Keep your droplets to yourself: Universal use of face masks along with social distancing
DOI:
https://doi.org/10.12957/bjhbs.2020.59715Keywords:
Coronavirus infections, Masks, Prevention & control.Abstract
Introduction: As the COVID-19 pandemic progresses around
the world, the universal use of face masks imposes itself as a
measure to mitigate the transmission of SARS-CoV-2 and is
currently recommended by the World Health Organization.
However, its effectiveness as a method of preventing COVID-
19 is still controversial. Objective: To review the literature
on the universal use of facial masks, including fabric ones, and
their recommendations for use. Methods: Narrative review
of published studies on the topic. Results: Face masks act predominantly
as a source control mechanism, as they capture
the droplets expelled by the user when speaking, coughing
or sneezing, protecting other people and the environment
from contamination by potentially infecting droplets. Evidence
of the effectiveness of its universal use as a method of
mitigating epidemics of viral respiratory infections is derived
from experimental studies and mathematical models. Proper
use of facial masks is essential to ensure their effectiveness
and prevent damage, and includes covering the nose, mouth
and chin, washing the fabric masks with soap and water after
use and hand hygiene several times a day, especially when
handling the mask. Conclusions: The universal use of facial
masks in the context of the COVID-19 pandemic is justified,
especially considering the occurrence of virus transmission
in the pre-symptomatic period, and should be adopted in
conjunction with other measures such as adequate social
distance and hygiene from the hands, following the motto
“I protect you and you protect me”.
References
Hartley DM, Perencevich EN. Public Health Interventions for
COVID-19: Emerging Evidence and Implications for an Evolving
Public Health Crisis. JAMA. 2020 May 19;323(19):1908–9.
Liu Y, Centre for Mathematical Modelling of Infectious Diseases
nCoV Working Group, Funk S, et al. The contribution
of pre-symptomatic infection to the transmission dynamics of
COVID-2019. Wellcome Open Res. 2020 Apr 1;5:58.
Chaw L, Koh WC, Jamaludin SA, et al. SARS-CoV-2 transmission
in different settings: Analysis of cases and close contacts
from the Tablighi cluster in Brunei Darussalam. medRxiv. 2020
Jul 10;2020.05.04.20090043.
Keshtkar-Jahromi M, Sulkowski M, Holakouie-Naieni K. Public
Masking: An Urgent Need to Revise Global Policies to Protect
against COVID-19. Am J Trop Med Hyg. 2020 Jun;102(6):1160–1.
Cheng KK, Lam TH, Leung CC. Wearing face masks in the
community during the COVID-19 pandemic: altruism and
solidarity. The Lancet [Internet]. 2020 Apr 16 [cited 2020 May
;0(0). Available from: https://www.thelancet.com/journals/
lancet/article/PIIS0140-6736(20)30918-1/abstract
ORIENTAÇÕES GERAIS – Máscaras faciais de uso não profissional
[Internet]. [cited 2020 Sep 9]. Available from: http://portal.
anvisa.gov.br/documents/219201/4340788/NT+M%C3%A1scaras.
pdf/bf430184-8550-42cb-a975-1d5e1c5a10f7
Atkeson A. What Will Be the Economic Impact of COVID-19
in the US? Rough Estimates of Disease Scenarios [Internet].
Cambridge, MA: National Bureau of Economic Research; 2020
Mar [cited 2020 Jun 7] p. w26867. Report No.: w26867. Available
from: http://www.nber.org/papers/w26867.pdf
Parodi SM, Liu VX. From Containment to Mitigation of COVID-
in the US. JAMA. 2020 Apr 21;323(15):1441–2.
Long Q-X, Tang X-J, Shi Q-L, et al. Clinical and immunological
assessment of asymptomatic SARS-CoV-2 infections. Nat Med.
Jun 18;1–5.
Anderson RM, Heesterbeek H, Klinkenberg D, et al. How
will country-based mitigation measures influence the
course of the COVID-19 epidemic? The Lancet. 2020 Mar
;395(10228):931–4.
Ferguson N, Laydon D, Nedjati Gilani G, et al. Report 9: Impact
of non-pharmaceutical interventions (NPIs) to reduce COVID19
mortality and healthcare demand [Internet]. Imperial College
London; 2020 Mar [cited 2020 Jun 5]. Available from: http://spiral.
imperial.ac.uk/handle/10044/1/77482
Máscaras caseiras podem ajudar na prevenção contra o Coronavírus
[Internet]. [cited 2020 Jun 7]. Available from: https://
www.saude.gov.br/noticias/agencia-saude/46645-mascaras-caseiras-
podvidasem-ajudar-na-prevencao-contra-o-coronavirus
MacIntyre CR, Chughtai AA. 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. Int J Nurs Stud. 2020
Aug;108:103629.
Jayaweera M, Perera H, Gunawardana B, et al. Transmission
of COVID-19 virus by droplets and aerosols: A critical review on
the unresolved dichotomy. Environ Res. 2020 Sep;188:109819.
Anderson EL, Turnham P, Griffin JR, et al. Consideration of the
Aerosol Transmission for COVID-19 and Public Health. Risk
Anal. 2020;40(5):902–7.
Atkinson J, Chartier Y, Pessoa-Silva CL, et al. Respiratory
droplets [Internet]. Natural Ventilation for Infection Control in
Health-Care Settings. World Health Organization; 2009 [cited
Jun 7]. Available from: https://www.ncbi.nlm.nih.gov/
books/NBK143281/
Tcharkhtchi A, Abbasnezhad N, Zarbini Seydani M, et al. An
overview of filtration efficiency through the masks: Mechanisms
of the aerosols penetration. Bioact Mater. 2020 Aug
;6(1):106–22.
Morawska L, Cao J. Airborne transmission of SARS-CoV-2:
The world should face the reality. Environ Int. 2020 Jun
;139:105730.
Tellier R, Li Y, Cowling BJ, et al. Recognition of aerosol transmission
of infectious agents: a commentary. BMC Infect Dis.
Jan 31;19(1):101.
Prather KA, Wang CC, Schooley RT. Reducing transmission of
SARS-CoV-2. Science. 2020 Jun 26;368(6498):1422–4.
van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and
Surface Stability of SARS-CoV-2 as Compared with SARSCoV-
N Engl J Med. 2020 Apr 16;382(16):1564–7.
Leung NHL, Chu DKW, Shiu EYC, et al. Respiratory virus shedding
in exhaled breath and efficacy of face masks. Nat Med.
May;26(5):676–80.
Gandhi M, Beyrer C, Goosby E. Masks Do More Than Protect
Others During COVID-19: Reducing the Inoculum of SARSCoV-
to Protect the Wearer. J Gen Intern Med. 2020 Jul
;1–4.
Offeddu V, Yung CF, Low MSF, et al. Effectiveness of Masks
and Respirators Against Respiratory Infections in Healthcare Workers: A Systematic Review and Meta-Analysis. Clin Infect
Dis Off Publ Infect Dis Soc Am. 2017 Nov 13;65(11):1934–42.
WHO-2019-nCov-IPC_Masks-2020.4-eng.pdf [Internet]. [cited
Jul 1]. Available from: https://apps.who.int/iris/bitstream/
handle/10665/332293/WHO-2019-nCov-IPC_Masks-2020.4-
eng.pdf?sequence=1&isAllowed=y
MacIntyre CR, Seale H, Dung TC, et al. A cluster randomised
trial of cloth masks compared with medical masks in healthcare
workers. BMJ Open. 2015 Apr 1;5(4):e006577.
van der Sande M, Teunis P, Sabel R. Professional and Home-
Made Face Masks Reduce Exposure to Respiratory Infections
among the General Population. PLoS ONE [Internet]. 2008 Jul
[cited 2020 May 27];3(7). Available from: https://www.ncbi.
nlm.nih.gov/pmc/articles/PMC2440799/
Garrett L. The Next Pandemic? Foreign Aff. 2005;84(4):3–23.
Davies A, Thompson K-A, Giri K, et al. Testing the Efficacy
of Homemade Masks: Would They Protect in an Influenza
Pandemic? Disaster Med Public Health Prep. 2013 May
;7(4):413–8.
Zangmeister CD, Radney JG, Vicenzi EP, et al. Filtration
Efficiencies of Nanoscale Aerosol by Cloth Mask Materials
Used to Slow the Spread of SARS-CoV-2. ACS Nano. 2020 Jul
;14(7):9188–200.
Verma S, Dhanak M, Frankenfield J. Visualizing the effectiveness
of face masks in obstructing respiratory jets. Phys Fluids.
Jun 1;32(6):061708.
Aydin O, Emon MAB, Cheng S, et al. Performance of
Fabrics for Home-Made Masks Against the Spread of
Respiratory Infections Through Droplets: A Quantitative
Mechanistic Study [Internet]. Epidemiology; 2020 Apr [cited
Aug 19]. Available from: http://medrxiv.org/lookup/
doi/10.1101/2020.04.19.20071779
Mueller AV, Eden MJ, Oakes JM, et al. Quantitative Method
for Comparative Assessment of Particle Removal Efficiency
of Fabric Masks as Alternatives to Standard Surgical Masks
for PPE. Matter [Internet]. 2020 Jul 9 [cited 2020 Aug 19];
Available from: http://www.sciencedirect.com/science/article/pii/
S2590238520303647
Stutt ROJH, Retkute R, Bradley M, et al. A modelling framework
to assess the likely effectiveness of facemasks in combination
with ‘lock-down’ in managing the COVID-19 pandemic. Proc R
Soc Math Phys Eng Sci. 2020 Jun 24;476(2238):20200376.
Eikenberry SE, Mancuso M, Iboi E, et al. To mask or not to
mask: Modeling the potential for face mask use by the general
public to curtail the COVID-19 pandemic. Infect Dis Model. 2020
Jan 1;5:293–308.
Wei WE. Presymptomatic Transmission of SARS-CoV-2 — Singapore,
January 23–March 16, 2020. MMWR Morb Mortal Wkly
Rep [Internet]. 2020 [cited 2020 May 27];69. Available from:
https://www.cdc.gov/mmwr/volumes/69/wr/mm6914e1.htm
Li R, Pei S, Chen B, et al. Substantial undocumented infection
facilitates the rapid dissemination of novel coronavirus (SARSCoV-
. Science. 2020 May 1;368(6490):489–93.
Howard J, Huang A, Li Z, et al. Face Masks Against COVID-19:
An Evidence Review. 2020 Apr 12 [cited 2020 May 24]; Available
from: https://www.preprints.org/manuscript/202004.0203/v1
WHO-2019-nCoV-IPCPPE_use-2020.2-eng.pdf [Internet]. [cited
Jun 7]. Available from: https://apps.who.int/iris/bitstream/
handle/10665/331498/WHO-2019-nCoV-IPCPPE_use-2020.2-
eng.pdf
Sim SW, Moey KSP, Tan NC. The use of facemasks to prevent
respiratory infection: a literature review in the context of the
Health Belief Model. Singapore Med J. 2014 Mar;55(3):160–7.
Mahase E. Covid-19: What is the evidence for cloth masks?
BMJ [Internet]. 2020 Apr 7 [cited 2020 May 29];369. Available
from: https://www.bmj.com/content/369/bmj.m1422
Chagas AM, Molloy JC, Prieto-Godino LL, et al. Leveraging
open hardware to alleviate the burden of COVID-19 on global
health systems. PLOS Biol. 2020 Apr 24;18(4):e3000730.
M. Mehedi R, Bhuyan MAH, Khan R, et al. A Simple Homemade
Cloth Mask for Mass People in Covid-19: Salt-Starching Treatment
on Fabric for Better Bioaerosol Filtration Efficiency. 2020
[cited 2020 May 24]; Available from: http://rgdoi.net/10.13140/
RG.2.2.26003.91681
Downloads
Published
How to Cite
Issue
Section
License
After the final approval, authors must send the copyright transfer agreement signed by the first author representing each additional author. In this agreement must be stated any conflicts of interest.
Brazilian Journal of Health and Biomedical Sciences de http://bjhbs.hupe.uerj.br/ is licensed under a License Creative Commons - Attribution-NonCommercial 4.0 International. 
