Saudi Pharmaceutical Journal 29 (2021) 121–133

Contents lists available at ScienceDirect

Saudi Pharmaceutical Journal

journal homepage: www.sciencedirect.com

Review

A novel perspective approach to explore pros and cons of face mask in

prevention the spread of SARS-CoV-2 and other pathogens
M.D. Faruque Ahmad a,⇑, Shadma Wahab b, Fakhruddin Ali Ahmad c, M. Intakhab Alam d, Hissana Ather e,
Ayesha Siddiqua f, Syed Amir Ashraf g, Mohammad Abu Shaphe h, Mohammed Idreesh Khan i,
Rashid Ali Beg h
a
Department of Clinical Nutrition, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
b
Department of Pharmacognosy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
c
Department of Laboratory Medicine Al-Hada and Taif Military Hospital, Saudi Arabia
d
Department of Pharmaceutics, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
e
Department of Pharmaceutical Chemistry, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
f
Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
g
Department of Clinical Nutrition, College of Applied Medial Sciences, University of Hail, Hail PO Box 2440, Saudi Arabia
h
Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Saudi Arabia
i
Department of Clinical Nutrition, College of Applied Health Sciences in Arras, Qassim University, Saudi Arabia

a r t i c l e i n f o a b s t r a c t

Article history: Corona virus disease 2019 (COVID-19) outbreak has become a severe community health threat across the
Received 6 October 2020 world. Covid-19 is a major illness, presently there is no as such any medicine and vaccine those can claim
Accepted 23 December 2020 for complete treatment. It is spreading particularly in a feeble immune people and casualties are expand-
Available online 31 December 2020
ing abruptly and put the health system under strain. Among the strategic measures face mask is one of
the most used measures to prevent spread of severe acute respiratory syndrome coronavirus 2 (SARS-
Keywords: CoV-2). Wearing a face mask possibly create a false sense of security lead to decline others measures.
SARS-CoV-2
Face mask could be risk for the people of under lying medical conditions, old age group, outdoor exercise,
Face mask
Hypoventilation
acute and chronic respiratory disorders and feeble innate immune. Restrictive airflow due to face mask is
Hypercapnia the main cause of retention of CO2 called hypercapnia that can lead to respiratory failure with symptoms
COPD of tachycardia, flushed skin, dizziness, papilledema, seizure and depression. According to latest updates
face shield and social distancing could be better substitute of face mask.
Ó 2020 The Author(s). Published by Elsevier B.V. on behalf of King Saud University. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
2. Rationale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
3. Pre-to post COVID-19 face mask compliance scenario . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
4. A pleiotropic approach of face mask in the prevention of SARS-CoV-2 spread . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
5. Efficacy and infiltrating capability of face mask. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
6. Factual facts of face mask . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128

⇑ Corresponding author.
E-mail address: [email protected] (M.D.F. Ahmad).
Peer review under responsibility of King Saud University.

Production and hosting by Elsevier

https://doi.org/10.1016/j.jsps.2020.12.014
1319-0164/Ó 2020 The Author(s). Published by Elsevier B.V. on behalf of King Saud University.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
M.D. Faruque Ahmad, S. Wahab, F. Ali Ahmad et al. Saudi Pharmaceutical Journal 29 (2021) 121–133

7. Face mask induced risk populace and allied health impediments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
8. A novel approach for alternate of face mask . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
9. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Declaration of Competing Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131

1. Introduction 2. Rationale

Corona virus disease 2019 (COVID-19) outbreak has been Introduction of mouth and nose coverage by using face mask
emerged as a serious global public health threat. COVID-19 is an can be traced back to the 20th century (Matuschek et al., 2020).
infectious pandemic outbreak caused by SARS-CoV-2 and this Historically, face mask had been a part of traditional sanitary prac-
novel strain of SARS-CoV-2 belongs to same family of coron- tices against contagious diseases in early modern Europe. Face
aviruses those are responsible for SARS-CoV and MERS-CoV masks used in today health care system and in the community
(Rasmussen et al., 2020; Chan et al., 2020; Wahab et al., 2020). can be seen as preventative measure to mitigate or prevent the
The cases are still rising in haste across the world and infected spread of infectious disease such as COVID-19. Earlier report sug-
235 countries, areas or territories estimated with approximately gests that, many of these non-pharmaceutical measures likewise
over 35.35 million people infected with 1.03 million deaths. Uni- face mask had been used for the control of community transmis-
ted States America has highest number of cases 7,341,406 among sion of severe acute respiratory syndrome (SARS) in 2003 and pan-
the all nations with the highest total death 208,433 according to demic influenza A H1N1 in 2009 in Hong Kong and other parts of
WHO report on October 6, 2020. As of October 6, 2020, cases from the world (Cheng et al., 2020). Since the outbreak of SARS-CoV-2,
WHO region reported 6,337,772 in Europe, 17,176,705 in Americ- the use of face masks has become ubiquitous around the world
as, 2,503,734 in Eastern Mediterranean, 633,080 in Western Paci- and it has become an important health measure or we can say as
fic, 7,488,605 in South East Asia and 1,206,767 in Africa (WHO, become a new normal after COVID-19 pandemic (Feng et al.,
2020). 2020). Al-though, several recommendations as well as usage
Cascella et al., stated strategic measures for COVID-19 preven- guidelines have been made available by World Health Organization
tion in health personnel aspects of patient isolation and infection (WHO), Centers for Disease Control and Prevention (CDC) and
control that include steps to be measured during the diagnosis other health agencies to prevent transmission of air droplets by
and care of infected patient, contact, droplet, blood and precaution holding it back. In addition, despite of various fact sheet or techni-
should be adopted during specimen collection and induction cal report available regarding the face mask, its usage in healthy
(Cascella et al., 2020). Different modes of transmission are investi- population is still controversial (Cheng et al., 2020). Subsequently
gated including contact, droplet, airborne, fomite, fecal-oral, blood according to our literature survey, we observed that, a lot of infor-
borne, mother to child and animal to human. Among them contact mation published discussing majorly the benefits of face mask
and droplet, airborne, fomite transmissions are considered to be rather than its drawback while worn for longer duration. We found
major contributors for the spread of COVID-19. Moreover, the that, there is several other health aspect associated with face mask,
fecal-oral transmission is a potential source due to the presence which need to address in this current pandemic.
of viral RNA in stool (Perisetti et al., 2020a). A number of studies Various studies have been conducted on face mask, studies
uncovered the potential of the fecal-oral route of transmission of were individually evaluated for their reporting and methodological
SARS-CoV-2. A pooled prevalence of 48.1% for stool RNA positivity quality using methods described in the Table 1. It is worthy of eval-
was obtained after review of 12 studies (Perisetti et al., 2020b). uating above all 11 studies examined the effectiveness and efficacy
Other factors too may be responsible for stool RNA positivity. As of face masks in Hajj setting. One investigation is related to stu-
per the report of Ling et al., 82% of the patients had persistent stool dents on or off-campus. In the clinical trials, faces mask to be the
RNA positivity even after viral respiratory clearance. The fecal-oral best performing intervention as compared to other physical non-
transmission of COVID-19 may be considered for the cause of diar- pharmaceutical intervention across different populations and set-
rhea in the community (Ling et al., 2020). Among the COVID-19 tings. Wearing a face mask was actually associated with greater
patients diarrhea is found to be commonly noted GI symptoms. A likelihood of respiratory illness. This finding is consistent with pre-
number studies were performed to investigate the prevalence of vious findings that face masks either offered no significant protec-
diarrhea. Accordingly, the result of prevalence of diarrhea was tion or were associated with sore throat and with longer duration
found to be 5–10% (Sultan et al., 2020; Cheung et al., 2020), 2– of sore throat and fever symptoms. The efectiveness of face mask in
50% (D’Amico et al., 2020), 22.1% (Hajifathalian et al., 2020) and source control hinges on the specific mode of transmission of etio-
36.6% from different studies performed elsewhere. It is not clear logical agent. The results from these types of studies could then be
factor play key role in causing the diarrhea in COVID-19 patients used to develop evidence based interventions to help prepare for
(Perisetti et al., 2020b; Perisetti et al., 2020c). future pandemics.
The significant measures for the public to clean hands subse-
quent to non living and living contacts, use sanitizers, face mask,
social distancing etc. Among the various measures applied by the 3. Pre-to post COVID-19 face mask compliance scenario
people face mask play an important role to control the spread of
SARS-CoV-2 through protecting from infected persons and protect- Yang et al., 2011 carried a study during the year 2007–2008 to
ing others from infection and reduce the risk of exposure (Fig. 1) see the compliance rate of face mask on 400 HCWs and they found
(Siddiqui et al., 2020a). Despite the fact that strategic measures that only 70% were in compliant of wearing mask while in contact
of face mask exhibits false sense of security and may lead to death with patients (Yang et al., 2011). A single-center, cross-sectional
in specific group of the people. study performed by McGaw et al., during the March and May

122
M.D. Faruque Ahmad, S. Wahab, F. Ali Ahmad et al. Saudi Pharmaceutical Journal 29 (2021) 121–133

Fig. 1. Contribution of face mask in control and prevention of severe acute respiratory syndrome coronavirus (SARS-CoV-2) in the community people and health personnel.

2009 on total 132 HCWs. They reported that face mask and safety 2020). Sarfarz et al., performed a survey study in hospital setting
goggles were 87%, and 56% respectively (McGaw et al., 2012). One with 397 participants and thye found that the overall compliance
of the studies conducted on nurses (n-1074) to see the compliance with face mask was 90.4% (Sarfraz et al., 2020). In addition, Alhas-
of PPE and they reported that only 44% nurses were adhering to the san et al., performed a cross sectional study to see the facemask
recommended uses of PPE (Nichol et al., 2013). Chughtai et al., sug- compliance among the HCWs and they found that facemask com-
gested both medical and cloth masks were in use during the pliance was proportionally higher 85.0% among nurses followed
4 weeks of their study and reported that medical mask used were by physician (50.0%). Majority (94.9%) of the respondents reported
77% (Chughtai et al., 2016). Similarly, Haile et al., reported that facemask use during procedures likely to generate splashes.
HCWs were following standard precaution while in the hospital (Alhassan et al., 2020). Earlier reports suggest that, HCWs had
setting was 12% (Haile et al., 2017). Based upon the above men- good knowledge (69%) and compliance (68%) with Covid19 con-
tioned pre-covid-19 face mask and safety goggles compliance rate, trol (Amanya et al., 2020). Tripathi et al., revealed a study on
we can say it actually varied from the region to region so it 1000 participants, they presented that 86.5% respondent were
becomes very difficult to say a particular compliance rate. wearing the face mask Tripathi et al., 2020). Moreover, major
However, since the declaration of COVID-19 outbreak on non-compliance of face mask and other personnel protective
March 11, 2020, a global pandemic from the WHO there has been equipment (PPE) were reported due to following reason such as
seen a sharp surge in the usage of facemask by the healthcare unavailability, uncomfortable while operating, poor visibility, fog-
work as well as the mass populations. Several studies have been ging while operating, re-use compromises, can’t wear along with
carried out by various authors to show the real representation other PPE, prefer to use goggles over other PPE other difficulty
of compliance rate for facemask and safety goggle during the cur- includes breathing on exertion, acne, itchy nose, difficulty breath-
rent pandemic. Picard et al observed that wearing of face mask in ing, discomfort, allergy and pain (Prakash et al., 2020;
HCWs showed a data published in the media during the pandemic Purushothaman et al., 2020). Overall, these findings suggest that
and conformed to show good practice guidelines in 70.8% of the post COVID-19 declaration; the use of PPE or face mask in partic-
photographs collected on some of the main French information ular has increased which is seen as important non pharmaceutical
websites (Picard et al., 2020). Parkash et al., conducted a study tools to mitigate the COVID-19 pandemic among the health work-
on compliance and perception about personal protective equip- ers as well as in mass population. However, these findings suggest
ments among health care workers involved in the surgery during that there are still opportunities for improvement in rates of pub-
COVID-19 pandemic. They found that overall compliance for PPE lic face mask use and a potential decrease in the spread of COVID-
usage was 96.3% (Prakash et al., 2020; Purushothaman et al., 19 in our population.

123
M.D. Faruque Ahmad, S. Wahab, F. Ali Ahmad et al. Saudi Pharmaceutical Journal 29 (2021) 121–133

Table 1
Various studies on effectiveness and efficacy of face masks.

Participants Interventions Comparisons outcomes Study design References

1437 young adults Residence halls were We observed significant These findings suggest that Residence halls were ClinicalTrials.gov
living in randomly assigned to 1 of 3 reductions in ILI during face masks and hand randomly assigned to 1 of 3 identifier:
university groups—face mask use, face weeks 4–6 in the mask and hygiene may reduce groups—face mask use, face NCT00490633.
residence halls masks with hand hygiene, or hand hygiene group, respiratory illnesses in masks with hand hygiene, or (Aiello et al.,
during the 2006– control— for 6 weeks. compared with the control shared living settings and control— for 6 weeks. 2010)
2007 Generalized models group, ranging from 35% mitigate the impact of the Generalized models
estimated rate ratios for (confidence interval [CI], influenza A(H1N1) estimated rate ratios for
clinically diagnosed or 9%–53%) to 51% (CI, 13%– pandemic. clinically diagnosed or
survey-reported influenza 73%), after adjusting for survey-reported ILI weekly
like illness (ILI) weekly and vaccination and other and cumulatively.
cumulatively. covariates.
NPIs in households Study nurses conducted Influenza transmission was This may be attributable to Respiratory swabs and (Simmerman
with a febrile, home visits within 24 h of not reduced by transmission that occurred serum were collected from et al., 2011)
influenza- enrollment and on days 3, 7, interventions to promote before the intervention, poor all household members and
positive child. and 21. Respiratory swabs hand washing and face mask facemask compliance, little tested for influenza by RT-
Households. and serum were collected use. difference in hand-washing PCR or serology.
from all household members frequency between study
and tested for influenza by groups.
RT-PCR or serology
1,178 young adults Discrete-time survival A significant reduction in Face masks and hand Participants were assigned Clinicaltrials.gov
living in 37 models using generalized the rate of ILI was observed hygiene combined may to face mask and hand NCT00490633
residence houses estimating equations to in weeks 3 through 6 of the reduce the rate of ILI and hygiene, face mask only, or (Aiello et al.,
in 5 university estimate intervention effects study, with a maximum confirmed influenza in control group during the 2012)
residence halls on ILI and confirmed reduction of 75% during the community settings. These study.
during the 2007– influenza A/B infection over final study week (rate ratio non-pharmaceutical
2008 influenza a 6-week study period were [RR] = 0.25, [95% CI, 0.07 to measures should be
season. examined. 0.87]). Both intervention recommended in crowded
groups compared to the settings at the start of an
control showed cumulative influenza pandemic.
reductions in rates of
influenza over the study
period, although results
could not reach to statistical
significance.
Australian pilgrims Tents were randomised to Mask use compliance was This pilot study shows that a Pilot study, The Hajj (Barasheed et al.,
of attending Haj ’supervised mask use’ versus 76% in the ’mask’ group and large trial to assess the pilgrimage, where the 2014)
’no supervised mask use’. 12% in the ’control’ group. effectiveness of facemasks incidence of influenza and
Pilgrims with ILI symptoms Based on developing use at Hajj is feasible other respiratory infections
for>3 days were recruited as syndromic ILI, less contacts is high, provides an excellent
’cases’ and those who slept became symptomatic in the opportunity to test the
within 2 m of them as ’mask’ tents compared to the effectiveness of facemasks
’contacts’ ’control’ tents (31% versus against syndromic and
53%, p = 0.04) laboratory-confirmed
infections
Malaysian Hajj A total of 387 survey forms Malaysian Hajj pilgrims The prevalence of A cross-sectional study was (Deris et al.,
pilgrims were available for analysis. were: cough 91.5%, runny respiratory symptoms was conducted by distributing 2010)
The mean age was 50.4 +/- nose 79.3%, fever 59.2%, and high among Malaysian Hajj survey forms to Malaysian
11.0 years. sore throat 57.1%. The pilgrims Hajj pilgrims at transit
prevalence of Hajj pilgrims center before flying back to
with triad of cough, Malaysia.
subjective fever, and sore
throat were 40.1%. The
symptoms lasted<2 weeks in
the majority of cases. Only
3.6% did not suffer from any
of these symptoms
405 Hajj pilgrims Pilgrims were administered A total of 165 (60.2%) Results suggest that Pre and post travel (Gautret et al.,
a post-travel questionnaire individuals presented with vaccination against questionnaire 2011)
by telephone that addressed at least one health problem influenza and the use of
compliance with preventive during their stay in Saudi surgical facemasks were not
measures against Arabia, including cough efficient against respiratory
respiratory infections and (48.5% of all pilgrims), sore infections
the occurrence of disease throat (36.1%),rhinorrhea
during their 4-week stay in (23.7%), sputum (13.5%),
Saudi Arabia shortness of breath (2.9%),
voice failure (2.9%),
subjective fever(10.9%),
myalgia (9.5%),
gastrointestinal symptoms
(9.5%), conjunctivitis (0.4%)
and Influenza like illness
1507 Hajjis A cross-sectional study Out of 1507 Hajjis, 54.7% Upper respiratory tract A cross-sectional study (Saeed et al.,
during November and developed symptoms, 97% infections is a common 2012)
December 2009 among reported upper respiratory health problem among

124
M.D. Faruque Ahmad, S. Wahab, F. Ali Ahmad et al. Saudi Pharmaceutical Journal 29 (2021) 121–133

Table 1 (continued)

Participants Interventions Comparisons outcomes Study design References

Hajjis registered while tract symptoms, and 9.3% studied domestic Hajjis.
visiting Primary Health Care reported diarrheal Generally, there is room for
Centers of Riyadh, Kingdom symptoms. People < 40 years improvement in the
of Saudi Arabia to get of age were more likely to adoption of preventive
mandatory meningococcal develop URTI. measures by Hajjis; and
meningitis vaccination. On there is still limited
return from Hajj, Hajjis were information on the use of
contacted on telephone to facemasks in spite of the fact
collect information on that using it significantly
occurrence of URTI and decreases the risk for URTI.
diarrhea along with other
associated activities in Hajj.
186 US Hajjis Surveys assessed In contrast to other studies Pre and post travel surveys Survey (Balaban et al.,
demographics, knowledge, that have found protective were completed by 186 2012)
attitudes, and practices effects of face masks at Hajj. participants. Respiratory
(KAP) related to influenza A Evidence for the efficacy of illness was reported by 76
(H1N1), vaccination, health face masks for preventing (41.3%) respondents; 144
seeking behaviors, sources the transmission of (77.4%) reported engaging in
of health information, influenza is limited. The recommended protective
protective behaviors during protective practices and behaviors during the Hajj.
the Hajj, and respiratory respiratory illness among US Reduced risk of respiratory
illness travelers to the 2009 Hajjis illness was associated with
study of influenza practicing social distancing,
transmission suggests that hand hygiene, and contact
poor face mask compliance avoidance. of respiratory
decreases their utility in illness.
mitigating the spread of
disease.
7448 school-aged Investigation of H1N1 infection was Providing education on This study analyzed data (Kim et al., 2012)
children in South epidemiological factors associated with body mass wearing facemasks and collected from the
Korea related to H1N1 infection in index (BMI), waist specific planning for participants.
school-aged children circumference (WC), the use abdominally obese children
of facemasks, contact history and adolescents may be
with H1N1-infected persons, effective means of reducing
and overseas travel history the spread of the influenza
(P < 0
05) pandemic in school-aged
children
119 French Hajj Clinical follow-up, The prevalence of S. Majority of pilgrims used Cohort study (Hoang et al.,
pilgrims. adherence to preventive pneumoniae carriage (1.8% facemasks at least 2019
measures and PCR-based pre-, 9.8% post-Hajj), H. sometimes during their stay
pharyngeal bacterial influenzae carriage (0.9%, in Saudi Arabia, only 14.3%
carriage pre- and post-Hajj 45.4%) and K. pneumoniae used masks frequently and
(2.8%, 9.8%) significantly less than half reported
increased post-Hajj. compliance with frequent
hand washing
Malaysian hajj A self-administered Only 31.8% of them All preventive measures A cross-sectional study (Hashim et al.,
pilgrims of 2013 proforma on social practiced good hand which include hand hygiene, 2016)
demographics, previous hygiene, ~82.9% of pilgrims wearing face masks and
experience of hajj or umrah, used surgical face masks, influenza vaccination must
smoking habits, co-morbid N95 face masks, dry towels, be practiced together as
illness and practices of wet towels or veils as their bundle of care to reduce
preventive measures against face masks. Nearly one-half respiratory illness
respiratory illness were to of the respondents (44.4%) effectively
obtain. took vitamins as their food
supplement. Malaysian hajj
pilgrims with previous
experience of hajj (OR 0.24;
95% CI 0.10–0.56) or umrah

4. A pleiotropic approach of face mask in the prevention of partial preventive measure may have a substantial impact on the
SARS-CoV-2 spread transmission of infection (Organization, 2019).
The most important benefit of wearing a mask is the person can
Covid-19 is a severe disease which does not currently have a limit the spread of the virus to others if someone knows or doesn’t
known cure or vaccine. It is a contagious infection which can be know about their infection, especially the asymptomatic person.
transmitted through respiratory droplets. Deaths are rapidly rais- Although the most effective way to avoid the spread of COVID-19
ing and there is a continuous strain on health care systems. To slow infections is to take proper hand hygiene steps and to maintain
the spread of deadly SARS-CoV-2 policymakers as a precautionary physical distancing but wearing a mask in public may restrict the
principle have highly recommended wearing face mask along with transmission of COVID-19 by individuals who have the virus. The
other social distancing steps (Greenhalgh et al., 2020; Siddiqui United States Centers for Disease Control and Prevention (CDC)
et al., 2020b). WHO recognizes that the wearing of masks by pop- and the World Health Organization (WHO) from the beginning
ulace exhibits remarkable effects in severe pandemics as a single integrated face masks into their guidelines to minimise virus

125
M.D. Faruque Ahmad, S. Wahab, F. Ali Ahmad et al. Saudi Pharmaceutical Journal 29 (2021) 121–133

transmission. The face mask is very crucial to cover the face, espe- experimental conditions in aerosol emission, but surgical masks
cially in the areas where other social distancing steps are hard to appear to block aerosols in such laboratory experiments (Van
hold (Desai and Aronoff, 2020). CDC initially encourages the face Doremalen et al., 2020; Leung et al., 2020) that strongly supports
mask use during the pandemic later on the advice was updated public wearing masks during the COVID-19 pandemic. Presymp-
that nose and mouth covering with only cloth face cover when in tomatic individuals tend to be responsible for around 50 percent
public can prevent others from infection. But coving the face with of infections (Ganyani et al., 2020), so a marginal decrease in com-
cloth cover doesn’t mean that one can forget social distancing. CDC munity transmission with mask might make a big difference. Such
guidelines suggest fabric face masks to the public rather than the essential preventive steps may be used to monitor the demand for
surgical and N95 masks that healthcare professionals use (How hospital bed spaces and ventilation systems. Face mask guidelines
to Protect Yourself & Others | CDC, 2020). However, it was found vary across countries. Many countries enforced compulsory face
that there is no claim that the mask is competent enough to spread mask regulations in public places and releases recommendations
the transmission of the virus, but carrying a mask could make on face mask use in community settings that are listed in Table 2
someone feel safer and remind of a preventive measure. (Feng et al., 2020).
There are several reasons to wear a face mask. Firstly it reduces
95% of the respiration that transmits the virus in an area up to 6
feet away, and it minimizes oral/fecal transmission by preventing 5. Efficacy and infiltrating capability of face mask
the virus from getting into persons nose or mouth if the personal
touch the infected surface and then their face. Masks, therefore, There is lack of direct evidences from published data or ran-
encourage us to continue to practice physical distancing. Mask domized controlled trials (RCT) on the use of masks as source con-
reminds people to be compliant with hand hygiene and not to trol for SARS-CoV-2. Efficacy of surgical masks against influenza,
touch the nose and mouth. Mask provides feeling to others in con- rhinovirus as well as seasonal coronavirus was studied and it
tributing to stopping the further spread and most importantly was reported that mask has significant role in source control for
mask gives protection to front line workers caring for COVID-19 the seasonal coronavirus droplets of all sizes but found less effec-
patients. Infants younger than two years should not wear masks, tive at blocking small influenza droplets and of blocking rhinovirus
and people who cannot become unaware of a mask by themselves droplets of any size (Leung et al., 2020). So, efficacy of mask on cur-
(Why Face Masks Are Crucial, 2020). In the studies, it was found rent SARS-CoV-2 is not yet clearly known. Vander et al. reported
that the SARS-CoV-2 is viable in the air for several hours under that almost all kind of mask may decrease viral exposure and risk

Table 2
Recommendations on the use of face mask in various countries in community settings during covid-19 pandemic.

Country Recommendations References

Japan  It is thought that the effectiveness of wearing a face mask to protect you from contracting viruses is (Q&A about the new coronaviru,
minimal 2020)
 If you are wearing a face mask in closed, poorly ventilated spaces it may help to prevent catching droplets
produced by others.
 Use of face masks is not very successful if you are in an open-air environment.
Germany  There is insufficient evidence to prove that wearing a surgical mask substantially decreases the likelihood (Coronavirus: Germany0 s new face
that a healthy individual may get contaminated while carrying it. mask regulations, 2020)
 According to WHO, in circumstances where it is not necessary to wear a mask can establish a false percep-
tion of safety as it may lead to ignoring basic sanitary steps, such as proper hygiene of the hand
China  Individuals at high risk of infection: surgical or disposable mask for medical use. (The state council’s joint prevention
 People at low risk of infection: disposable mask for medical use. and control mechanism, 2020)
 People at very low risk of infection: may not have to wear a mask or can wear a non-medical mask (like a
fabric mask)
UK  Face masks perform a quite significant role in areas like hospitals, though there is very less evidence of (Hutchings, 2020)
widespread benefits for members of the public
Saudi Arabia  According to the Ministry of Health (MOH), the proper wearing of a face mask improves its effectiveness (MOH, 2020)
 MOH has provided the appropriate way to wear cloth face masks, emphasizing that the masks must have
multiple layers, whether handmade or sold from the market.
 MOH instructed the public to wash or sanitize their hands well before wearing a face mask
India  Masks are personal protection devices that will prevent the user from contracting seasonal influenza, or (Guidelines on use of masks, 2020)
any other aerosol/ droplet borne/ airborne infection if used correctly
 To all health workers operating in an infectious environment, masks should be used mandatorily.
 The type of mask that must be used is related to a person’s risk of exposure.
 The risk categorization can change depending on the level of environmental contamination expected and
virus transmissibility
Hong Kong  Surgical masks can prevent the transmission of respiratory viruses from diseased individuals. (Guidelines on Prevention of
 Wearing a surgical mask is important for people who are symptomatic (though they have mild symptoms). Coronavir us Disease 2019, 2020)
 Whether taking public transit or living in crowded areas wear a surgical mask
 It is necessary to wear a mask appropriately and prior wearing then after removing a mask maintain good
hand hygiene
USA  Centers for Disease Control and Prevention do not recommend a face mask for the people who are well, (How to Protect Yourself & Others |
(including respirators) to defend against respiratory diseases, including COVID-19 CDC, 2020)
UAE  The Supreme Committee emphasized that all members of the community should wear face masks outside (Gulf News, 2020)
their homes at all times.
 The committee indicated the need for excluded groups’ parents and guardians to maintain a physical dis-
tance of at least two meters from others.
 The Committee stated that only under the circumstances specified in the guidelines, face masks may be
removed and highlighted the importance of physical distancing
Singapore  If you have respiratory problems like a cough or runny nose, wear a mask (Ministry of health, Singapore
updates on COVID-19)

126
M.D. Faruque Ahmad, S. Wahab, F. Ali Ahmad et al. Saudi Pharmaceutical Journal 29 (2021) 121–133

Table 3
Different types of face masks with their characteristic, advantage and disadvantage.

S.N. Types Characteristics Advantages Disadvantages References

1 Filtering face  Prevent aerosol (<5 lm) and droplet-  Highly efficient for airborne  Initial and periodic fit (Jefferson et al., 2009;
piece (FFP) size (5 lm to 50 lm) particles particles i.e dust, infectious testing. Nikiforuk et al., 2017;
Respirator masks transmission. agents, gases, or vapors.  Poor tolerance due to Leung et al., 2020)
breathing resistance, heat
and moisture build up.
 Possibility of contamina-
tion due to face and neck
exposure.
FFP 1  Filtering > 80% of aerosols (total  Prevent dust and pollutants  Not effective for viral and (Jefferson et al., 2009;
inward leakage < 22%). aerosol particle Nikiforuk et al., 2017;
Leung et al., 2020)
FFP2-N95   94% efficacy  Respiratory Filters  Non-washable (Leung et al., 2020)
respirator  Non-oil resistant- electrets filters.  Exclusively for healthcare  Thermal discomfort
least filter 95% of aerosols around workers(HCW)  Single-use only
0.3 lm.  Working hours sufficient  High Breathing difficulty
 Four principal layers inner layer, sup- durability 8 hrs  No eye protection
port layer, filter layer and layer mask
filter layer from inside to outside
FFP3-N100/N99/  Strongly resistant/oil-proof  Respiratory Filters  Low breathing difficulty (Rodriguez et al., 2020)
P100/P100  Filtering capacity 99.97% of the aero-  High priority for healthcare  Thermal discomfort
respirator/gas sol particles. workers
mask  High fitting ,
 Reusable
2 Medical mouth–  Effective to protect the wearer from  Fluid-resistant  Loose-fitting; (Leung et al., 2020;
nose protection large particles (>10 um)  Affordable and no fitting test  Less protection for aerosol Burnettet et al., 2020;
(MNP)  Physical barrier and disposable inhalation and fine parti- Mansour et al., 2009)
Surgical Mask  Patients and health care cles suspended in the air.
workers  Short duration < 4 h.
 Prevention of contact  No respiratory filter
precaution  Facial and ocular
contamination
 Limited efficiency respira-
tory diseases transmission.
3 Non-medical  Protect against particles with a  Reusable and sterilize  Low sealing and fitting Davies et al., 2013;
mask(NMM) diameter > 200 nm.  Outward protection in low-  High penetration of aero- Konda et al., 2020;
Cloth face mask  Polypropylene Fabrics risk settings sol particles Sharma et al., 2020)
 >95% bacterial filtration  Not fluid resistant
efficiency  Low efficacy viral infection
 Use by the general public transmission
 Decreased transmission of  Ineffective to prevent
respiratory droplets during influenza-like diseases as
breathing, speaking, or compared to the surgical
coughing. masks
 Insufficient breathability

of infection on population regardless of unfitness and poor adher- unfiltered air (COVID-19, 2020). Various characteristics of face
ence (Vander et al., 2008). A case report of china regarding the effi- mask can be seen Table 3.
cacy of mask on controlled setting of airplane passengers was A cloth mask is intended to capture droplets emitted while the
published. A person onboard was later on found positive for user is talking, coughing, or sneezing. Studies reported filtration
COVID-19 but during the flight from China to Toronto he was efficacy of cloth mask as compared to surgical mask. Cloth mask
wearing the mask and when nearby close seated 25 other passen- made up of household materials had filtration rate between 49%
gers along with flight attendants were tested they all found nega- and 86% for 0.02 lm exhaled particles while surgical masks filtered
tive (Schwartz et al., 2020). 89% of those type particles (Davies et al., 2013). Data suggest that a
Filtering capability of masks depends upon different types of surgical mask was found to filtered 75% of particles between
mask, as mask could be made of the various designs and materials. 0.02 lm to 1 lm on the other hand the cloth mask was found to
A typical droplet size is 5 lm–10 lm while the particle sizes for filter 60% (Van der Sande et al., 2008). Overall, it was concluded
speech are on the order of 1 lm (Howard et al., 2020). Surgical face mask exhibit significant role to prevent the speared of SARS-
mask are also known as medical mask which have better bacteria CoV-2. A detailed discussion of the fascinating world of face masks
filtration and air permeability and can protect from contact with in the current scenario is needed, which requires an extensive and
droplets and splashes by reducing exposure to the saliva and respi- overwhelming literature survey. The main focus of this review arti-
ratory secretions. A surgical mask also filters out large particles in cle is on various aspects of the face mask. The search for the word
the air and should only be used once. N95 mask provides more ‘‘Face mask” the phrases ‘‘Face mask prevent the spread of infec-
safety and security than a surgical mask. Surgical N95 respirators tious diseases” and ‘‘Face mask role in the prevention of corona
are most widely used as personal protective equipment in health virus disease” PubMed database reveals a growing trend in the
care environments such as hospitals among healthcare profession- number of the published articles, especially a rapid rise in publica-
als. When the person who wears, inhales, it can filter out the big tions from 2019 onward. It was concluded that research on face
and small both kind of particles. An N95 mask may block 95% of mask is desperately needed to know the veracity in community
very small particles and when wearer breathes out, it releases health. The search results are depicted in Fig. 2 illustrates a global
127
M.D. Faruque Ahmad, S. Wahab, F. Ali Ahmad et al. Saudi Pharmaceutical Journal 29 (2021) 121–133

Fig. 2. Graphically represented statistical data of number of publications in PubMed from 1900 to 2020. Publications in PubMed by using search bar for searching keywords/
phrases: (1) Face mask (blue); (2) Face mask prevent the spread of infectious diseases (orange) and (3) Face mask role in the prevention of corona virus disease (grey). Moving
average trend lines show the importance and urgent need for research concerning the development of face mask in present scenario of COVID-19.

trend in the number of published works on the Face masks from 7. Face mask induced risk populace and allied health
1920 to 2020. impediments

According to WHO SARS-CoV-2 infects all age groups. Neverthe-

6. Factual facts of face mask less, proofs suggest that 2 category of people are vulnerable to
COVID-19 infection disease. They are under lying medical condi-
According Belgium’s Federal Public Service for Health use of tions that include chronic respiratory disease, diabetes, cardiovas-
face mask to prevent infection of coronavirus barely creates sense cular disease and cancer and other category are over 60 year old
in hospitals where coronavirus patients are treated and patients age people (Fig. 4). The possibility of severe disease steadily rises
specimens are tested (Lifesaver or false protection, 2020). Beijing’s with time starting from approximately 40 years. Face mask is used
Centre for Disease Control and Prevention (CDC) in its guidelines to protect from infections but it is not advisable to sensitive illness
confirmed people can go outdoors without wearing mask to con- group such as chronic obstructive pulmonary disease (COPD),
firm COVID-19 outbreak is under control. CDC also guided that res- acute and chronic respiratory infection, asthma, apnea and dysp-
idents must have to compliance rules of social distancing (China: nea etc. (Patel and Majmundar, 2018). Patients exhibit clinical
CDC issues new guidelines, 2020). manifestations primarily related to the pulmonary system that
Wearing a face mask may possibly provide a false sense of include dyspnea, cough with sputum production, fatigue and in
safety and lead to decline social distancing and hands washing severe cases, ARDS, respiratory failure. COVID-19 patients were
compliance (Greenhalgh et al., 2020). Face mask wearers get irrita- found to exhibit extra pulmonary clinical manifestations including
tion and feel awkward that lead to touch and adjust mask repeat- affect multiple other organs and organ systems including gastroin-
edly. This irritation leads to infect face, ears and eyes. Exhaled air testinal, ocular, hepatic, cardiovascular, renal, dermatologic, and
with wearing face mask get into eyes contact that leads to uneasi- neurological systems (Johnson et al., 2020; Ramachandran et al.
ness and makes an impulse to finger the eyes, nose and face that 2020). Furthermore, the vulnerability to infection is not same for
could be a cause of infection. Speech of volume and quality gets male and female patients. Due to the elevated level of estrogen,
hampered owing to wearing face mask that lead to involuntarily females are investigated to be at lower risk of severity and mortal-
make closer to each other consequently people be inclined to non- ity than male COVID-19 patients. Similarly, the different ethnic
compliance of social distancing. Most of us are new face mask groups are found to have different infectivity and mortality. Due
users, so level of mask safety could not achieve by all of us and it to a higher prevalence of diabetes, obesity, hypertension, asthma
leads to noncompliance aspects of its use, reuse and dispose conse- and heart rate in minority groups, African American and Hispanic
quentially chances of infections will increase. Wearers have long communities have revealed increased rates of infection and hospi-
nose or face deformities cannot fix mask accurate manner and talization compared to Caucasian populations (Kopel et al., 2020).
may cause of infection from SARS-CoV-2 and other microbial In Current covid-19 pandemic outbreak US Centers for Disease
pathogens. People ignorance and lack of knowledge how to wear Control and Prevention recommended some guidelines regarding
face mask may be cause of infect themselves and infect to others. wearing face masks. Everybody should use a cloth face cover in
It is the need of the hour to get proper training under the supervi- public place but it should be avoided to be applied on children
sion of expert in each and every concern to maintain hygiene and who are below 2 years or someone who has breathing difficulties,
achieve the optimum benefits of face mask. Complications with incapacitated or incapable to remove face mask without others
face mask can be seen in Fig. 3. assistance (How to Protect Yourself & Others | CDC, 2020).

128
M.D. Faruque Ahmad, S. Wahab, F. Ali Ahmad et al. Saudi Pharmaceutical Journal 29 (2021) 121–133

Fig. 3. Complications with face mask lead to increase risk of aspiration, difficult to deliver fraction of inspired oxygen (FiO2), painful facial trauma, difficult to expectoration of
secretion, difficult to communicate, claustrophobic etc.

Fig. 4. Face mask wearers under risk specially old age, children, acute and chronic respiratory disease, outdoor exercise and underlying medical condition.

129
M.D. Faruque Ahmad, S. Wahab, F. Ali Ahmad et al. Saudi Pharmaceutical Journal 29 (2021) 121–133

Restrictive airflow owing to face mask is the main reason for sec- eign pathogens in the body (Chen et al., 2018). Efficacy of innate
ondary complications that may cause of retention of CO2 is called immunity is depending on load of virus. Humidity accumulates
hypercapnia. Furthermore, complications associated with hyper- inside mask due to restricted air flow that is favourable condition
capnia include tachycardia, dyspnea, confusion, flushed skin, dizzi- for SARS-CoV-2 survival. Particularly children and infant dis-
ness, and headache. Severe hypercapnia can lead to respiratory charge nasal fluid frequently and have lack of sense to maintain
failure with symptoms of papilledema, seizure and depression hygiene. Hence, children and infant should be monitored by par-
(Patel and Majmundar, 2018). COPD patients wearing mask may ents and caretakers to avoid moisture and humidity inside face
lead to hypercapnia and they should be monitored by medical mask by nasal and mouth discharges. That could be the reason
practitioners to avoid critical illness. Restrictive airflow due to face of increase viral load or other contamination. Consequentially,
mask creates high concentration of CO2 in body in sensitive groups viral load and possibility of infection increase and innate immu-
that exhibits fatal reaction by decreasing pH and leading to respi- nity decreases in mask wearing people. Present pandemic
ratory acidosis. The important issue is that CO2 regulates blood pH COVID-19 infection direct depending on immune system of indi-
and high concentration CO2 in blood makes blood acidic and law vidual. As a consequence, the most of the old age people and
concentration makes alkaline both conditions either acidic or alka- underlying health conditions people are more susceptible for
line could lead to health hazards (Fig. 5). Overall, it is concluded SARS-CoV-2 infection. Face mask and gloves sometimes misguide
that it is better to avoid face mask and maintain social distancing the people that they are fully protected. Wearers believe face
and other measures particularly to sensitive group (Diaz Milian mask is enough to protect from infection and with gloved hand
et al., 2019). touch their body and face while the efficacy of innate immunity
The innate immune comprises a rapid response mechanism of reveals on skin surface rather than gloves. Consequentially, peo-
first line barrier to avert microbial invasion. The major use of the ple leave the habits of hand sanitization and increases chances
innate immune reaction is to instantly prevent the spread of for- of exposure.

Fig. 5. Restrictive airflow due to face mask may lead to hypercapnia and hypercapnia associated secondary complications include tachycardia, dyspnea, confusion, flushed
skin, dizziness and headache, and severe hypercapnia can lead to respiratory failure with symptoms of depression, papilledema and seizure.

130
M.D. Faruque Ahmad, S. Wahab, F. Ali Ahmad et al. Saudi Pharmaceutical Journal 29 (2021) 121–133

There should be proper precaution particularly at the time of scopists face shield for colony-forming units (CFU). The result was
exercise with mask. Restriction of air flow is common during phys- found to be significantly higher after endoscopy; 1–15 CFU 40%,
ical activity or exercise. It has been observed exercise with face 16–3 CFU 2.6%, 30 or more CFU 2.6% (Perisetti et al., 2020c). More-
mask lead to disturb the equilibrium of oxygen and carbon dioxide over, in another similar study on endoscopists, the splash rate to
exchange. Use of face mask continuously for a long period of time the skin of face, forearms and, feet was 9.5% and overall splash rate
during exercise may affect supply of oxygen throughout the body to the eyes was 4.1%.
and people may suffer from hypoxia. People with asthma, hypoxia Current pandemic outbreak made it more popular. It minimises
and high blood pressure, and others underlying health conditions the interaction between people either they are healthy or sick by
must take advice from healthcare practitioners regarding the use residing at home. Social distancing include strictly avoid contact,
of face mask during physical exercise (Patel and Majmundar, stop social gathering and stay home etc. It is a non pharmaceutical
2018; Diaz et al., 2019). self effort to control the spread of infectious disease chiefly current
The Sun UK news paper reported that 26 years old jogger died COVID-19. WHO define social distancing in 2009 during flu pan-
due to running 2 miles with face mask in Wuhan, China. After sur- demic to maintain an arm’s length distance from others. Further-
gery doctors confirmed collapsed lung was the reason for death more, CDC revised it in pandemic COVID-19 that avoid mass
and revealed that the runner left lung was compressed by 90%. gathering and in practice avoid close proximity to each other and
Moreover, it was also reported that in Hunan province of China suggest maintaining 6 feet distance. Among various types of infec-
14 years old two boys died due to abruptly collapsed. They were tions control social distancing most effective to prevent fomites
running in school track during physical education class with face infection (Interim U.S. Guidance, 2020; Kinlaw et al., 2009).
mask. According to death certificate reason for death was sudden
cardiac arrest (China: CDC issues new guidelines, 2020). 9. Conclusion

COVID-19 outbreak has been appeared globally as a serious

8. A novel approach for alternate of face mask public health threat. Even extremely equipped nations are now fac-
ing second subsequent wave of this pandemic outbreaks that have
United States Health care Infection Control Practices Advisory obligated for social distancing measures. Application of face mask
Committee (HICPAC) suggests to health professionals that face in the public will be contemplated only as temporary measures
and eyes should be fully protected throughout the patient care pro- for several perceptive groups of people not as a substitute for
cedures. Fluids sprays and splashes comprise infectious pathogens established precautionary procedures. It is the need of the hour
that could affect heath care personnel. These fluids droplets can be to search alternates that could prove better efficacy than present
adhered to mouth, eyes, nose mucous membrane and broken skin face mask. Face shield and social distancing could be better substi-
surface consequentially patient handlers may get infected. The pre- tute of face mask for individual group of people that include COPD,
sent HICPAC guidelines clearly recommend wearing face shield acute and chronic respiratory disease, outdoor exercise, old age,
during handling patients particularly for SARS-CoV-2 and avian underlying medical conditions and hypercapnia sensitive group
influenza (Siegel et al., 2007). It has been seen in in vitro study that but further clinical studies are required to be carried out.
cloth mask may cause of filtration of natural and anthropogenic
aerosols that could be virus and same size of aerosol particles. Face Declaration of Competing Interest
shield decreased 96% instant exposure of virus in simulated health
worker in a simulation study. Same study with physical distancing The authors declare that they have no known competing finan-
decreased inhaled virus by 92%. (Lindsley et al., 2014; Perencevich cial interests or personal relationships that could have appeared
et al., 2020). Face shields exhibit several benefits over face mask. to influence the work reported in this paper.
They can be repeatedly use by cleaning them with disinfectants,
soap and detergents. Face shield cover complete face, so exposure Acknowledgments
of infection through nose, mouth and eyes will be reduced. To get
entire efficacy, clinical trials should be conducted on broad scale on The authors express thanks to every front-line personnel in the
different parameters to achieve optimum benefits. fight against COVID-19.
Despite face shields numerous benefits, some adverse effects
have also been noted. Clinicians dealing with airway management
are susceptible of airborne respiratory pathogens exposure (Ho
et al., 2004). Most of them particularly anesthesiologist using extra References
precautions, including face shield. It has been observed numerous
times face shield sharp lower edge pressed the patients eyes, Aiello, A.E., Murray, G.F., Perez, V., Coulborn, R.M., Davis, B.M., Uddin, M., Shay, D.K.,
Waterman, S.H., Monto, A.S., 2010. Mask use, hand hygiene, and seasonal
potential causing sever eyes injuries (Kamming et al., 2003). influenza-like illness among young adults: A randomized intervention trial. J.
Hyperbaric oxygen (HBO) has been employed for several years to Infect. Dis. 201, 491–498.
treat diving-related diseases that include arterial gas embolism Aiello, A.E., Perez, V., Coulborn, R.M., Davis, B.M., Uddin, M., Monto, A.S., 2012.
Facemasks, hand hygiene, and influenza among young adults: A randomized
and decompression sickness. Ocular refractive changes have been intervention trial. PLoS ONE 7.
reported to the patients who received HBO by oronasal mask or Alhassan, A.R., Ed, K., Em, D., 2020. Surgical healthcare providers’ compliance to
face shield (Evanger et al., 2004). hand hygiene and facemask use: A case of tamale teaching hospital, Ghana. J.
Prev. Infect. Control, 6.
Social distancing is not a novel notion it has been employed to Amanya, S.B., Nyeko, R., Obura, B., Acen, J., Nabasirye, C., Oyella, F., Afayo, V., Okwir,
avert the spread of infection through across the world since M., 2020. Knowledge and compliance with covid-19 infection prevention and
ancient times. Current pandemic outbreak made it more popular. control measures among health workers in regional referral hospitals in
Northern Uganda: A cross-sectional online survey. Res. Sq. 18, 268–276.
It minimises the interaction between people either they are
Balaban, V., Stauffer, W.M., Hammad, A., Afgarshe, M., Abd-Alla, M., Ahmed, Q.,
healthy or sick by residing at home. It was reported that the effect Memish, Z.A., Saba, J., Harton, E., Palumbo, G., Marano, N., 2012. Protective
of exposure was reduced after following the norms of social dis- practices and respiratory illness among US travelers to the 2009 Hajj. J. Travel
tancing for endoscopist during endoscopy. The occurrence rate Med. 19, 163–168.
Barasheed, O., Almasri, N., Badahdah, A.-M., Heron, L., Taylor, J., McPhee, K., Ridda, I.,
was reduced by 2.2 when endoscopy was performed at 6 feet away Haworth, E., Dwyer, D., Rashid, H., Booy on behalf of the Hajj Research Team, R.,
(Johnston et al., 2019). Similar study was performed on 227 endo- 2014. Pilot randomised controlled trial to test effectiveness of facemasks in

131
M.D. Faruque Ahmad, S. Wahab, F. Ali Ahmad et al. Saudi Pharmaceutical Journal 29 (2021) 121–133

preventing influenza-like Illness transmission among Australian Hajj pilgrims Guidelines on use of masks: Ministry of Health and Family Welfare. https://
in 2011. Infect. Disord. Drug Targets. 14, 110–116. ncdc.gov.in/ showfile.php?lid=363 (Accessed: 8 September 2020).
Burnett, R., Chen, H., Szyszkowicz, M., Fann, N., Hubbell, B., Pope, C.A., Apte, J.S., Haile, T.G., Engeda, E.H., Abdo, A.A., 2017. Compliance with Standard Precautions
Brauer, M., Cohen, A., Weichenthal, S., Coggins, J., Di, Q., Brunekreef, B., Frostad, and Associated Factors among Healthcare Workers in Gondar University
J., Lim, S.S., Kan, H., Walker, K.D., Thurston, G.D., Hayes, R.B., Lim, C.C., Turner, M. Comprehensive Specialized Hospital, Northwest Ethiopia. J. Environ. Public
C., Jerrett, M., Krewski, D., Gapstur, S.M., Diver, W.R., Ostro, B., Goldberg, D., Health 2017.
Crouse, D.L., Martin, R.V., Peters, P., Pinault, L., Tjepkema, M., Van Donkelaar, A., Hajifathalian, K., Krisko, T., Mehta, A., Kumar, S., Schwartz, R., Fortune, B., Sharaiha,
Villeneuve, P.J., Miller, A.B., Yin, P., Zhou, M., Wang, L., Janssen, N.A.H., Marra, M., R.Z., Kaplan, A., Gonzalez, S., Skaf, D., Ang, B., Choi, A., Wong, A., Aboubakr, A.,
Atkinson, R.W., Tsang, H., Thach, T.Q., Cannon, J.B., Allen, R.T., Hart, J.E., Laden, F., Niec, R., Rohan, E., Speiser, J., Ying, X., Pan, Y., Ianelli, M., Rajan, A., Ravishankar,
Cesaroni, G., Forastiere, F., Weinmayr, G., Jaensch, A., Nagel, G., Concin, H., A., Tewani, S., Dawod, E., Dawod, Q., Rosenblatt, R., Carr-Locke, D., Shah, S.,
Spadaro, J.V., 2018. Global estimates of mortality associated with longterm Mahadev, S., Wan, D., Crawford, C., Sholle, E., Brown, R., Cohen, D., 2020.
exposure to outdoor fine particulate matter. Proc. Natl. Acad. Sci. U. S. A. 115, Gastrointestinal and hepatic manifestations of 2019 novel coronavirus disease
9592–9597. in a large cohort of infected patients from New York: Clinical implications.
Cascella, M., Rajnik, M., Cuomo, A., Dulebohn, S.C., Di Napoli, R., 2020. Features, Gastroenterology 159, 1137–1140.
Evaluation and Treatment Coronavirus (COVID-19). StatPearls Publishing, Hashim, S., Ayub, Z.N., Mohamed, Z., Hasan, H., Harun, A., Ismail, N., Rahman, Z.A.,
StatPearls. Suraiya, S., Naing, N.N., Aziz, A.A., 2016. The prevalence and preventive
Chan, J.F.W., Kok, K.H., Zhu, Z., Chu, H., To, K.K.W., Yuan, S., Yuen, K.Y., 2020. measures of the respiratory illness among Malaysian pilgrims in 2013 Hajj
Genomic characterization of the 2019 novel human-pathogenic coronavirus season. J. Travel Med. 23.
isolated from a patient with atypical pneumonia after visiting Wuhan. Emerg. Ho, A.M.H., Lam, G.C.S., Karmakar, M.K., 2004. Potential eye injury due to protective
Microbes Infect. 9, 221–236. face shields [10]. Anesthesiology 100, 201.
Chen, Y., Zhou, Z., Min, W., 2018. ‘Mitochondria, oxidative stress and innate Hoang, V.T., Meftah, M., Anh Ly, T.D., Drali, T., Yezli, S., Alotaibi, B., Raoult, D., Parola,
immunity Frontiers in Physiology. Frontiers Media S.A., 1487 https://doi.org/ P., Pommier de Santi, V., Gautret, P., 2019. Bacterial respiratory carriage in
10.3389/fphys.2018.01487. French Hajj pilgrims and the effect of pneumococcal vaccine and other
Cheng, V.C.C., Wong, S.C., Chuang, V.W.M., So, S.Y.C., Chen, J.H.K., Sridhar, S., To, K.K. individual preventive measures: A prospective cohort survey. Travel Med.
W., Chan, J.F.W., Hung, I.F.N., Ho, P.L., Yuen, K.Y., 2020. The role of community- Infect. Dis. 31.
wide wearing of face mask for control of coronavirus disease 2019 (COVID-19) How to Protect Yourself & Others | CDC (no date a). https://www.
epidemic due to SARS-CoV-2. J. Infect. 81, 107–114. cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html
Cheung, K.S., Hung, I.F.N., Chan, P.P.Y., Lung, K.C., Tso, E., Liu, R., Ng, Y.Y., Chu, M.Y., (Accessed: 13 August 2020).
Chung, T.W.H., Tam, A.R., Yip, C.C.Y., Leung, K.H., Fung, A.Y.F., Zhang, R.R., Lin, Y., Howard, J. et al., 2020. Face mask against COVID-19: An evidence review. Br. Med. J.,
Cheng, H.M., Zhang, A.J.X., To, K.K.W., Chan, K.H., Yuen, K.Y., Leung, W.K., 2020. 1–8 https://doi.org/10.20944/preprints202004.0203.v1.
Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal Hutchings, R., 2020. The impact of Covid-19 on the use of digital technology in the
samples from a Hong Kong cohort: systematic review and meta-analysis. NHS.
Gastroenterology 159, 81–95. Interim U.S. Guidance for Risk Assessment and Work Restrictions for Healthcare
China: CDC issues new guidelines saying wearing face mask is not compulsory - Personnel with Potential Exposure to COVID-19 | CDC (2020). https://www.
Republic World (no date). Available at: https://www.republicworld.com/world- cdc.gov/coronavirus/2019-ncov/ hcp/guidance-risk-assesment-hcp.html
news/rest-of-the-world-news/china-cdc-issues-guidelines-saying-wearing- (Accessed: 13 August 2020).
face-mask-in-not-compulsory.html (Accessed: 13 August 2020). Jefferson, T., Del Mar, C.B., Dooley, L., Ferroni, E., Al-Ansary, L.A., Bawazeer, G.A., van
Chughtai, A.A., Seale, H., Dung, T.C., Hayen, A., Rahman, B., Raina MacIntyre, C., 2016. Driel, M.L., Nair, S., Jones, M.A., Thorning, S., Conly, J.M., 2011. Physical
Compliance with the use of medical and cloth masks among healthcare workers interventions to interrupt or reduce the spread of respiratory viruses.
in Vietnam. Ann. Occup. Hyg. 60, 619–630. Cochrane database Syst. Rev.
Coronavirus: Germany0 s new face mask regulations explained | Germany| News and Johnson, K.D., Harris, C., Cain, J.K., Hummer, C., Goyal, H., Perisetti, A., 2020.
in-depth reporting from Berlin and beyond. https://www.dw. com/ Pulmonary and extra-pulmonary clinical manifestations of COVID-19. Front.
en/coronavirus-germanys-new-face-mask-regulations-explained/a-53260732 Med. 7, 526.
(Accessed: 14 September 2020). Johnston, E.R., Habib-Bein, N., Dueker, J.M., Quiroz, B., Corsaro, E., Ambrogio, M.,
Covid-19: Gulf News. https://gulfnews.com/uae/covid-19-dubai-releases-new- Kingsley, M., Papachristou, G.I., Kreiss, C., Khalid, A., 2019. Risk of bacterial
guidelines-on-wearing-masks-1.15909 39 965613 (Accessed: 6 October 2020). exposure to the endoscopist’s face during endoscopy. Gastrointest. Endosc. 89,
COVID-19: How much protection do face masks offer? - Mayo Clinic. https:// www. 818–824.
mayoclinic .org/diseases-conditions/coronavirus/in-depth/coronavirus-mask/ Kamming, D., Gardam, M., Chung, F., 2003. Editorial I anaesthesia and SARS. Br. J.
art-20485449 (Accessed: 14 September 2020). Anaesth., 715–718
D’Amico, F., Baumgart, D.C., Danese, S., Peyrin-Biroulet, L., 2020. Diarrhea during Kim, C.O., Nam, C.M., Lee, D.C., Chang, J., Lee, J.W., 2012. Is abdominal obesity
COVID-19 infection: pathogenesis, epidemiology, prevention, and management. associated with the 2009 influenza A (H1N1) pandemic in Korean school-aged
Clin. Gastroenterol. Hepatol. children?. Influenza Other Resp. 6, 313–317.
Davies, A. et al., 2013. ‘Testing the efficacy of homemade masks: would they protect Kinlaw, K., Barrett, D.H., Levine, R.J., 2009. Ethical guidelines in pandemic influenza:
in an influenza pandemic?’, Disaster medicine and public health preparedness. recommendations of the ethics subcommittee of the advisory committee of the
Disaster Med Public Health Preparedness 7 (4), 413–418. https://doi.org/ director, centers for disease control and prevention. Disaster Med. Public Health
10.1017/dmp.2013.43. Prep. 3 (suppl 2), S185–S192.
Davies, A., Thompson, K.A., Giri, K., Kafatos, G., Walker, J., Bennett, A., 2013. Testing Konda, A., Prakash, A., Moss, G.A., Schmoldt, M., Grant, G.D., Guha, S., 2020. Aerosol
the efficacy of homemade masks: would they protect in an influenza filtration efficiency of common fabrics used in respiratory cloth masks. ACS
pandemic?. Disaster Med. Public Health Prep. 7, 413–418. Nano 14, 6339–6347.
Deris, Z.Z., Hasan, H., Sulaiman, S.A., Wahab, M.S.A., Naing, N.N., Othman, N.H., 2010. Kopel, J., Perisetti, A., Roghani, A., Aziz, M., Gajendran, M., Goyal, H., 2020. Racial and
The prevalence of acute respiratory symptoms and role of protective measures gender-based differences in COVID-19. Front. Public Health 8, 418.
among Malaysian Hajj pilgrims. J. Travel Med. 17, 82–88. Leung, N.H.L. et al., 2020. Respiratory virus shedding in exhaled breath and efficacy
Desai, A.N., Aronoff, D.M., 2020. Masks and coronavirus disease 2019 (covid-19). of face masks nature medicine. Nat. Res. 26 (5), 676–680. https://doi.org/
Jama. 10.1038/s41591-020-0843-2.
Diaz Milian, R. et al., 2019. Expiratory central airway collapse in adults: anesthetic Leung, N., Chu, D., Shiu, E., Chan, K.H., McDevitt, J.J., Hau, B., Yen, H.L., Li, Y., Ip, D.,
implications (Part 1). J. Cardiothoracic Vascular Anesthesia. W.B. Saunders, Peiris, J., Seto, W.H., Leung, G.M., Milton, D.K., Cowling, B.J., 2020. Respiratory
2546–2554. https://doi.org/10.1053/j.jvca.2018.08.205. virus shedding in exhaled breath and efficacy of face masks. Nat. Med. 26 (5),
Evanger, K., Haugen, O.H., Irgens, Å., Aanderud, L., Thorsen, E., 2004. Ocular 676–680.
refractive changes in patients receiving hyperbaric oxygen administered by Leung, N.H.L., Chu, D.K.W., Shiu, E.Y.C., Chan, K.H., McDevitt, J.J., Hau, B.J.P., Yen, H.L.,
oronasal mask or hood. Acta Ophthalmol. Scand. 82, 449–453. Li, Y., Ip, D.K.M., Peiris, J.S.M., Seto, W.H., Leung, G.M., Milton, D.K., Cowling, B.J.,
Feng, S., et al., 2020. ‘Rational use of face masks in the COVID-19 pandemic’, The 2020. Respiratory virus shedding in exhaled breath and efficacy of face masks.
Lancet Respiratory Medicine. Lancet Publishing Group, pp. 434–436. doi: Nat. Med. 26, 676–680.
10.1016/S2213-2600(20)30134-X. Lifesaver or false protection: do face masks stop coronavirus? | Financial Times.
Feng, S., Shen, C., Xia, N., Song, W., Fan, M., Cowling, B.J., 2020. Rational use of face Available at: https://www.ft.com/content/64ac8848-a005-466a-bc93-
masks in the COVID-19 pandemic. Lancet Respir. Med. 1, 434–436. fb1e38b19182 (Accessed: 13 August 2020).
Ganyani, T., et al., 2020. ‘Estimating the generation interval for COVID-19 based on Lindsley, W.G., et al., 2014. ‘Efficacy of face shields against cough aerosol
symptom onset data’, medRxiv. Cold Spring Harbor Laboratory Press, p. droplets from a cough simulator’, J. Occupational and Environ. Hygiene.
2020.03.05.20031815. doi: 10.1101/2020.03.05.20031815. Taylor and Francis Inc., 11(8), pp. 509–518. doi: 10.1080/15459624.
Gautret, P., Vu Hai, V., Sani, S., Doutchi, M., Parola, P., Brouqui, P., 2011. Protective 2013.877591.
measures against acute respiratory symptoms in French pilgrims participating Ling, Y., Xu, S.B., Lin, Y.X., Tian, D., Zhu, Z.Q., Dai, F.H., Wu, F., Song, Z.G., Huang, W.,
in the Hajj of 2009. J. Travel Med. 18, 53–55. Chen, J., Hu, B.J., Wang, S., Mao, E.Q., Zhu, L., Zhang, W.H., Lu, H.Z., 2020.
Greenhalgh, T. et al., 2020. Face masks for the public during the covid-19 crisis. The Persistence and clearance of viral RNA in 2019 novel coronavirus disease
BMJ. BMJ Publishing Group 369. https://doi.org/10.1136/bmj.m1435. rehabilitation patients. Chin. Med. J. 133, 1039–1043.
Guidelines on Prevention of Coronavirus Disease 2019 (COVID-19) for the General Mansour, A.A., Even, J.L., Phillips, S., Halpern, J.L., 2009. Eye protection in
Public (no date). https://www.chp.gov.hk/en/healthtopics/content/24/102466. orthopaedic surgery. An in vitro study of various forms of eye protection and
html (Accessed: 8 August 2020). their effectiveness. J. Bone Joint Surg. Am. 91, 1050–1054.

132
M.D. Faruque Ahmad, S. Wahab, F. Ali Ahmad et al. Saudi Pharmaceutical Journal 29 (2021) 121–133

Matuschek, C., Moll, F., Fangerau, H., Fischer, J.C., Zänker, K., Van Griensven, M., Saeed, K.M.I., Mofleh, J., Hafiz Rasooly, M., Iabal Aman, M., 2012. Occurrence of acute
Schneider, M., Kindgen-Milles, D., Knoefel, W.T., Lichtenberg, A., Tamaskovics, respiratory infection, diarrhea and jaundice among Afghan pilgrims, 2010. J.
B., Djiepmo-Njanang, F.J., Budach, W., Corradini, S., Häussinger, D., Feldt, T., Epidemiol. Glob. Health 2, 215–220.
Jensen, B., Pelka, R., Orth, K., Peiper, M., Grebe, O., Maas, K., Bölke, E., Sarfraz, S., Raza, R., Aziz, K., Umar, M., Noreen, K., Shehryar, M., 2020. Compliance on
Haussmann, J., 2020. The history and value of face masks. Eur. J. Med. Res. 25, the use of different types of face mask by healthcare workers and general public
1–8. in tertiary care hospital of RMU during COVID-19 pandemic. J. Rawalpindi Med.
McGaw, C.D., Tennant, I., Harding, H.E., Cawich, S.O., Crandon, I.W., Walters, C., Coll. 24, 71–76.
2012. Healthcare workers’ attitudes to and compliance with infection control Schwartz, K.L. et al., 2020. Lack of COVID-19 transmission on an international flight.
guidelines in the operating department at the university hospital of the West CMAJ. Can. Med. Assoc., E410 https://doi.org/10.1503/cmaj.75015.
Indies, Jamaica. Int. J. Infect. Control, 8. Sharma, S.K., Mishra, M., Mudgal, S.K., 2020. Efficacy of cloth face mask in
Ministry of Health, Singapore Updates on COVID-19 (Coronavirus disease 2019) prevention of novel coronavirus infection transmission: A systematic review
local situation. https://www.moh.gov.sg/covid-19. (Accessed: 14 August 2020). and meta-analysis. J. Educ. Health Promot. 28, 192.
MOH News - MOH: Proper Use of Face Mask Increases Its Efficiency. https:// Siddiqui, A.J., Jahan, S., Ashraf, S.A., Alreshidi, M., Ashraf, M.S., Patel, M., Snoussi, M.,
www.moh.gov.sa/ en/Ministry/MediaCenter/News/Pages/News-2020-07-04- Singh, R., Adnan, M., 2020. Current status and strategic possibilities on potential
003.aspx (Accessed: 8 August 2020). use of combinational drug therapy against COVID-19 caused by SARS-CoV-2. J.
Nichol, K., McGeer, A., Bigelow, P., O’Brien-Pallas, L., Scott, J., Holness, D.L., 2013. Biomol. Struct. Dyn. 5, 1–14.
Behind the mask: Determinants of nurse’s adherence to facial protective Siddiqui, A.J., Danciu, C., Ashraf, S.A., Moin, A., Singh, R., Alreshidi, M., Patel, M.,
equipment. Am. J. Infect. Control 41, 8–13. Jahan, S., Kumar, S., Alkhinjar, M.I.M., Badraoui, R., Snoussi, M., Adnan, M., 2020.
Nikiforuk, A.M., Cutts, T.A., Theriault, S.S., Cook, B.W.M., 2017. Challenge of liquid Plants-derived biomolecules as potent antiviral phytomedicines: New insights
stressed protective materials and environmental persistence of Ebola virus. Sci. on ethnobotanical evidences against coronaviruses. Plants (Basel). 21, 1244.
Rep., 7 Siegel, J.D., Rhinehart, E., Jackson, M., Chiarello, L.H.C.I.C.P.A. Committee, 2007. 2007
Organization, W.H., 2019. Non-pharmaceutical public health measures for guideline for isolation precautions: preventing transmission of infectious
mitigating the risk and impact of epidemic and pandemic influenza: annex: agents in health care settings. Am. J. Infect. Control 35 (10), S65.
report of systematic literature reviews. World Health Organization. Simmerman, J.M., Suntarattiwong, P., Levy, J., Jarman, R.G., Kaewchana, S., Gibbons,
Patel, S., Majmundar, S.H., 2018. Physiology, Carbon Dioxide Retention, StatPearls. R.V., Cowling, B.J., Sanasuttipun, W., Maloney, S.A., Uyeki, T.M., Kamimoto, L.,
StatPearls Publishing. Available at: http://www.ncbi.nlm.nih.gov/pubmed/ Chotipitayasunondh, T., 2011. Findings from a household randomized
29494063 (Accessed: 13 August 2020). controlled trial of hand washing and face masks to reduce influenza
Perencevich, E.N., Diekema, D.J., Edmond, M.B., 2020. Moving personal protective transmission in Bangkok, Thailand. Influenza Other Resp. 5, 256–267.
equipment into the community. JAMA. Am. Med. Assoc. 323 (22), 2252. https:// Sultan, S., Altayar, O., Siddique, S.M., Davitkov, P., Feuerstein, J.D., Lim, J.K., Falck-
doi.org/10.1001/jama.2020.7477. Ytter, Y., El-Serag, H.B., 2020. AGA institute rapid review of the gastrointestinal
Perisetti, A., Gajendran, M., Goyal, H., 2020. Putative mechanisms of diarrhea in and liver manifestations of COVID-19, meta-analysis of international data, and
COVID-19. Clin. Gastroenterol. Hepatol. https://doi.org/10.1016/j. recommendations for the consultative management of patients with COVID-19.
cgh.2020.06.008. Gastroenterology 159, 320–334.
Perisetti, A., Gajendran, M., Mann, R., Elhanafi, S., Goyal, H., 2020. COVID-19 The State Council’s Joint Prevention and Control Mechanism issued the ‘Technical
extrapulmonary illness - special gastrointestinal and hepatic considerations. Guidelines for the Selection and Use of Masks for the Prevention of New
Dis. Mon., 101064 Coronavirus Infection by Different Populations’_Department
Perisetti, A., Goyal, H., Gajendran, M., Boregowda, U., Mann, R., Sharma, N., 2020. Government_Chinese Government Network. http://www.gov.cn /xinwen/
Prevalence, mechanisms, and implications of gastrointestinal symptoms in 2020-02/05/content_5474774.htm (Accessed: 8 August 2020).
COVID-19. Front. Med. 7, 741. Tripathi, R., Alqahtani, S.S., Albarraq, A.A., Meraya, A.M., Tripathi, P., Banji, D.,
Picard, J., Cornec, G., Baron, R., Saliou, P., 2020. Wearing of face masks by healthcare Alshahrani, S., Ahsan, W., Alnakhli, F.M., 2020. Awareness and preparedness of
workers during COVID-19 lockdown: what did the public observe through the COVID-19 outbreak among healthcare workers and other residents of south-
French media?. J. Hosp. Infect. 106, 617–620. West Saudi Arabia: A cross-sectional survey. Front. Public Heal. 8, 482.
Prakash, G., Shetty, P., Thiagarajan, S., Gulia, A., Pandrowala, S., Singh, L., Thorat, V., Van der Sande, M., Teunis, P., Sabel, R., 2008. Professional and home-made face
Patil, V., Divatia, J.V., Puri, A., Pramesh, C.S., 2020. Compliance and perception masks reduce exposure to respiratory infections among the general population.
about personal protective equipment among health care workers involved in PLoS ONE 3 (7).
the surgery of COVID-19 negative cancer patients during the pandemic. J. Surg. Van Doremalen, N. et al., 2020. Aerosol and surface stability of SARS-CoV-2 as
Oncol. 122, 1013–1019. compared with SARS-CoV-1. New England Journal of Medicine. Massachussetts
Purushothaman, P.K., Priyangha, E., Vaidhyswaran, R., 2020. Effects of prolonged use Medical Society, 1564–1567. https://doi.org/10.1056/NEJMc2004973.
of facemask on healthcare workers in tertiary care hospital during COVID-19 Wahab, S., Ahmad, I., Usmani, S., Ahmad, M.P., 2020. Epidemiological situation and
pandemic. Indian J. Otolaryngol. Head Neck Surg., 02124 efficacy of dexamethasone for the treatment planning of COVID-19: A
Q&A (English) about the new coronavirus. https://www.mhlw.go.jp/ perspective review. Curr. Drug Deliv. 17.
stf/seisakunitsuite /bunya/kenkou_iryou/dengue_fever_qa_00014.html Wahab, S., Ahmad, I., Usmani, S., Ahmad, M.P., 2020. Epidemiological situation and
(accessed August 14, 2020). efficacy of dexamethasone for the treatment planning of COVID-19: A
Ramachandran, P., Onukogu, I., Ghanta, S., Gajendran, M., Perisetti, A., Goyal, H., perspective review. Curr. Drug Deliv. 17. https://doi.org/10.2174/
Aggarwal, A., 2020. Gastrointestinal symptoms and outcomes in hospitalized 1567201817666201006144008.
coronavirus disease 2019 patients. Dig. Dis. 38, 373–379. WHO, 2020. Coronavirus (COVID-19). https://covid19.who.int (accessed 6.10.20).
Rasmussen, S.A., Smulian, J.C., Lednicky, J.A., Wen, T.S., Jamieson, D.J., 2020. Why Face Masks Are Crucial Now in the Battle Against COVID-19 (no date). https://
Coronavirus disease 2019 (COVID-19) and pregnancy: what obstetricians www. healthline.com/health-news/face-masks-importance-battle-with-
need to know. Am. J. Obstet. Gynecol. covid19 (Accessed: 11 August 2020).
Rodriguez-Martinez, C.E., Sossa-Briceño, M.P., Cortés, J.A., 2020. Decontamination Yang, P., Seale, H., Raina MacIntyre, C., Zhang, H., Zhang, Z., Zhang, Y., Wang, X., Li, X.,
and reuse of N95 filtering facemask respirators: A systematic review of the Pang, X., Wang, Q., 2011. Mask-wearing and respiratory infection in healthcare
literature. Am. J. Infect. Control. workers in Beijing, China. Brazilian J. Infect. Dis. 15, 102–108.

133