Mask crisis during the COVID-19 outbreak

Biosurfactant-capped CuO nanoparticles coated cotton/polypropylene fabrics toward antimicrobial textile applications

The global COVID-19 pandemic has led to an increase in the importance of implementing effective measures to prevent the spread of microorganisms. Consequently, there is a growing demand for antimicrobial materials, specifically antimicrobial textiles and face masks, because of the surge in diseases caused by bacteria and viruses like SARS-CoV-2. Face masks that possess built-in antibacterial properties can rapidly deactivate microorganisms, enabling reuse and reducing the incidence of illnesses. Among the numerous types of inorganic nanomaterials, copper oxide nanoparticles (CuO NPs) have been identified as cost-effective and highly efficient antimicrobial agents for inactivating microbes. Furthermore, biosurfactants have recently been recognized for their potential antimicrobial effects, in addition to inorganic nanoparticles. Therefore, this research's primary focus is synthesizing biosurfactant-mediated CuO NPs, integrating them into natural and synthetic fabrics such as cotton and polypropylene and evaluating the resulting fabrics' antimicrobial activity. Using rhamnolipid (RL) as a biosurfactant and employing a hydrothermal method with a pH range of 9-11, RL-capped CuO NPs are synthesized (RL-CuO NPs). To assess their effectiveness against gram-positive (Staphylococcus aureus) and gram-negative (Escherichia coli) microorganisms, the RL-CuO NPs are subjected to antibacterial testing. The RL-capped CuO NPs exhibited antimicrobial activity at much lower concentrations than the individual RL, CuO. RL-CuO NPs have shown a minimum inhibitory concentration (MIC) of 1.2 mg ml-1and minimum bactericidal concentration (MBC) of 1.6 mg ml-1forE. coliand a MIC of 0.8 mg ml-1and a MBC of 1.2 mg ml-1forS. aureus, respectively. Furthermore, the developed RL-CuO NPs are incorporated into cotton and polypropylene fabrics using a screen-printing technique. Subsequently, the antimicrobial activity of the coated fabrics is evaluated, revealing that RL-CuO NPs coated fabrics exhibited remarkable antibacterial properties against both gram-positive and gram-negative bacteria.

Evolution of psychopathology, purpose in life, and moral courage in healthcare workers during the COVID-19 pandemic: a longitudinal study

Introduction

Almost 2 years and five infection waves after the COVID-19 pandemic started, healthcare workers continued dealing with the pandemic situation and facing the health consequences and the mental health disorders it caused. This study aimed to evaluate the onset and progression of psychopathology as well as the role of predictor variables such as purpose in life and moral courage among healthcare workers during this time.

Materials and methods

This was a longitudinal prospective study carried out with 45 Spanish healthcare workers who answered two questionnaires, the first questionnaire in April-May 2020 (T1) and the second questionnaire in September-October 2021 (T2).

Results

Although 29.5% of the sample considered that their mental health had improved over this time, almost half of them (47.7%) said it had not changed, while 22.7% reported a decline in their mental health from the first time they were asked. Specifically, 46.8% presented anxiety, 23.4% depression, and 42.6% acute stress at T1, and 38.3% had anxiety, 17% depression, and 27.7% post-traumatic stress disorder at T2. Despite this, there were no differences between T1 and T2 anxiety scores (p = 0.53), although there was a decrease in depression (p = 0.03) and acute stress (p = 0.02) scores. Predictor variable outcomes such as purpose in life (p = 0.88) and moral courage (p = 0.86; p = 0.38) did not change over time, but when modelling the data, purpose in life predicted psychopathology at T1, which in turn affected the psychopathology results at T2.

Conclusion

This study showed that, although psychopathology decreased over the months, its prevalence remained high. Even though the purpose in life predicted psychopathology at T1, it seems that once the psychopathology is established (T2), the factors that would improve it would be different from the protective factors that prevented its establishment, which become secondary.

Advanced Plasmonic Nanoparticle-Based Techniques for the Prevention, Detection, and Treatment of Current COVID-19

Coronavirus is an ongoing global pandemic caused by severe acute respiratory syndrome coronavirus 2. Coronavirus disease 2019 known as COVID-19 is the worst pandemic since World War II. The outbreak of COVID-19 had a significant repercussion on the health, economy, politics, and environment, making coronavirus-related issues more complicated and becoming one of the most challenging pandemics of the last century with deadly outcomes and a high rate of the reproduction number. There are thousands of different types - or variants - of COVID circulating across the world. Viruses mutate all the time; it emphasizes the critical need for the designing of efficient vaccines to prevent virus infection, early and fast diagnosis, and effective antiviral and protective therapeutics. In this regard, the use of nanotechnology offers new opportunities for the development of novel strategies in terms of prevention, diagnosis, and treatment of COVID-19. This review presents an outline of the platforms developed using plasmonic nanoparticles in the detection, treatment, and prevention of SARS-CoV-2. We select the best strategies in each of these approaches. The properties of metallic plasmon NPs and their relevance in the development of novel point-of-care diagnosis approaches for COVID-19 are highlighted. Also, we discuss the current challenges and the future perspectives looking towards the clinical translation and the commercial aspects of nanotechnology and plasmonic NP-based diagnostic tools and therapy to fight COVID-19 pandemic. The article could be of significance for researchers dedicated to developing suitable plasmonic detection tools and therapy approaches for COVID-19 viruses and future pandemics.

Comparison of toxicity and cellular responses following pulmonary exposure to different types of nanofibers

Pulmonary effects of inhaled microfibers are an emerging public health concern. In this study, we investigated toxicity following pulmonary exposure to synthetic polyethylene oxide fibroin (PEONF) and silk fibroin (SFNF) nanofibers and the cellular responses. When instilled intratracheally weekly for four weeks, body weight gain was significantly reduced in female mice exposed to the higher dose of SFNF when compared with the control group. The total number of cells in the lungs was more significant in all treated groups than in the control, whereas the relative portion of neutrophils and eosinophils increased significantly only in female mice exposed to SFNF. Both types of nanofibers induced notable pathological changes and increased pulmonary expression of MCP-1α, CXCL1, and TGF-β. More importantly, blood calcium, creatinine kinase, sodium, and chloride concentration were affected significantly, showing sex- and material-dependent differences. The relative portion of eosinophils increased only in SFNF-treated mice. In addition, both types of nanofibers induced necrotic and late apoptotic cell death in alveolar macrophages after 24 h of exposure, with accompanying oxidative stress, increased NO production, cell membrane rupture, intracellular organelle damage, and intracellular calcium accumulation. Additionally, multinucleated giant cells were formed in cells exposed to PEONF or SFNF. Taken together, the findings indicate that inhaled PEONF and SFNF may cause systemic adverse health effects with lung tissue damage, showing differences by sex- and material. Furthermore, PEONF- and SFNF-induced inflammatory response may be partly due to the low clearance of dead (or damaged) pulmonary cells and the excellent durability of PEONF and SFNF.

Effect of UV-C germicidal irradiation (UVGI) on the structural integrity of N95 and KN95 respirators

This study focuses on reprocessing a group of filtering facepiece respirators (FFR) using ultraviolet germicidal irradiation (UVGI). The aim is to explore the possibility of disinfecting selected KN95 FFRs, in comparison with the N95 FFRs, and assess their viability for reusage. For this purpose, five models of unused N95 and KN95 FFR models obtained from the hospital were exposed to UV-C light using a customized UVGI chamber. The material integrity of treated FFRs was examined in terms of particle penetration and strap tension. The surface morphology of all models is inspected to determine the visible changes of each FFR upon exposure to 1-100 cycles (1 cycle is equivalent to 1 J/cm² UV dose). The penetration test results indicate that the physical properties of the KN95 and N95 FFRs remain within permissible limits despite being reprocessed by up to 100 cycles (100 J/cm²). Using a microscope, the physical observations also reveal that no visible damage can be seen even after 100 J/cm² exposure. Apart from the filter bodies, the tension of each strap was also found to not be significantly affected by UV radiation by at least 10 disinfection cycles (10 J/cm²). This confirms that KN95, as well as N95 FFRs, can be subjected to UV treatment as a means of disinfection.

Personal Protection Equipment and Infection Control Procedures among Health Workers during the COVID-19 Pandemic

Health workers have been particularly affected by the COVID-19 pandemic, but it is unclear which healthcare professions are more exposed. We search for information that can help identify health workers who are employed in exposure-prone professions and who, therefore, routinely wear and adopt strict infection control equipment and measures from other colleagues. Our purpose is to test the hypothesis that health professionals historically considered less exposure-prone are affected more severely by COVID-19. Taking dentists as an example of exposure-prone healthcare professionals, this study aims to analyze data on COVID-19-related deaths reported by the Italian board of doctors and dentists’ database to evaluate the number of COVID-19-related deaths of doctors and dentists in Italy from the beginning of the pandemic to 31 December 2022. As of 31 December 2021, out of 364 deaths, 38 were dentists, and of the remaining 326 doctors, 140 were general practitioners (GPs). The percentage of deaths among dentists, total doctors and GPs results in 0.06%, 0.09% and 0.33%, respectively, for the whole sample. Excluding subjects over 70 years of age, the corresponding values are 0.05%, 0.06% and 0.25%. Most of the deaths occurred in Lombardia, and the geographical distribution overlaps the trend of the corresponding general Italian population. Considering the outcome of “death”, dentists, despite being at high risk, are not particularly affected by COVID-19.

Nanotechnology Role Development for COVID-19 Pandemic Management

The global outbreak of coronavirus disease has sent an ominous message to the field of innovative and advanced technology research and development (COVID-19). To accomplish this, convectional technology and recent discoveries can be combined, or new research directions can be opened up using nanotechnology. Nanotechnology can be used to prevent, diagnose, and treat SARS-CoV-2 infection. As the pandemic spreads, a thorough examination of nanomaterials' role in pandemic response is highly desirable. According to this comprehensive review article, nanotechnology can be used to prevent, diagnose, and treat COVID-19. This research will be extremely useful during the COVID-19 outbreak in terms of developing rules for designing nanostructure materials to combat the outbreak.

Are used face masks handled as infectious waste? Novel pollution driven by the COVID-19 pandemic

The extensive use of face masks has raised concerns about environmental pollution through improper disposal of used face masks after the emergence of COVID-19. The increasing use of PPEs to preventing the spread of COVID-19 has resulted in several environmental hazards, creating a new environmental barrier for solid waste management and worsened plastic pollution. This study aimed at assessing the occurrence and distribution of face masks in a metropolitan (Adum – Kumasi), municipal (Ejisu), community (Abenase) and an institution (KNUST) in Ghana. The study showed that a total of 535 face masks were numerated along a stretch of 1,720 m with a density ranging from 0.04 m to 0.42 m. A no significant relationship (P = 0.602) was established between the observation distances and the number of waste face masks numerated. The study also showed that for a 1% increase in the number of face masks on working days, there would be a 0.775% increase in non-working days. A review of literature showed that the disposal of used face masks results in the release of micro- and nano-plastics, Pb, Cu, Sb, Zn, Mn, Ti, Fe and Ca into environmental media. Plastic pollution may be a concern to ecosystems due to its persistence in the environment, lack of environmental awareness, sensitization and education, and poor waste management systems. To ensure a sustainable management of waste face masks, significant efforts are needed. These may include proper disposal, redesigning and producing masks from biodegradable materials, incorporating waste face masks into construction materials, and recycling PPE by pyrolyzing are suggested options for the effective management of face masks.

How to Optimize the Allocation of Anti-epidemic Materials in Public Health Emergencies From the Perspective of Public Economics

During the COVID-19 public health crisis, market failures such as shortage of supplies and soaring prices of anti-epidemic materials – with masks as the core – have occurred. In essence, such anti-epidemic materials have the dual nature of necessities with low elasticity of demand and private products with positive externalities. This research explores the understanding of anti-pandemic materials and how different initiatives, and evaluation to increase availability of necessary resources can be effective in curbing a pandemic. Market regulation results in a non-Pareto optimal allocation of resources and the difficulty of exerting the positive externalities of products. However, in China, the market failure of anti-epidemic materials was quickly resolved, due to the institutional advantages of socialism with Chinese characteristics, the social responsibility drive of domestic enterprises, and cultural genes that focus on equity and concern for the disadvantaged. The optimal allocation of anti-epidemic materials gave access to exerting efficiency and fairness effects, positive external effects, and public effects.

Facemasks and ferrous metallurgy: improving gasification reactivity of low-volatile coals using waste COVID-19 facemasks for ironmaking application

The global pandemic response to COVID-19 has led to the generation of huge volumes of unrecyclable plastic waste from single use disposable face coverings. Rotary hearth furnaces can be used to recover Zn and Fe from non-recyclable steelmaking by-product dusts, and waste plastic material such as facemasks could be utilized as a supplementary reductant for the rotary hearth furnace (RHF), but their fibrous form makes milling and processing to appropriate sizing for RHF application extremely challenging. A scalable method of grinding facemasks to powder by melting and mixing with Welsh coal dust reported herein provides a solution to both environmental challenges. The melt-blended PPE/coal dust shows a dramatically improved CO₂ gasification reactivity (E_a = 133-159 kJmol^-1) when compared to the untreated coal (E_a = 183-246 kJmol^-1), because of improved pore development in the coal during the pyrolysis stage of heating and the catalytic activity of the CaO based ash present in the facemask plastic. The results are promising for the application of waste facemasks in recycling steelmaking by-product dusts in rotary hearth furnaces and may also be suitable for direct injection to the blast furnace subject to further study.

The Association Between Facial Dermatosis and Face-Mask Wearing During COVID-19 in Saudi Arabia

Background: During the coronavirus pandemic of 2019, there has been an upsurge in the number of reported cases of facial dermatosis caused by face masks wearing within the general population. Face mask-induced facial dermatosis has been investigated previously in healthcare workers without involving the general population. However, as a precautionary measure against the coronavirus disease 2019 (COVID-19) pandemic, wearing a face mask has become mandatory for the general population, similar to healthcare workers. 

Objective: To measure the prevalence of COVID-19 pandemic-induced facial dermatosis. Also, to determine the type of face mask used that causes the most facial dermatosis and the association between prolonged usage of face masks and facial dermatosis in Western Saudi Arabia's population.

Methods: The study covers the Western region of Saudi Arabia. A self-administered Google survey was shared on social media. The study used prior surveys from similar studies. The data collection included participants’ demographic information, pre-existing skin conditions, mask type, and mask-related skin conditions. The data were analyzed using the statistical package for the social sciences (SPSS) version 20.0 (IBM Corp., Armonk, NY).

Results: The median age was 30 years (interquartile range {IQR} 23-43). Females represented 65.5% of our sample. Face mask-wearing was associated with skin changes in 41.7% of the population. The most common skin condition associated with mask use was pimples and pustules representing 28.7%, of which the most common site was on the cheeks 31.4%. Acne vulgaris was the most common pre-existing skin condition, affecting 8.7% of the total population. Of the total, 46.2% experienced an exacerbation of their pre-existing skin condition with or after wearing masks. Skin changes were significantly associated with skin type and duration of wearing the mask (P<0.001).

Conclusion: The prevalence of facial mask-induced facial dermatosis is 41.7% of the general population in which surgical mask was responsible for most cases. In addition, there is a strong association between the duration of wearing the mask and facial dermatosis.

COVID-19 in Low- and Middle-Income Countries (LMICs): A Narrative Review from Prevention to Vaccination Strategy

The management of the COVID-19 pandemic represents a challenging process, especially for low- and middle-income countries (LMICs) due to the serious economic and health resource problems it generates. In this article, we assess COVID-19 situation in LMICs and outline emerging problems and possible solutions. The prevention and control of COVID-19 would be based on focused tests exploiting those systems (e.g., GeneXpert^®) already used in other scenarios. This would be less stressful for the healthcare system in LMICs. Avoiding close contact with people suffering from acute respiratory infections, frequent handwashing, and avoiding unprotected contact with farm or wild animals are recommended infection control interventions. The appropriate use of personal protective equipment (PPE) is required, despite its procurement being especially difficult in LMICs. Patients’ triage should be based on a simple and rapid logarithm to decide who requires isolation and targeted testing for SARS-CoV-2. Being able to estimate which patients will develop severe disease would allow hospitals to better utilize the already limited resources more effectively. In LMICs, laboratories are often in the capital cities; therefore, early diagnosis and isolation become difficult. The number of ICU beds is often insufficient, and the equipment is often old and poorly serviced. LMICs will need access to COVID-19 treatments at minimal prices to ensure that all who need them can be treated. Year-to-date, different vaccines have been approved and are currently available. The main obstacle to accessing them is the limited ability of LMICs to purchase significant quantities of the vaccine.

Unmasking People’s Opinions behind Mask-Wearing during COVID-19 Pandemic—A Twitter Stance Analysis

Wearing a mask by the general public has been a controversial issue from the beginning of the COVID-19 pandemic as the public authorities have had mixed messages, either advising people not to wear masks if uninfected, to wear as a protective measure, to wear them only when inside a building/room with insufficient air flow or to wear them in all the public places. To date, the governments have had different policies regarding mask-wearing by the general public depending on the COVID-19 pandemic evolution. In this context, the paper analyzes the general public’s opinion regarding mask-wearing for the one-year period starting from 9 January 2020, when the first tweet regarding mask-wearing in the COVID-19 context has been posted. Classical machine learning and deep learning algorithms have been considered in analyzing the 8,795,633 tweets extracted. A random sample of 29,613 tweets has been extracted and annotated. The tweets containing news and information related to mask-wearing have been included in the neutral category, while the ones containing people’s opinions (for or against) have been marked using a symmetrical approach into in favor and against categories. Based on the analysis, it has been determined that most of the mask tweets are in the area of in favor or neutral, while a smaller percentage of tweets and retweets are in the against category. The evolution of the opinions expressed through tweets can be further monitored for extracting the public perspective on mask-wearing in times of COVID-19.

Lessons learned in preventing COVID-19 within a skilled nursing facility during the early pandemic

Objective

Guided by the vulnerable population framework, the aim was to describe the risks and protective strategies for COVID-19 spread and infections in a Skilled Nursing Facility (SNF).

Method

We conducted a retrospective cohort (March 1st–August 31st, 2020) study. Data were collected from internal COVID-19 documents and resident electronic health records. Data were summarized and analyzed using descriptive statistics, relative risk calculations, and cases charted by week onset.

Results

There were 325 residents who lived in and 296 staff who worked at the SNF during the study period. There was a total of 2 confirmed cases among residents and 4 confirmed cases among staff. Cases were isolated and all were living at their baseline health status at the end of the study.

Conclusion

Understanding the vulnerability to and protective strategies for COVID-19 within SNFs could strengthen resident care, resiliency among the SNF community, and improve health policies.

The Influence of Family Function on State Anxiety of Chinese College Students During the Epidemic of COVID-19

The Coronavirus Disease 2019 (COVID-19) may affect mental health. There is little research about the influence of family function on the state anxiety of college students in the context of the global pandemic. The study aimed to clarify that generalized anxiety disorder (GAD) and trait anxiety had mediating effects in family function on the state anxiety of Chinese college students following the "stay-at-home" order during the outbreak of COVID-19. This cross-sectional study was conducted online with 1,039 respondents. We analyzed demographics, The State-Trait Anxiety Inventory (ST-AI) and Chinese Family Function Scale (FAD-18), Generalized Anxiety Disorder-7 (GAD-7), and used path analysis to discuss the influence of family function on state and trait anxiety. The results showed that female students' state and trait anxiety was higher than that of male students (P < 0.05). Medical students' state and trait anxiety was lower than that of literature students (P < 0.05). The GAD of the male was lower compared with the female. The score of family function has significant differences in gender, age, education, and region (P < 0.05). Gender, family function, state anxiety, trait anxiety, and GAD relate to others (r = 0.07∼0.85, p < 0.05). The results of fit indices for measurement invariance models showed that the impact of family function among GAD, state and trait anxiety across gender is significantly different (each step p < 0.05). GAD and trait anxiety had a complete meditating effect between family function and state anxiety (the proportion of standard indirect mediating effect was 24.94% in females and 36.79% in males). A healthy family function may alleviate GAD and anxiety of college students during the COVID-19 pandemic.

Recent Progress in Nanotechnology for COVID-19 Prevention, Diagnostics and Treatment

The COVID-19 pandemic is currently an unprecedented public health threat. The rapid spread of infections has led to calls for alternative approaches to combat the virus. Nanotechnology is taking root against SARS-CoV-2 through prevention, diagnostics and treatment of infections. In light of the escalating demand for managing the pandemic, a comprehensive review that highlights the role of nanomaterials in the response to the pandemic is highly desirable. This review article comprehensively discusses the use of nanotechnology for COVID-19 based on three main categories: prevention, diagnostics and treatment. We first highlight the use of various nanomaterials including metal nanoparticles, carbon-based nanoparticles and magnetic nanoparticles for COVID-19. We critically review the benefits of nanomaterials along with their applications in personal protective equipment, vaccine development, diagnostic device fabrication and therapeutic approaches. The remaining key challenges and future directions of nanomaterials for COVID-19 are briefly discussed. This review is very informative and helpful in providing guidance for developing nanomaterial-based products to fight against COVID-19.

Association between COVID-19 outcomes and mask mandates, adherence, and attitudes

We extend previous studies on the impact of masks on COVID-19 outcomes by investigating an unprecedented breadth and depth of health outcomes, geographical resolutions, types of mask mandates, early versus later waves and controlling for other government interventions, mobility testing rate and weather. We show that mask mandates are associated with a statistically significant decrease in new cases (-3.55 per 100K), deaths (-0.13 per 100K), and the proportion of hospital admissions (-2.38 percentage points) up to 40 days after the introduction of mask mandates both at the state and county level. These effects are large, corresponding to 14% of the highest recorded number of cases, 13% of deaths, and 7% of admission proportion. We also find that mask mandates are linked to a 23.4 percentage point increase in mask adherence in four diverse states. Given the recent lifting of mandates, we estimate that the ending of mask mandates in these states is associated with a decrease of -3.19 percentage points in mask adherence and 12 per 100K (13% of the highest recorded number) of daily new cases with no significant effect on hospitalizations and deaths. Lastly, using a large novel survey dataset of 847 thousand responses in 69 countries, we introduce the novel results that community mask adherence and community attitudes towards masks are associated with a reduction in COVID-19 cases and deaths. Our results have policy implications for reinforcing the need to maintain and encourage mask-wearing by the public, especially in light of some states starting to remove their mask mandates.

COVID-19 and the digestive system: A comprehensive review

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is spreading at an alarming rate, and it has created an unprecedented health emergency threatening tens of millions of people worldwide. Previous studies have indicated that SARS-CoV-2 ribonucleic acid could be detected in the feces of patients even after smear-negative respiratory samples. However, demonstration of confirmed fecal-oral transmission has been difficult. Clinical studies have shown an incidence rate of gastrointestinal (GI) symptoms ranging from 2% to 79.1% in patients with COVID-19. They may precede or accompany respiratory symptoms. The most common GI symptoms included nausea, diarrhea, and abdominal pain. In addition, some patients also had liver injury, pancreatic damage, and even acute mesenteric ischemia/thrombosis. Although the incidence rates reported in different centers were quite different, the digestive system was the clinical component of the COVID-19 section. Studies have shown that angiotensin-converting enzyme 2, the receptor of SARS-CoV-2, was not only expressed in the lungs, but also in the upper esophagus, small intestine, liver, and colon. The possible mechanism of GI symptoms in COVID-19 patients may include direct viral invasion into target cells, dysregulation of angiotensin-converting enzyme 2, immune-mediated tissue injury, and gut dysbiosis caused by microbiota. Additionally, numerous experiences, guidelines, recommendations, and position statements were published or released by different organizations and societies worldwide to optimize the management practice of outpatients, inpatients, and endoscopy in the era of COVID-19. In this review, based on our previous work and relevant literature, we mainly discuss potential fecal-oral transmission, GI manifestations, abdominal imaging findings, relevant pathophysiological mechanisms, and infection control and prevention measures in the time of COVID-19.

The Dilemma of Masks During the COVID-19 Outbreak

Background

Many people have experienced novel coronavirus pneumonia since the beginning of the COVID-19 pandemic in Wuhan, China. The Chinese government has encouraged people to wear face masks in public places; however, due to the large population, there may be a series of problems related to this recommendation, including shortages of masks and lack of an optimal disposal method for used masks.

Objective

The purpose of this study is to understand the current status of mask shortages and used masks in China.

Methods

A questionnaire survey was designed to assess the current status of mask shortages and used masks. The differences among groups were analyzed with chi-square tests.

Results

The constituent ratio of those who reuse masks was 61%. Obtaining masks from the drugstore was reported to be very difficult due to high demand and short supply, and approximately 1/3 of the respondents purchased expensive masks. Most people know how to properly handle used masks, and only 7% of them casually discard masks. However, 50% of respondents have seen others throw away used masks at will. A further subgroup analysis showed that respondents in Central China tended to use masks repeatedly, as did medical personnel. Females, people living in the central region, and medical personnel may find it more difficult to purchase masks in drugstores. Non-medical personnel may be more likely to buy expensive masks. Females, people living in the western region, and medical personnel may be more likely to know how to properly handle used masks and not to discard used masks at will. Medical personnel may be more likely to observe others discarding used masks at will.

Conclusion

In response to COVID-19, the public should be encouraged to use face masks and are advised not to reuse or throw away masks at will due to safety concerns.

Organisation and timeline of measures in French psychiatric establishments during the first wave of the COVID-19 epidemic: EvOlu'Psy study

BACKGROUND

The onset of COVID-19 required rapid organisational changes in the mental health domain. Most mental health-care departments appear to have set up infection control measures and also organised planning, coordination and measures that enabled them to provide psychiatric care in a restrictive environment. Our objective was to assess the organisation by psychiatric facilities in France of their response to COVID-19, during the first wave.

METHODS

In June 2020, a cross-sectional study was performed by an audit with 48 items which was proposed to 331 hospitals in metropolitan France with a capacity for full-time, that is, inpatient psychiatric hospitalisation of adults.

RESULTS

Of the 331 establishments contacted, 94 (28.4%) agreed to respond to the survey questionnaire. Full-time inpatient hospitalisation was completely or partially maintained by 94.7% (n = 89) of facilities. Specific measures concerning respect for patients' rights were reported by 58% (n = 55) of establishments. Overall, 74.5% (n = 70) had set up a dedicated channel of care for patients at risk of severe COVID-19, and 52.1% (n = 49) a system for routine screening at admission for these risk factors. Nearly half the establishments (48.9%, n = 46) reported they had set up specific training programmes for patients about barrier measures and social distancing.

CONCLUSIONS

French psychiatric establishments on the whole were able to provide a necessary reorganisation of their management of patients and their families, regardless of facility status. Patients' rights nonetheless seem to have not received the attention they merited during the early pandemic period. Somatic management of patients with mental illness must absolutely be improved.

Nosocomial infection of COVID‑19: A new challenge for healthcare professionals (Review)

Nosocomial infections, also known as hospital-acquired infections, pose a serious challenge to healthcare professionals globally during the Coronavirus disease 2019 (COVID‑19) pandemic. Nosocomial infection of COVID‑19 directly impacts the quality of life of patients, as well as results in extra expenditure to hospitals. It has been shown that COVID‑19 is more likely to transmit via close, unprotected contact with infected patients. Additionally, current preventative and containment measures tend to overlook asymptomatic individuals and superspreading events. Since the mode of transmission and real origin of COVID‑19 in hospitals has not been fully elucidated yet, minimizing nosocomial infection in hospitals remains a difficult but urgent task for healthcare professionals. Healthcare professionals globally should form an alliance against nosocomial COVID‑19 infections. The fight against COVID‑19 may provide valuable lessons for the future prevention and control of nosocomial infections. The present review will discuss some of the key strategies to prevent and control hospital‑based nosocomial COVID‑19 infections.

The Utilization of Protective Face Masks among Polish Healthcare Workers during COVID-19 Pandemic: Do We Pass the Exam?

Relevant personal protective measures during the COVID-19 pandemic include face masks, possibly decreasing the risk of infection among the general population and healthcare workers (HCW) if utilized properly. The aim of the study was to assess whether different Polish HCW utilize face masks according to the 2020 World Health Organization guidance (WHO) criteria. This cross-sectional study included 1156 respondents who participated in an internet survey evaluating mask-related behaviors. All the WHO criteria were complied with by 1.4% of participants, regardless of medical profession, specialty or place of employment. HCW mostly adhered to criterion 1 (C1; strict covering of the face and mouth with the mask; 90.8%), C4 (washing/disinfecting the hands after touching/taking off the mask; 49%) and C3 (taking off the mask properly without touching the anterior surface; 43.4%), whereas C2 (avoidance of touching the mask with hands) was complied with least commonly (6.8%). HCW with mask-induced itch (31.6%) complied to C2 less often (odds ratio 0.53; p = 0.01). The study reveals that Polish HCW rarely adhere to all the 2020 WHO guidance criteria on the use of masks, whereas the adherence to particular criteria is variable and may be associated with the presence of skin-related conditions and other factors. Better compliance with the recommendations in the future is necessary to increase personal safety of HCW and prevent the transmission of SARS-CoV-2.

Increased Prevalence of Face Mask-Induced Itch in Health Care Workers

BACKGROUND

Face mask use has increased significantly due to the COVID-19 pandemic. Health care workers (HCW) wear masks for prolonged periods and are prone to adverse effects. Very little is known about face-mask-associated itch.

METHODS

This Internet survey study investigated the prevalence, intensity and clinical characteristics of itch related to the use of face masks by HCW during the COVID-19 pandemic. The results were subsequently compared to the students' group.

RESULTS

A total of 1156 HCW completed the survey. Among them, 31.6% (365) reported suffering from itch associated with face mask use. Itch was more frequent among females. Moreover, subjects who reported sensitive skin, atopic predispositions and facial dermatoses tended to report itch more frequently. The worst case of itch in the seven days prior to the study, assessed with the numeric rating scale (NRS), was 4.6 ± 2.0 points. Itch prevalence increased along with the duration of face mask use, being 34.6% among those who wore masks for more than 4 h. HCW reported itch significantly more frequently than students.

CONCLUSIONS

Face-mask-associated itch is a frequent problem among HCW in the COVID-19 pandemic. Itch sensation may cause scratching, which may decrease necessary protection during the pandemic.

Municipal solid waste management during the SARS-COV-2 outbreak and lockdown ease: Lessons from Italy

The literature on municipal solid waste in relation to COVID-19 is scarce. Based on the experience of Italy, the present article contributes to the strategies aimed at preventing a second virus outbreak. In fact, the mismanagement of municipal solid waste could undermine the strategies during the ease of the lockdown. During the SARS-COV-2 outbreak in Italy, there was a general decrease in the selective collection rate (-15% in one municipality with a well-developed door-to-door collection system). Delays in the publication of guidelines on waste management impacted on the safety of the operators collecting potentially infected waste. Contrarily to expectations, single-use masks and gloves do not have significant impact on waste management, accounting for <1% of the residual municipal solid waste collected annually. However, the dispersion of abandoned masks and gloves outside indoor environments is creating environmental problems. Recommendations on waste management and the protection of waste operators are discussed. Finally, guidelines on the most appropriate waste treatment are presented and analyzed. The results presented in this article show that the MSW management sector has found useful solutions to tackle COVID-19; however, these solutions are not being shared sufficiently. The case study analyzed in the present work could help define strategies for preventing or controlling similar future epidemics or pandemic episodes.

Comparison of COVID-19 and MERS Risk Communication in Korea: A Case Study of TV Public Service Advertisements

Purpose

In recent years, the world has been under threat of novel infectious diseases such as Middle East respiratory syndrome (MERS) and coronavirus disease 2019 (COVID-19). Governmental risk communication plays a key role in overcoming the public health crises caused by the emergence of these infectious diseases. The purpose of this study was to identify the focus of Korean public service advertisements (PSAs) in response to the MERS and COVID-19 outbreaks, along with the differences between them.

Methods

A total of five MERS and 17 COVID-19 TV PSAs were analyzed using Lasswell’s Sender, Message, Channel, Receiver, and Effect model and the responses of the Korean government were compared between the MERS and COVID-19 outbreaks.

Results

During the MERS outbreak, the Korean government failed to gain the public’s trust through its PSAs. Despite its best efforts, it provided opaque and selective information on the crisis. Conversely, in the case of COVID-19, the Korean government has successfully worked to strengthen community awareness by supporting and encouraging the public.

Conclusion

Despite the Korean government’s improved communication in the COVID-19 crisis, there has been an insufficient response to the needs of vulnerable groups that could be placed in at-risk situations as a result of domestic violence or mental health problems during outbreaks of novel infectious diseases that require aggressive management.

The mental health of neurological doctors and nurses in Hunan Province, China during the initial stages of the COVID-19 outbreak

BACKGROUND

Neurological symptoms are increasingly being noted among COVID-19 patients. Currently, there is little data on the mental health of neurological healthcare workers. The aim of this study was to identify the prevalence and influencing factors on anxiety and depression in neurological healthcare workers in Hunan Province, China during the early stage of the Coronavirus Disease 2019 (COVID-19) outbreak.

METHODS

An online cross-sectional study was conducted among neurological doctors and nurses in early February 2020 in Hunan Province. Symptoms of anxiety and depression were assessed by the Chinese version of the Self-Rating Anxiety Scale (SAS) (defined as a total score ≥ 50) and Self-Rating Depression Scale (SDS) (defined as a total score ≥ 53). The prevalences of probable anxiety and depression were compared between different groups, and multivariate logistic regression analysis was used to understand the independent influencing factors on anxiety and depression.

RESULTS

The prevalence of probable anxiety and depression in neurological nurses (20.3 and 30.2%, respectively) was higher than that in doctors (12.6 and 20.2%, respectively). Female healthcare workers (18.4%) had a higher proportion of anxiety than males (10.8%). Probable anxiety and depression were more prevalent among nurses, younger workers (≤ 40 years), and medical staff with junior titles. Logistic regression analysis showed that a shortage of protective equipment was independently associated with probable anxiety (OR = 1.980, 95% CI: 1.241-3.160, P = 0.004), while young age was a risk factor for probable depression (OR = 2.293, 95% CI: 1.137-4.623, P = 0.020) among neurological healthcare workers.

CONCLUSIONS

Probable anxiety and depression were more prevalent among neurological nurses than doctors in Hunan Province. The shortage of protective equipment led to probable anxiety, and young age led to probable depression in healthcare workers in neurology departments, which merits attention during the battle against COVID-19.

COVID-19 - The Availability of ICU Beds in Brazil during the Onset of Pandemic

Background

Brazil faces some challenges in the battle against the COVID-19 pandemic, including: the risks for cross-infection (community infection) increase in densely populated areas; low access to health services in areas where the number of beds in intensive care units (ICUs) is scarce and poorly distributed, mainly in states with low population density.

Objective

To describe and intercorrelate epidemiology and geographic data from Brazil about the number of intensive care unit (ICU) beds at the onset of COVID-19 pandemic.

Methods

The epidemiology and geographic data were correlated with the distribution of ICU beds (public and private health systems) and the number of beneficiaries of private health insurance using Pearson's Correlation Coefficient. The same data were correlated using partial correlation controlled by gross domestic product (GDP) and number of beneficiaries of private health insurance.

Findings

Brazil has a large geographical area and diverse demographic and economic aspects. This diversity is also present in the states and the Federal District regarding the number of COVID-19 cases, deaths and case fatality rate. The effective management of severe COVID-19 patients requires ICU services, and the scenario was also dissimilar as for ICU beds and ICU beds/10,000 inhabitants for the public (SUS) and private health systems mainly at the onset of COVID-19 pandemic. The distribution of ICUs was uneven between public and private services, and most patients rely on SUS, which had the lowest number of ICU beds. In only a few states, the number of ICU beds at SUS was above 1 to 3 by 10,000 inhabitants, which is the number recommended by the World Health Organization (WHO).

Conclusions

Brazil needed to improve the number of ICU beds units to deal with COVID-19 pandemic, mainly for the SUS showing a late involvement of government and health authorities to deal with the COVID-19 pandemic.

Ultraviolet germicidal irradiation for filtering facepiece respirators disinfection to facilitate reuse during COVID-19 pandemic: A review

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UVGI is one possible method for respiratory disinfection to facilitate the reuse of dwindling supplies.

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Appropriate dose UVGI exposition could provide enough energy to effectively decontaminate respiratory viral agent and maintenance respirator's integrity for reuse.

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Further evidence concerning UVGI as a decontamination technique for SARS-COV-2 is needed.

Background

To review the effect of ultraviolet germicidal irradiation (UVGI) as a disinfection method for filtering facepiece respirators (FFRs) to facilitate reuse during COVID-19 pandemic.

Methods

Systematic review of the research concerning UVGI for FFRs disinfection to facilitate reuse (also termed limited reuse) during respiratory infectious diseases where aerosol transmission is considered possible.

Results

UVGI is one possible method for respiratory disinfection to facilitate the reuse of dwindling supplies. Appropriate dose UVGI exposition could provide enough energy to effectively decontaminate respiratory viral agents and maintain respirator's integrity for reuse. There was not currently sufficient research evidence on the effect of UVGI to inactivate coronaviruses SARS-CoV-2, and the practical application of UVGI is still unclear. .

Conclusion

Appropriate dose UVGI exposition could provide enough energy to effectively decontaminate respiratory viral agents and maintain respirator's integrity for reuse. Further evidence concerning UVGI as a decontamination technique specifically for SARS-CoV-2 isneeded.

The use of face masks during the COVID-19 pandemic in Poland: A survey study of 2315 young adults

Face masks wearing during the coronavirus disease 2019 (COVID‐19) pandemic became ubiquitous. The aim of our study was to assess the use of face masks among young adults during the current viral pandemic. The survey was based on specially created Google Forms and posted on numerous Facebook groups for young people in Poland. Seven days were considered as a recall period. A total of 2315 answers were obtained, 2307 were finally analysis, as eight questionnaires were removed because of data incompleteness. 60.4% of responders declared using the face masks. Those who reported an atopic predisposition wore face masks significantly (P = .007) more commonly (65.5% and 57.7%, respectively). Cloth masks (46.2%) appeared to be most popular ones, followed by surgical masks (39.2%), respirators (N95 and FFP) (13.3%), half‐face elastomeric respirators (0.8%) and full‐face respirators (0.4%). Females significantly more frequently (P = .0001) used cloth masks; respirators, half‐face elastomeric respirators and full‐face respirators were used more commonly by males (P < .0001, P = .001 and P = .001, respectively). 23.9% of responders who used single‐use mask wore it again. Moreover, 73.6% participants declared mask decontamination; however, the procedures were not always appropriate. We suggest that our results may be of help in construction of general public education campaigns on the proper use of face masks.

[Masks as personal protective equipment in the COVID-19 pandemic: How, when and which should be used]

Antecedentes y objetivo

Durante la pandemia COVID-19 se ha producido un aumento de la demanda de mascarillas por parte de profesionales sanitarios y de la población general. En este contexto, se hace necesario sintetizar las características y las indicaciones de uso de los distintos tipos de mascarillas existentes.

Material y métodos

Se consultaron y recopilaron las diferentes recomendaciones difundidas por instituciones de reconocido prestigio, como la Organización Mundial de la Salud, The European Centre for Disease Prevention, The Centre for Evidence-Based Medicine o el Ministerio de Sanidad del Gobierno de España.

Resultados

Las instituciones consultadas aconsejan reservar las mascarillas filtering face piece (FFP) para el personal sanitario, especialmente en la realización de procedimientos generadores de aerosoles (PGA) (protección mínima de FFP2), y plantean posibles sistemas de reutilización durante épocas de escasez. Asimismo, se recomienda el uso de mascarillas quirúrgicas en profesionales que no realicen PGA y en población sintomática, existiendo variación en las indicaciones de uso para población general sana.

Conclusión

En situaciones de escasez de equipos de protección individual por pandemia de COVID-19 se debe establecer una priorización y racionalización de uso de cada tipo de mascarilla en función del usuario y de la actividad a realizar.

The Effects of the Face Mask on the Skin Underneath: A Prospective Survey During the COVID-19 Pandemic

PURPOSE

The study aimed to explore the prevalence and possible risk factors to prevent the face mask related adverse skin reactions during the ongoing COVID-19 after a recommendation of face mask wearing for public use in Thailand.

RESULTS

The prevalence of face mask related adverse skin reactions was 454 cases (54.5%), of which acne was the most frequent (399; 39.9%), followed by rashes on the face (154; 18.4%), and itch symptoms (130; 15.6%). Wearing a surgical mask showed a higher risk of adverse skin reaction compared to a cloth mask, OR (95% CI) = 1.54 (1.16-2.06). A duration of face mask wearing of more than 4 hours/day and the reuse of face masks increased the risk of adverse skin reactions compared to changing the mask every day, adjusted OR(95% CI) = 1.96 (1.29-2.98), and 1.5 (1.11-2.02).

CONCLUSION

Suggestions were made for wearing a cloth mask in non-health care workers (HCW) to decrease the risk of face mask related adverse skin reactions. This suggestion could potentially help in decreasing the demand of surgical masks which should be reserved for the HCW population during the ongoing COVID-19 pandemic.