Revisiting the evidence for physical distancing, face masks, and eye protection.
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ABSTRACT:
SUBMITTER: Zhou Q
PROVIDER: S-EPMC8376236 | biostudies-literature | 2021 Aug
REPOSITORIES: biostudies-literature
Publications
Revisiting the evidence for physical distancing, face masks, and eye protection.
Zhou Qi Q Wang Xiaoqin X Estill Janne J Yang Kehu K Chen Yaolong Y
Lancet (London, England) 20210801 10301
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Project description: Not available
| S-EPMC8426154 | biostudies-literature
Project description:BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings.MethodsWe did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-to-person virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respiratory syndrome, and Middle East respiratory syndrome from 21 standard WHO-specific and COVID-19-specific sources. We searched these data sources from database inception to May 3, 2020, with no restriction by language, for comparative studies and for contextual factors of acceptability, feasibility, resource use, and equity. We screened records, extracted data, and assessed risk of bias in duplicate. We did frequentist and Bayesian meta-analyses and random-effects meta-regressions. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO, CRD42020177047.FindingsOur search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25 697 patients). Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds ratio [aOR] 0·18, 95% CI 0·09 to 0·38; risk difference [RD] -10·2%, 95% CI -11·5 to -7·5; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2·02 per m; pinteraction=0·041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD -14·3%, -15·9 to -10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12-16-layer cotton masks; pinteraction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD -10·6%, 95% CI -12·5 to -7·7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings.InterpretationThe findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance.FundingWorld Health Organization.
| S-EPMC7263814 | biostudies-literature
Project description:Governments across the world have implemented restrictive policies to slow the spread of COVID-19. Recommended face mask use has been a controversially discussed policy, among others, due to potential adverse effects on physical distancing. Using a randomized field experiment (N = 300), we show that individuals kept a significantly larger distance from someone wearing a face mask than from an unmasked person during the early days of the pandemic. According to an additional survey experiment (N = 456) conducted at the time, masked individuals were not perceived as being more infectious than unmasked ones, but they were believed to prefer more distancing. This result suggests that wearing a mask served as a social signal that led others to increase the distance they kept. Our findings provide evidence against the claim that mask use creates a false sense of security that would negatively affect physical distancing. Furthermore, our results suggest that behavior has informational content that may be affected by policies. Supplementary Information The online version contains supplementary material available at 10.1007/s40881-021-00108-6.
| S-EPMC8590132 | biostudies-literature
Project description: Not available
| S-EPMC8137366 | biostudies-literature
Project description:The performance of masks, whether intended to protect the community from exhaled infectious aerosol or to protect the wearer from inhaled infectious aerosol, depends on factors such as filtration efficiency, particle size distribution, leakage, and ventilation rate. These factors depend on the activities and facial features of the mask wearer so that the mask performance for real-world applications is difficult to predict. The present work shows how protection factor, a quantity often used to describe mask performance, can be estimated without involving human volunteers. By constraining these factors to known values, mask protection factors can be compared fairly and efficiently following a series of filtration efficiency measurements performed in the laboratory. Protection factors and mask emissions for exhalation and inhalation were evaluated for masks of seven types currently in use around the world and for a hypothetical mask with 99% efficiency on all particles. The performance of reusable masks made from cotton fabric was limited by the size of the native cotton fibers. Masks that utilized finer fibers, particularly electret fibers with relatively small diameters, showed excellent performance with moderate flow resistance. Results from this work, in addition to simple guidance for mask fit and usage, can facilitate risk communication and decision-making efforts during the COVID-19 pandemic.
| S-EPMC7927284 | biostudies-literature
Project description:The World Health Organization has advocated mandatory face mask usage to combat the spread of COVID-19, with multilayer masks recommended for enhanced protection. However, this recommendation has not been widely adopted, with noncompliant persons citing discomfort during prolonged usage of face masks. And yet, a scientific understanding on how face mask fabrics/garment systems affect thermophysiological comfort remains lacking. We aimed to investigate how fabric/garment properties alter the thermal and evaporative resistances responsible for thermophysiological strain. We constructed 12 different layered facemasks (D1-D5, T1-T6, Q1) with various filters using commercially available fabrics. Three approaches were employed: (1) the evaporative and thermal resistances were measured in all the test face masks using the medium size to determine the effect of fabric properties; (2) the effect of face mask size by testing close-fitted (small), fitted (medium) and loose fitted (large) face mask T-6; (3) the effect of face mask fit by donning a large size face mask T-6, both loose and tightened using thermal manikin, Newton. ANOVA test revealed that the additional N95 middle layer filter has no significant effect on the thermal resistances of all the face masks, and evaporative resistances except for face masks T-2 and T-3 (P-values<0.05) whereas size significantly affected thermal and evaporative resistances (P-values<0.05). The correlation coefficient between the air gap size and the thermal and evaporative resistance of face masks T-6 were R2 = 0.96 and 0.98, respectively. The tight fit large face mask had superior performance in the dissipation of heat and moisture from the skin (P-values <0.05). Three-layer masks incorporating filters and water-resistant and antimicrobial/antiviral finishes did not increase discomfort. Interestingly, using face masks with fitters improved user comfort, decreasing thermal and evaporative resistances in direct opposition to the preconceived notion that safer masks decrease comfort.
| S-EPMC8989302 | biostudies-literature
Project description:Physical distancing has been an important policy to mitigate the spread of the novel coronavirus disease 2019 (COVID-19) in public settings. However, the current 1-2 m physical distancing rule is based on the physics of droplet transport and could not directly translate into infection risk. We therefore revisit the 2-m physical distancing rule by developing an infection-risk-based model for human speaking. The key modeling framework components include viral load, droplets dispersion and evaporation, deposition efficiency, viral dose-response rate and infection risk. The results suggest that the one-size-fits-all 2-m physical distancing rule derived from the pure droplet-physics-based model is not applicable under some realistic indoor settings, and may rather increase transmission probability of diseases. Especially, in thermally stratified environments, the infection risk could exhibit multiple peaks for a long distance beyond 2 m. With Sobol's sensitivity analysis, most variance of the risk is found to be significantly attributable to the variability in temperature gradient, exposure time and breathing height difference. Our study suggests there is no such magic 2 m physical distancing rule for all environments, but it needs to be used alongside other strategies, such as using face cover, reducing exposure time, and controlling the thermal stratification of indoor environment.
| S-EPMC8016632 | biostudies-literature
Project description:The novel coronavirus (COVID-19) pandemic has significantly impacted United States residents. Prevention behaviors are critical to minimizing transmission of SARS-CoV-2 in the U.S., to ultimately reduce the health, social, and economic burdens of COVID-19. Yet, health behavior decision-making is complex, and uptake of preventative behaviors has been variable. Women may provide pro-prevention behavior modeling to their networks, facilitating uptake diffusion. The COPE Study enrolled 491 women residing in the United States from May to June of 2020; women completed an online survey of COVID-19 experiences and prevention behaviors. We employed binary logistic modeling to identify factors predicting women's practice of (1) staying home except for essential activities, (2) physical distancing in public, and (3) wearing a face mask in public. Findings demonstrate that women's prevention behaviors are influenced by multilevel factors. Women living in urban environments, having minimal formal education, or having a household annual income of USD 30,000-50,000 are less likely to practice prevention behaviors. Cultural context may be an important factor in the decision-making process. Results aid in the identification what interventional "levers" may warrant consideration to promote uptake of such behaviors, and whom to engage. Because women are modelers of behavior, it is critical to engage them in prevention behavior interventions.
| S-EPMC7795406 | biostudies-literature
Project description:This population-based observational, cross-sectional, and descriptive survey was to investigate the relationship of increased face mask usage in the coronavirus disease (COVID-19) era with mask-associated dry eye (MADE). Participants aged 6-79 years old with formal school education were selected. All participants finished the 19-item questionnaire online, distributed through different social media platforms. From 6925 participants who submitted eligible questionnaires, MADE was reported in 547 participants, which included 419 participants who developed new dry eye symptoms after wearing face masks and 128 participants whose pre-existing dry eye symptoms worsened with mask wearing. Longer time of face mask wearing, nonstandard wearing of face masks, reduced outdoor time, decreased daily reading time, shortened visual display terminals time, and dry environment were positively associated with MADE. There were significant associations between perceived MADE and age, female sex, education, use of glasses and contact lenses, and pre-existing dry eye. MADE was more common in adults aged > 20 years than those aged ≤ 20 years or juveniles. MADE incidence increased. Standard wearing of face masks was suggested as a protective factor for MADE. Awareness about the possible risk of MADE should also be created and the clinical dry eye signs should be verified.Clinical trial registration number: NCT04744805.
| S-EPMC9007396 | biostudies-literature
Project description:Cotton and surgical face masks in community settings: bacterial contamination and face mask hygiene
| PRJEB45406 | ENA