Use of N95, Surgical, and Cloth Masks to Prevent COVID-19 in Health Care and Community Settings: Living Practice Points From the American College of Physicians (Version 1).
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ABSTRACT:
SUBMITTER: Qaseem A
PROVIDER: S-EPMC7357230 | biostudies-literature | 2020 Oct
REPOSITORIES: biostudies-literature
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Use of N95, Surgical, and Cloth Masks to Prevent COVID-19 in Health Care and Community Settings: Living Practice Points From the American College of Physicians (Version 1).
Qaseem Amir A Etxeandia-Ikobaltzeta Itziar I Yost Jennifer J Miller Matthew C MC Abraham George M GM Obley Adam J AJ Forciea Mary Ann MA Jokela Janet A JA Humphrey Linda L LL Centor Robert M RM Andrews Rebecca R Bledsoe Thomas A TA Haeme Ray R Kansagara Devan L DL Marcucci Maura M
Annals of internal medicine 20200618 8
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Project description:According to the familiar axiom, the eyes are the window to the soul. However, wearing masks to prevent the spread of viruses such as COVID-19 involves obscuring a large portion of the face. Do the eyes carry sufficient information to allow for the accurate perception of emotions in dynamic expressions obscured by masks? What about the perception of the meanings of specific smiles? We addressed these questions in two studies. In the first, participants saw dynamic expressions of happiness, disgust, anger, and surprise that were covered by N95, surgical, or cloth masks or were uncovered and rated the extent to which the expressions conveyed each of the same four emotions. Across conditions, participants perceived significantly lower levels of the expressed (target) emotion in masked faces, and this was particularly true for expressions composed of more facial action in the lower part of the face. Higher levels of other (non-target) emotions were also perceived in masked expressions. In the second study, participants rated the extent to which three categories of smiles (reward, affiliation, and dominance) conveyed positive feelings, reassurance, and superiority, respectively. Masked smiles communicated less of the target signal than unmasked smiles, but not more of other possible signals. The present work extends recent studies of the effects of masked faces on the perception of emotion in its novel use of dynamic facial expressions (as opposed to still images) and the investigation of different types of smiles.Supplementary informationThe online version contains supplementary material available at 10.1007/s42761-021-00097-z.
| S-EPMC8790014 | biostudies-literature
Project description:Face coverings are a key component of preventive health measure strategies to mitigate the spread of respiratory illnesses. In this study five groups of masks were investigated that are of particular relevance to the SARS-CoV-2 pandemic: re-usable, fabric two-layer and multi-layer masks, disposable procedure/surgical masks, KN95 and N95 filtering facepiece respirators. Experimental work focussed on the particle penetration through mask materials as a function of particle diameter, and the total inward leakage protection performance of the mask system. Geometric mean fabric protection factors varied from 1.78 to 144.5 for the fabric two-layer and KN95 materials, corresponding to overall filtration efficiencies of 43.8% and 99.3% using a flow rate of 17 L/min, equivalent to a breathing expiration rate for a person in a sedentary or standing position conversing with another individual. Geometric mean total inward leakage protection factors for the 2-layer, multi-layer and procedure masks were <2.3, while 6.2 was achieved for the KN95 masks. The highest values were measured for the N95 group at 165.7. Mask performance is dominated by face seal leakage. Despite the additional filtering layers added to cloth masks, and the higher filtration efficiency of the materials used in disposable procedure and KN95 masks, the total inward leakage protection factor was only marginally improved. N95 FFRs were the only mask group investigated that provided not only high filtration efficiency but high total inward leakage protection, and remain the best option to protect individuals from exposure to aerosol in high risk settings. The Mask Quality Factor and total inward leakage performance are very useful to determine the best options for masking. However, it is highly recommended that testing is undertaken on prospective products, or guidance is sought from impartial authorities, to confirm they meet any implied standards.
| S-EPMC8494377 | biostudies-literature
Project description:BackgroundThe effectiveness of cloth face masks to prevent viral spread has not yet been conclusively established. In this meta-analysis, we evaluate their effectiveness in comparison to standard medical/surgical and N95-typed masks against viral spread.MethodsWe identified literature through a systematic search in three databases and meta-analytically synthesized relevant studies by means of random-effects as well as multilevel modelling.ResultsTwelve studies comprising k = 28 effect sizes (N = 338) were included. Medical/surgical and N95-typed masks outperformed cloth masks, yielding a large effect (g = 1.40). This effect remained robust when data were grouped according to comparisons with medical/surgical masks (g = 1.25) and N95-typed masks (g = 1.29). However, effects were differentiated according to mask fit, indicating reversals of signs when cloth mask effects were compared with ill-fitting medical/surgical and N95-typed masks (gs = -12.50 and - 10.90, respectively).ConclusionsCloth face masks were found to have significantly poorer filtering performance than medical/surgical masks and N95 masks, but only if non-cloth masks were properly fitted. Our results illustrate the necessity of using well-fitting medical/surgical or N95-typed masks to prevent viral spread, although some allowance should be made in circumstances where higher compliance with cloth mask mandates are expected.
| S-EPMC10901268 | biostudies-literature
Project description: Not available
| S-EPMC8297419 | biostudies-literature
Project description:IntroductionThe COVID-19 pandemic has made well-fitting face masks a critical piece of protective equipment for healthcare workers and civilians. While the importance of wearing face masks has been acknowledged, there remains a lack of understanding about the role of good fit in rendering protective equipment useful. In addition, supply chain constraints have caused some organizations to abandon traditional quantitative or/and qualitative fit testing, and instead, have implemented subjective fit checking. Our study seeks to quantitatively evaluate the level of fit offered by various types of masks, and most importantly, assess the accuracy of implementing fit checks by comparing fit check results to quantitative fit testing results.MethodsSeven participants first evaluated N95 and KN95 respirators by performing a fit check. Participants then underwent quantitative fit testing wearing five N95 respirators, a KN95 respirator, a surgical mask, and fabric masks.ResultsN95 respirators offered higher degrees of protection than the other categories of masks tested; however, it should be noted that most N95 respirators failed to fit the participants adequately. Fit check responses had poor correlation with quantitative fit factor scores. KN95, surgical, and fabric masks achieved low fit factor scores, with little protective difference recorded between respiratory protection options. In addition, small facial differences were observed to have a significant impact on quantitative fit.ConclusionFit is critical to the level of protection offered by respirators. For an N95 respirator to provide the promised protection, it must fit the participant. Performing a fit check via NHS self-assessment guidelines was an unreliable way of determining fit.
| S-EPMC7822328 | biostudies-literature
Project description:BackgroundFew treatments exist for coronavirus disease 2019 (COVID-19).PurposeTo evaluate the effectiveness and harms of remdesivir for COVID-19.Data sourcesSeveral databases, tables of contents of journals, and U.S. Food and Drug Administration and company websites were searched from 1 January through 31 August 2020.Study selectionEnglish-language, randomized trials of remdesivir treatments for adults with suspected or confirmed COVID-19. New evidence will be incorporated using living review methods.Data extractionSingle-reviewer abstraction and risk-of-bias assessment verified by a second reviewer; GRADE (Grading of Recommendations Assessment, Development and Evaluation) methods used for certainty-of-evidence assessments.Data synthesisFour randomized trials were included. In adults with severe COVID-19, remdesivir compared with placebo probably improves recovery by a large amount (absolute risk difference [ARD] range, 7% to 10%) and may result in a small reduction in mortality (ARD range, -4% to 1%) and a shorter time to recovery or clinical improvement. Remdesivir may have little to no effect on hospital length of stay. Remdesivir probably reduces serious adverse events by a moderate amount (ARD range, -6% to -8%). Compared with a 10-day remdesivir course, a 5-day course may reduce mortality, increase recovery or clinical improvement by small to moderate amounts, reduce time to recovery, and reduce serious adverse events among hospitalized patients not requiring mechanical ventilation. Recovery due to remdesivir may not vary by age, sex, symptom duration, or disease severity.LimitationsLow-certainty evidence with few published trials, including 1 preliminary report and 2 open-label trials. Trials excluded pregnant women and adults with severe kidney or liver disease.ConclusionIn hospitalized adults with COVID-19, remdesivir probably improves recovery and reduces serious adverse events and may reduce mortality and time to clinical improvement. For adults not receiving mechanical ventilation or extracorporeal membrane oxygenation, a 5-day course of remdesivir may provide similar benefits to and fewer harms than a 10-day course.Primary funding sourceU.S. Department of Veterans Affairs, Veterans Health Administration Office of Research and Development, Health Services Research and Development Service, and Evidence Synthesis Program.
| S-EPMC7564604 | biostudies-literature
Project description: Not available
| S-EPMC8496689 | biostudies-literature
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| S-EPMC8900283 | biostudies-literature
Project description:BackgroundMillions of people have acquired and died from SARS-CoV-2 infection during the COVID-19 pandemic. Healthcare workers (HCWs) are required to wear personal protective equipment (PPE), including surgical masks and P2/N95 respirators, to prevent infection while treating patients. However, the comparative effectiveness of respirators and masks in preventing SARS-CoV-2 infection and the likelihood of experiencing adverse events (AEs) with wear are unclear.MethodsSearches were carried out in PubMed, Europe PMC and the Cochrane COVID-19 Study Register to 14 June 2021. A systematic review of comparative epidemiological studies examining SARS-CoV-2 infection or AE incidence in HCWs wearing P2/N95 (or equivalent) respirators and surgical masks was performed. Article screening, risk of bias assessment and data extraction were duplicated. Meta-analysis of extracted data was carried out in RevMan.ResultsTwenty-one studies were included, with most having high risk of bias. There was no statistically significant difference in respirator or surgical mask effectiveness in preventing SARS-CoV-2 infection (OR 0.85, [95%CI 0.72, 1.01]). Healthcare workers experienced significantly more headaches (OR 2.62, [95%CI 1.18, 5.81]), respiratory distress (OR 4.21, [95%CI 1.46, 12.13]), facial irritation (OR 1.80, [95%CI 1.03, 3.14]) and pressure-related injuries (OR 4.39, [95%CI 2.37, 8.15]) when wearing respirators compared to surgical masks.ConclusionThe existing epidemiological evidence does not enable definitive assessment of the effectiveness of respirators compared to surgical masks in preventing infection. Healthcare workers wearing respirators may be more likely to experience AEs. Effective mitigation strategies are important to ensure the uptake and correct use of respirators by HCWs.
| S-EPMC8769935 | biostudies-literature
Project description:BackgroundClinicians and patients want to know the benefits and harms of outpatient treatment options for the Omicron variant of SARS-CoV-2.PurposeTo assess the benefits and harms of 22 different COVID-19 treatments.Data sourcesThe Epistemonikos COVID-19 L·OVE platform, the iSearch COVID-19 portfolio, and the World Health Organization (WHO) COVID-19 Research Database from 26 November 2021 to 2 March 2023.Study selectionTwo reviewers independently screened abstracts and full texts against a priori-defined criteria.Data extractionOne reviewer extracted the data and assessed the risk of bias and certainty of evidence (COE). A second reviewer verified the data abstraction and assessments.Data synthesisTwo randomized controlled trials and 6 retrospective cohort studies were included. Nirmatrelvir-ritonavir was associated with a reduction in hospitalization due to COVID-19 (for example, 0.7% vs. 1.2%; moderate COE) and all-cause mortality (for example, <0.1% vs. 0.2%; moderate COE). Molnupiravir led to a higher recovery rate (31.8% vs. 22.6%; moderate COE) and reduced time to recovery (9 vs. 15 median days; moderate COE) but had no effect on all-cause mortality (0.02% vs. 0.04%; moderate COE) and the incidence of serious adverse events (0.4% vs. 0.3%; moderate COE). Ivermectin had no effect on time to recovery (moderate COE) and resulted in no difference in adverse events compared with placebo (low COE). Sotrovimab resulted in no difference in all-cause mortality compared with no treatment (low COE). No eligible studies for all other treatments of interest were identified.LimitationEvidence for nirmatrelvir-ritonavir and sotrovimab is based on nonrandomized studies only.ConclusionNirmatrelvir-ritonavir and molnupiravir probably improve outcomes for outpatients with mild to moderate COVID-19.Primary funding sourceAmerican College of Physicians. (PROSPERO: CRD42023406456).
| S-EPMC10620953 | biostudies-literature