (3.8%), human respiratory syncytial virus (2.0%), human parainfluenza virus (1.1%) and InfAH3N2 (1.1%) in the post-COVID-19 group.

Conclusions

The proportion of non-COVID-19 viral pneumonia decreased significantly after the COVID-19 outbreak, among which InfAH1N1 (2009) pneumonia decreased the most dramatically.

Safety and efficacy of total one-day perioperative completion for inguinal hernia repair during the COVID-19 pandemic: a retrospective cohort study

Purpose

During the coronavirus disease 2019 (COVID-19) pandemic, frequent perioperative interactions between patients and medical staff increased the risk of nosocomial infections. Total 1-day perioperative completion (TODPC) involves conducting preoperative evaluations, performing the operation, and facilitating discharge within a single day. This study aimed to evaluate the safety of TODPC in reducing perioperative contact by utilizing online and telephone appointment systems for inguinal hernia (IH) repairs.

Methods

In this retrospective cohort study, we analyzed data from patients who underwent IH repairs. The study was divided into 2 periods relative to the COVID-19 pandemic: 18 months pre-pandemic (Group 1, September 2018-February 2020) and 18 months post-pandemic onset (Group 2, March 2020-August 2021). We compared the frequency of TODPC, daycare surgeries (which require hospital visits for preoperative evaluations and admission on the day of surgery), preoperative contacts, hernia types, incarcerations, organ resections, and instances of COVID-19 transmission among medical staff and patients.

Results

The study included 5,728 participants, comprising 4,614 pediatric and 1,114 adult patients. The rate of TODPC implementation was higher in Group 2 than in Group 1 (91.0% vs. 75.0%, P < 0.001). The incidence of organ resections was low and did not differ significantly between the 2 groups. Throughout the study, there were no reported nosocomial COVID-19 infections among patients, parents, caregivers, or medical staff.

Conclusion

TODPC for IH repair was a safe strategy for minimizing the need for organ resections and reducing the risk of mass COVID-19 infections during the pandemic period from March 2020 to August 2021.

Admission screening testing of patients and staff N95 respirators are cost-effective in reducing COVID-19 hospital-acquired infections

BACKGROUND

Coronavirus disease 2019 (COVID-19) outbreaks in acute care settings can have severe consequences for patients due to their underlying vulnerabilities, and can be costly due to additional patient bed-days and the need to replace isolating staff. This study assessed the cost-effectiveness of clinical staff N95 respirators and admission screening testing of patients to reduce COVID-19 hospital-acquired infections.

METHODS

An agent-based model was calibrated to data on 178 outbreaks in acute care settings in Victoria, Australia between October 2021 and July 2023. Outbreaks were simulated under different combinations of staff masking (surgical, N95) and patient admission screening testing [none, rapid antigen test (RAT), polymerase chain reaction]. For each scenario, average diagnoses, COVID-19 deaths, quality-adjusted life years from discharged patients, and costs (masks, testing, patient COVID-19 bed-days, staff replacement costs while isolating) from acute COVID-19 were estimated over a 12-month period.

FINDINGS

Compared with no admission screening testing and staff surgical masks, all scenarios were cost saving with health gains. Staff N95 respirators + RAT admission screening of patients was the cheapest scenario, saving A$78.4M [95% uncertainty interval (UI) 44.4M-135.3M] and preventing 1543 (95% UI 1070-2146) deaths state-wide per annum. Both interventions were individually beneficial: staff N95 respirators saved A$54.7M and 854 deaths state-wide per annum, while RAT admission screening of patients saved A$57.6M and 1176 deaths state-wide per annum.

INTERPRETATION

In acute care settings, staff N95 respirators and admission screening testing of patients can reduce hospital-acquired COVID-19 and COVID-19 deaths, and are cost saving because of reduced patient bed-days and staff replacement needs.

Functionalized Face Masks as Smart Wearable Sensors for Multiple Sensing

Wearable sensors provide continuous physiological information and measure deviations from healthy baselines, resulting in the potential to personalize health management and diagnosis of diseases. With the emergence of the COVID-19 pandemic, functionalized face masks as smart wearable sensors for multimodal and/or multiplexed measurement of physical parameters and biochemical markers have become the general population for physiological health management and environmental pollution monitoring. This Review examines recent advances in applications of smart face masks based on implantation of digital technologies and electronics and focuses on respiratory monitoring applications with the advantages of autonomous flow driving, enrichment enhancement, real-time monitoring, diversified sensing, and easily accessible. In particular, the detailed introduction of diverse respiratory signals including physical, inhalational, and exhalant signals and corresponding associations of health management and environmental pollution is presented. In the end, we also provide a personal perspective on future research directions and the remaining challenges in the commercialization of smart functionalized face masks for multiple sensing.

Recovering Valuable Chemicals from Polypropylene Waste via a Mild Catalyst-Free Hydrothermal Process

Waste polypropylene (PP) presents a significant environmental challenge, owing to its refractory nature and inert C-C backbone. In this study, we introduce a practical chemical recovery strategy from PP waste using a mild catalyst-free hydrothermal treatment (HT). The treatment converts 64.1% of the processed PP into dissolved organic products within 2 h in an air atmosphere at 160 °C. Higher temperatures increase the PP conversion efficiency. Distinct electron absorption and emission characteristics of the products are identified by spectral analysis. Fourier transform-ion cyclotron resonance-mass spectrometry (FT-ICR-MS) reveals the oxidative cracking of PP into shorter-chain homologues (10-50 carbon atoms) containing carboxylic and carbonyl groups. Density functional theory (DFT) calculations support a reaction pathway involving thermal C-H oxidation at the tertiary carbon sites in the polymer chain. The addition of 1% H2O2 further enhances the oxidation reaction to produce valuable short-chain acetic acids, enabling gram-scale recycling of both pure PP and disposable surgical masks from the real world. Techno-economic analysis (TEA) and environmental life cycle costing (E-LCC) analysis suggest that this hydrothermal oxidation recovery technology is financially viable, which shows significant potential in tackling the ongoing plastic pollution crisis and advancing plastic treatment methodologies toward a circular economy paradigm.

[Effect of non-pharmacological preventive measures on the incidence of respiratory and gastrointestinal pathologies]

OBJECTIVE

The use of non-pharmacological preventive measures during the COVID-19 pandemic has helped to reduce the incidence of multiple airborne or contact diseases. The objective of this paper was to evaluate the impact that all preventive measures have had on the transmission of different microorganisms, both by respiratory and contact transmission.

METHODS

We compared the incidence of different infectious episodes coded with the CIAP-2 code (International Classification of Primary Care second edition of the WONCA International Classification Committee) collected from the computerized history of primary care, both with respiratory tract and digestive tract involvement, in the period from March 2018 to February 2020 (pre-pandemic period) and from March 2020 to February 2022 (pandemic period). The data corresponded to the entire region, with an estimated average population for the four years of 650,000 people. The statistical treatment of the data consisted of a descriptive analysis with the calculation of absolute values and percentages. Rates were calculated and compared using data provided by the National Institute of Statistics as a denominator. The P was obtained by statistical comparison by the exact method. A comparison of rates was made.

RESULTS

The incidence in the number of CIAP-2 episodes studied, both corresponding to respiratory and gastrointestinal pathologies, comparing the period March 2018-February 2020 with the period March 2020-February 2022 decreased by 65.81%, from 534,439 cases to 182,707.

CONCLUSIONS

The preventive measures applied during the pandemic produce a significant decrease in pathology involving the respiratory or the digestive tract.

Longitudinal assessment of the impact of COVID-19 infection on mask-wearing behaviors

BACKGROUND

Wearing a mask was a crucial component in slowing the COVID-19 pandemic. However, little is known about the intersectionality between mask usage, risk perception, and infection. The purpose of this study was to investigate whether risk perceptions and masking behaviors are associated with contracting SARS-CoV-2 and how contracting SARS-CoV-2 subsequently changes masking behaviors in specific situations.

METHODS

This cohort study utilized survey data from the UC San Diego ZAP COVID-19 study (n = 1,230) to evaluate the risk of contracting SARS-CoV-2 in relation to baseline risk perceptions and masking behaviors in various situations and how contracting SARS-CoV-2 affects subsequent masking behavior.

RESULTS

We found that more consistent self-reported mask use in indoor public spaces (p = 0.03) and in other people's houses (p = 0.002) was associated with remaining free of SARS-CoV-2 infection. We also found that contracting SARS-CoV-2 was associated with a subsequent increase in mask use in other people's houses (p = 0.01).

CONCLUSIONS

Our findings suggest that consistent mask use is correlated with decreased infection and that contracting SARS-CoV-2 may modify mask use behaviors in high-risk situations. These findings may help inform future public health messaging for infectious disease prevention.

TRIAL REGISTRATION

This study has not been previously registered as it is an observational study. There was no pre-registration of the analytic plan for the present study.

Microstructure-dependent particulate filtration using multifunctional metallic nanowire foams

The COVID-19 pandemic has shown the urgent need for the development of efficient, durable, reusable and recyclable filtration media for the deep-submicron size range. Here we demonstrate a multifunctional filtration platform using porous metallic nanowire foams that are efficient, robust, antimicrobial, and reusable, with the potential to further guard against multiple hazards. We have investigated the foam microstructures, detailing how the growth parameters influence the overall surface area and characteristic feature size, as well as the effects of the microstructures on the filtration performance. Nanogranules deposited on the nanowires during electrodeposition are found to greatly increase the surface area, up to 20 m2 g-1. Surprisingly, in the high surface area regime, the overall surface area gained from the nanogranules has little correlation with the improvement in capture efficiency. However, nanowire density and diameter play a significant role in the capture efficiency of PM0.3 particles, as do the surface roughness of the nanowire fibers and their characteristic feature sizes. Antimicrobial tests on the Cu foams show a >99.9995% inactivation efficiency after contacting the foams for 30 seconds. These results demonstrate promising directions to achieve a highly efficient multifunctional filtration platform with optimized microstructures.

FFP2 induced breathing resistance does not affect metabolism and well-being during brisk walking and stair climbing - a randomized controlled trial

OBJECTIVES

N95 or Type II filtering face pieces (FFP2) are often worn during work hours or on public transportation to prevent airborne infection. The aim of this randomized controlled crossover study is to assess the impact of FFP2 induced breathing resistance on pulmonary function, blood gas values and discomfort during walking and stair climbing.

METHODS

N = 16 healthy adults (24.8 ± 2.2 years; 10 females, ) participated. Interventions included (1) six minutes of walking in a 16-meter-long hallway (612 m) and (2) eight minutes of stair climbing in a two-story staircase (420 stairs), both with and without a FFP2 (> 48 h wash-out). Spiroergometric data (Ventilation, breathing frequency, tidal volume, oxygen uptake and carbon dioxide exhalation (primary outcome), end tidal carbon dioxide- and oxygen pressure) and self-reported response (Perceived exertion, dyspnoea and pain) were assessed during activities. Blood gas analysis (capillary carbon dioxide- (pCO2) (primary outcome) and oxygen partial pressure (pO2), pH, lactate and base excess) was measured immediately after cessation of activities. Manipulation effects (FFP2 versus no mask) were tested using repeated measures analyses of variance.

RESULTS

Analysis showed no effect of FFP2 on pCO2 or other blood-gas parameters but on carbon dioxide exhalation during walking: (mean 1067, SD 209 ml/min) (mean 1908, SD 426 ml/min) (F(15) = 19.5; p < 0.001; ηp2 = 0.566) compared to no mask wearing (mean 1237, SD 173 ml/min; mean 1908, SD 426 ml/min). Ventilation was decreased and dyspnoea was increased by FFP2 during activities. FFP2 led to lower oxygen uptake and lower end tidal oxygen but higher end tidal carbon dioxide during stair climbing.

CONCLUSIONS

FFP2 decreased ventilation based on slower breathing patterns and led to limitations in pulmonary gas exchange and increased subjective dyspnoea. However, invasive diagnostics revealed no signs of clinically relevant metabolic effects immediately after everyday physical activities.

Epidemic modelling suggests that in specific circumstances masks may become more effective when fewer contacts wear them

BACKGROUND

The effectiveness of non-pharmaceutical interventions to control the spread of SARS-CoV-2 depends on many contextual factors, including adherence. Conventional wisdom holds that the effectiveness of protective behaviours, such as wearing masks, increases with the number of people who adopt them. Here we show in a simulation study that this is not always true.

METHODS

We use a parsimonious network model based on the well-established empirical facts that adherence to such interventions wanes over time and that individuals tend to align their adoption strategies with their close social ties (homophily).

RESULTS

When these assumptions are combined, a broad dynamic regime emerges in which the individual-level reduction in infection risk for those adopting protective behaviour increases as adherence to protective behaviour decreases. For instance, at 10 % coverage, we find that adopters face nearly a 30 % lower infection risk than at 60 % coverage. Based on surgical mask effectiveness estimates, the relative risk reduction for masked individuals ranges from 5 % to 15 %, or a factor of three. This small coverage effect occurs when the outbreak is over before the pathogen is able to invade small but closely knit groups of individuals who protect themselves.

CONCLUSIONS

Our results confirm that lower coverage reduces protection at the population level while contradicting the common belief that masking becomes ineffective at the individual level as more people drop their masks.

Knowledge and Practice of Precautions and Prevention of COVID-19 Among Adolescents in Umuahia, Nigeria: A Cross-Sectional Study

Background The coronavirus disease 2019 (COVID-19) pandemic has posed significant challenges worldwide, particularly in developing countries with limited healthcare resources. Among the various demographics, adolescents represent a crucial group in understanding and curbing the spread of the virus. Aim This research aims to assess the level of knowledge and practice of COVID-19 prevention measures among adolescents in a developing country. Methodology This study's descriptive cross-sectional study design was appropriate for capturing a snapshot of adolescents' understanding of COVID-19 in Umuahia, Abia State, Nigeria, a developing country. The study's participants were secondary school students in Umuahia's urban and rural secondary schools, aged 10-19. Fisher's formula was used to calculate the sample size. A multistage systematic sampling method was used to select 424 participants. Data were gathered using a self-administered questionnaire. The Statistical Package for the Social Sciences (SPSS) software version 25 (IBM SPSS Statistics, Armonk, NY) was used to handle and evaluate the data that had been obtained. Results All the respondents were aware of COVID-19, primarily informed through social media and television (TV). It is concerning that less than half correctly identify the disease as caused by a virus (46.9%), with some falsely attributing it to bacteria (31.1%) or fungi (15.6%). While the majority of respondents knew about the existence of COVID-19 vaccines, only 63.4% were aware that there was no definitive cure for the disease. The most worrying finding was the limited awareness and practice of recommended precautions to prevent the spread of COVID-19. Handwashing with soap and water, social distancing, and using hand sanitizers were the most frequently recognized precautions. However, even these were poorly practiced, with less than 30% of the respondents following them regularly. It was also noted that misconceptions about precautions exist, including unusual practices such as regularly drinking hot water or eating bitter kola/pepperfruit. Also, the most prominent reason for refusal among the respondents for COVID-19 vaccines was parental refusal, accounting for 57.5% of negative responses. Conclusion The study's findings underscore the urgent need for tailored, accessible, and effective health education strategies to improve adolescents' understanding and adoption of COVID-19 preventive measures in the region.

A Critical Analysis of All-Cause Deaths during COVID-19 Vaccination in an Italian Province

Immortal time bias (ITB) is common in cohort studies and distorts the association estimates between the treated and untreated. We used data from an Italian study on COVID-19 vaccine effectiveness, with a large cohort, long follow-up, and adjustment for confounding factors, affected by ITB, with the aim to verify the real impact of the vaccination campaign by comparing the risk of all-cause death between the vaccinated population and the unvaccinated population. We aligned all subjects on a single index date and considered the "all-cause deaths" outcome to compare the survival distributions of the unvaccinated group versus various vaccination statuses. The all-cause-death hazard ratios in univariate analysis for vaccinated people with 1, 2, and 3/4 doses versus unvaccinated people were 0.88, 1.23, and 1.21, respectively. The multivariate values were 2.40, 1.98, and 0.99. Possible explanations of this trend of the hazard ratios as vaccinations increase could be a harvesting effect; a calendar-time bias, accounting for seasonality and pandemic waves; a case-counting window bias; a healthy-vaccinee bias; or some combination of these factors. With 2 and even with 3/4 doses, the calculated Restricted Mean Survival Time and Restricted Mean Time Lost have shown a small but significant downside for the vaccinated populations.

Effectiveness and context dependency of social norm interventions: five field experiments on nudging pro-environmental and pro-social behavior

Social norm interventions hold the potential to change people's behavior. Five field experiments (N = 1,163) examined the effects of a simple and easily realizable social norm nudge based on the social media format "Be like Bill." The nudge consisted of a stick figure named Toni that communicated descriptive and injunctive norms regarding pro-environmental or pro-social behaviors. Nudge conditions were compared to no-intervention control conditions. Experiment 1 (N = 179) focused on paper towel consumption in a women's restroom at a German university. The nudge condition used less paper towels than the control condition, d = 0.48. Experiment 2 (N = 183) replicated this result (d = 0.32) in a more diverse setting of a women's restroom at a German Christmas market. Experiment 3 (N = 250) examined differences in the effects of prescriptive (i.e., 'do-norm') versus proscriptive (i.e., 'do not-norm') social norms on paper towel consumption again in a university women's restroom. The effectiveness of both social norm nudge conditions was shown in comparison to the control condition (d = 0.46; d = 0.40), while the prescriptive and proscriptive social norm manipulations did not differ. Experiment 4 (N = 206) applied the nudging approach to the use of plastic lids in a coffee shop, where no effect was found. Finally, Experiment 5 (N = 345) focused on the pro-social behavior of mask wearing in a bakery toward the end of the Covid-19 pandemic restrictions in Germany. In the nudge condition, more visitors put on face masks compared to the control group, d = 0.39. Limitations and contextual factors regarding the applicability of our social norm nudge are discussed.

Analyzing evolutionary game theory in epidemic management: A study on social distancing and mask-wearing strategies

When combating a respiratory disease outbreak, the effectiveness of protective measures hinges on spontaneous shifts in human behavior driven by risk perception and careful cost-benefit analysis. In this study, a novel concept has been introduced, integrating social distancing and mask-wearing strategies into a unified framework that combines evolutionary game theory with an extended classical epidemic model. To yield deeper insights into human decision-making during COVID-19, we integrate both the prevalent dilemma faced at the epidemic's onset regarding mask-wearing and social distancing practices, along with a comprehensive cost-benefit analysis. We explore the often-overlooked aspect of effective mask adoption among undetected infectious individuals to evaluate the significance of source control. Both undetected and detected infectious individuals can significantly reduce the risk of infection for non-masked individuals by wearing effective facemasks. When the economical burden of mask usage becomes unsustainable in the community, promoting affordable and safe social distancing becomes vital in slowing the epidemic's progress, allowing crucial time for public health preparedness. In contrast, as the indirect expenses associated with safe social distancing escalate, affordable and effective facemask usage could be a feasible option. In our analysis, it was observed that during periods of heightened infection risk, there is a noticeable surge in public interest and dedication to complying with social distancing measures. However, its impact diminishes beyond a certain disease transmission threshold, as this strategy cannot completely eliminate the disease burden in the community. Maximum public compliance with social distancing and mask-wearing strategies can be achieved when they are affordable for the community. While implementing both strategies together could ultimately reduce the epidemic's effective reproduction number ([Formula: see text]) to below one, countries still have the flexibility to prioritize either of them, easing strictness on the other based on their socio-economic conditions.

Please wear a mask: a systematic case for mask wearing mandates

This paper combines considerations from ethics, medicine and public health policy to articulate and defend a systematic case for mask wearing mandates (MWM). The paper argues for two main claims of general interest in favour of MWM. First, MWM provide a more effective, just and fair way to tackle the ongoing COVID-19 pandemic than policy alternatives such as laissez-faire approaches, mask wearing recommendations and physical distancing measures. And second, the proffered objections against MWM may justify some exemptions for specific categories of individuals, but do not cast doubt on the justifiability of these mandates. Hence, unless some novel decisive objections are put forward against MWM, governments should adopt MWM.

Masks and respirators for prevention of respiratory infections: a state of the science review

SUMMARYThis narrative review and meta-analysis summarizes a broad evidence base on the benefits-and also the practicalities, disbenefits, harms and personal, sociocultural and environmental impacts-of masks and masking. Our synthesis of evidence from over 100 published reviews and selected primary studies, including re-analyzing contested meta-analyses of key clinical trials, produced seven key findings. First, there is strong and consistent evidence for airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory pathogens. Second, masks are, if correctly and consistently worn, effective in reducing transmission of respiratory diseases and show a dose-response effect. Third, respirators are significantly more effective than medical or cloth masks. Fourth, mask mandates are, overall, effective in reducing community transmission of respiratory pathogens. Fifth, masks are important sociocultural symbols; non-adherence to masking is sometimes linked to political and ideological beliefs and to widely circulated mis- or disinformation. Sixth, while there is much evidence that masks are not generally harmful to the general population, masking may be relatively contraindicated in individuals with certain medical conditions, who may require exemption. Furthermore, certain groups (notably D/deaf people) are disadvantaged when others are masked. Finally, there are risks to the environment from single-use masks and respirators. We propose an agenda for future research, including improved characterization of the situations in which masking should be recommended or mandated; attention to comfort and acceptability; generalized and disability-focused communication support in settings where masks are worn; and development and testing of novel materials and designs for improved filtration, breathability, and environmental impact.

Risk of Severe Acute Respiratory Syndrome Coronavirus 2 Transmission in Seoul, Korea

BACKGROUND

The risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission during the endemic phase may vary from that during the previous pandemic phase. We evaluated the risk of infection in a general population with laboratory-confirmed coronavirus disease 2019 (COVID-19) in a community setting in Korea.

MATERIALS AND METHODS

This study included 1,286 individuals who had been in contact with an index COVID-19 case between January 24, 2020, and June 30, 2022. Variables such as age, sex, nationality, place of contact, level of contact, the status of exposed cases, period, and level of mask-wearing were assessed.

RESULTS

Among 1,286 participants, 132 (10.30%) were confirmed to have COVID-19. With increasing age, the risk of the exposed persons contracting COVID-19 from index cases tended to increase (P <0.001), especially for people in their 70s (odds ratio, 1.24; 95% confidence interval, 1.11-1.40; P <0.001). We found an increasing trend in the risk of a COVID-19 exposed case becoming a secondary infection case (P <0.001) in long-term care facilities where the attack rate was high.

CONCLUSION

The risk of COVID-19 transmission is high in long-term care facilities where many older adults reside. Intensive management of facilities at risk of infection and strict mask-wearing of confirmed COVID-19 cases are necessary to prevent the risk of COVID-19 infection.

Children's experiences of mask-wearing: a systemic review and narrative synthesis

RATIONALE

Masks have been widely used as a preventative tool during the COVID-19 pandemic. However, the use of masks by children has been controversial, with international guidelines recommending a risk-based approach to national policymakers.

AIMS AND OBJECTIVES

We aimed to conduct a systematic review that explores children's experiences of mask-wearing, drawing on an evidence base that describes mask-wearing in different contexts including air pollution, and to prevent the spread of infectious disease.

METHODS

We searched MEDLINE, Embase and PsycINFO in June 2021, with repeat searches in August 2022 and January 2024, for primary research studies exploring children's experiences of masks. Included studies reported on participants between 4 and 14 years (inclusive), with no restrictions on language where an English translation was available. Two reviewers independently screened titles and abstracts and reviewed full texts, with discrepancies resolved by a third reviewer. We used the Mixed Methods Appraisal Tool for quality appraisal and narrative synthesis to identify key findings. We also conducted stakeholder consultation (Patient and Public Involvement (PPI)) with nine children, where they submitted annotated drawings of their preferred masks to complement our review findings.

RESULTS

We screened 982 titles and abstracts and reviewed 94 full texts. 45 studies were included in the synthesis. Children's experiences of mask-wearing were influenced by their perceived necessity, social norms around their use and parental attitudes. Challenges related to mask-wearing were described, including difficulty reading facial expressions and physical discomfort. Children found it easier to wear masks when sitting and in cooler environments, and they benefited from unmasking during outdoor break time at school. As part of the PPI consultation, children highlighted the importance of mask design and the environmental impact of masks.

CONCLUSION

Children's experiences of mask-wearing were varied and context-dependent, with several mask-design challenges raised. Future policy on mask-wearing needs to consider the context in which mask-wearing would be most beneficial, and how local adaptations to policy can respond to children's needs.