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An overview on wearing the face mask to avoid transmission of coronavirus disease 2019

Mohammadbeigi, Maryama; Alizadeh Koshkohi, Safaralib; Meskini, Maryamc,d

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Reviews in Medical Microbiology: October 2020 - Volume 31 - Issue 4 - p 221-233
doi: 10.1097/MRM.0000000000000218
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Novel coronaviruses (CoVs) were zoonotic pathogens, but the first human-to-human transmission has been reported recently. Pneumonia of unknown cause detected in Wuhan, China, was first reported to the WHO Country Office in China on 31 December 2019 [1]. As mentioned in the chart Table 1  , as of 12 February 2020 to 4 May 2020, 3467 321 cases and 246 979 death of coronavirus disease 2019 (COVID-19) had been reported [2].

Table 1:
The number of cases, deaths, and confirmed cases in the last 14 days from the coronavirus disease 2019 outbreak according to WHO situation report on 4 May 2020 (European Centre for Disease Prevention and Control).
Table 1 (Continued):
The number of cases, deaths, and confirmed cases in the last 14 days from the coronavirus disease 2019 outbreak according to WHO situation report on 4 May 2020 (European Centre for Disease Prevention and Control).
Table 1 (Continued):
The number of cases, deaths, and confirmed cases in the last 14 days from the coronavirus disease 2019 outbreak according to WHO situation report on 4 May 2020 (European Centre for Disease Prevention and Control).

With the passage of time and the spread of COVID-19, since there are no particular therapies available, standard public health measures appropriate for a virus spread by droplets were instituted. People began to wear face masks, which, due to masks scarce at the beginning of the COVID-19 outbreak. To avoid significant disasters, use straightforward and inexpensive methods such as face masks is serious. Face masks can prevent respiratory infections from human-to-human [3,4]. Use the strategy of face masks with ideal levels of compliance could potentially reduce the number of observed cases of respiratory infection. One of the approaches was imperative to control and prevent the transfer of infection in healthcare settings [3].

This is a smart decision to use a face mask to avoid virus transmission for vulnerable people who were exposed to high-risk areas [3,4]. The use of the face mask is also recommended for controlling and preventing respiratory infections [5]. Observations have shown that viruses can remain viable infectious drop aerosols for hours and on surfaces up to days [6], and it was accepted that the coronavirus could be transmitted through aerosols [7]. Evidence showed that protective effects had been observed when hand washing is combined with the use of face masks [3].

The standard public health measures were the main initial fight factor to control this epidemic in the world. The findings show that COVID-19 could be transmitted and can cause severe disease and death; therefore, the world needs to hang up high readiness [5]. Analysis of the spatial broadcast of coronavirus showed that the distance of transmission outbreaks could be more than 200 m [7]. Estimated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains viable in aerosols throughout research (3 h in aerosols), including the stability of SARS-CoV-2 in aerosols and on various surfaces [8,9]. Epidemiological data proving that not only can subclinical patients transmit the virus effectively, but patients can as well as shed high amounts of the virus and infect others even after recovery from the acute illness [10].

The size of the virus is estimated at 60–180 nm and spikes virus about 9–12 nm [11], which could help in choosing the right mask and respiratory protection. Anyone who came to close contact with a person with respiratory symptoms (such as sneezing, coughing) was at risk for respiratory distress, because of the potential infection of COVID-19 [12,13].

The scope of application of the use of face masks for susceptible occupational groups including medical and health professionals, public health, infection prevention and control, occupational health experts, environmental safety staff, healthcare managers, healthcare staff in opinions have been wanted WHO currently advises that people should wear face masks if they have respiratory signs or if they were caring for somebody with symptoms [3,5,12–14].

Three type of masks and strategies to combat coronavirus disease 2019 transmission

China has taken to curb the spread of COVID-19, which reported in detail in Table 1  , including canceled public transit. The use of personal protective equipment such as using the face masks, so, at the beginning of 2020, more people began to wear face masks with the COVID-19 outbreak [3,4,15]. According to the information received, masks prevent the widespread infection between the patient and healthcare individuals [3,5]. As well, compliance with recommended infection control practices was a progressive signification subject due to the Occupational Safety and Health Administration (OSHA) caution that, given the exit of new infectious diseases that affect both patients and healthcare workers [16].

The most common method, which was used to avoid transmission of COVID-19, used by healthcare workers, healthy, and the infected individual were wearing a face mask [17] that had various types such as single-use face masks, respiratory masks, and surgical masks [18]. In general, Single-use face masks were thin and consisted of only one layer, which just was abled of refining rather larger particles (3 μm) [18]. These masks were commonly used under normal conditions, not in areas with outbreaks and high prevalence of a contagious respiratory disease. However, it is also used to control the spread of the disease in public [17]. Although a respirator mask is required for airborne infection [18]. Surgical masks are commonly more useful than single-use face masks in against virus particles. A surgical mask perhaps sufficient to prohibit droplet transfer, so they could efficaciously reduce COVID-19 transmission. Most of the healthcare workers using surgical masks to protect themselves against COVID-19 [18]. Surgical masks or medical masks provide obstacles against droplets and big respiratory particles and splashes of blood, and other body fluids. However, they do not effectively filter small particles [16,19] Coughs, sneezes, and breathing generates drop aerosols [20,21]. The filtration specifications of surgical masks are rather variable and depended on the layers which were used [18].

Furthermore, current epidemiological reports have described the absence of transmission from patients to healthcare workers during routine care while using surgical masks, eye definable, and proper hygiene [22]. On the contrary, many surgical masks also unable to filter virus loaded particles. Therefore, could not be used as a replacement for respirator masks [23–25].

There were respirator masks into three different categories filtering facepiece 1 (FFP1), filtering facepiece 2 (FFP2), and filtering facepiece 3 (FFP3) [18,16]. During the running coronavirus crisis, WHO guidance for FFP1, FFP2, and FFP3 respirator masks can be considered as personal protective equipment by diminishing the number of physical contacts and risk of the pollution [18]. FFP respirators were examples of personal protective equipment that are used to protect the wearer from airborne particles and liquid contaminating the face. Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), and OSHA were also regulated FFP respirators [17–19,22]. Hence, FFP respirator, that barricade at least 95% of particles from transferring through the filter during a test are given a 95 designation. In the same way, those that prevent 99 and 99.97% of the particles from passing through the filter are given the nomination of 99 and 100, respectively [16]. N95 respirator masks must pass warrant tests conducted by NIOSH [16]. N95 masks could cover, at least, the mouth and nose and were a disposable mask. Compelling evidence to wear an N95 mask, the most generally used type of respirator for healthcare workers settings due to their convenience, ease of use, and low cost relative to other types of respirators [17,19]. Similarly used to protect infectious droplets (>5 μm in size) [16].

These types of masks are not fully compatible with the face, and when inhaled, a large amount of polluted air could be entered into the lungs from the space between the mask and the face [26]. It should be noted that due to the nature of this type of mask (considerable leakage from the sides of the mask), no leak test has been designed for them [22]. Although, if it was necessary and sensitive, N95 or FFP 2 and surgical masks could be used. These masks must be completely adhered to the face, not leaked, and the leak test must be performed each time before use [25]. These masks protect against dust, myasthenia gravis, fibroids, and bio-aerosols. The N95 masks remove at least 95% of micron-sized suspended particles, whereas the FFP2 masks protect at least 94% of suspended particles. The gold standard mask to definition against microscopic particles were FFP2 or N95 [4], as well the N95 face mask was required as a minimum level of respiratory protective [22]. So, wearing these two types of masks could be a benefit to the health and safety of healthcare workers [16].

Limited data were showed that the surgical masks and the N95 masks offer similar protection against viral respiratory infection [27]. However, in an in-vitro study aiming to compare respirator masks, in comparison with surgical masks, show protection factors in the N95 face mask were 11.5–15.9 times useful than those of surgical masks [26].

It is widely accepted that coronavirus is transmitted via droplets from the respiratory system of infected patients. As a result, the respiratory tract exposes to high viral levels. Face masks might be a valuable option to protect healthcare personnel and people against disease transmission. Preventive measures should thus include the regular wear of face mask covering the nose and mouth for the public and all healthcare workers present in healthcare. To reduce the risk of contamination so that the use of surgical masks and N95 masks recommended (Fig. 1).

Fig. 1:
The number of confirmed case (a) and death (b) of coronavirus disease 2019 by Africa continent of 4 May 2020.

Homemade face mask against coronavirus disease 2019

During the running novel coronavirus crisis, that was mentioned in detail by continent in Figs. 1–5, as the face mask is the gold standard manner to definition against microscopic particles [19,28]; consequently, the face mask was required as a minimum level of respiratory protective [18,22].

Fig. 2:
The number of confirmed case (a) and death (b) of coronavirus disease 2019 by America continent as of 4 May 2020.
Fig. 3:
The number of confirmed case (a) and death (b) of coronavirus disease 2019 by Asia continent as of 4 May 2020.
Fig. 4:
The number of confirmed case (a) and death (b) of coronavirus disease 2019 by Europe continent as of 4 May 2020.
Fig. 5:
The number of confirmed case (a) and death (b) of coronavirus disease 2019 by Oceania continent as of 4 May 2020.

Due to the overwhelming demand, On April 3, US health officials recommended an arts-and-crafts project which uses face masks that made with a cloth mask, then wear it when you go closed spaces such as grocery stores, shopping centers, public transport. In public, it may play a role as a means of source control to diminish the spread of respiratory infection in the community by minimizing the repulse of respiratory droplets from infected individuals. They have not yet developed symptoms or remained asymptomatic. The use of medical face masks by healthcare workers must be given precedence over the uses in the community. Currently, the CDC recommends using simple cloth face coverings (CFC) to reduce transmission of the novel coronavirus, and it could help people who may have the virus. However, they do not know to reduce the transmission of the novel coronavirus individually.

CFC fashioned from household items or made at home from simple materials with low cost could be used as an additional, voluntary public health manner. The CFC recommended are not medical masks. Use of CFC to help slow the spread of novel virus (Fig. 6) [28].

Fig. 6:
On April 3, US health officials recommended an arts-and-crafts project to US Centers for Disease Control and Prevention recommended that if you are a medical professional, please used N95 or surgical mask.

During the current COVID-19 crisis, many people have been forced to use homemade masks. In the healthcare crisis in which healthcare resources are limited or restrictions for people and infected individual, therefore using homemade masks were useful, and it is highly affordable. The use of face masks in society should be considered only as a complementary solution, and it was not as a replacement for the appointed preventive solution. As an example, social distance, respiratory etiquette, meticulous hand hygiene, and avoiding touching the face, nose, eyes, and mouth should be considered too. Proper use of face masks was vital for the effectiveness of the manner and could be corrected through education campaigns.

Recommendations on the use of face masks (make a cloth mask) in the community should carefully take into account evidence gaps, the supply situation, and potential adverse side effects. A drastic manner to address helping in this critical situation was suitable (Fig. 7).

Fig. 7:
Chart 1: The number of confirmed cases, death, and confirmed cases in the 14 days which is reported by WHO by continent.

Mental health and coronavirus disease 2019

Several types of research have indicated a bidirectional link between virus and bacteria with mental disorders like depression. These disorders, not only affecting physical health but also individual, family, and public mental health [29–31]. In addition, this mistrust of health facilities have also been linked to the variety of diseases, and disparities based on ethnicity and race [32,33]. Any uncertain situation could lead to anxiety symptoms, and with the influence of COVID-19, the absence of proper treatment for the infectious disease could lead to stated fear, anxiety, depression, and frustration [34]. The psychosocial consequence of COVID-19 outbreak with psychological teams and psychiatrists, mental health professionals, and psychological support (National Health Commission of China 2020). One prime example could by of Pakistan, where still many of the citizens have used traditional methods for prevention and treatment. Moreover, many of the citizens have not believed in scientific methods for controlling practices of COVID-19 [35,36]. Therefore it is essential, placing psychiatrists and mental health to help both infected and none infected individuals in understanding the possible effect of COVID-19 and assisting their patients and public in dealing with the newest threat in most effective ways [34]. Behavior and method of life-changing and challenging healthcare system functioning [37]. This disease pandemics not only for virus disease people all over the world but also it is caused and included by the way that humanity behaved [38]. Performing general and global functions that raise and educate unanimity coherence and resilience may remarkable help achieving equality for mental health in the 21st century and improving public, and global mental health [38].

The prevention was better than the cure. Using simple methods such as washing hands and using a face mask protects not only the health of the body but also protects mental health. One of the benefits of the universal consummation of face masks is that it prevents the differentiation of individuals who wear masks when unwell because everybody was covering their faces with masks face.

Recyclable face masks to protect against coronavirus disease 2019

Considering the seriousness of the new coronavirus outbreak had been a significant outbreak of CoVs in the 21st century, which have caused a worldwide epidemic of respiratory disease. The SARS-CoV-2 was an emerging disease in humans, inside the face masks could be used to block respiratory transmission from human-to-human, and was a manner to control respiratory disease [39–41]. The people must wear a mask every day, which will create a considerable demand for masks in public areas. In the long run, masks went out of stock and must be changed every 2–24 h [40–43]. Therefore, mask shortages during the SARS-CoV-2 outbreak, as a result, could be considered a crisis. Scholars cannot abandon the use of masks because of the insufficient document [41–44].

As an attempt to solving the shortage of protective face masks for healthcare professionals, different antiviral strategies have been explored to better the safety of disposable mask reuse without compromising protective filtration capacity and structural entirety [45–47]. A wide variety of strategies viral decontaminate, including ultraviolet (UV) germicidal irradiation (UVGI), ethylene oxide, or vaporized hydrogen peroxide facilities were currently employed for sterilization of laboratory equipment. UVGI supported on the light source employed, and such facilities can be calibrated via radiometry to render a measured amount of UV radiation per unit surface area (Joules per square centimeter) for some time sufficient to viral decontaminate filtering facepiece respirators (FFRs) [44–47]. There was evidence that UVGI has also influence at significantly reducing virus contamination from droplets and aerosols applied to filter facepiece respirators [46,47], even with mucin or sebum soiling [48]. No evidence has yet existed that UVGI effectiveness at eradicating SARS-CoV-2, it has demonstrated efficacy at ruining the original SARS-CoV in viral culture media [49].

Healthcare facilities should mediate immediate implementation of collection plans for used FFRs in the forecast of near-future sterilization and reuse programs. In the current situation, to enable everyone to wear face masks to protect others in social interactions. Benefit using other recommendations: autoclaving, a well known sterilization process that exposes the masks to a temperature of 121 °C. Also considered dry or moist heat at 70 °C, which, we believed, should be hot enough to destroy the virus. Other advice, it was imperative to test the effects of washing on the face mask performance. In addition, to the antiviral action of the other processes, washing helps eliminate organic residues that can form protective layers around pathogens, diminishing the effectiveness of the decontamination protocols [50].


One real concern is the shortage of face masks for healthcare workers and the public. Face masks in healthcare centers is urgent to protect. Frontline health workers, whereas the evidence supporting face masks in the general public, is both them limited and of variable quality. For the public, attention has, therefore, change to the use of cloth masks. Therefore, the studies on medical masks are changed to cloth masks. Nonetheless, given the gravity of the pandemic, unlike stringent isolation and social distancing measures, using cloth masks is cheap and easy, and may even help economic activity. To curb the spread of COVID-19 (Fig. 7), also substantial societal and economic costs, recommend wearing a mask in public. Moreover, wearing a face mask in public may become the face of our unified, at result reinforce the significance of social distancing measures.


We are thankful for the Qazvin University of Medical Science, Pasteur Institute of Iran, and Pasteur Student research committee to give us this opportunity to write this article.

There has been no financial support for this work that could have influenced its outcomes.

Availability of data and material: All data are available.

Code availability: Microsoft 2013 were be used for figure, chart, and table.

Conflicts of interest

Authors don’t have conflicts of interest associated with this publication.


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COVID 19; coronaviruses; coronavirus disease 2019; face mask; prevention; severe acute respiratory syndrome coronavirus 2; transmission

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