face mask

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Introduction

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]

* 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

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]

More general terms

More specific terms

Additional terms

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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/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. ↑ 5.0 5.1 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
  6. ↑ 6.0 6.1 Fischer EP, Fischer MC, Grass D et al Low-cost measurement of facemask efficacy for filtering expelled droplets during speech. Science Advances 07 Aug 2020: PMID: https://www.ncbi.nlm.nih.gov/pubmed/32917603 Free article https://advances.sciencemag.org/content/early/2020/08/07/sciadv.abd3083
  7. ↑ 7.0 7.1 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
  8. ↑ 8.0 8.1 O'Shea D How to Reduce Skin Irritation From Face Masks? Medscape - Sep 29, 2020. https://www.medscape.com/viewarticle/938223
  9. ↑ 9.0 9.1 Samannan R, Holt G, Calderon-Candelario R et al Effect of Face Masks on Gas Exchange in Healthy Persons and Patients with COPD. Ann Am Thoracic Soc. Oct 2, 2020 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33003954 https://www.atsjournals.org/doi/abs/10.1513/AnnalsATS.202007-812RL
  10. ↑ 10.0 10.1 Chan NC, Li K, Hirsh J. Peripheral Oxygen Saturation in Older Persons Wearing Nonmedical Face Masks in Community Settings. JAMA. Published online October 30, 2020. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33125030 https://jamanetwork.com/journals/jama/fullarticle/2772655
  11. ↑ 11.0 11.1 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. ↑ 12.0 12.1 IHME COVID-19 Forecasting Team. Modeling COVID-19 scenarios for the United States. Nat Med 2020 Oct 23; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/33097835 https://www.nature.com/articles/s41591-020-1132-9
  13. ↑ 13.0 13.1 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/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
  15. ↑ Nebehay S WHO Fine-Tunes Advice on COVID Masks for Public, Health Workers. Medscape - Dec 02, 2020 https://www.medscape.com/viewarticle/941853
  16. ↑ Chu DK, Aki EA, Duda S et al Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet. June 1, 2020 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32497510 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142-9/fulltext
    MacIntyre CR, Wang Q. Physical distancing, face masks, and eye protection for prevention of COVID-19. Lancet. 2020 Jun 1:S0140-6736(20)31183-1. PMID: https://www.ncbi.nlm.nih.gov/pubmed/3249751
  17. ↑ 17.0 17.1 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/33300958 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2020.8234
  18. ↑ Berg S Clear up your patients' confusion about which masks work best. AMA Public Health. Dec 16, 2020 https://www.ama-assn.org/delivering-care/public-health/clear-your-patients-confusion-about-which-masks-work-best
  19. ↑ 19.0 19.1 19.2 19.3 19.4 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. ↑ 20.0 20.1 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. ↑ 21.0 21.1 21.2 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: https://www.ncbi.nlm.nih.gov/pubmed/33600386 https://www.cdc.gov/mmwr/volumes/70/wr/mm7007e1.htm
  22. ↑ 22.0 22.1 Lubrano R, Bloise S, Testa A et al Assessment of Respiratory Function in Infants and Young Children Wearing Face Masks During the COVID-19 Pandemic. JAMA Netw Open. 2021;4(3):e210414 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33651109 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2776928
  23. ↑ 23.0 23.1 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/33704362 https://jamanetwork.com/journals/jamasurgery/fullarticle/2777510
  24. ↑ 24.0 24.1 Guy JP Jr, Massetti GM, Sauber-Schatz E. Mask Mandates, On-Premises Dining, and COVID-19. JAMA. Published online April 1, 2021. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33792610 https://jamanetwork.com/journals/jama/fullarticle/2778233
  25. ↑ 25.0 25.1 Lange R (Texas Tech), Tracey E (Johns Hopkins Medicine) Face Masks and Exercise; Dosing Psilocybin: It's TTHealthWatch! Also this week: COVID and inactivity, and inflammatory diets. Medpage Today April 17, 2021 https://www.medpagetoday.com/podcasts/healthwatch/92141
  26. ↑ 26.0 26.1 Sax PE Is It Time to Eliminate Outdoor Mask Mandates? NEJM Journal Watcth. HIV and ID Observations. https://blogs.jwatch.org/hiv-id-observations/index.php/is-it-time-to-eliminate-outdoor-mask-mandates/2021/04/19/
  27. ↑ 27.0 27.1 27.2 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
  28. ↑ 28.0 28.1 28.2 Kalter L Once Fully Vaccinated, No Need to Mask Up in Most Places, CDC Says. Medscape - May 13, 2021 https://www.medscape.com/viewarticle/951087
  29. ↑ Peeples L What the science says about lifting mask mandates With COVID rates dropping and vaccinations on the rise, the United States and other places are removing some requirements for face coverings. Are they moving too fast? Nature. NEWS FEATURE May 25, 2021 https://www.nature.com/articles/d41586-021-01394-0
  30. ↑ 30.0 30.1 Kampert M, Singh T, Sahoo D et al Effects of Wearing an N95 Respirator or Cloth Mask Among Adults at Peak Exercise. A Randomized Crossover Trial. JAMA Netw Open. 2021;4(6):e2115219 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34190998 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781514
  31. ↑ Phend C JAMA Peds Retracts Much-Hyped Masks Study. Controversial study had numerous problems, journal says. MedPage Today July 16, 2021 https://www.medpagetoday.com/infectiousdisease/covid19/93609
    Walach H, Weikl R, Prentice J et al Experimental Assessment of Carbon Dioxide Content in Inhaled Air With or Without Face Masks in Healthy ChildrenA Randomized Clinical Trial. JAMA Pediatr. Published online June 30, 2021 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34190984 https://jamanetwork.com/journals/jamapediatrics/fullarticle/2781743
    Christakis D, Fontanarosa PB Notice of Retraction. Walach H, et al. Experimental Assessment of Carbon Dioxide Content in Inhaled Air With or Without Face Masks in Healthy Children: A Randomized Clinical Trial. JAMA Pediatr. Published online June 30, 2021. JAMA Pediatr. Published online July 16, 2021. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34269801 https://jamanetwork.com/journals/jamapediatrics/fullarticle/2782288
  32. ↑ Centers for Disease Control & Prevention (CDC) GUIDANCE FOR UNVACCINATED PEOPLE Your Guide to Masks. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html
  33. ↑ Walker M CDC: School's In. Mask Up. Agency stresses masking to protect those too young to be vaccinated. MedPage Today July 9, 2021 https://www.medpagetoday.com/infectiousdisease/covid19/93505
  34. ↑ Moon S Los Angeles County to reinstate mask mandate amid rise in Covid-19 cases and hospitalizations. CNN. July 16, 2021 https://www.cnn.com/2021/07/16/us/los-angeles-county-mask-mandate/index.html
  35. ↑ 35.0 35.1 Walker M CDC Changes Mind on Indoor Masking Guidance. Expected new recommendations affect schools, 64xfaslareas with surges, regardless of vaccination status. MedPage Today July 27, 2021 https://www.medpagetoday.com/infectiousdisease/covid19/93772
    McNamara D CDC Calls for Masks in Schools, Hard-Hit Areas, Even if Vaccinated. Medscape - Jul 27, 2021 https://www.medscape.com/viewarticle/955488
  36. ↑ 36.0 36.1 Chow D Largest study of masks yet details their importance in fighting Covid-19. Science News. 2021. Spetember 1. https://www.nbcnews.com/science/science-news/largest-mask-study-yet-details-importance-fighting-covid-19-rcna1858
    Abaluck J, Kwong LH, Styczynski A et al The Impact of Community Masking on COVID-19: A Cluster-Randomized Trial in Bangladesh. Innovations for Poverty Action. 2021. September 1. https://www.poverty-action.org/publication/impact-community-masking-covid-19-cluster-randomized-trial-bangladesh
  37. ↑ Splete H Some Face Mask Modifications Improve Fit and Boost Performance for Medical Professionals and for Public, Study Finds. Medscape. December 30, 2021 https://www.medscape.com/viewarticle/965813
  38. ↑ 38.0 38.1 Andrejko KL, Pry JM, Myers JF, et al. Effectiveness of Face Mask or Respirator Use in Indoor Public Settings for Prevention of SARS-CoV-2 Infection - California, February-December 2021. MMWR Morb Mortal Wkly Rep. ePub: 4 February 2022 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35143470 https://www.cdc.gov/mmwr/volumes/71/wr/mm7106e1.htm
  39. ↑ 39.0 39.1 Hein I Healthcare Workers Who Wear Better Masks Get Less COVID. Observational study affirms better odds of dodging infection by wearing a respirator mask. MedPage Today August 15, 2022 https://www.medpagetoday.com/infectiousdisease/covid19/100227
    Dorr T, Haller S, Muller MF et al Risk of SARS-CoV-2 Acquisition in Health Care Workers According to Cumulative Patient Exposure and Preferred Mask Type. JAMA Netw Open. 2022;5(8):e2226816. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35969403 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795150
  40. ↑ 40.0 40.1 Cowger TL et al. Lifting universal masking in schools - Covid-19 incidence among students and staff. N Engl J Med 2022 Nov 9; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36351262 https://www.nejm.org/doi/10.1056/NEJMoa2211029
  41. ↑ 41.0 41.1 41.2 41.3 O'Mary L Medical Masks, N95s May Offer Similar Prevention vs COVID: Study. Mescape. Nov 29, 2022 https://www.medscape.com/viewarticle/984734
    Loeb M et al Medical Masks Versus N95 Respirators for Preventing COVID-19 Among Health Care Workers. Ann Intern Med 2022. Nov 29 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36442064 https://www.acpjournals.org/doi/10.7326/M22-1966
    Johnson K Study Comparing Surgical and N95 Masks Sparks Concern. Medscape. Dec 5, 2022 https://www.medscape.com/viewarticle/984992
    Van Beusekom M Study on masks vs N95 respirators for health workers spurs concerns. University of Minnesota. CIDRAP News. Nov 29, 2022 https://www.cidrap.umn.edu/covid-19/study-masks-vs-n95-respirators-health-workers-spurs-concerns
  42. ↑ 42.0 42.1 Chou R, Dana T Major Update: Masks for Prevention of SARS-CoV-2 in Health Care and Community Settings - Final Update of a Living, Rapid Review. Ann Intern Med. 2023. May 16. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37186920 Free article https://www.acpjournals.org/doi/10.7326/M23-0570
  43. ↑ 43.0 43.1 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

Patient information

face mask patient information

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