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face mask

Venturi mask has beem referred to as face mask in ICU settings Indications: - SARS-CoV-2 pandemic - face masks are effective at preventing viral spread - relative effectiveness of cloth face masks - 3 layer > 2 layer > 1 layer > no mask [5] - face masks offer protection for others & to the mask wearer as well [11] * N95/KN95 masks > surgical masks > polypropylene masks, & handmade cotton face masks; all appear efficacious for blocking respiratory droplets - adjusted odds of a positive test result compared with not wearing a mask (aOR) - N95/K95: aOR=0.17, surgical mask: aOR=0.34, cloth mask: aOR=0.44 [38] - bandanas & fleeces seem to offer little protection [6] * surgical masks superior to cloth masks [36] * healthcare workers exposed to patients with Covid-19 have less chance of infection with Covid-19 if wearing an N95/KN95 mask vs a surgical mask (21% vs 35%) [39] * surgical masks might provide protection similar to that of N95 respirators in preventing SARS-CoV-2 infection among healthcare workers [41] - actually, authors only able confirm that N95 respirator not >= 2-fold more effective than surgical mask in prevention of Covid-19 [41] - study met with criticism [41] - surgical masks & N95 respirators may afford similar protection from Covid-19 infection in patient care settings; however, superiority of N95 respirators cannot be ruled out [42] * wearing a face shield on top of a surgical mask may reduce community health workers' risk for COVID-19 * CDC recommends wearing a cloth mask over a disposable surgical mask or or tying knots in a medical mask's ear loops close to the mask & tucking in the excess side material to improve fit [21] * a regular, unknotted surgical mask blocks 42% of particles from a cough; a cloth mask alone blocks 44% a cloth mask over a surgical mask blocks 93% of particles from a cough [21] Contraindications: - medical face mask exemptions during the COVID-19 pandemic - children < 2 years of age; children < 5 years of age [7] - surgical face masks do not interfere with respirations in infants & children < 12 years of age [22] - people with difficulty breathing - anyone unable to place or remove the face mask - persons with sensory processing disorders may be unable to tolerate masks - Facial deformities that are incompatible with masking * chronic pulmonary disease probably not an indication for face mask exemption - these persons themselves are at higher risk of severe COVID-19 - cbronic cough renders these persons at higher risk of transmitting COVID-19 - thus more a compelling reason for masking rather than for exemption * no significant increase in CO2 retention in patients with COPD during or after 6 minute walk test [9] * wearing a 3-layer nonmedical face mask is not associated with a decline in SaO2 in elderly persons in the community [10] Benefit/risk: - face masks on everyone could save > 100,000 lives in U.S. Nov 2020-Feb 2021 [12] - surgeons who wore clear masks were perceived by patients to be better communicators, have more empathy, & elicit greater trust [23] - during a maximal exercise stress test, a cloth face mask reduced exercise time by 14% & maximal oxygen consumption by 29% [25] - exercise stress testing while wearing a face mask lowers VO2-max & maximal heart rate [30] - discontinuing mandatory masking in Massachusetts school districts in early 2022 resulted in 45 additional COVID-19 cases per 1000 students & staff over 15 weeks [40] Notes: - CDC issued a public health order requiring masks to "be worn at train and subway stations, bus terminals, and airports nationwide, as well as on planes, trains, and other types of public transportation" in the U.S. [19] - The order requires people to wear masks "while boarding, disembarking, and traveling on any conveyance into or within the United States," as well as "at any transportation hub that provides transportation" within the U.S. [19] - The order includes exceptions "for people with disabilities who cannot wear a mask and other cases, and said masks can be removed briefly while eating, drinking, taking medication, going through security screenings, and other circumstances." [19] - The order makes refusing "to wear a mask a violation of federal law, enforced by the Transportation Security Administration and other federal, state, and local authorities." [19] - not wearing a mask during COVID-19 health emergency isn't a free speech right, appeals court say [43] - medical exemption from masking is considered a disability modification under the Americans With Disabilities Act - talcum powder, a beeswax mixture & petroleum jelly provide the best skin protection from long-term personal protective equipment use [8] - compliance with recommendations for wearing face masks may be low, 46% in 1 study [13] - state face mask mandates reduce COVID-19 hospitalizations [20] - many consumer-grade masks available to the public are comparable with or better than their non-N95 mask counterparts [17] - indoor venues such as bars & restaurants, where social distancing is challenging & consistent mask use is not feasible, increases risk of SARS-CoV2 transmission [24] - CDC guidelines for indoor activities for fully vaccinated persons still require a face mask [27] - outdoors, especially while distanced, may require face mask masks only for lengthy interactions with others at close distance [26,27] - CDC announces fully vaccinated persons no longer need to wear masks or physically distance, regardless of location (indoors or outdoors) or size of the gathering [28] - CDC still advises travelers to wear face masks on airplanes, buses or trains [28] - CDC now recommend all teachers & students wear face masks in school, & that people living in COVID-19 hotspots, or areas of the country with large outbreaks, wear face masks indoors, regardless of vaccination status (July 27, 2021) [35]

Related

Venturi mask (Hudson mask, nonrebreathing mask)

Specific

disposable N-95 particulate respirator (Teknol, TB mask)

General

device (medical device)

References

  1. Fisher KA, Barile JP, Guerin RJ, et al. Factors Associated with Cloth Face Covering Use Among Adults During the COVID-19 Pandemic - United States, April and May 2020. MMWR Morb Mortal Wkly Rep 2020;69:933-937 PMID: 32673303 https://www.cdc.gov/mmwr/volumes/69/wr/mm6928e3.htm
  2. Hendrix MJ, Walde C, Findley K, Trotman R. Absence of Apparent Transmission of SARS-CoV-2 from Two Stylists After Exposure at a Hair Salon with a Universal Face Covering Policy - Springfield, Missouri, May 2020. MMWR Morb Mortal Wkly Rep 2020;69:930-932 PMID: 32673300 https://www.cdc.gov/mmwr/volumes/69/wr/mm6928e2.htm
  3. Wang X, Ferro EG, Zhou G et al Association Between Universal Masking in a Health Care System and SARS-CoV-2 Positivity Among Health Care Workers. JAMA. Published online July 14, 2020 PMID: 32663246 https://jamanetwork.com/journals/jama/fullarticle/2768533 - Brooks JT, Butler JC, Redfield RR. Universal Masking to Prevent SARS-CoV-2 Transmission - The Time Is Now. JAMA. Published online July 14, 2020 PMID: 32663243 https://jamanetwork.com/journals/jama/fullarticle/2768532 - Brooks JT, Butler JC Effectiveness of Mask Wearing to Control Community Spread of SARS-CoV-2. JAMA. 2021;325(10):998-999 PMID: 33566056 https://jamanetwork.com/journals/jama/fullarticle/2776536
  4. Dorfman D, Raz, M Mask Exemptions During the COVID-19 Pandemic - A New Frontier for Clinicians. JAMA Network. JAMA Health Forum. https://jamanetwork.com/channels/health-forum/fullarticle/2768376
  5. Physician's First Watch, July 23, 2020 Reference to Thorax article David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
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  7. World Health Organization. August 21, 2020 Advice on the use of masks for children in the community in the context of COVID-19. Annex to the Advice on the use of masks in the context of COVID-19. https://www.who.int/publications/i/item/WHO-2019-nCoV-IPC_Masks-Children-2020.1
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  11. Centers for Disease Control and Prevention (CDC) Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2. Coronavirus Disease-19 (COVID-19). Nov 10, 2020 https://www.cdc.gov/coronavirus/2019-ncov/more/masking-science-sars-cov2.html
  12. IHME COVID-19 Forecasting Team. Modeling COVID-19 scenarios for the United States. Nat Med 2020 Oct 23; [e-pub] PMID: 33097835 https://www.nature.com/articles/s41591-020-1132-9
  13. Bundgaard H, Bundgaard JS, Raaschou-Pedersen DET, et al. Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers. PMID: 33205991 https://www.acpjournals.org/doi/10.7326/M20-6817 - Frieden TR, Cash-Goldwasser S. Of masks and methods. Ann Intern Med 2020 Nov 18; PMID: 33205992 PMCID: PMC7707211 Free PMC article https://www.acpjournals.org/doi/10.7326/M20-7499 - Laine C, Goodman SN, Guallar E. The Role of Masks in Mitigating the SARS-CoV-2 Pandemic: Another Piece of the Puzzle. PMID: 33205993 https://www.acpjournals.org/doi/10.7326/M20-7448
  14. Watson J A Visual Guide to Face Masks: What Works, What Doesn't Medscape. Septembet 17, 2020 https://www.medscape.com/slideshow/6013216
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  17. Clapp PW, Sickbert-Bennett EE, Samet JM et al Evaluation of Cloth Masks and Modified Procedure Masks as Personal Protective Equipment for the Public During the COVID-19 Pandemic. JAMA Intern Med. Published online December 10, 2020. PMID: 33300948 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2020.8168 - Steinbrook R Filtration Efficiency of Face Masks Used by the Public During the COVID-19 Pandemic. JAMA Intern Med. Published online December 10, 2020. PMID: 33300958 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2020.8234
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  19. AMA Morning News. Feb 1, 2021 American Medical Association - Laris M CDC issues sweeping mask mandate for planes, public transportation in U.S. Washington Post. Jan 29, 2021 https://www.washingtonpost.com/local/trafficandcommuting/cdc-issues-sweeping-mask-mandate-for-planes-public-transportation-in-us/2021/01/30/db31f364-6197-11eb-9061-07abcc1f9229_story.html
  20. Edwards E. Mask mandates can help reduce the strain on hospitals, CDC says. States with mask mandates saw a decrease in Covid-19 hospitalizations, easing overall hospital burdens. NBC News. Feb 5, 2021 https://www.nbcnews.com/health/health-news/mask-mandates-can-help-reduce-strain-hospitals-cdc-says-n1256879
  21. AMA Morning News Feb 11, 2021 American Medical Association - Brooks JT, Beezhold DH, Noti JD, et al. Maximizing Fit for Cloth and Medical Procedure Masks to Improve Performance and Reduce SARS-CoV-2 Transmission and Exposure, 2021. MMWR Morb Mortal Wkly Rep. ePub: 10 February 2021 PMID: 33600386 https://www.cdc.gov/mmwr/volumes/70/wr/mm7007e1.htm
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  23. Kratzke IM, Rosenbaum ME, Cox C et al Effect of Clear vs Standard Covered Masks on Communication With Patients During Surgical Clinic Encounters. A Randomized Clinical Trial. JAMA Surg. Published online March 11, 2021 PMID: 33704389 https://jamanetwork.com/journals/jamasurgery/fullarticle/2777511 - Schwarze ML, Kalbfell EL Benefits of Clear Masks in Communication With Patients. JAMA Surg. Published online March 11, 2021 PMID: 33704362 https://jamanetwork.com/journals/jamasurgery/fullarticle/2777510
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  27. Centers for Disease Control & Prevention (CDC) Choosing Safer Activities Updated Apr. 27, 2021 https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/participate-in-activities.html
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  43. Catalini M Not wearing a mask during COVID-19 health emergency isn't a free speech right, appeals court say. Associated Press. Feb 6, 2024 https://apnews.com/article/covid-mask-free-speech-lawsuits-new-jersey-108abf877288999f34d1c604b731d34c