Case-Control Study of Use of Personal Protective Measures and Risk for SARS-CoV 2 Infection, Thailand

Feasibility of a virtual safety officer in detecting PPE donning and doffing violations

A safety officer (SO) can assist healthcare workers in minimizing respiratory transmission of communicable diseases through verification of compliance with safety protocols, such as appropriately donning and doffing personal protective equipment (PPE). This project sought to determine if observation of PPE donning and doffing for detection of protocol violations by a virtual safety officer (VSO) was a feasible option to improve the safety of the workplace. Five healthcare workers with experience serving as safety officers were enrolled in a feasibility study in which they observed actors donning and doffing PPE in-person and noted errors using a curated checklist for documentation. One month later, the same participants viewed recordings of the in-person sessions and again recorded errors for seven trials. Five hundred and twenty-three responses recorded from the SOs across the in-person and virtual trials aligned 88.7% of the time. SOs were more accurate in the virtual setting than in the in-person setting (87.6% vs. 82.4%, respectively). However, Cohen's kappa showed lower inter-rater reliability when observing virtually than in-person, especially in the doffing steps of the protocol. A VSO may be a feasible option when assessing whether participants can correctly follow PPE donning and doffing protocols. Future work includes incorporating real-time observation, 360-degree cameras, virtual reality (VR), and augmented reality (AR) to increase visualization, thereby increasing inter-rater reliability.

Impact of disease severity, age, sex, comorbidity, and vaccination on secondary attack rates of SARS-CoV-2: a global systematic review and meta-analysis

BACKGROUND

Understanding the key drivers of SARS-CoV-2 transmission is essential for shaping effective public health strategies. However, transmission risk is subject to substantial heterogeneity related to disease severity, age, sex, comorbidities, and vaccination status in different population settings and regions. We aimed to quantify the impact of these factors on secondary attack rates (SARs) of SARS-CoV-2 across diverse population settings and regions, and identify key determinants of transmission to inform targeted interventions for improving global pandemic response.

METHODS

To retrieve relevant literature covering the duration of the COVID-19 pandemic, we searched Ovid MEDLINE, Ovid Embase, Web of Science, and the Cochrane COVID-19 Study Register between January 1, 2020 and January 18, 2024 to identify studies estimating SARs of SARS-CoV-2, defined as the proportion of close contacts infected. We pooled SAR estimates using a random-effects model with the Freeman-Tukey double arcsine transformation and derived Clopper-Pearson 95% confidence intervals (CIs). Risk of bias was assessed using a modified Newcastle-Ottawa scale. This study was registered with PROSPERO, CRD42024503782.

RESULTS

A total of 159 eligible studies, involving over 19 million close contacts and 6.8 million cases from 41 countries across five continents, were included in the analysis. SARs increased with disease severity in index cases, ranging from 0.10 (95% CI: 0.06-0.14; I2 = 99.65%) in asymptomatic infection to 0.15 (95% CI: 0.09-0.21; I2 = 92.49%) in those with severe or critical conditions. SARs by age were lowest at 0.20 (95% CI: 0.16-0.23; I2 = 99.44%) for close contacts under 18 years and highest at 0.29 (95% CI: 0.24-0.34; I2 = 99.65%) for index cases aged 65 years or older. Among both index cases and close contacts, pooled SAR estimates were highest for Omicron and lowest for Delta, and declined with increasing vaccine doses. Regionally, North America had the highest SAR at 0.27 (95% CI: 0.24-0.30; I2 = 99.31%), significantly surpassing SARs in Europe (0.19; 95% CI: 0.15-0.25; I2 = 99.99%), Southeast Asia (0.18; 95% CI: 0.13-0.24; I2 = 99.24%), and the Western Pacific (0.11; 95% CI: 0.08-0.15; I2 = 99.95%). Among close contacts with comorbidities, chronic lung disease and hypertension were associated with the highest SARs. No significant association was found between SARs and the sex of either index cases or close contacts.

CONCLUSIONS

Secondary attack rates varied substantially by demographic and regional characteristics of the studied populations. Our findings demonstrate the role of booster vaccinations in curbing transmission, underscoring the importance of maintaining population immunity as variants of SARS-CoV-2 continue to emerge. Effective pandemic responses should prioritise tailored interventions that consider population demographics and social dynamics across different regions.

Prevalence and correlates of facemask usage during the second wave of COVID-19 pandemic in Uganda

The World Health Organization (WHO) and the United States Centers for Disease Control and Prevention (US CDC) documented wearing facemasks in public as one of the most important prevention measures to limit COVID-19 spread. Considering this, WHO and the US CDC developed guidelines for wearing facemasks in public. This study aimed to determine the prevalence and correlates of facemask wearing during the COVID-19 pandemic in northern Uganda. We conducted a cross-sectional study on 587 adults across nine districts in northern Uganda, across 24 high-volume health facilities offering free COVID-9 vaccines. Respondents were selected from the health facilities using a single-stage systematic sampling method. Data was collected in a face-to-face questionnaire interview with an internal validity of Cronbach's α = 0.72 and entered into Excel. A local Institutional Research Board (IRB) approved the study, and Stata 18 was used for data analysis using Modified Poisson Regression to generate prevalence ratios (PR) and adjusted prevalence ratios (aPR), with a p-value set at < 0.05. The reported prevalence of facemask wearing in public among respondents was high [88.7%,95%CI:86%,-91%]. A multivariate analysis found that obese respondents and those who were receptive (agreed) to the lockdown measures were respectively,1.12 times more likely to wear facemasks [aPR = 1.12,95%CI:1.04-1.19;p < 0.01], and1.23 times more likely to wear facemasks [aPR = 1.23, 95%CI:1.07-1.41;p < 0.01]. The most significant finding from this study was the high prevalence of self-reported facemask wearing among adult community members in northern Uganda. The correlates of wearing facemasks were, being obese and agreeing with the presidential directives on the lockdown measures. Although this prevalence is within acceptable rates, the strict enforcement of the practice by security forces has raised concerns among many community members and human rights advocates. We recommend more studies on communities' perspectives on the challenges and benefits of facemask-wearing after the COVID-19 pandemic.

Review of animal transmission experiments of respiratory viruses: Implications for transmission risk of SARS-COV-2 in humans via different routes

Exploring transmission risk of different routes has major implications for epidemic control. However, disciplinary boundaries have impeded the dissemination of epidemic information, have caused public panic about "air transmission," "air-conditioning transmission," and "environment-to-human transmission," and have triggered "hygiene theater." Animal experiments provide experimental evidence for virus transmission, but more attention is paid to whether transmission is driven by droplets or aerosols and using the dichotomy to describe most transmission events. Here, according to characteristics of experiment setups, combined with patterns of human social interactions, we reviewed and grouped animal transmission experiments into four categories-close contact, short-range, fomite, and aerosol exposure experiments-and provided enlightenment, with experimental evidence, on the transmission risk of severe acute respiratory syndrome coronavirus (SARS-COV-2) in humans via different routes. When referring to "air transmission," context should be showed in elaboration results, rather than whether close contact, short or long range is uniformly described as "air transmission." Close contact and short range are the major routes. When face-to-face, unprotected, horizontally directional airflow does promote transmission, due to virus decay and dilution in air, the probability of "air conditioning transmission" is low; the risk of "environment-to-human transmission" highly relies on surface contamination and human behavior based on indirect path of "fomite-hand-mucosa or conjunctiva" and virus decay on surfaces. Thus, when discussing the transmission risk of SARS-CoV-2, we should comprehensively consider the biological basis of virus transmission, environmental conditions, and virus decay. Otherwise, risk of certain transmission routes, such as long-range and fomite transmission, will be overrated, causing public excessive panic, triggering ineffective actions, and wasting epidemic prevention resources.

Evaluating layer contributions and salt coating effects on mask performance

The impact of respiratory diseases is vast and multifaceted, affecting individuals, healthcare systems, and global economies. In response to the spread of respiratory pathogens, masks and respirators have become pivotal, demonstrating their capability to mitigate transmission. However, the limitations of conventional face masks or respirators, such as their single-use nature, environmental impact, and the risk of contact-based transmission, have accelerated the development of antimicrobial masks. Designing effective antimicrobial masks requires a deep understanding of the properties of each layer and the identification of an optimal configuration to enhance their protective efficiency. In this study, we investigated the filtration performance, including filtration efficiency and breathability, of individual layers in conventional 3-ply masks and stacked spunbond (SB) fabrics with and without salt coating, under both dry and wet fabric conditions. We aimed to elucidate the filtration efficiency of each mask layer with respect to particle size and type (NaCl aerosols, DOP aerosols), with particular focus on the impact of salt-coated SB fabric and its application. While bare fabrics showed a decrease in filtration efficiency with increased wetness, salt-coated fabrics exhibited enhanced filtration efficiency. Importantly, evaluating the efficacy of a stack comprised of salt-coated SB fabrics across diverse antimicrobial respiratory devices highlighted its efficacy as both the outermost layer in a 3-ply mask and as a mask covering (i.e., a supplementary layer over a mask or respirator). This investigation not only emphasizes the significance of salt-coated antimicrobial technology in mitigating disease transmission but also offers a practical approach for adeptly implementing this technology in respiratory protection devices.

Identifying the interplay between protective measures and settings on the SARS-CoV-2 transmission using a Bayesian network

Contact tracing played a crucial role in minimizing the onward dissemination of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) in the recent pandemic. Previous studies had also shown the effectiveness of preventive measures such as mask-wearing, physical distancing, and exposure duration in reducing SARS-CoV-2 transmission. However, there is still a lack of understanding regarding the impact of various exposure settings on the spread of SARS-CoV-2 within the community, as well as the most effective preventive measures, considering the preventive measures adherence in different daily scenarios. We aimed to evaluate the effect of individual protective measures and exposure settings on the community transmission of SARS-CoV-2. Additionally, we aimed to investigate the interaction between different exposure settings and preventive measures in relation to such SARS-CoV-2 transmission. Routine SARS-CoV-2 contact tracing information was supplemented with additional data on individual measures and exposure settings collected from index patients and their close contacts. We used a case-control study design, where close contacts with a positive test for SARS-CoV-2 were classified as cases, and those with negative results classified as controls. We used the data collected from the case-control study to construct a Bayesian network (BN). BNs enable predictions for new scenarios when hypothetical information is introduced, making them particularly valuable in epidemiological studies. Our results showed that ventilation and time of exposure were the main factors for SARS-CoV-2 transmission. In long time exposure, ventilation was the most effective factor in reducing SARS-CoV-2, while masks and physical distance had on the other hand a minimal effect in this ventilation spaces. However, face masks and physical distance did reduce the risk in enclosed and unventilated spaces. Distance did not reduce the risk of infection when close contacts wore a mask. Home exposure presented a higher risk of SARS-CoV-2 transmission, and any preventive measures posed a similar risk across all exposure settings analyzed. Bayesian network analysis can assist decision-makers in refining public health campaigns, prioritizing resources for individuals at higher risk, and offering personalized guidance on specific protective measures tailored to different settings or environments.

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.

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 estimation in relation to anxiety and depression for low probability negative events

Foundational cognitive models propose that people with anxiety and depression show risk estimation bias, but most literature does not compute true risk estimation bias by comparing people's subjective risk estimates to their individualized reality (i.e., person-level objective risk). In a diverse community sample (N = 319), we calculated risk estimation bias by comparing people's subjective risk estimates for contracting COVID-19 to their individualized objective risk. Person-level objective risk was consistently low and did not differ across symptom levels, suggesting that for low probability negative events, people with greater symptoms show risk estimation bias that is driven by subjective risk estimates. Greater levels of anxiety, depression, and COVID-specific perseverative cognition separately predicted higher subjective risk estimates. In a model including COVID-specific perseverative cognition alongside anxiety and depression scores, the only significant predictor of subjective risk estimates was COVID-specific perseverative cognition, indicating that symptoms more closely tied to feared outcomes may more strongly influence risk estimation. Finally, subjective risk estimates predicted information-seeking behavior and eating when anxious, but did not significantly predict alcohol or marijuana use, drinking to cope, or information avoidance. Implications for clinical practitioners and future research are discussed.

Using clinical cases to guide healthcare

Evidence-based practice (EBP) has been the gold standard in healthcare for nearly three centuries and aims to assist physicians in providing the safest and most effective healthcare for their patients. The well-established hierarchy of evidence lists systematic reviews and meta-analyses at the top however these methodologies are not always appropriate or possible and in these instances case-control studies, case series and case reports are utilised to support EBP. Case-control studies allow simultaneous study of multiple risk factors and can be performed rapidly and relatively cheaply. A recent example was during the Coronavirus pandemic where case-control studies were used to assess the efficacy of personal protective equipment for healthcare workers. Case series and case reports also play a role in EBP and are particularly useful to study rare diseases such as inflammatory bowel disease in transgender and gender non-conforming individuals. They are also vital in generating and disseminating early signals and encouraging further research. Whilst these methodologies have weaknesses, particularly with regards to bias and loss of patient confidentiality for rare pathologies, they have an important part to play in EBP and when appropriately utilised can significantly impact upon clinical practice.

Predictors to Intensive Care Unit admission among patient with coronavirus disease in Sukraraj Tropical and Infectious Disease Hospital, Nepal: A case-control study

The clinical features of COVID-19 are vary widely, ranging from asymptomatic states or mild upper respiratory tract infections to severe pneumonia. Previous studies have shown that 20.0% of COVID-19 patients are hospitalized, out of which 10.0-20.0% are admitted to the Intensive Care Unit. The present study aims to assess predictors associated with COVID-19 leading to Intensive Care Unit admission among reverse transcriptase- polymerase chain reaction (RT-PCR) positive patients in Sukraraj Tropical and infectious disease hospital, Nepal. A case-control study was conducted from June 2022 to July 2022 among patients admitted to Sukraraj Tropical and Infectious Disease Hospital. A hospital-based age (± 2 years) and sex-matched case-control study design were adopted in which ICU admitted (case group, n = 33) and general ward admitted (control group, n = 66) were included. Data were collected using a structured questionnaire comprising of socio-demographic, clinical, and preventive predictors. Data were analyzed using the Statistical Package for Social Science version 11.5. The Chi-square test and conditional logistic regression to determine the predictors associated with ICU admission. High blood pressure, high C-reactive protein and poor application of preventive practices were found to be the predictors of ICU admission. Conditional logistics regression analyses revealed that independent risk factors associated with ICU admission were elevated blood pressure (AOR = 2.22; 95% CI 1.05-4.71, p = 0.015) and abnormal C-Reactive Protein (AOR = 2.92; 95% CI 1.24-6.84, p = 0.012) at the time of hospital admission were more likely to get admitted to ICU. Likewise, patients with poor preventive practice (AOR = 3.34; 95% CI 1.19-9.31, p = 0.02) more likely to get admitted to ICU than patient with good preventive practices.These research findings hold potential significance for facilitating early triage and risk assessment in COVID-19 patients.

Exploring the Barriers and Facilitators of Mask-Wearing Behavior During the COVID-19 Pandemic in Taiwan, the United States, the Netherlands, and Haiti: A Qualitative Study

OBJECTIVE

This study explored the barriers and facilitators of mask-wearing behaviors during the pandemic in Taiwan, the United States, the Netherlands, and Haiti.

METHODS

Face-to-face interviews were conducted in Taiwan and online interviews were conducted with participants in the United States, the Netherlands, and Haiti.

RESULTS

In general, the habit of wearing a mask before coronavirus disease 2019 (COVID-19) was reported by Taiwanese participants. Additionally, Taiwanese participants perceived that wearing a mask was a social responsibility during the pandemic, suggesting that the collectivistic context might influence mask-wearing behavior. Unlike the Taiwanese population, some people in the United States and the Netherlands were reluctant to wear masks due to perceived restrictions on their freedom. Participants from Haiti mentioned that people who wore masks encountered violence, bullying, and discrimination. The results of this study suggest that political leadership and mask mandates have a strong impact on people's mask-wearing behavior.

CONCLUSIONS

These findings have valuable implications for the design of diverse behavioral interventions to enhance mask-wearing as part of infectious disease preparedness. Additionally, the findings from these countries offer valuable insights for the development of effective public health interventions to enhance society's resilience during the current pandemic and future infectious disease outbreaks.

[Sociodemographic and environmental factors associated with mask use during the COVID-19 pandemic]

OBJECTIVE

During COVID-19 pandemic, prevention measures were implemented to mitigate the community transmission of SARS-CoV-2. Compliance with these measures was influenced by several sociodemographic and environmental factors. However, literature addressing compliance with these prevention measures among the general population remains limited. The study aimed to assess the association of sociodemographic and environmental factors and mask usage during close contact situations.

METHODS

A cross-sectional study was conducted with a sample of 1,778 individuals identified through close contact tracing of individuals diagnosed with SARS-CoV-2 by the COVID-19 Coordination Center of Mallorca, from February to June 2021. A descriptive analysis was conducted, and a logistic regression model was utilized to evaluate factors associated with mask non-compliance.

RESULTS

The mean age of the participants was 42.8±17.4 years, with 53.6% being female. Among close contacts, 60.8% (95% CI: 57.8-62.3) did not use masks during their contact. No significant differences were observed between genders or across age groups (p=0.497 and p=0.536, respectively). Factors linked to mask non-compliance included the home setting, indoor spaces without ventilation, and closer physical distances (p<0.001).

CONCLUSIONS

Our findings indicate that mask adherence was notably lower among close contacts exposed to higher risk. In future public health crises, interventions should be developed to raise awareness about risks and promote adherence to preventive and control measures.

Personal protective measures and settings on the risk of SARS-COV-2 community transmission: a case-control study

Background

During the SARS-CoV-2 pandemic, nurses of primary health care has been an important role in Spain. Even so, the data obtained in the tracing have been scarcely used to investigate the possible mechanisms of transmission. Few studies focused on community transmission, evaluating the effectiveness of individual protective measures and exposure environment. The main aim of the study was to evaluate the association between individual protective measures and SARS-CoV-2 transmission in the community and to compare secondary attack rates in different exposure settings.

Methods

A case-control study from contact tracing of SARS-CoV-2 index patients. COVID-19 contact tracing was led by nurses at the COVID-19 Coordinating Centre in Majorca (Spain). During the systematic tracing, additional information for this study was collected from the index patient (social-demographic variables, symptoms, the number of close contacts). And also, the following variables from their close contacts: contact place, ventilation characteristics mask-wearing, type of mask, duration of contact, shortest distance, case-contact relationship, household members, and handwashing, the test result for SARS-CoV-2 diagnostic. Close contacts with a positive test for SARS-CoV-2 were classified as "cases" and those negative as "controls."

Results

A total of 1,778 close contacts from 463 index patients were identified. No significant differences were observed between the sexes but between age groups. Overall Secondary Attack Rate (SAR) was 24.0% (95% CI: 22.0-26.0%), 36.9% (95% CI: 33.2-40.6%) in closed spaces without ventilation and 50.7% (95% CI: 45.6-55.8%) in exposure time > 24 h. A total of 49.2% of infections occurred among household members. Multivariate logistic regression analysis showed that open-air setting (OR 0.43, 95% CI: 0.27-0.71), exposure for less than 1 h (OR 0.19, 95% CI: 0.11-0.32), and wearing a mask (OR 0.49, 95% CI: 0.28-0.85) had a protective effect transmission of SARS-CoV-2 in the community.

Conclusion

Ventilation of the space, mask-wearing and shorter exposure time were associated with a lower risk of transmission in the community. The data obtained allowed an assessment of community transmission mechanisms and could have helped to improve and streamline tracing by identifying close contacts at higher risk.

Effectiveness of wearing masks during the COVID-19 outbreak in cohort and case-control studies: a systematic review and meta-analysis

OBJECTIVE

To evaluate the efficacy of wearing a mask to prevent COVID-19 infection.

METHODS

This was a systematic review and meta-analysis of cohort and case-control studies, considering the best level of evidence available. Electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Clinical Trials.gov) were searched to identify studies that evaluated the effectiveness of wearing masks compared with that of not wearing them during the COVID-19 pandemic. Risk of bias and quality of evidence were assessed using the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation.

RESULTS

Of the 1,028 studies identified, 9 met the inclusion criteria (2 cohort studies and 7 case-control studies) and were included in the analysis. The meta-analysis using cohort studies alone showed statistically significant differences, wearing a cloth mask decreased by 21% [RD = -0.21 (95% CI, -0.34 to -0.07); I2 = 0%; p = 0,002] the risk of COVID-19 infection, but the quality of evidence was low. Regarding case-control studies, wearing a surgical mask reduced the chance of COVID-19 infection [OR = 0.51 (95% CI, 0.37-0.70); I2 = 47%; p = 0.0001], as did wearing an N95 respirator mask [OR = 0.31 (95% CI, 0.20-0.49); I2 = 0%; p = 0.00001], both with low quality of evidence.

CONCLUSIONS

In this systematic review with meta-analysis, we showed the effectiveness of wearing masks in the prevention of SARS-CoV-2 infection regardless of the type of mask (disposable surgical mask, common masks, including cloth masks, or N95 respirators), although the studies evaluated presented with low quality of evidence and important biases.

Factors Associated with SARS-CoV-2 Infection Evaluated by Antibody Response in a Sample of Workers from the Emilia-Romagna Region, Northern Italy

Factors associated with SARS-CoV-2 infection risk are still debated. This case-control study aims to investigate the possible relationship between SARS-CoV-2 infection, evaluated through antibody response, and the main sociodemographic, occupational, clinical-anamnestic, and biochemical factors in a population of Modena province (Northern Italy), mainly workers. Both workers who voluntarily joined the screening campaign proposed by companies and self-referred individuals who underwent serological testing were enrolled. Subjects with antibody positivity were recruited as cases (n = 166) and subjects tested negative (n = 239) as controls. A questionnaire on sociodemographic, occupational, and clinical data was administered through telephone interviews. Serum zinc/iron/copper/chromium/nickel, vitamins D/B12, folates, triglycerides, and LDL/HDL/total cholesterol were measured. Cases lived more often in urban areas (61.8% vs. 57%). Cases and controls did not differ significantly by working macrocategories, but the percentage of workers in the ceramic sector was higher among cases. Low adherence to preventive measures in the workplace was more frequent among seropositives. Folate concentration was significantly lower among cases. Therefore, adequate folate levels, living in rural areas, and good adherence to preventive strategies seem protective against infection. Workers in the ceramic sector seem to be at greater risk; specific factors involved are not defined, but preventive interventions are needed.

Association of known SARS-CoV-2 serostatus and adherence to personal protection measures and the impact of personal protective measures on seropositivity in a population-based cross-sectional study (MuSPAD) in Germany

BACKGROUND

In 2020/2021 in Germany, several non-pharmacological interventions were introduced to lower the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We investigated to what extent knowledge of prior infection with SARS-CoV-2 or vaccination status influenced the use of personal protection measures (PPM). Further, we were interested in the effect of compliance with PPM on SARS-CoV-2 serostatus.

METHODS

Data was based on a sequential, multilocal seroprevalence study (MuSPAD), carried out in eight locations from July 2020 to August 2021. We estimated the association between a known SARS-CoV-2 serostatus (reported positive PCR test or vaccination) and self-reported PPM behavior (hand hygiene, physical distancing, wearing face mask), just as the association of PPM compliance with seropositivity against nucleocapsid (NC), receptor-binding domain (RBD), and spike protein (S) antigens. We identified relevant variables and deduced adjustment sets with directed acyclic graphs (DAG), and applied mixed logistic regression.

RESULTS

Out of the 22,297 participants (median age: 54 years, 43% male), 781 were classified as SARS-CoV-2-infected and 3,877 had a vaccinated immune response. Vaccinated individuals were less likely to keep 1.5 m distance [OR = 0.74 (95% CI: 0.57-0.97)] and only partly physically distanced [OR = 0.71 (95% CI: 0.58-0.87)]. Participants with self-reported positive PCR test had a lower chance of adhering partly to physical distancing [OR = 0.70 (95% CI: 0.50-0.99)] in comparison to the reference group. Higher odds of additionally wearing a face mask was observed in vaccinated [OR = 1.28 (95% CI: 1.08-1.51)] even if it was not obligatory. Overall, among unvaccinated participants, we found little evidence of lower odds of seropositivity given mask wearing [OR: 0.91 (95% CI: 0.71-1.16)], physical distancing [OR: 0.84 (95% CI: 0.59-1.20)] and no evidence for completely adhering to hand cleaning [OR: 0.97 (95% CI: 0.29-3.22)].

CONCLUSIONS

A known confirmed prior infection and vaccination may have the potential to influence adherence to PPM.

[Factors associated with adherence to COVID-19 preventive behaviors in ELSA-Brasil participants]

The aim of the study is to assess the adherence to recommended prevention measures during the COVID-19 pandemic and to investigate the factors associated with this adherence in the adult population. This study has a cross-sectional design and used data from the complementary study Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) - COVID, conducted from 2020 to 2021. Data were analyzed using the chi-square test and multinomial logistic regression. The sample consisted of 5,440 participants. The preventive measure with the highest adherence was the use of a face mask (95.5%). There was greater adherence by females and lower chance of adherence by white people, by those who consume alcoholic beverages, people who were retired, as well as for those who live alone or who have family members who did not follow the recommendations to stay at home. Greater adherence to preventive behaviors was observed in only one third of the participating population, which demonstrates that there was a need for greater awareness of the risks in specific populations. The findings contribute to improving our understanding about health promotion and COVID-19 prevention.

Effectiveness of face masks for reducing transmission of SARS-CoV-2: a rapid systematic review

This rapid systematic review of evidence asks whether (i) wearing a face mask, (ii) one type of mask over another and (iii) mandatory mask policies can reduce the transmission of SARS-CoV-2 infection, either in community-based or healthcare settings. A search of studies published 1 January 2020-27 January 2023 yielded 5185 unique records. Due to a paucity of randomized controlled trials (RCTs), observational studies were included in the analysis. We analysed 35 studies in community settings (three RCTs and 32 observational) and 40 in healthcare settings (one RCT and 39 observational). Ninety-five per cent of studies included were conducted before highly transmissible Omicron variants emerged. Ninety-one per cent of observational studies were at 'critical' risk of bias (ROB) in at least one domain, often failing to separate the effects of masks from concurrent interventions. More studies found that masks (n = 39/47; 83%) and mask mandates (n = 16/18; 89%) reduced infection than found no effect (n = 8/65; 12%) or favoured controls (n = 1/65; 2%). Seven observational studies found that respirators were more protective than surgical masks, while five found no statistically significant difference between the two mask types. Despite the ROB, and allowing for uncertain and variable efficacy, we conclude that wearing masks, wearing higher quality masks (respirators), and mask mandates generally reduced SARS-CoV-2 transmission in these study populations. This article is part of the theme issue 'The effectiveness of non-pharmaceutical interventions on the COVID-19 pandemic: the evidence'.

Masks During Pandemics Caused by Respiratory Pathogens-Evidence and Implications for Action

Importance

As demonstrated by the influenza virus and SARS-CoV-2, viruses spread by the respiratory route can cause deadly pandemics, and face masks can reduce the spread of these pathogens. The effectiveness of responses to future epidemics and pandemics will depend at least in part on whether evidence on masks, including from the COVID-19 pandemic, is utilized.

Observations

Well-designed observational studies have demonstrated the association of mask use with reduced transmission of SARS-CoV-2 in community settings, and rigorous evaluations of mask mandates have found substantial protection. Disagreement about whether face masks reduce the spread of SARS-CoV-2 has been exacerbated by a focus on randomized trials, which are limited in number, scope, and statistical power. Many effective public health policies have never been assessed in randomized clinical trials; such trials are not the gold standard of evidence for the efficacy of all interventions. Masking in the community to reduce the spread of SARS-CoV-2 is supported by robust evidence from diverse settings and populations. Data on the epidemiologic, environmental, and mask design parameters that influence the effectiveness of masking provide insights on when and how masks should be used to prevent transmission.

Conclusions and Relevance

During the next epidemic or pandemic caused by a respiratory pathogen, decision-makers will need to rely on existing evidence as they implement interventions. High-quality studies have shown that use of face masks in the community is associated with reduced transmission of SARS-CoV-2 and is likely to be an important component of an effective response to a future respiratory threat.

Considering Social Identity Threat Alongside the Health Belief Model to Examine Mask-Wearing Intentions of Black, Latinx, and Asian Individuals in the U.S. During COVID-19

During the COVID-19 pandemic, U.S. public health officials have recommended various safety protocols to "stop the spread", and atop the list is wearing a mask. Individuals from particular racial groups have also contended with a surge of racial profiling and race-based discrimination that has positioned mask-wearing as a risky yet health-promoting behavior. Using the health belief model (HBM), this study considers how racism and health intersect by examining the emotions, behavioral intentions, and health outcomes of mask-wearing among Black, Latinx, and Asian individuals. Cross-sectional survey data from 521 participants from across the United States were collected and analyzed using quantitative analyses. Results did not indicate significant differences in mask-wearing intentions between racial groups as predicted by the health belief model constructs; however, group differences in experiences of racism did shape perceptions of and behaviors related to mask-wearing. Mask-wearing was also related to more positive emotional experiences, and social cues to action predicted intentions to wear a mask. Implications for encouraging health-promoting behaviors across diverse populations during public health crises are discussed.

A network meta-analysis of risk factors of infection among close contacts of COVID-19

Objective

We aimed to use network meta-analysis to compare the impact of infection risk factors of close contacts with COVID-19, identify the most influential factors and rank their subgroups. It can provide a theoretical basis for the rapid and accurate tracking and management of close contacts.

Methods

We searched nine databases from December 1, 2019 to August 2, 2023, which only took Chinese and English studies into consideration. Odd ratios (ORs) were calculated from traditional meta-estimated secondary attack rates (SARs) for different risk factors, and risk ranking of these risk factors was calculated by the surface under the cumulative ranking curve (SUCRA).

Results

25 studies with 152647 participants identified. Among all risk factors, the SUCRA of type of contact was 69.6 % and ranked first. Among six types of contact, compared with transportation contact, medical contact, social contact and other, daily contact increased risk of infection by 12.11 (OR: 12.11, 95 % confidence interval (CI): 6.51-22.55), 7.76 (OR: 7.76, 95 % CI: 4.09-14.73), 4.65 (OR: 4.65, 95 % CI: 2.66-8.51) and 8.23 OR: 8.23, 95 % CI: 4.23-16.01) times, respectively. Overall, SUCRA ranks from highest to lowest as daily contact (94.7 %), contact with pollution subjects (78.4 %), social contact (60.8 %), medical contact (31.8 %), other (27.9 %), transportation contact (6.4 %).

Conclusion

The type of contact had the greatest impact on COVID-19 close contacts infection among the risk factors we included. Daily contact carried the greatest risk of infection among six types of contact, followed by contact with pollution subjects, social contact, other, medical contact and transportation contact. The results can provide scientific basis for rapid assess the risk of infection among close contacts based on fewer risk factors and pay attention to high-risk close contacts during management, thereby reducing tracking and management costs.

Combined Infection Control Interventions Protect Essential Food Workers from Occupational Exposures to SARS-CoV-2 in the Agricultural Environment

Essential food workers experience elevated risks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection due to prolonged occupational exposures in food production and processing areas, shared transportation (car or bus), and employer-provided shared housing. Our goal was to quantify the daily cumulative risk of SARS-CoV-2 infection for healthy susceptible produce workers and to evaluate the relative reduction in risk attributable to food industry interventions and vaccination. We simulated daily SARS-CoV-2 exposures of indoor and outdoor produce workers through six linked quantitative microbial risk assessment (QMRA) model scenarios. For each scenario, the infectious viral dose emitted by a symptomatic worker was calculated across aerosol, droplet, and fomite-mediated transmission pathways. Standard industry interventions (2-m physical distancing, handwashing, surface disinfection, universal masking, ventilation) were simulated to assess relative risk reductions from baseline risk (no interventions, 1-m distance). Implementation of industry interventions reduced an indoor worker's relative infection risk by 98.0% (0.020; 95% uncertainty interval [UI], 0.005 to 0.104) from baseline risk (1.00; 95% UI, 0.995 to 1.00) and an outdoor worker's relative infection risk by 94.5% (0.027; 95% UI, 0.013 to 0.055) from baseline risk (0.487; 95% UI, 0.257 to 0.825). Integrating these interventions with two-dose mRNA vaccinations (86 to 99% efficacy), representing a worker's protective immunity to infection, reduced the relative infection risk from baseline for indoor workers by 99.9% (0.001; 95% UI, 0.0002 to 0.005) and outdoor workers by 99.6% (0.002; 95% UI, 0.0003 to 0.005). Consistent implementation of combined industry interventions, paired with vaccination, effectively mitigates the elevated risks from occupationally acquired SARS-CoV-2 infection faced by produce workers. IMPORTANCE This is the first study to estimate the daily risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across a variety of indoor and outdoor environmental settings relevant to food workers (e.g., shared transportation [car or bus], enclosed produce processing facility and accompanying breakroom, outdoor produce harvesting field, shared housing facility) through a linked quantitative microbial risk assessment framework. Our model has demonstrated that the elevated daily SARS-CoV-2 infection risk experienced by indoor and outdoor produce workers can be reduced below 1% when vaccinations (optimal vaccine efficacy, 86 to 99%) are implemented with recommended infection control strategies (e.g., handwashing, surface disinfection, universal masking, physical distancing, and increased ventilation). Our novel findings provide scenario-specific infection risk estimates that can be utilized by food industry managers to target high-risk scenarios with effective infection mitigation strategies, which was informed through more realistic and context-driven modeling estimates of the infection risk faced by essential food workers daily. Bundled interventions, particularly if they include vaccination, yield significant reductions (>99%) in daily SARS-CoV-2 infection risk for essential food workers in enclosed and open-air environments.

Inactivation characteristics of a 280 nm Deep-UV irradiation dose on aerosolized SARS-CoV-2

A non-filter virus inactivation unit was developed that can control the irradiation dose of aerosolized viruses by controlling the lighting pattern of a 280 nm deep-UV (DUV)-LED and the air flowrate. In this study, the inactivation properties of aerosolized SARS-CoV-2 were quantitatively evaluated by controlling the irradiation dose to the virus inside the inactivation unit. The RNA concentration of SARS-CoV-2 remained constant when the total irradiation dose of DUV irradiation to the virus exceeded 16.5 mJ/cm2. This observation suggests that RNA damage may occur in regions below the detection threshold of RT-qPCR assay. However, when the total irradiation dose was less than 16.5 mJ/cm2, the RNA concentration monotonically increased with a decreasing LED irradiation dose. However, the nucleocapsid protein concentration of SARS-CoV-2 was not predominantly dependent on the LED irradiation dose. The plaque assay showed that 99.16% of the virus was inactivated at 8.1 mJ/cm2 of irradiation, and no virus was detected at 12.2 mJ/cm2 of irradiation, resulting in a 99.89% virus inactivation rate. Thus, an irradiation dose of 23% of the maximal irradiation capacity of the virus inactivation unit can activate more than 99% of SARS-CoV-2. These findings are expected to enhance versatility in various applications. The downsizing achieved in our study renders the technology apt for installation in narrow spaces, while the enhanced flowrates establish its viability for implementation in larger facilities.

Major Update: Masks for Prevention of SARS-CoV-2 in Health Care and Community Settings-Final Update of a Living, Rapid Review

BACKGROUND

Optimal use of masks for preventing COVID-19 is unclear.

PURPOSE

To update an evidence synthesis on N95, surgical, and cloth mask effectiveness in community and health care settings for preventing SARS-CoV-2 infection.

DATA SOURCES

MEDLINE, EMBASE, medRxiv (3 June 2022 to 2 January 2023), and reference lists.

STUDY SELECTION

Randomized trials of interventions to increase mask use and risk for SARS-CoV-2 infection and observational studies of mask use that controlled for potential confounders.

DATA EXTRACTION

Two investigators sequentially abstracted study data and rated quality.

DATA SYNTHESIS

Three randomized trials and 21 observational studies were included. In community settings, mask use may be associated with a small reduced risk for SARS-CoV-2 infection versus no mask use, on the basis of 2 randomized trials and 7 observational studies. In routine patient care settings, surgical masks and N95 respirators may be associated with similar risk for SARS-CoV-2 infection, on the basis of 1 new randomized trial with some imprecision and 4 observational studies. Evidence from observational studies was insufficient to evaluate other mask comparisons due to methodological limitations and inconsistency.

LIMITATION

Few randomized trials, studies had methodological limitations and some imprecision, suboptimal adherence and pragmatic aspects of randomized trials potentially attenuated benefits, very limited evidence on harms, uncertain applicability to Omicron variant predominant era, meta-analysis not done due to heterogeneity, unable to formally assess for publication bias, and restricted to English-language articles.

CONCLUSION

Updated evidence suggests that masks may be associated with a small reduction in risk for SARS-CoV-2 infection in community settings. Surgical masks and N95 respirators may be associated with similar infection risk in routine patient care settings, but a beneficial effect of N95 respirators cannot be ruled out.

PRIMARY FUNDING SOURCE

None.

Influence of setting-dependent contacts and protective behaviours on asymptomatic SARS-CoV-2 infection amongst members of a UK university

We survey 62 users of a university asymptomatic SARS-CoV-2 testing service on details of their activities, protective behaviours and contacts in the 7 days prior to receiving a positive or negative SARS-CoV-2 PCR test result in the period October 2020-March 2021. The resulting data set is novel in capturing very detailed social contact history linked to asymptomatic disease status during a period of significant restriction on social activities. We use this data to explore 3 questions: (i) Did participation in university activities enhance infection risk? (ii) How do contact definitions rank in their ability to explain test outcome during periods of social restrictions? (iii) Do patterns in the protective behaviours help explain discrepancies between the explanatory performance of different contact measures? We classify activities into settings and use Bayesian logistic regression to model test outcome, computing posterior model probabilities to compare the performance of models adopting different contact definitions. Associations between protective behaviours, participant characteristics and setting are explored at the level of individual activities using multiple correspondence analysis (MCA). We find that participation in air travel or non-university work activities was associated with a positive asymptomatic SARS-CoV-2 PCR test, in contrast to participation in research and teaching settings. Intriguingly, logistic regression models with binary measures of contact in a setting performed better than more traditional contact numbers or person contact hours (PCH). The MCA indicates that patterns of protective behaviours vary between setting, in a manner which may help explain the preference for any participation as a contact measure. We conclude that linked PCR testing and social contact data can in principle be used to test the utility of contact definitions, and the investigation of contact definitions in larger linked studies is warranted to ensure contact data can capture environmental and social factors influencing transmission risk.

Perceived Barriers of Accessing Healthcare among Migrant Workers in Thailand during the Coronavirus Disease 2019 (COVID-19) Pandemic: A Qualitative Study

The outbreak of Coronavirus Disease 2019 (COVID-19) has threatened health and well-being in all populations. This impact is also deepening structural inequalities for migrant workers in Thailand. Due to their vulnerability and limited opportunity to access health services, they have greater risks in many health aspects compared to other populations. This qualitative study sought to examine the key health concerns and barriers during the COVID-19 pandemic on healthcare access among migrant workers in Thailand through the lens of policymakers, healthcare professionals, experts on migrant health, and migrant workers. We conducted 17 semi-structured in-depth interviews of stakeholders from health and non-health sectors in Thailand from July to October 2021. The interviews were transcribed and analyzed using both deductive and inductive thematic approaches. Thematic coding was applied. The results showed that financial constraints were a major barrier for healthcare access among migrant workers. These included affordability of healthcare and difficulty accessing funds (migrant health insurance). Structural barriers included some health facilities opening for emergency cases only. Insufficient healthcare resources were profound during the peak of positive cases. Cognitive barriers included negative attitudes and diverse understanding of healthcare rights. Language and communication barriers, and a lack of information also played an important role. Conclusion, our study highlights healthcare access barriers to migrant workers in Thailand during the COVID-19 pandemic. Recommendations for future resolution of these barriers were also proposed.

Seroprevalence of anti-SARS-CoV-2 antibodies and associated factors among household contacts of COVID-19 confirmed cases in Bangkok, Thailand

Background

High COVID-19 transmission among household (HH) contacts of infected cases were reported with seroprevalence varying from 5.5% to 57.2% worldwide. Data on seroprevalence among HH contacts and factors associated with seropositivity in Thailand are limited.

Objectives

To determine the seroprevalence and factors associated with anti-SARS-CoV-2 antibodies among HH contacts of COVID-19 confirmed cases.

Materials and methods

Data on confirmed COVID-19 cases (primary cases) in Bangkok from March 2020-July 2021 were retrieved from Institute for Urban Disease Control and Prevention. Primary cases were contacted within 14 days of testing positive for permission to contact their HH contacts via telephone. HH contacts were then recruited to complete questionnaires about demographics, and risk factors and blood was collected and tested for total immunoglobulin antibody against SARS-CoV-2 spike S1 protein. Factors associated with seropositivity were analysed by logistic regression.

Results

Eligible participants of 452 HH contacts of infected cases in Bangkok were contacted. Seroprevalence was 20.5% among HH contacts. Factors associated with seropositivity after multivariate analysis were relationship to index case (being other relatives to index case (other than close relatives/spouse) [aOR 4.04, 95% CI; 1.15, 14.14, p.029] and being a co-worker to index cases [aOR 0.16, 95% CI; 0.045, 0.60, p.006]), always staying in the same room with index case [aOR 5.64, 95% CI; 1.95, 16.34, p.001], sharing utensil [aOR 0.25, 95% CI; 0.074, 0.82, p.023], and participation in leisure activities together with index case [aOR 4.77, 95% CI; 1.47, 15.51, p.009].

Conclusion

Serological investigation can be used in detecting COVID-19 infection in conjunction with other molecular techniques. It is a useful tool for studies on seroprevalence in a population as well as seroconversion after a vaccination campaign. Sharing living environments are associated with seropositivity in HH contacts. Nevertheless, individual practices can be affected by awareness, cultural differences, and control measures implemented by each country.

Characteristics of Respiratory Syncytial Virus Infection in Hospitalized Children Before and During the COVID-19 Pandemic in Thailand

OBJECTIVES

This study compared the epidemiological and clinical manifestations of patients hospitalized with respiratory syncytial virus (RSV) infection before and during the coronavirus disease 2019 (COVID-19) pandemic at a tertiary care hospital in Chiang Mai Province, Thailand.

METHODS

This retrospective observational study utilized data from all cases of laboratory-confirmed RSV infection at Maharaj Nakorn Chiang Mai Hospital from January 2016 to December 2021. Differences in the clinical presentation of RSV infection before (2016 to 2019) and during (2020 to 2021) the COVID-19 pandemic were analyzed and compared.

RESULTS

In total, 358 patients hospitalized with RSV infections were reported from January 2016 to December 2021. During the COVID-19 pandemic, only 74 cases of hospitalized RSV infection were reported. Compared to pre-pandemic levels, the clinical presentations of RSV infection showed statistically significant decreases in fever on admission (p=0.004), productive cough (p=0.004), sputum (p=0.003), nausea (p=0.03), cyanosis (p=0.004), pallor (p&lt;0.001), diarrhea (p&lt;0.001), and chest pain (p<0.001). Furthermore, vigilant measures to prevent the spread of COVID-19, including lockdowns, also interrupted the RSV season in Thailand from 2020 to 2021.

CONCLUSIONS

The incidence of RSV infection was affected by the COVID-19 pandemic in Chiang Mai Province, Thailand, which also changed the clinical presentation and seasonal pattern of RSV infection in children.

Examining the Impacts of Title 42 in the Rio Grande Valley, Texas: Perceptions From Stakeholders in Immigrant Health and Wellbeing

During the initial weeks of the COVID-19 pandemic in the United States, the Department of Health and Human Services implemented a little-known public health law, referred to as "Title 42." The law immediately received criticism from public health professionals and pandemic response experts around the country. Years after its initial implementation, however, the policy has been consistently maintained through numerous court decisions as necessary to prevent COVID-19. This article explores the perceived impact of Title 42 on COVID-19 containment and overall health security in the Rio Grande Valley, Texas, based on interviews conducted with public health professionals, medical professionals, nonprofit staff, and social workers. Our findings show that Title 42 was not perceived to prevent the spread of COVID-19 and likely decreased overall health security in this region.

Association between self-reported masking behavior and SARS-CoV-2 infection wanes from Pre-Delta to Omicron-predominant periods - North Carolina COVID-19 Community Research Partnership (NC-CCRP)

BACKGROUND

Wearing a face mask is a primary public health method to reduce SARS-CoV-2 transmission.

METHODS

We performed a nested case-control analysis within the North Carolina COVID-19 Community Research Partnership (NC-CCRP) of adults who completed daily surveillance surveys, April 2020 - February 2022. We assessed the association between self-reported mask wearing behavior during nonhousehold interactions and COVID-19 infection during 3 pandemic periods using conditional logistic regression models of risk of infection that were adjusted for demographics, vaccination status, and recent known exposure to COVID-19.

RESULTS

Among 3,901 cases and 27,813 date-matched controls, there was a significant interaction between mask use and time period (P < .001). Prior to July 2021, the odds of a reported infection were 66% higher (aOR = 1.66, 95% CI = 1.43-1.91) among participants reporting ≥1 day not wearing a mask compared to those who reported no days (1,592 cases, 11,717 controls). During the Delta-predominant period, the results were similar (aOR = 1.53, 95% CI = 1.23-1.89; 659 cases, 4,649 controls). This association was attenuated during the Omicron-predominant period, where odds of an infection was 16% higher (aOR = 1.16, 95% CI = 1.03-1.32; 1,563 cases, 10,960 controls).

CONCLUSIONS

While the effect of not wearing a mask remains significant, during the Omicron-predominant period we observed a decrease in the association between self-reported mask wearing and risk of SARS-CoV-2 infection.

High rates of observed face mask use at Colorado universities align with students' opinions about masking and support the safety and viability of in-person higher education during the COVID-19 pandemic

BACKGROUND

Over the course of the COVID-19 pandemic, colleges and universities have focused on creating policies, such as mask mandates, to minimize COVID-19 transmission both on their campuses and in the surrounding community. Adherence to and opinions about these policies remain largely unknown.

METHODS

The Centers for Disease Control and Prevention (CDC) developed a cross-sectional study, the Mask Adherence and Surveillance at Colleges and Universities Project (MASCUP!), to objectively and inconspicuously measure rates of mask use at institutes of higher education via direct observation. From February 15 through April 11, 2021 the University of Colorado Boulder (CU, n = 2,808 observations) and Colorado State University Fort Collins (CSU, n = 3,225 observations) participated in MASCUP! along with 52 other institutes of higher education (n = 100,353 observations) spanning 21 states and the District of Columbia. Mask use was mandatory at both Colorado universities and student surveys were administered to assess student beliefs and attitudes.

RESULTS

We found that 91.7%, 93.4%, and 90.8% of persons observed at indoor locations on campus wore a mask correctly at University of Colorado, Colorado State University, and across the 52 other schools, respectively. Student responses to questions about masking were in line with these observed rates of mask use where 92.9% of respondents at CU and 89.8% at CSU believe that wearing masks can protect the health of others. Both Colorado universities saw their largest surges in COVID-19 cases in the fall of 2020, with markedly lower case counts during the mask observation window in the spring of 2021.

CONCLUSION

High levels of mask use at Colorado's two largest campuses aligned with rates observed at other institutes across the country. These high rates of use, coupled with positive student attitudes about mask use, demonstrate that masks were widely accepted and may have contributed to reduced COVID-19 case counts. This study supports an emerging body of literature substantiating masks as an effective, low-cost measure to reduce disease transmission and establishes masking (with proper education and promotion) as a viable tactic to reduce respiratory disease transmission on college campuses.

Virucidal Activities of Acidic Electrolyzed Water Solutions with Different pH Values against Multiple Strains of SARS-CoV-2

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a threat to human health. Acidic electrolyzed water (AEW) has recently been suggested to demonstrate virucidal activity. Many types of AEW with different pH values, generated by the electrolysis of different chemicals, such as sodium chloride, potassium chloride, and hydrochloric acid, are commercially available. In this study, we compared the virucidal activities of these types of AEW against SARS-CoV-2, including the ancestral strain and variant Alpha, Beta, Gamma, Delta, and Omicron strains. Virus solution (viral titer, 6.9 log₁₀ 50% tissue culture infective dose [TCID₅₀]/mL) was mixed with AEW (free available chlorine concentration, 34.5 ppm) at mixing ratios of 1:9, 1:19, and 1:49. At mixing ratios of 1:9 and 1:19, AEW with a pH of 2.8 showed stronger virucidal activities than AEW with a pH of 4.1 to 6.5 against the SARS-CoV-2 ancestral strain in 20 s. From the strongest to the weakest virucidal activity, the AEW pH levels were as follows: pH 2.8, pH 4.1 to 5.4, pH 6.4 to 6.5. At a ratio of 1:49, the viral titers of viruses treated with all AEW solutions at pH 2.8 to 6.5 were almost below the detection limit, which was 1.25 log₁₀ TCID₅₀/mL. The virus inactivation efficiency of AEW was reduced in the presence of fetal bovine serum and other substances contained in the virus solution used in this study. AEW with pH values of 2.8 to 6.5 showed virucidal activity against all of the tested SARS-CoV-2 strains, including the ancestral and variant strains. These results provide useful knowledge for the effective application of AEW as a SARS-CoV-2 disinfectant. IMPORTANCE Acidic electrolyzed water (AEW) demonstrates virucidal activity against multiple viruses. Since AEW exhibits low toxicity, is inexpensive, and is environmentally friendly, it can be a useful disinfectant against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the pH values of currently available AEW products vary, the impact of different pH values on SARS-CoV-2 inactivation has not previously been evaluated in detail. In this study, we compared the virucidal activities of multiple AEW solutions with different pH values, under the same experimental conditions. We found that AEW solutions with lower pH values demonstrated more potent virucidal activity. Also, we showed that the extent of virus inactivation by the AEW was based on the balance of the abundance of free available chlorine, virus, and other organic substances in the mixture. AEW exhibited rapid virucidal activity against multiple SARS-CoV-2 strains. This study demonstrated the usefulness of AEW as a disinfectant which can be applied to the inactivation of SARS-CoV-2.

Preventive Behaviors and Influencing Factors among Thai Residents in Endemic Areas during the Highest Epidemic Peak of the COVID-19 Outbreak

This research aims to investigate COVID-19 preventive behavior and influencing factors among Thai residents during the highest epidemic peak of COVID-19. Nine hundred and forty-six residents in five districts with high COVID-19 infection cases in Thailand were systematically included in this cross-sectional survey. The results showed that 87.2% and 65.2% of the residents had a high level of general knowledge and preventive measures, respectively. As to COVID-19 attitudes, poor levels of attitude among Thai residents were found in risk perception (53.6%) and mistrust issues (70.4%). Moreover, this study presents good preventive behavior (77.0%) among Thai residents. Multiple logistic regression showed that the influence factors of COVID-19 preventive behavior were the young age group (AOR 2.97, 95% CI 1.68-5.25), high income (AOR 1.38, 95% CI 1.03-1.86), and high level of general COVID-19 knowledge (AOR 2.21, 95% CI 1.64-2.96). The conclusion was that providing information on COVID-19 via social media was the key mechanism of policy action for increasing the level of COVID-19 preventive behavior during the highest epidemic peak in Thailand. In addition, the pandemic preparedness and response policy, with resident participation and involvement, could be recommended for the resilience of pandemic preparedness.

Level of Physical Activity, Sleep Quality and Use of Personal Protective Equipment of Students at Wroclaw Medical University during the COVID-19 Pandemic

The study was conducted in October 2020 and March 2021 among Wroclaw Medical University students of different years and faculties. The objective of the study was to establish the relationship between some determinants, such as gender and the levels of physical activity, and the quality of sleep of medical students during the pandemic. Ultimately, 696 responses from October and 652 from March were included. To determine the level of physical activity, the International Physical Activity Questionnaire (IPAQ) was used, and for sleep quality, the Pittsburgh Sleep Quality Index (PSQI) was used. The findings pointed to a higher Total MET m/w (metabolic equivalent of task in minutes a week) in men compared to women in both study periods (2020: 1845.8 to 1542.5, p = 0.009; 2021: 2040.7 to 1826.6, p = 0.025). This was mainly due to a higher Vigorous Exercises MET m/w in men (2020: 837.3 to 635.8, p = 0.008; 2021: 773.3 to 490.3, p = 0.0006). Moreover, women had a lower quality of sleep resulting from problems in Habitual Sleep Efficiency, Sleep Disturbances, and Daytime Dysfunctions. An adequate level of physical activity and a good night's rest are the fundaments of health; therefore, it is necessary to determine the causes of their deficiencies in order that we can counteract them.

Addressing Complexity in the Pandemic Context: How Systems Thinking Can Facilitate Understanding of Design Aspects for Preventive Technologies

The COVID-19 pandemic constitutes a wicked problem that is defined by rapidly evolving and dynamic conditions, where the physical world changes (e.g., pathogens mutate) and, in parallel, our understanding and knowledge rapidly progress. Various preventive measures have been developed or proposed to manage the situation, including digital preventive technologies to support contact tracing or physical distancing. The complexity of the pandemic and the rapidly evolving nature of the situation pose challenges for the design of effective preventive technologies. The aim of this conceptual paper is to apply a systems thinking model, DSRP (distinctions, systems, relations, perspectives) to explain the underlying assumptions, patterns, and connections of the pandemic domain, as well as to identify potential leverage points for design of preventive technologies. Two different design approaches, contact tracing and nudging for distance, are compared, focusing on how their design and preventive logic are related to system complexity. The analysis explains why a contact tracing technology involves more complexity, which can challenge both implementation and user understanding. A system utilizing nudges can operate using a more distinct system boundary, which can benefit understanding and implementation. However, frequent nudges might pose challenges for user experience. This further implies that these technologies have different contextual requirements and are useful at different levels in society. The main contribution of this work is to show how systems thinking can organize our understanding and guide the design of preventive technologies in the context of epidemics and pandemics.

Association Between Population-Level Factors and Household Secondary Attack Rate of SARS-CoV-2: A Systematic Review and Meta-analysis

Background

Accurate estimation of household secondary attack rate (SAR) is crucial to understand the transmissibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The impact of population-level factors, such as transmission intensity in the community, on SAR estimates is rarely explored.

Methods

In this study, we included articles with original data to compute the household SAR. To determine the impact of transmission intensity in the community on household SAR estimates, we explored the association between SAR estimates and the incidence rate of cases by country during the study period.

Results

We identified 163 studies to extract data on SARs from 326 031 cases and 2 009 859 household contacts. The correlation between the incidence rate of cases during the study period and SAR estimates was 0.37 (95% CI, 0.24-0.49). We found that doubling the incidence rate of cases during the study period was associated with a 1.2% (95% CI, 0.5%-1.8%) higher household SAR.

Conclusions

Our findings suggest that the incidence rate of cases during the study period is associated with higher SAR. Ignoring this factor may overestimate SARs, especially for regions with high incidences, which further impacts control policies and epidemiological characterization of emerging variants.

Association between COVID-19 and consistent mask wearing during contact with others outside the household-A nested case-control analysis, November 2020-October 2021

BACKGROUND

Face masks have been recommended to reduce SARS-CoV-2 transmission. However, evidence of the individual benefit of face masks remains limited, including by vaccination status.

METHODS

As part of the COVID-19 Community Research Partnership cohort study, we performed a nested case-control analysis to assess the association between self-reported consistent mask use during contact with others outside the household and subsequent odds of symptomatic SARS-CoV-2 infection (COVID-19) during November 2020-October 2021. Using conditional logistic regression, we compared 359 case-participants to 3544 control-participants who were matched by date, adjusting for enrollment site, age group, sex, race/ethnicity, urban/rural county classification, and healthcare worker occupation.

RESULTS

COVID-19 was associated with not consistently wearing a mask (adjusted odds ratio [aOR] 1.49; 95% confidence interval [CI] [1.14, 1.95]). Compared with persons ≥14 days after mRNA vaccination who also reported always wearing a mask, COVID-19 was associated with being unvaccinated (aOR 5.94; 95% CI [3.04, 11.62]), not wearing a mask (aOR 1.62; 95% CI [1.07, 2.47]), or both unvaccinated and not wearing a mask (aOR 9.07; 95% CI [4.81, 17.09]).

CONCLUSIONS

Our findings indicate that consistent mask wearing can complement vaccination to reduce the risk of COVID-19.

Effectiveness of Using Face Masks and Personal Protective Equipment to Reducing the Spread of COVID-19: A Systematic Review and Meta-Analysis of Case-Control Studies

Recently published researches show that 59% of all transmission came from asymptomatic transmission and at the time of diagnosis health-care workers (HCWs) tend to present without respiratory symptoms. These evidences have raised questions on whether an essential policy for use of personal protective equipment (PPE) is the best approach in HCW and other people or not. Therefore, this study conducted to investigate the effectiveness of using face masks and PPE in reducing the spread of COVID-19 in health-care and non-health-care settings. This systematic review and meta-analysis study was prepared according to the preferred reporting items for systematic review and meta-analysis statement and guided by meta-analysis of observational studies recommendations. Searches in databases were conducted from December 2019 to July 2021. Random-effects meta-analysis was performed to investigate the effect of using face masks and PPE on spread of COVID-19. Heterogeneity among studies was assessed using Cochran's Q test and the I ² metrics. In total, 9920 individuals from 14 studies were included in this study. In all settings, application of PPE or any type of masks was associated with reduction in risk of COVID-19 (odds ratio [OR] = 0.44; 95% confidence interval [CI]: [0.29, 0.65]; I ² = 85.21%). In the HCW subgroup, the protective effect had a combined OR of 0.33 (95% CI: (0.15,0.73), I ² = 82.61%). Six studies were found protective effects of wearing mask in non-HCWs (OR = 0.58, 95% CI: (0.31, 1.06), I ² = 85.63%). Results suggest that there is association between face mask/PPE use and reduction of COVID-19.

The effectiveness of social distancing in reducing transmission during influenza epidemics: A systematic review

BACKGROUND

Social distance practices are crucial for outpatient clinics during disease outbreaks and are an effective preventive measure for reducing influenza transmission during such pandemics in people with poor health.

METHODS

This study applies an evidence-based practice (EBP) approach to confirm the effectiveness of social distancing in healthy individuals during an influenza pandemic and employs the induced ordered weighted averaging model to confirm the effectiveness of EBP. The study design, validity, reliability, results, and generalizability focused on discussing three systematic reviews and two cohort studies via the Critical Appraisal Skills Programme (CASP). First, by introducing the patient, intervention, comparison, outcome (PICO) question; second, by establishing the five steps of EBP; third, by utilizing the CASP checklist for the appraisal; and finally, by presenting a conclusion.

RESULTS

According to the hierarchy of evidence, preferred reporting items for systematic reviews and meta-analyses retrieved five articles for addressing the PICO question. All the evidence demonstrates that social distancing is valuable during influenza pandemics among non-infected individuals. Precise, timely, and robust social distancing implementation can reduce the spread of infection, delay the epidemic peak, and ease the pressure on healthcare resources. Gatekeepers are responsible for guiding individuals through the implementation process for reducing influenza transmission, particularly in densely populated areas.

CONCLUSIONS

Social distance is crucial for outpatient clinics during an epidemic and effectively reduces the spread of infection, delay epidemic peaks, and eases pressure on healthcare resources.

Application of the Capability, Opportunity, Motivation and Behavior (COM-B) model to identify predictors of two self-reported hand hygiene behaviors (handwashing and hand sanitizer use) to prevent COVID-19 infection among U.S. adults, Fall 2020

BACKGROUND

Handwashing with soap and water is an important way to prevent transmission of viruses and bacteria and worldwide it is estimated handwashing can prevent 1 in 5 viral respiratory infections. Frequent handwashing is associated with a decreased risk for infection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Using a hand sanitizer with at least 60% alcohol when handwashing is not feasible can also help prevent the transmission of viruses and bacteria.

OBJECTIVE

Since early 2020, the public has been encouraged to handwash frequently with soap and water and use alcohol-based hand sanitizer when soap and water are not available to reduce COVID-19 transmission. This study's objectives were to assess U.S. adults' perceptions of components of the Capability, Opportunity, Motivation and Behavior (COM-B) Model in relation to these two hand hygiene behaviors and to identify relationships between these components and hand hygiene behaviors.

METHODS

Items assessing capability, opportunity, motivation, and hand hygiene behaviors were included in FallStyles, a survey completed by 3,625 adults in the fall of 2020 through an online panel representative of the U.S.

POPULATION

We calculated composite capability, opportunity, and motivation measures and descriptive statistics for all measures. Finally, we conducted multiple logistic regressions to identify predictors of handwashing and hand sanitizer use.

RESULTS

Most respondents reported frequently washing hands with soap and water (89%) and using alcohol-based hand sanitizer (72%) to prevent coronavirus. For capability, over 90% of respondents said that neither behavior takes a lot of effort, but fewer agreed that they knew when, or how, they should engage in handwashing (67%; 74%) and hand sanitizer use (62%; 64%). For opportunity, over 95% of respondents said lack of time didn't make it hard to engage in either behavior; fewer said visual cues reminded them to engage in the behaviors (handwashing: 30%; sanitizer use: 48%). For motivation, the majority believed the two behaviors were good ways to prevent coronavirus illness (handwashing: 76%; sanitizer use: 59%). Regressions indicated that capability, opportunity, and particularly motivation were positively associated with both hand hygiene behaviors.

CONCLUSIONS

The COM-B model was a helpful framework for increasing understanding of hand hygiene behavior; it identified capability, opportunity, and motivation as predictors of both handwashing and hand sanitizer use.

Using a Proximity-Detection Technology to Nudge for Physical Distancing in a Swedish Workplace During the COVID-19 Pandemic: Retrospective Case Study

BACKGROUND

The recent COVID-19 pandemic has contributed to the emergence of several technologies for infectious disease management. Although much focus has been placed on contact-tracing apps, another promising new tactic is proximity tracing, which focuses on health-related behavior and can be used for primary prevention. Underpinned by theories on behavioral design, a proximity-detection system can be devised that provides a user with immediate nudges to maintain physical distance from others. However, the practical feasibility of proximity detection during an infectious disease outbreak has not been sufficiently investigated.

OBJECTIVE

We aimed to evaluate the feasibility of using a wearable device to nudge for distance and to gather important insights about how functionality and interaction are experienced by users. The results of this study can guide future research and design efforts in this emerging technology.

METHODS

In this retrospective case study, a wearable proximity-detection technology was used in a workplace for 6 weeks during the production of a music competition. The purpose of the technology was to nudge users to maintain their physical distance using auditory feedback. We used a mixed methods sequential approach, including interviews (n=8) and a survey (n=30), to compile the experiences of using wearable technology in a real-life setting.

RESULTS

We generated themes from qualitative analysis based on data from interviews and open-text survey responses. The quantitative data were subsequently integrated into these themes: feasibility (implementation and acceptance-establishing a shared problem; distance tags in context-strategy, environment, and activities; understanding and learning; and accomplishing the purpose) and design aspects (a purposefully annoying device; timing, tone, and proximity; and additional functions).

CONCLUSIONS

This empirical study reports on the feasibility of using wearable technology based on proximity detection to nudge individuals to maintain physical distance in the workplace. The technology supports attention to distance, but the usability of this approach is dependent on the context and situation. In certain situations, the audio signal is frustrating, but most users agree that it needs to be annoying to ensure sufficient behavioral adaption. We proposed a dual nudge that involves vibration followed by sound. There are indications that the technology also facilitates learning how to maintain a greater distance from others, and that this behavior can persist beyond the context of technology use. This study demonstrates that the key value of this technology is that it places the user in control and enables immediate action when the distance to others is not maintained. This study provides insights into the emerging field of personal and wearable technologies used for primary prevention during infectious disease outbreaks. Future research is needed to evaluate the preventive effect on transmission and investigate behavioral changes in detail and in relation to different forms of feedback.

The Effect of Preventive Measures and Vaccination against SARS-CoV-2 on the Infection Risk, Treatment, and Hospitalization: A Cross-Sectional Study of Algeria

Coronavirus disease (COVID-19) caused by the SARS-CoV-2 virus continues to afflict many countries around the world. The resurgence of COVID-19 cases and deaths in many countries shows a complacency in adhering to preventive guidelines. Consequently, vaccination continues to be a crucial intervention to reduce the effects of this pandemic. This study investigated the impact of preventive measures and COVID-19 vaccination on the infection, medication, and hospitalization. A cross-sectional online survey was conducted between 23 December 2021 and 12 March 2022 in Algeria. To evaluate the effectiveness of strategies aimed at avoiding and minimizing SARS-CoV-2 infection and severity, a questionnaire was created and validated. Descriptive statistics and logistic regression analyses were computed to identify associations between dependent and independent variables. Variables with a p-value of < 0.05 were considered statistically significant. Our results indicated that out of 2294 answers received, only 16% of our sample was vaccinated, and more than 60% did not apply preventive guidelines. As a result, 45% were infected with SARS-CoV-2, 75% took treatment (even preventive), and 9% were hospitalized. The logistic regression showed that the impact of preventive measures on the unvaccinated is statistically not significant (OR: 0.764, 95% CI = 0. 555-1.052; p = 0.09). However, this relationship changes significantly for people who are vaccinated (OR: 0.108, 95% CI = 0.047-0.248; p < 0.0001). Our results also demonstrated that the impact of protective measures on non-vaccinated individuals is statistically significant in reducing the need to receive anti-COVID-19 treatments (OR: 0.447, 95% CI = 0.321-0.623; p < 0.0001). Furthermore, the results showed that the impact of preventive measures on the non-vaccinated population is also statistically significant in reducing the risk of hospitalization (OR: 0.211, 95% CI = 0.081-0.548; p < 0.0001). Moreover, vaccinated individuals who neglect preventive measures must take the COVID-19 medication at a rate of 3.77 times (OR: 3.77) higher than those who follow preventive measures and are vaccinated. In short, our findings demonstrate the importance of combining preventive measures and vaccination in order to fight against the pandemic. Therefore, we advise the Ministry of Health and relevant authorities to put more effort into enhancing public knowledge about the COVID-19 infection and vaccination through education and awareness initiatives. Parallel to implementing vaccination as additional preventive strategy, behavioral change initiatives must be improved to encourage adherence to COVID-19 prevention recommendations.

Factors affecting face mask-wearing behaviors to prevent COVID-19 among Thai people: A binary logistic regression model

OBJECTIVES

Face mask wearing is a standard preventive measure, in addition to handwashing and physical distancing. Individuals may find that wearing a face mask protects their physical health and prevents viral transmission. However, none of the studies in Thailand identified factors associated with face mask-wearing behaviors among Thai people. Therefore, this study aims to determine factors affecting face mask-wearing behaviors to prevent COVID-19.

METHODS

This research is analytical survey research. The data used in this study were under the project title "The assessment of psychosocial and behavioral response and compliance to restriction measures to prevent and control COVID-19: A series of the rapid survey." A total of 6,521 people participated in an online survey by multi-stage sampling. Bivariate logistic regression analysis was used to examine the factors associated with face mask-wearing behaviors.

RESULTS

After adjusting for independent variables (i.e., gender, age, education, career, smoking, and comorbidity disease), the bivariate logistic regression analysis revealed that gender, age, and career were statistically significant to the face mask-wearing behaviors (p < 0.05). Level of education, smoking, and comorbidity disease were not statistically significant with face mask-wearing behaviors among Thai people.

CONCLUSION

Further study should explore broader on individual face mask perceptions and wearing in the continuing of COVID-19 across gender, age, and careers to better understand their health behaviors and to inform further policy. In addition, the development of an intervention to promote face mask wearing should target men who age below 30 yrs. and did not work in government services careers as this group of the population was likely not to wear a face mask outside the home.

Associations Between Conventional Healthy Behaviors and Social Distancing During the COVID-19 Pandemic: Evidence From the 2020 Community Health Survey in Korea

OBJECTIVES

Many studies have shown that social distancing, as a non-pharmaceutical intervention (NPI) that is one of the various measures against coronavirus disease 2019 (COVID-19), is an effective preventive measure to suppress the spread of infectious diseases. This study explored the relationships between traditional health-related behaviors in Korea and social distancing practices during the COVID-19 pandemic.

METHODS

Data were obtained from the 2020 Community Health Survey conducted by the Korea Disease Control and Prevention Agency (n=98 149). The dependent variable was the degree of social distancing practice to cope with the COVID-19 epidemic. Independent variables included health-risk behaviors and health-promoting behaviors. The moderators were vaccination and unmet medical needs. Predictors affecting the practice of social distancing were identified through hierarchical multiple logistic regression analysis.

RESULTS

Smokers (adjusted odds ratio [aOR], 0.924) and frequent drinkers (aOR, 0.933) were more likely not to practice social distancing. A greater degree of physical activity was associated with a higher likelihood of practicing social distancing (aOR, 1.029). People who were vaccinated against influenza were more likely to practice social distancing than those who were not (aOR, 1.150). However, people with unmet medical needs were less likely to practice social distancing than those who did not experience unmet medical needs (aOR, 0.757).

CONCLUSIONS

Social distancing practices were related to traditional health behaviors such as smoking, drinking, and physical activity. Their patterns showed a clustering effect of health inequality. Therefore, when establishing a strategy to strengthen social distancing, a strategy to protect the vulnerable should be considered concomitantly.

Preventive measures focused on the urban-rural interface protect rural food-producing communities from SARS-CoV-2

INTRODUCTION

Rural food-producing communities are fundamental for the development of economic activities associated with sustainability and food security. However, despite the importance of rurality in Colombia, preventive strategies continue to be implemented homogeneously, without considering the dynamics of SARS-CoV-2 in rural food-producing communities.

OBJECTIVE

To model real areas in Colombia involving rural and urban populations that have intrinsic SARS-CoV-2 transmission dynamics. Characterize rural-urban interactions by means of a parameter that provides different scenarios and allows us to identify interactions capable of preventing SARS-CoV-2 transmission in rural food-producing communities.

MATERIALS AND METHODS

The dynamics of SARS-CoV-2 infection was modeled in five case studies (Boyacá, Caquetá, Cundinamarca, Santander and Sucre) considering urban and rural areas and their interaction (connectivity) in the urban-rural interface. For this purpose, an epidemiological compartmental model considering a classification of individuals according to their economic activity and their epidemiological status was assessed.

RESULTS

Preventive measures focused on the urban-rural interface impact the number of deaths in rural areas. Hence, it is possible to assume that the dynamics of the disease in rural areas depend on the constant interaction with infected individuals from urban areas, which occurs due to the food production dynamics in the urban-rural interface.

CONCLUSIONS

Preventive measures should focus on places of high transmissibility and risk for rural communities, such as the urban-rural interface. This work highlights the importance of national heterogeneous preventive measures and the protection of rural communities from the social and economic impacts of SARS-CoV-2.

Lessons from the health policies for children during the pandemic in Japan

It is everyone's desire to seek the sound growth of children through food education and there is a critical need for fostering an environment for this purpose. Health policies are important for this support. To the present, the Japanese society has been greatly disrupted by COVID-19 pandemic. "Stay at home", "mokusyoku (silent eating)", and mask wearing were encouraged in nationwide campaigns as public health measures to combat COVID-19. There are some papers reporting negative effects of "stay at home" and lockdowns such as weight gain, decrease in physical activities and change in eating habits. In Japan, while benefits and advantages of food education during mealtime were previously well studied, the "mokusyoku" rule may directly run counter to this food education. Moreover, there are several reports showing that nutrients might contribute to prevention of infectious diseases. Japanese children were also encouraged to wear masks all day long. The results of the clinical research, especially randomized control trials, show limited protective effect of masks. On the other hand, negative outcomes of the masks were reported in various scenes. This review focuses on these topics and arousing reconsideration for a better environment for children.

A full-face mask for protection against respiratory infections

BACKGROUND

Aerosols and droplets are the transmission routes of many respiratory infectious diseases. The COVID-19 management guidance recommends against the use of nebulized inhalation therapy directly in the emergency room or in an ambulance to prevent possible viral transmission. The three-dimensional printing method was used to develop an aerosol inhalation treatment mask that can potentially prevent aerosol dispersion. We conducted this utility validation study to understand the practicability of this new nebulizer mask system.

RESULTS

The fit test confirmed that the filter can efficiently remove small particles. The different locations of the mask had an excellent fit with a high pressure making a proper face seal usability. The full-face mask appeared to optimize filtration with pressure and is an example of materials that perform well for improvised respiratory protection using this design. The filtering effect test confirmed that the contamination of designated locations could be protected when using the mask with filters. As in the clinical safety test, a total of 18 participants (10 [55.6%] females; aged 33.1 ± 0.6 years) were included in the final analysis. There were no significant changes in SPO2, EtCO2, HR, SBP, DBP, and RR at the beginning, 20th, 40th, or 60th minutes of the test (all p >.05). The discomfort of wearing a mask increased slightly after time but remained within the tolerable range. The vision clarity score did not significantly change during the test. The mask also passed the breathability test.

CONCLUSION

The results of our study showed that this mask performed adequately in the fit test, the filtering test, and the clinical safety test. The application of a full-face mask with antiviral properties, together with the newly designed shape of a respirator that respects the natural curves of a human face, will facilitate the production of personal protective equipment with a highly efficient filtration system.

METHODS

We conducted three independent tests in this validation study: (1) a fit test to calculate the particle number concentration and its association with potential leakage; (2) a filtering effect test to verify the mask's ability to contain aerosol spread; and (3) a clinical safety test to examine the clinical safety, comfortableness, and visual clarity of the mask.

Adherence to COVID-19 Guidelines among Current, Former, and Never Smokers

Objectives: In this paper, we explore the adherence patterns to US Centers for Disease Control and Prevention (CDC) COVID-19 mitigation guidelines among current, former, and never smokers. Methods: We used an online cross-sectional survey of adults 18 years or older in 5 northeastern states of the US (N=1084). Results: Unadjusted analyses revealed that current smokers reported lower adherence to the CDC guidelines than former smokers (27.5 vs 29.4, p<.05). After accounting for sociodemographic covariates, this finding was no longer statistically significant. However, compared to former smokers, never smokers reported wearing their mask less often (OR=0.65; 95% CI=0.45-0.94) and current smokers were less likely to report always practicing illness-related hygiene skills (OR=0.60; 95% CI=0.39-0.93).Conclusions: Never smokers had poorer adherence to CDC guidelines than former smokers, namely wearing their masks, and current smokers were less likely to always follow the hygiene recommendations. Results should inform future public health efforts in targeting current smokers with lower adherence to CDC guidelines and learning from the ability of former smokers to demonstrate high adherence.