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3M one of the world's largest manufacturers of masks and respirators says, “No matter how well a respirator seals to the face and how efficient the filter media is, wearers should expect a small amount of leakage inside any respirators.”
N95 masks remove particles from the air breathed through it. These respirators filter out at least 95% of very small (0.3 micron) particles. N95 FFRs are capable of filtering out all types of particles, including bacteria and viruses.
Because surgical masks are designed to keep infections from spreading (by trapping droplets from the wearer), used masks can become laden with coronavirus. If these virus-carrying masks are disposed of improperly (e.g. outside of a hospital setting), they can infect others.
A randomised trial of 446 nurses in the emergency departments, and medical and paediatric units of 8 tertiary care Ontario hospitals found that the incidence of laboratory-confirmed influenza was similar in nurses wearing the surgical mask and those wearing the N95 respirator.
There are homemade cloth face masks, surgical masks and N95 respirators. A 2008 study showed that homemade masks may be half as effective as surgical masks, and up to 50 times less effective than N95 respirators.
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A 2006 report by the US National Academy of Sciences discourages the reuse of masks because the hazardous buildup of harmful particles within the mesh, cannot be cleaned out without damaging the fibres or other components of the device (such as the straps or nose clip).
A team of researchers blasted virus-laden fluids into a rotating cylinder to create an aerosolised cloud of air, and found that the virus remained stable for several hours within that cloud, raising fears about its ability to persist in ambient air.
Saskia Popescu of George Mason University said the study doesn’t reflect “what’s occurring when you’re just walking down the street," and is “...more akin to medically invasive procedures like intubation... [which] are unique to the healthcare setting."
Lydia Bourouiba, an associate professor at MIT, has researched the dynamics of exhalations and found that exhalations cause gaseous clouds that can travel up to 27 feet (8.2 meters). Masks can reduce the distance travelled by gaseous clouds and the amount of droplets in them.
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A 2008 study of flu viruses found they can become aerosolised in exhalations without coughing or sneezing. While it remains an open question whether coronavirus can also be aerosolised, it may be wise to err on the side of caution and wear masks (given what we know about flu).
Paul Hunter (University of East Anglia) and his colleagues analysed the efficacy of face masks, and found that they seem to prevent sick people from spreading the studied viruses, but the evidence is weak and inconsistent.
Hospitals around the world are reporting personal protective equipment (PPE) shortages, which causes healthcare workers to fall ill at faster rates and in larger numbers. This reduces the number of active healthcare workers and the number of people who are treated successfully.
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A relatively small study of hospitalised flu patients—across 6 major hospitals in 2 districts of Beijing, China, and involving 245 people with influenza-like illness (ILI)—found that mask-wearers were less likely to infect their family members.
The study compared rates of infection—with clinical respiratory illness (CRI) and influenza-like illness (ILI)—between healthcare workers who wore disposable medical masks vs reusable cloth ones. The rates of all infection outcomes were highest among those wearing cloth masks.
In a systematic review of 31 studies (undertaken at the University of East Anglia), it was found there is enough evidence to support the use of face masks for short periods of time, by particularly vulnerable individuals, when in transient higher-risk situations.
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The study, which compared homemade vs surgical masks, found both significantly reduced the number of microorganisms expelled by volunteers, although the surgical mask was 3 times more effective at blocking transmission than the homemade mask.
Live influenza virus was measurable from the air behind all surgical masks tested. The data indicate that a surgical mask will reduce exposure to aerosolised infectious influenza virus; reductions ranged from 1.1- to 55-fold (average 6-fold), depending on the design of the mask.
The study concluded, "Results suggest that household transmission of influenza can be reduced by the use of NPI, such as face masks and intensified hand hygiene, when implemented early and used diligently."
The study concluded, "Influenza transmission was not reduced by interventions to promote hand washing and face mask use." Although, it also says the ineffectiveness "... may be attributable to transmission that occurred before the intervention..." and other factors.
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The study concluded that surgical masks can effectively reduce the emission of influenza virus particles into the environment in respiratory droplets, but not in aerosols. They also reduced coronavirus detection and viral copies in large respiratory droplets and aerosols.