The impact and effectiveness of the general public wearing masks to reduce the spread of pandemics in the UK: a multidisciplinary comparison of single-use masks versus reusable face masks
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Abstract
During the coronavirus (COVID-19) pandemic, the UK government mandated the use of
face masks in various public settings and recommended the use of reusable masks to
combat shortages of medically graded single-use masks in healthcare. To assist decision-making
on the choice of masks for future pandemics, where shortages may not be a contributing
factor, the University College London (UCL) Plastic Waste Innovation Hub has carried
out a multidisciplinary comparison between single-use and reusable masks based on
their anatomy, standalone effectiveness, behavioural considerations, environmental
impact and costs. Although current single-use masks have a higher standalone effectiveness
against bacteria and viruses, studies show that reusable masks have adequate performance
in slowing infection rates of respiratory viruses. Material flow analysis (MFA), life
cycle assessment (LCA) and cost comparison show that reusable masks have a lower environmental
and economic impact than single-use masks. If every person in the UK uses one single-use
mask each day for a year, it will create a total of 124,000 tonnes of waste, 66,000
tonnes of which would be unrecyclable contaminated plastic waste (the masks), with
the rest being the recyclable packaging typically used for transportation and distribution
of masks. Using reusable masks creates >85% less waste, generates 3.5 times lower
impact on climate change and incurs 3.7 times lower costs. Further behavioural research
is necessary to understand the extent and current practices of mask use; and how these
practices affect mask effectiveness in reducing infection rates. Wearing single-use
masks may be preferred over reusable masks due to perceptions of increased hygiene
and convenience. Understanding behaviour towards the regular machine-washing of reusable
masks for their effective reuse is key to maximise their public health benefits and
minimise environmental and economic costs.
Background Improving the design and implementation of evidence-based practice depends on successful behaviour change interventions. This requires an appropriate method for characterising interventions and linking them to an analysis of the targeted behaviour. There exists a plethora of frameworks of behaviour change interventions, but it is not clear how well they serve this purpose. This paper evaluates these frameworks, and develops and evaluates a new framework aimed at overcoming their limitations. Methods A systematic search of electronic databases and consultation with behaviour change experts were used to identify frameworks of behaviour change interventions. These were evaluated according to three criteria: comprehensiveness, coherence, and a clear link to an overarching model of behaviour. A new framework was developed to meet these criteria. The reliability with which it could be applied was examined in two domains of behaviour change: tobacco control and obesity. Results Nineteen frameworks were identified covering nine intervention functions and seven policy categories that could enable those interventions. None of the frameworks reviewed covered the full range of intervention functions or policies, and only a minority met the criteria of coherence or linkage to a model of behaviour. At the centre of a proposed new framework is a 'behaviour system' involving three essential conditions: capability, opportunity, and motivation (what we term the 'COM-B system'). This forms the hub of a 'behaviour change wheel' (BCW) around which are positioned the nine intervention functions aimed at addressing deficits in one or more of these conditions; around this are placed seven categories of policy that could enable those interventions to occur. The BCW was used reliably to characterise interventions within the English Department of Health's 2010 tobacco control strategy and the National Institute of Health and Clinical Excellence's guidance on reducing obesity. Conclusions Interventions and policies to change behaviour can be usefully characterised by means of a BCW comprising: a 'behaviour system' at the hub, encircled by intervention functions and then by policy categories. Research is needed to establish how far the BCW can lead to more efficient design of effective interventions.
The emergence of a pandemic affecting the respiratory system can result in a significant demand for face masks. This includes the use of cloth masks by large sections of the public, as can be seen during the current global spread of COVID-19. However, there is limited knowledge available on the performance of various commonly available fabrics used in cloth masks. Importantly, there is a need to evaluate filtration efficiencies as a function of aerosol particulate sizes in the 10 nm to 10 μm range, which is particularly relevant for respiratory virus transmission. We have carried out these studies for several common fabrics including cotton, silk, chiffon, flannel, various synthetics, and their combinations. Although the filtration efficiencies for various fabrics when a single layer was used ranged from 5 to 80% and 5 to 95% for particle sizes of 300 nm, respectively, the efficiencies improved when multiple layers were used and when using a specific combination of different fabrics. Filtration efficiencies of the hybrids (such as cotton–silk, cotton–chiffon, cotton–flannel) was >80% (for particles 90% (for particles >300 nm). We speculate that the enhanced performance of the hybrids is likely due to the combined effect of mechanical and electrostatic-based filtration. Cotton, the most widely used material for cloth masks performs better at higher weave densities (i.e., thread count) and can make a significant difference in filtration efficiencies. Our studies also imply that gaps (as caused by an improper fit of the mask) can result in over a 60% decrease in the filtration efficiency, implying the need for future cloth mask design studies to take into account issues of “fit” and leakage, while allowing the exhaled air to vent efficiently. Overall, we find that combinations of various commonly available fabrics used in cloth masks can potentially provide significant protection against the transmission of aerosol particles.
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