Face Coverings Research Articles

Of masks and methylene blue—The use of methylene blue photochemical treatment to decontaminate surgical masks contaminated with a tenacious small nonenveloped norovirus

BackgroundIn the context of the SARS-CoV-2 pandemic, reuse of personal protective equipment, specifically that of medical face coverings, has been recommended. The reuse of these typically single-use only items necessitates procedures to inactivate contaminating human respiratory and gastrointestinal pathogens. We previously demonstrated decontamination of surgical masks and respirators contaminated with infectious SARS-CoV-2 and various animal coronaviruses via low concentration- and short exposure methylene blue photochemical treatment (10 µM methylene blue, 30 minutes of 12,500-lux red light or 50,000 lux white light exposure).MethodsHere, we describe the adaptation of this protocol to the decontamination of a more resistant, non-enveloped gastrointestinal virus and demonstrate efficient photodynamic inactivation of murine norovirus, a human norovirus surrogate.ResultsMethylene blue photochemical treatment (100 µM methylene blue, 30 minutes of 12,500-lux red light exposure) of murine norovirus-contaminated masks reduced infectious viral titers by over four orders of magnitude on surgical mask surfaces.Discussion and ConclusionsInactivation of a norovirus, the most difficult to inactivate of the respiratory and gastrointestinal human viruses, can predict the inactivation of any less resistant viral mask contaminant. The protocol developed here thus solidifies the position of methylene blue photochemical decontamination as an important tool in the package of practical pandemic preparedness.

Feature, Barrier Face Coverings for Workers.

Face coverings have been recommended for the public and workers to prevent person-to-person transmission of COVID-19. Throughout 2020, guidelines for face coverings recommended multiple layers worn tightly against the face with straps or ear loops. This article briefly describes a new ASTM 3502 Standard Specification for Barrier Face Coverings (BFCs) and the development of performance criteria for workplace BFCs ahead of the Occupational Safety and Health Administration (OSHA) COVID-19 Emergency Temporary Standards (ETS). We also describe a method for comparing the effect on the time to receipt of an infectious dose (ID) of BFCs with varying degrees of inward leakage (personal protection) and outward leakage (source control). The role of BFCs in workplace settings during the pandemic and for exposure to infectious respiratory organisms after the pandemic remains in question. It will be important for occupational health and safety professionals to recognize their limitations in contrast with respiratory protection.

Health sciences students' perception of the communicative impacts of face coverings during the COVID-19 pandemic at a South African University.

BackgroundThe use of face masks and/or shields can pose a challenge during communication. They block facial expressions thus removing visual cues and affect sound transmission making it difficult to hear speech clearly. Given the widespread use of face coverings, it seems reasonable to clarify if communication in typical speakers and listeners has significantly differed. Health science students as future practitioners need to understand challenges that arise from using face coverings.ObjectiveThis study aimed to determine health sciences students’ perception of the communicative impacts of face coverings.MethodThe study employed a descriptive, self-administered online survey, obtaining information from 96 health science undergraduate students.ResultsAll participants changed their manner of speaking in that they spoke louder when wearing masks and focused more on eye contact when someone was wearing masks. These were statistically significant (p = 0.450 and p = 0.035 respectively). Fifty-three percent reported using more listening effort and feeling anxious when communicating. Approximately 33% indicated that it was challenging to read emotions, such as sad or unhappy, when someone wore a mask. Most, 61%, were positive or very positive about wearing masks. The level of difficulty differed depending on the listening environment. It was harder to understand the doctor, nurse, or other healthcare workers when they wore face coverings than when listening to their friends and family, which had little effect, this being statistically significant (p = 0.025).ConclusionChallenges envisaged in practice included frequent communication breakdowns, inability to connect and build trust between patient and practitioner, and communicating in noisy environments. Coping strategies, future clinical and research implications were proposed, and limitations acknowledged.

Preparation of surface-functionalized electrospun PVA nanowebs for potential remedy for SARS-CoV-2

Infections with coronaviruses remain a burden that is negatively affecting human life. The use of metal oxides to prevent and control the spread of severe acute respiratory syndrome coronavirus (SARS-CoV-2) has been widely studied. However, the use of metal oxides in masks to enhance the performances of barrier face coverings in trapping and neutralizing SARS-CoV-2 remained unexplored. In the present study, we explore the possibility of developing surface functional PVA/ZnO electrospun nanowebs to be used as a component of multilayer barrier face coverings. Polyvinyl alcohol (PVA) and zinc acetate (ZnA) nanowebs were electrospun as precursor samples. After calcination at 400 degrees centigrade under a controlled atmosphere of nitrogen gas, product nanowebs containing ZnO (PVA/ZnO) were obtained. The presence of ZnO was determined using an attenuated total reflectance Fourier Transform Infrared (FT-IR) spectrometer. This study inspired the possibility of developing surface-functional materials to produce enhanced performance masks against the spread of SARS-CoV-2.

Motion- Based Respiratory Rate Estimation with Motion Artifact Removal Using Video of Face and Upper Body.

Respiratory rate (RR) is a significant indicator of health conditions. Remote contactless measurement of RR is gaining popularity with recent respiratory tract infection awareness. Among various methods of contactless RR measurement, a video of an individual can be used to obtain an instantaneous RR. In this paper, we introduce an RR estimation based on the subtle motion of the head or upper chest captured on an RGB camera. Motion-based respiratory monitoring allows us to acquire RR from individuals with partial face coverings, such as glasses or a face mask. However, motion-based RR estimation is vulnerable to the subject's voluntary movement. In this work, adaptive selection between face and chest regions plus a motion artifact removal technique enables us to obtain a much cleaner respiratory signal from the video recordings. The average mean absolute error (MAE) for controlled and natural breathing is 1.95 BPM using head motion only and 1.28 BPM using chest motion only. Our results demonstrate the possibility of continuous monitoring of breathing rate in real-time with any personal device equipped with an RGB camera, such as a laptop or a smartphone.

Development of Harmonized COVID-19 Occupational Questionnaires.

Harmonized tools and approaches for data collection can help to detect similarities and differences within and between countries and support the development, implementation, and assessment of effective and consistent preventive strategies. We developed open source occupational questionnaires on COVID-19 within COVID-19 working groups in the OMEGA-NET COST action (Network on the Coordination and Harmonisation of European Occupational Cohorts, omeganetcohorts.eu), and the EU funded EPHOR project (Exposome project for health and occupational research, ephor-project.eu). We defined domains to be included in order to cover key working life aspects of the COVID-19 pandemic. Where possible, we selected questionnaire items and instruments from existing questionnaire resources. Both a general occupational COVID-19 questionnaire and a specific occupational COVID-19 questionnaire are available. The general occupational COVID-19 questionnaire covers key working life aspects of the COVID-19 pandemic, including the domains: COVID-19 diagnosis and prevention, Health and demographics, Use of personal protective equipment and face covering, Health effects, Work-related effects (e.g. change in work schedule and work–life balance), Financial effects, Work-based risk factors (e.g. physical distancing, contact with COVID-19-infected persons), Psychosocial risk factors, Lifestyle risk factors, and Personal evaluation of the impact of COVID-19. For each domain, additional questions are available. The specific occupational COVID-19 questionnaire focusses on occupational risk factors and mitigating factors for SARS-CoV2 infection and COVID-19 disease and includes questions about the type of job, amount of home working, social distancing, human contact (colleagues, patients, and members of the public), commuting, and use of personal protective equipment and face coverings. The strength of this initiative is the broad working life approach to various important issues related to SARS-CoV-2 infection, COVID-19 disease, and potentially future pandemics. It requires further work to validate the questionnaires, and we welcome collaboration with researchers willing to do this. A limitation is the moderate number of questions for each of the domains in the general questionnaire. Only few questions on general core information like ethnicity, demographics, lifestyle factors, and general health status are included, but the OMEGA-NET questionnaires can be integrated in existing questionnaires about sociodemographic and health-related aspects. The questionnaires are freely accessible from the OMEGA-NET and the EPHOR homepages.

Latex Allergens in the Ear Straps of Face Coverings and Masks in the UK: Initial Findings

The SARS-CoV-2 pandemic led to an unprecedented demand for PPE and generated a small-scale industry making personalised face coverings. Concerns had been raised about the use of natural rubber latex (NRL) as an elastomeric material, with its health risks. We have investigated the levels of four NRL allergens and total protein in elastomeric ear-straps in manufactured face coverings and the material sold for their production, and a number of imported N95/KN95 PPE masks. None of the samples identified whether NRL was involved or not. NRL allergens levels in manufactured masks were low or not detectable; 3/10 of the N95/KN95 masks showed levels above the limit of detection, probably reflecting low-level cross-contamination during manufacture. Three batches of material sold for “the manufacture of ear straps for face coverings” had significant but variable levels of allergen (250–2526 ng/g of material). Historically, extractable protein measurements have been used as an indicator of possible NRL proteins. This study showed significant levels of apparent protein in sample extracts without measurable NRL allergens or confirmation by electrophoresis. Therefore, the immunochemical measurement of NRL allergens remains key to rule out elastomeric material with the potential to cause latex-related health problems.

Mask or No Mask for COVID-19? Do the Individual Characteristics of Governors Affect the Adoption of Statewide Public Mask Mandates?

Public mask mandates are widely recognized as one of the most effective policy tools to mitigate the spread of COVID-19. Across the US, states vary widely in the timeline of adopting a state-level requirement to wear face coverings. Governors play a crucial role in making policy responses to the coronavirus pandemic. Building upon the upper echelons theory, this research explores the determinants of the timing of issuing statewide public mask mandates, focusing on the individual characteristics of state governors. Based on an event history analysis, the study finds that the two characteristics (political ideology and gubernatorial power) of state governor have influenced the time to adoption of statewide public mask mandates. Furthermore, managerial discretion and job demand have a moderating effect on the linkage between the personal traits of state governors and the timeline of adopting public mask mandates.

Trends in the Use of Face Coverings in Publicly Accessible Spaces During the COVID-19 Pandemic, King County, Washington, November 2020-May 2021.

Objectives:Appropriate face covering use at public venues can help mitigate the transmission of SARS-CoV-2 in the absence of widespread vaccination and provide protection when viral variants become more infectious. The objective of this study was to evaluate compliance with a statewide face mask mandate by examining trends in face covering use in publicly accessible spaces in King County, Washington.Methods:From November 27, 2020, through May 11, 2021, we conducted a repeated cross-sectional observational study of face covering use across publicly accessible venues (eg, grocery and convenience stores, airport, transit center, post office). Trained observers recorded perceived sex, estimated age group, and face covering use. We calculated estimates of overall face covering use and prevalence ratios (PRs) with 95% CIs.Results:We observed 9865 people in 53 unique venues during 229 observation intervals during 6 observation periods. Correct face covering use was 87.2% overall and lowest at semi-outdoor venues such as transit hubs (78.1%) and the pick-up curb of Seattle–Tacoma International Airport (69.0%). Correct face covering use was lowest among men (PR = 1.42; 95% CI, 1.27-1.58) and among people aged 2-11 years (PR = 2.74; 95% CI, 2.37-3.17) and 12-17 years (PR = 1.36; 95% CI, 1.07-1.72). Compliance declined among adults aged ≥60 years and among younger age groups before vaccine eligibility.Conclusions:Overall compliance with the statewide face mask mandate in King County was high. Layered mitigation strategies, including but not limited to the use of face coverings, and methods to assess adherence to them are crucial to preventing SARS-CoV-2 transmission.

The effects of face coverings, own-ethnicity biases, and attitudes on emotion recognition

As a result of the COVID-19 pandemic, face coverings were introduced as a safety measure in certain environments in England and some research suggests that they can affect emotion recognition. Factors such as own-ethnicity bias (e.g. whether people perceiving and expressing emotions are of the same ethnicity) and social biases are also known to influence emotion recognition. However, it is unclear whether these factors interact with face coverings to affect emotion recognition. Therefore, this study examined the effects of face coverings, own-ethnicity biases, and attitudes on emotion recognition accuracy. In this study, 131 participants viewed masked and unmasked emotional faces varying in ethnicity and completed a questionnaire on their attitudes towards face masks. We found that emotion recognition was associated with masks and attitudes: accuracy was lower in masked than unmasked conditions and attitudes towards masks Inside and Outside were associated with emotion recognition. However, a match between perceiver and stimulus ethnicity did not have a significant effect on emotion recognition. Ultimately, our results suggest that masks, and negative attitudes towards them, were associated with poorer emotion recognition. Future research should explore different mask-wearing behaviours and possible in-group/out-group biases and their interaction with other social cues (e.g. in-group biases).

Does Temporal Stability Moderate Reasoned Action Approach Relations With Covid-19 Preventive Behaviors?

BackgroundPreventive behaviors continue to play an important role in reducing the spread of the SARS-CoV-2 virus.PurposeThis study aimed to apply the reasoned action approach (RAA) to predict Covid-19 preventive intentions and behavior and to test whether temporal stability moderates relations between RAA constructs and behavior.MethodsA representative sample of UK adults (N = 603) completed measures of RAA variables (i.e., experiential attitudes, instrumental attitudes, injunctive norms, descriptive norms, capacity, autonomy and intention) in relation to six Covid-19 preventive behaviors (i.e., wearing face coverings, social distancing, hand sanitizing, avoiding the three Cs [closed spaces, crowded places, and close contacts], cleaning surfaces, and coughing/sneezing etiquette) at baseline (December 2020) and after 1 month. Self-reported behavior was assessed at baseline and after 1 and 2 months.ResultsThe RAA was predictive of Covid-19 preventive intentions at time 1 and time 2; instrumental attitudes, descriptive norms, and capability were the strongest predictors at each time point. The RAA also predicted subsequent behavior across time points with intention, descriptive norms, and capability the strongest/most consistent predictors. Temporal stability moderated a number of RAA–behavior relationships including those for intention, descriptive norms, and capability. In each case, the relationships became stronger as temporal stability increased.ConclusionsHealth cognitions as outlined in the RAA provide appropriate targets for interventions to promote Covid-19 preventive intentions and behavior. Moreover, given that continued performance of Covid-19 preventive behaviors is crucial for reducing transmission of the SARS-CoV-2 virus, the results highlight the need for consistent messaging from governments and public health organizations to promote positive intentions and maintain preventive behavior.

Future Acceptability of Respiratory Virus Infection Control Interventions in General Population to Prevent Respiratory Infections.

Background and Objectives: In both pandemic and non-pandemic situations, nonpharmaceutical public health measures may offer easy, low-cost, and effective means of reducing the spread and impact of acute respiratory infections. It is unknown whether such measures would be acceptable to the Saudi community beyond the current pandemic. Materials and Methods: A validated survey was used to test community acceptance of the measures. Respondents were asked which infection control practices they planned to maintain and which they believed should be policies for the community as a whole after the COVID-19 pandemic has subsided. Results: The survey was completed by 2057 people (95% completion rate), 1486 (72%) of whom were female, 259 (12.5%) of whom were current smokers, and 72 (3.5%) of whom had chronic lung disease. The most prevalent age groups were 18–30 years (933; 45.4%) and 31–40 years (483; 23.5%), with 641 individuals over 40 years old. Of the responses, 93% indicated that they would continue washing their hands more often; 92% wanted both clinicians and patients to wear masks in hospitals; 86% would continue avoiding smoking in indoor and outdoor areas; 73% would continue wearing a face covering on public transportation; 70% indicated that they would continue wearing a face covering in indoor public places. Regarding the respiratory virus infection control measures, 85% (11/13) received significant support (≥70% acceptability level) for continuation as policies in the future. Wearing face coverings outdoors and social distancing outdoors received little support (45% and 66%, respectively). Of the respiratory virus infection control measures, 54% received less support from current smokers than non-smokers (acceptability level < 70%). People with chronic respiratory disease supported 77% of the measures being regarded as policies in the future. Conclusion: The Saudi community supports nonpharmacological respiratory infection control measures that reduce the likelihood of infection. Public health campaigns should target smokers to increase awareness of the importance of these measures in lowering infections. Based on the findings of this study, nonpharmacological treatments should be presented and included in future recommendations for both the public and patients diagnosed with chronic respiratory diseases.

Relaxing Mask Mandates in New Jersey

Relaxing Mask Mandates in New Jersey

Considerations and concerns regarding the readiness to remove face coverings.

As of February 24, 2022, the government of the United Kingdom has taken a step towards deregulation and has lifted most of the COVID-19 related restrictions, including face-covering requirements in indoor public places [1,2]. People tested positive for COVID-19 were exempted from self-isolation and close contact tracing. The recent peak of the pandemic due to […]

In-Person Education During the Early COVID-19 Pandemic at Wichita Collegiate School.

IntroductionThe COVID-19 pandemic forced most Kansas schools to adopt remote or hybrid learning in 2020–2021. Wichita Collegiate School proceeded with an in-person teaching model. The purpose of this study was to determine if in-person learning can be done safely during the COVID-19 pandemic prior to vaccine use.MethodsWichita Collegiate is a private school located in Sedgwick County, Kansas. The study population included 671 students (grades 1 – 12) and 130 staff. The procedures implemented during the school year (August 19, 2020 – May 21, 2021) included: mandatory face coverings, six feet physical distancing, and daily temperature checks. A registered nurse performed contact tracing and executed quarantine requirements per the U.S. Centers for Disease Control and Prevention guidelines.ResultsOver the study period, 487 students and staff were tested for COVID-19 and 18.5% (n = 90) were positive. Overall, students and staff rate of COVID-19 infection was lower than the expected rate when compared to the surrounding community of Sedgwick County. Thorough contract tracing of positive cases revealed that 2.2% (n = 2) individuals were likely exposed to COVID-19 at school.ConclusionsThis study suggested that transmission of COVID-19 was infrequent in a school setting with in-person attendance, even before widespread vaccine availability. By following public health guidelines and utilizing contact tracing, it was possible to limit the spread of COVID-19 during in-person learning. This has immediate implications for how schools safely returned to in-person learning in the post-vaccine era.

Impact of local mask mandates upon COVID-19 case rates in Oklahoma.

Use of face coverings has been shown to reduce transmission of SARS-CoV-2. Despite encouragements from the CDC and other public health entities, resistance to usage of masks remains, forcing government entities to create mandates to compel use. The state of Oklahoma did not create a state-wide mask mandate, but numerous municipalities within the state did. This study compares case rates in communities with mandates to those without mandates, at the same time and in the same state (thus keeping other mitigation approaches similar). Diagnosed cases of COVID-19 were extracted from the Oklahoma State Department of Health reportable disease database. Daily case rates were established based upon listed city of residence. The daily case rate difference between each locality with a mask mandate were compared to rates for the portions of the state without a mandate. All differences were then set to a d0 point of reference (date of mandate implementation). Piecewise linear regression analysis of the difference in SARS-CoV-2 infection rates between mandated and non-mandated populations before and after adoption of mask mandates was then done. Prior to adopting mask mandates, those municipalities that eventually adopted mandates had higher transmission rates than the rest of the state, with the mean case rate difference per 100,000 people increasing by 0.32 cases per day (slope of difference = 0.32; 95% CI 0.13 to 0.51). For the post-mandate time period, the differences are decreasing (slope of -0.24; 95% CI -0.32 to -0.15). The pre- and post- mandate slopes differed significantly (p<0.001). The change in slope direction (-0.59; 95% CI -0.80 to -0.37) shows a move toward reconvergence in new case diagnoses between the two populations. Compared to rates in communities without mask mandates, transmission rates of SARS-CoV-2 slowed notably in those communities that adopted a mask mandate. This study suggests that government mandates may play a role in reducing transmission of SARS-CoV-2, and other infectious respiratory conditions.

Impact of ventilation and avoidance measures on SARS-CoV-2 risk of infection in public indoor environments

BackgroundThe literature includes many studies which individually assess the efficacy of protective measures against the spread of the SARS-CoV-2 virus. This study considers the high infection risk in public buildings and models the quality of the indoor environment, related safety measures, and their efficacy in preventing the spread of the SARS-CoV-2 virus. MethodsSimulations are created that consider protective factors such as hand hygiene, face covering and engagement with Covid-19 vaccination programs in reducing the risk of infection in a university foyer. Furthermore, a computational fluid dynamics model is developed to simulate and analyse the university foyer under three ventilation regimes. The probability of transmission was measured across different scenarios. FindingsEstimates suggest that the Delta variant requires the air change rate to be increased >1000 times compared to the original strain, which is practically not feasible. Consequently, appropriate hygiene practices, such as wearing masks, are essential to reducing secondary infections. A comparison of different protective factors in simulations found the overall burden of infections resulting from indoor contact depends on (i) face mask adherence, (ii) quality of the ventilation system, and (iii) other hygiene practices. InterpretationRelying on ventilation, whether natural, mechanical, or mixed, is not sufficient alone to mitigate the risk of aerosol infections. This is due to the internal configuration of the indoor space in terms of (i) size and number of windows, their location and opening frequency, as well as the position of the air extraction and supply inlets, which often induce hotspots with stagnating air, (ii) the excessive required air change rate. Hence, strict reliance on proper hygiene practices, namely adherence to face coverings and hand sanitising, are essential. Consequently, face mask adherence should be emphasized and promoted by policymakers for public health applications. Similar research may need to be conducted using a similar approach on the Omicron (B.1.1.529) variant.

The Effects of Face Coverings on Perceived Exertion and Attention Allocation during a Stepping Task.

The COVID-19 pandemic has impacted the entire world from lockdowns to various recommended restrictions including social distancing and wearing face coverings. In a safe environment, cardiovascular exercise is important for both physical health and mental health. The current study examined the effects of face coverings on rating of perceived exertion and attention allocation during an exertive stepping task. Participants completed a stepping task with a weighted vest at 20% of their bodyweight until volitional fatigue with a face covering (n = 23) or without a face covering (n = 31). Results revealed a non-significant difference (p = 0.25) in the duration of the stepping task (in seconds) between the no face covering (M = 455.81, SD = 289.77) and face covering (M = 547.83, SD = 285.93) conditions. Results indicated increases in perceived exertion (p < 0.001) and heart rate (p < 0.001) as time progressed across the four time points (i.e., 30 s, 1/3 time to exhaustion, 2/3 time to exhaustion, and exhaustion) in both conditions. No significant differences were found between the conditions for RPE (p = 0.09) and heart rate (p = 0.50). Participants wearing a face covering were more internally focused across the duration of the stepping task (p = 0.05). This study has relevance for applied practitioners implementing physical activity interventions that require face coverings.

Commercial airline passengers' willingness to fly with COVID-19 safety measures

In the commercial aviation industry, safety is always a primary concern, with a central focus on the well?being of passengers and crew members. Given the significance of safety, the COVID?19 pandemic has resulted in drastic changes to the way commercial airlines operate. The airline industry has had to adopt precautions to help ensure safety by minimizing the risk of transmission for both passengers and airline employees during air travel. We examined passengers' willingness to fly with various commercial airline COVID-19 safety precaution scenarios: control (none), face coverings (masks), negative PCR test, boarding and deplaning five rows at a time, and paired combinations of these precautions. The within-subject design assessed Willingness to Fly (Rice et al., 2015, 2020) for all scenarios in random order. Participants were recruited from the US Amazon Mechanical Turk (MTurk) user population. Willingness to fly was positive for all scenarios (N= 202). The control scenario, with no precautions listed, had the lowest willingness to fly (0.69); Scenario 3, negative PCR test required, had the highest willingness to fly (0.81). However, contrary to expectations, there was no statistically significant difference in willingness to fly between the scenarios. These results suggest that participants are willing to fly regardless of the precautions, meaning that air travelers are still willing to fly under the commonly used pandemic precautions or without.

Lack of Teachers’ Facial Expression in the COVID-19 Pandemic: Problems and Ways to Solutions

Since the novel coronavirus 2019 (COVID-19) outbroke a global pandemic, nearly 2.5 years of adapting to lockdown, isolation, separation and masking up has tremendous shift in our social and daily life. Face covering is imperative to prevent infection and slow the spread of COVID-19, it hinders communication by reducing one’s ability to recognize and interpret the facial expression and emotion of whom we are interacting. Specifically, face coverings would hinder children’s learning ability and varies development, including cognitive, speech, emotions and social interaction. A survey was conducted to collect primary data about 1) students’ ability to recognize emotions of masked faces and 2) students’ perception on teaching performance when teachers’ mouth and facial expression are hidden away. Survey results found that among six fundamental emotions (surprise, sadness, fear, happiness, anger and disgust), disgusted and happy expressions are relatively difficult to be recognized correctly compared with other emotional expressions. The survey also found that facial expressions of a teacher make teaching more interesting and engaging. Lack of facial expression makes both teaching and learning inefficient. Finally, this paper suggested that teachers may put more emphasis on other non-verbal communications to alleviate the problem.