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Preliminary Report on Surgical Mask Induced Deoxygenation During Major Surgery

Conclusions: Considering our findings, pulse rates of the surgeon’s increase and SpO2 decrease after the first hour. This early change in SpO2 may be either due to the facial mask or the operational stress. Since a very small decrease in saturation at this level, reflects a large decrease in PaO2, our findings may have a clinical value for the health workers and the surgeons.

Preliminary Report on Surgical Mask Induced Deoxygenation During Major Surgery

Universal Masking in Hospitals in the Covid-19 Era

We know that wearing a mask outside health care facilities offers little, if any, protection from infection. Public health authorities define a significant exposure to Covid-19 as face-to-face contact within 6 feet with a patient with symptomatic Covid-19 that is sustained for at least a few minutes (and some say more than 10 minutes or even 30 minutes). The chance of catching Covid-19 from a passing interaction in a public space is therefore minimal. In many cases, the desire for widespread masking is a reflexive reaction to anxiety over the pandemic.

Universal Masking in Hospitals in the Covid-19 Era
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Face Masks to Prevent Transmission of Influenza Virus: A Systematic Review

Influenza viruses circulate around the world every year. From time to time new strains emerge and cause global pandemics. Many national and international health agencies recommended the use of face masks during the 2009 influenza A (H1N1) pandemic. We reviewed the English-language literature on this subject to inform public health preparedness. There is some evidence to support the wearing of masks or respirators during illness to protect others, and public health emphasis on mask wearing during illness may help to reduce influenza virus transmission. There are fewer data to support the use of masks or respirators to prevent becoming infected. Further studies in controlled settings and studies of natural infections in healthcare and community settings are required to better define the effectiveness of face masks and respirators in preventing influenza virus transmission.

Face Masks to Prevent Transmission of Influenza Virus: A Systematic Review

Use of Surgical Face Masks to Reduce the Incidence of the Common Cold Among Health Care Workers in Japan: A Randomized Controlled Trial

Conclusion: Face mask use in health care workers has not been demonstrated to provide benefit in terms of cold symptoms or getting colds. A larger study is needed to definitively establish noninferiority of no mask use.

Use of Surgical Face Masks to Reduce the Incidence of the Common Cold Among Health Care Workers in Japan: A Randomized Controlled Trial

Effectiveness of Surgical and Cotton Masks in Blocking SARS–CoV-2: A Controlled Comparison in 4 Patients

In conclusion, both surgical and cotton masks seem to be ineffective in preventing the dissemination of SARS–CoV-2 from the coughs of patients with COVID-19 to the environment and external mask surface.

Effectiveness of Surgical and Cotton Masks in Blocking SARS–CoV-2: A Controlled Comparison in 4 Patients
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Headaches Associated With Personal Protective Equipment – A Cross-Sectional Study Among Frontline Healthcare Workers During COVID-19

Most healthcare workers develop de novo PPE-associated headaches or exacerbation of their pre-existing headache disorders.

Headaches Associated With Personal Protective Equipment – A Cross-Sectional Study Among Frontline Healthcare Workers During COVID-19
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Optical Microscopic Study of Surface Morphology and Filtering Efficiency of Face Masks

The pore size of masks ranged from 80 to 500 μm, which was much bigger than particular matter having diameter of 2.5 μm or less (PM2.5) and 10 μm or less (PM10) size. The PM10 filtering efficiency of four of the selected masks ranged from 63% to 84%. The poor filtering efficiency may have arisen from larger and open pores present in the masks. Interestingly, we found that efficiency dropped by 20% after the 4th washing and drying cycle. We observed a change in pore size and shape and a decrease in microfibers within the pores after washing. Stretching of CM surface also altered the pore size and potentially decreased the filtering efficiency. As compared to CMs, the less frequently used surgical/paper masks had complicated networks of fibers and much smaller pores in multiple layers in comparison to CMs, and therefore had better filtering efficiency. This study showed that the filtering efficiency of cloth face masks were relatively lower, and washing and drying practices deteriorated the efficiency. We believe that the findings of this study will be very helpful for increasing public awareness and help governmental agencies to make proper guidelines and policies for use of face mask.

Optical Microscopic Study of Surface Morphology and Filtering Efficiency of Face Masks
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The Use of Masks and Respirators to Prevent Transmission of Influenza: A Systematic Review of the Scientific Evidence

None of the studies established a conclusive relationship between mask/respirator use and protection against influenza infection.

The Use of Masks and Respirators to Prevent Transmission of Influenza: A Systematic Review of the Scientific Evidence

A Cluster Randomised Trial of Cloth Masks Compared With Medical Masks in Healthcare Workers

Conclusions: This study is the first RCT of cloth masks, and the results caution against the use of cloth masks. This is an important finding to inform occupational health and safety. Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection. Further research is needed to inform the widespread use of cloth masks globally. However, as a precautionary measure, cloth masks should not be recommended for HCWs, particularly in high-risk situations, and guidelines need to be updated.

A Cluster Randomised Trial of Cloth Masks Compared With Medical Masks in Healthcare Workers

What to know about respiratory acidosis

Respiratory acidosis develops when air inhaled into and exhaled from the lungs does not get adequately exchanged between the carbon dioxide from the body for oxygen from the air.

What to know about respiratory acidosis
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Face Coverings, Aerosol Dispersion and Mitigation of Virus Transmission Risk

The SARS-CoV-2 virus is primarily transmitted through virus-laden fluid particles ejected from the mouth of infected people. In some countries, the public has been asked to use face covers to mitigate the risk of virus transmission – yet, their outward effectiveness is not ascertained. We used a Background Oriented Schlieren technique to investigate the air flow ejected by a person while quietly and heavily breathing, while coughing, and with different face covers. We found that all face covers without an outlet valve reduce the front flow through jet by more than 90 per cent. For the FFP1 and FFP2 masks without exhalation valve, the front throughflow does not extend beyond one half and one quarter of a metre, respectively. Surgical and hand-made masks, and face shields, generate several leakage jets, including intense backward and downwards jets that may present major hazards. We also simulated an aerosol generating procedure (extubation) and we showed that this is a major hazard for clinicians. These results can aid policy makers to make informed decisions and PPE developers to improve their product effectiveness by design.

Face Coverings, Aerosol Dispersion and Mitigation of Virus Transmission Risk
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Medical Masks

Face masks should be used only by individuals who have symptoms of respiratory infection such as coughing, sneezing, or, in some cases, fever. Face masks should also be worn by health care workers, by individuals who are taking care of or are in close contact with people who have respiratory infections, or otherwise as directed by a doctor. Face masks should not be worn by healthy individuals to protect themselves from acquiring respiratory infection because there is no evidence to suggest that face masks worn by healthy individuals are effective in preventing people from becoming ill. Face masks should be reserved for those who need them because masks can be in short supply during periods of widespread respiratory infection. Because N95 respirators require special fit testing, they are not recommended for use by the general public.

Medical Masks
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Scientific studies referenced in the film:

  1. Disposable surgical face masks for preventing surgical wound infection in clean surgery
  2. The evolution of the surgical mask: filtering efficiency versus effectiveness – PubMed
  3. Surgical face masks in modern operating rooms—a costly and unnecessary ritual? – Journal of Hospital Infection
  4. Wearing of caps and masks not necessary during cardiac catheterization – PubMed
  5. COMMENTARY: Masks-for-all for COVID-19 not based on sound data | CIDRAP
  6. One Virus Particle Is Enough To Cause Infectious Disease — ScienceDaily
  7. Transmission of Measles | CDC
  8. Droplets and Aerosols in the Transmission of SARS-CoV-2 | NEJM
  9. Closed environments facilitate secondary transmission of coronavirus disease 2019 (COVID-19) | medRxiv
  10. A cluster randomised trial of cloth masks compared with medical masks in healthcare workers | BMJ Open
  11. Unmasking the surgeons: the evidence base behind the use of facemasks in surgery
  12. Surgical mask to prevent influenza transmission in households: a cluster randomized trial – PubMed
  13. Use of surgical face masks to reduce the incidence of the common cold among health care workers in Japan: a randomized controlled trial – PubMed
  14. A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients
  15. A replaceable, more efficient filter for N95 masks — ScienceDaily
  16. Surgical Mask vs N95 Respirator for Preventing Influenza Among Health Care Workers: A Randomized Trial | Geriatrics | JAMA | JAMA Network
  17. Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis
  18. The efficacy of medical masks and respirators against respiratory infection in healthcare workers – MacIntyre – 2017 – Influenza and Other Respiratory Viruses – Wiley Online Library
  19. Effectiveness of Surgical and Cotton Masks in Blocking SARS–CoV-2: A Controlled Comparison in 4 Patients | Annals of Internal Medicine
  20. Respiratory virus shedding in exhaled breath and efficacy of face masks | Nature Medicine
  21. Coronavirus: hamster research shows effectiveness of masks ‘huge’ in Covid-19 battle, Hong Kong scientists say | South China Morning Post
  22. Identifying airborne transmission as the dominant route for the spread of COVID-19 | PNAS
  23. Sexual Health in the SARS-CoV-2 Era
  24. The physiological impact of wearing an N95 mask during hemodialysis as a precaution against SARS in patients with end-stage renal disease – PubMed
  25. Respiratory consequences of N95-type Mask usage in pregnant healthcare workers—a controlled clinical study
  26. Carbon dioxide re‐breathing with close fitting face respirator masks – Fletcher – 2006 – Anaesthesia – Wiley Online Library
  27. Carbon dioxide rebreathing in respiratory protective devices: influence of speech and work rate in full-face masks – PubMed
  28. Preliminary report on surgical mask induced deoxygenation during major surgery – PubMed
  29. Protective Facemask Impact on Human Thermoregulation: An Overview | Annals of Work Exposures and Health | Oxford Academic
  30. Amygdala Responsivity to High-Level Social Information from Unseen Faces | Journal of Neuroscience
  31. Children show increase in mental health difficulties over COVID-19 lockdown
  32. RE: Mental health issues in children amidst COVID-19 pandemic | CMAJ
  33. Effects of wearing N95 and surgical facemasks on heart rate, thermal stress and subjective sensations
  34. Immune study points to new ways to treat lung disease — ScienceDaily
  35. Psychological Stress and the Human Immune System: A Meta-Analytic Study of 30 Years of Inquiry
  36. Frontiers | The Developmental Origins of the Social Brain: Empathy, Morality, and Justice | Psychology
  37. WHO | Up to 650 000 people die of respiratory diseases linked to seasonal flu each year
  38. Tracking Changes in SARS-CoV-2 Spike: Evidence that D614G Increases Infectivity of the COVID-19 Virus
  39. Comorbidities the rule in New York’s COVID-19 deaths | The Hospitalist
  40. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area | Critical Care Medicine | JAMA | JAMA Network
  41. The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States | Cardiology | JAMA | JAMA Network
  42. A Spotlight on World Obesity Rates — Central Intelligence Agency
  43. FDA clears IND application for natural killer cell-based COVID-19 therapy
  44. Innate immunity in COVID-19 patients mediated by NKG2A receptors, and potential treatment using Monalizumab, Cholroquine, and antiviral agents – PubMed
  45. Immune response to a 30-minute walk – PubMed
  46. Sleep-deprivation reduces NK cell number and function mediated by β-adrenergic signalling – PubMed
  47. The impact of stressful life events on natural killer cells – Schlesinger – 1991 – Stress Medicine – Wiley Online Library
  48. Sleep deprivation effect on the immune system mirrors physical stress — ScienceDaily
  49. When Physicians Counsel About Stress: Results of a National Study