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In The Loop Group

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Facemasks ^HOT^

Facemasks are recommended for diseases transmitted through droplets and respirators for respiratory aerosols, yet recommendations and terminology vary between guidelines. The concepts of droplet and airborne transmission that are entrenched in clinical practice have recently been shown to be more complex than previously thought. Several randomised clinical trials of facemasks have been conducted in community and healthcare settings, using widely varying interventions, including mixed interventions (such as masks and handwashing), and diverse outcomes. Of the nine trials of facemasks identified in community settings, in all but one, facemasks were used for respiratory protection of well people. They found that facemasks and facemasks plus hand hygiene may prevent infection in community settings, subject to early use and compliance. Two trials in healthcare workers favoured respirators for clinical respiratory illness. The use of reusable cloth masks is widespread globally, particularly in Asia, which is an important region for emerging infections, but there is no clinical research to inform their use and most policies offer no guidance on them. Health economic analyses of facemasks are scarce and the few published cost effectiveness models do not use clinical efficacy data. The lack of research on facemasks and respirators is reflected in varied and sometimes conflicting policies and guidelines. Further research should focus on examining the efficacy of facemasks against specific infectious threats such as influenza and tuberculosis, assessing the efficacy of cloth masks, investigating common practices such as reuse of masks, assessing compliance, filling in policy gaps, and obtaining cost effectiveness data using clinical efficacy estimates.


The Centers for Disease Control and Prevention (CDC) advise the use of simple cloth face coverings to slow the spread of the virus and to help people who are unaware they have the virus from spreading it to others. This has led to questions from the Food and Agriculture Sector about what respirators, disposable facemasks, such as surgical or medical masks, or cloth face coverings are most appropriate for various settings. This fact sheet, developed in collaboration with CDC, provides a quick reference to these items potentially worn by workers in the Food and Agriculture Sector. Respirators, disposable facemasks, or cloth face coverings are designed and worn for different purposes as described in the table below.

Currently, there are no specific guidelines on the most effective materials and designs for facemasks to minimize the spread of droplets from coughs or sneezes to mitigate the transmission of COVID-19. While there have been prior studies on how medical-grade masks perform, data on cloth-based coverings used by the vast majority of the general public are sparse.

Results showed that loosely folded facemasks and bandana-style coverings stop aerosolized respiratory droplets to some degree. However, well-fitted homemade masks with multiple layers of quilting fabric, and off-the-shelf cone style masks, proved to be the most effective in reducing droplet dispersal. These masks were able to curtail the speed and range of the respiratory jets significantly, albeit with some leakage through the mask material and from small gaps along the edges.

This study reports a comprehensive empirical investigation of the nature and correlates of anti-mask attitudes during the COVID-19 pandemic. Accumulating evidence underscores the importance of facemasks, as worn by the general public, in limiting the spread of infection. Accordingly, mask wearing has become increasingly mandatory in public places such as stores and on public transit. Although the public has been generally adherent to mask wearing, a small but vocal group of individuals refuse to wear masks. Anti-mask protest rallies have occurred in many places throughout the world, sometimes erupting violently. Few empirical studies have examined the relationship between anti-mask attitudes and mask non-adherence and little is known about how such attitudes relate to one another or other factors (e.g., non-adherence to social distancing, anti-vaccination attitudes). To investigate these issues, the present study surveyed 2,078 adults from the US and Canada. Consistent with other surveys, we found that most (84%) people wore masks because of COVID-19. The 16% who did not wear masks scored higher on most measures of negative attitudes towards masks. Network analyses indicated that negative attitudes about masks formed an intercorrelated network, with the central nodes in the network being (a) beliefs that masks are ineffective in preventing COVID-19, and (b) psychological reactance (PR; i.e., an aversion to being forced to wear masks). These central nodes served as links, connecting the network of anti-masks attitudes to negative attitudes toward SARSCoV2 vaccination, beliefs that the threat of COVID-19 has been exaggerated, disregard for social distancing, and political conservatism. Findings regarding PR are important because, theoretically, PR is likely to strengthen other anti-masks attitudes (e.g., beliefs that masks are ineffective) because people with strong PR react with anger and counter-arguments when their beliefs are challenged, thereby leading to a strengthening of their anti-mask beliefs. Implications for improving mask adherence are discussed.

Citation: Taylor S, Asmundson GJG (2021) Negative attitudes about facemasks during the COVID-19 pandemic: The dual importance of perceived ineffectiveness and psychological reactance. PLoS ONE 16(2): e0246317.

All edges were positive (i.e., positive regularized partial correlations). Stronger edges are indicated by thicker lines. For all edges, p

Overall, patients rated high satisfaction in both groups (mean 5.6 on maximum scale of 7) and no significant association was found between facemask wearing and patient satisfaction. As patient expectations contributes greatly to the rating of patient satisfaction, facemask wearing appears to have neither a positive nor negative effect on patient satisfaction, which may reflect, in part cultural tolerance to mask wearing following the SARS epidemic in 2003 and the widespread use of facemasks in health care settings. Patient enablement was poor in both groups (PEI mean score 2.6, maximum 12) and similar to primary care patients in the UK (PEI mean score 3) [22].

In last few months, many communications were brought to the public that face masks are ineffective during a pandemic crisis. Since April 27, 2020 face masks have become mandatory for shopping and in public transportation in Germany. In the Netherlands, it became mandatory only for public transportation, from June 1, 2020 onwards. However, in Asian countries people have been wearing masks in public for ages. Although New York and Hong Kong are both metropolitan areas, the corona virus pandemia was devastating in the US and not in Hongkong. This fact alone implies a necessary, and a more distinguished view of the normative application of facemasks. In two manuscripts, we are now describing the use of masks during this viral pandemic. This first review describes the history of facemasks. The second will concentrate on benefits and risks by wearing facemasks in modern times.

Still in the 1990s, there were only uncertain data available. Therefore, an unresolved discussion was present between surgery and hospital hygiene, if wound infections could be reduced by the use of surgical mouth and nose protection [29, 30]. Today, following the recommendations of the RKI (German Robert Koch-Institute for hygiene), the available data indicate that surgical facemasks lower the contamination of indoor air [31].

During the COVID-19 pandemic, the use of facemasks seems to be an accepted procedure worldwide although a scientific discussion is going on up to now, which has its roots in the history of medicine and science. Future research on efficiency and efficacy of long-term mask wearing outside of hospital settings is warranted and will allow for insights that are more detailed.

The appropriate use of facemasks, recommended or mandated by authorities, is critical to prevent the spread of COVID-19 in the community. We aim to evaluate frequency and quality of facemask use in general populations.

Since the emergence of the Coronavirus (COVID-19) epidemic, wearing a facemask in the community has become commonplace. In many countries, facemasks are mandatory in crowded areas where social distancing cannot be respected and are recommended outdoors [1].Appropriate use of facemasks is critical for protection in the community to prevent the spread of COVID-19 [2]. However, the constraints and discomfort caused in a population unfamiliar with this protective equipment can result in suboptimal use, leading to ineffective protection against COVID-19. Observation and quantification of the quality of facemask use is required to: assess the level of respiratory protection, inform decision makers on the effectiveness of measures, and identify levers for behavior change. We evaluated the frequency and the quality of facemask use in the general populations with different socio-spatial backgrounds, and contextual factors associated with the appropriate use of the facemask.


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