Facemasks and COVID-19 prevention: to use or not to use

  • Abdel-Hady El-Gilany
  • Nesrine Saad Farrag

Abstract

There are uncertainty and conflicting opinions about the effectiveness of facemasks in prevention of COVID-19 either alone or with other non-specific measures in different settings. However, their use was recommended and even enforced by authorities in different countries and situations. Availability, types, utilization and acceptability of facemasks at community level are crucial for their effects on COVID-19 mitigation. There is a lack of strong evidence either in favor of or against the wide scale use of facemasks by the general public. The World Health Organization initially advised general public not wear masks but later advised masks for everybody. This narrative review highlights all these controversies and summarizes the updated recommendations.

Keywords: COVID-19, facemasks, medical masks, cloth masks, respirators

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References

1. World Health Organization (WHO). Coronavirus [Internet]. WHO;2020 [cited 2020 Sep. 3]. Available from:
https://www.who.int/health-topics/coronavirus#tab=tab_1
2. Saxena SK, Kumar S, Maurya VK, Sharma R, Dandu HR, Bhatt MLB. Current Insight into the Novel Coronavirus Disease 2019 (COVID-19). In: Coronavirus Disease 2019 (COVID-19) Epidemiology, Pathogenesis, Diagnosis, and Therapeutics. Springer Nature Singapore Pte Ltd; 2020. p. 1–8.
3. Yadav T, Saxena SK. Transmission Cycle of SARS-CoV and SARS-CoV-2. In: Saxena SK, editor. Coronavirus Disease 2019 (COVID-19) Epidemiology, Pathogenesis, Diagnosis, and Therapeutics. Springer Nature Singapore Pte Ltd; 2020. p. 33–42.
4. Center for Disease Control and Prevention (CDC). Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | CDC [Internet]. CDC;2020 [cited 2020 Sep. 3]. Available from:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html?CDC_AA_refVal=https %3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Finfection-control%2Fcontrol-recommendations.html
5. Wold Health Organization (WHO). Advice on the use of masks in the community, during home care and in healthcare settings in the context of the novel coronavirus (COVID-19) outbreak [Internet]. 2020 [cited 2020 Sep 3]. Available from:
https://www.who.int/publications/i/item/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak
6. Humphreys J. The importance of wearing masks in curtailing the COVID-19 pandemic. J Fam Med Prim Care [Internet]. 2020 [cited 2020 Sep.3];9(6):2606. Available from: http://www.jfmpc.com/text.asp?2020/9/6/2606/287902
7. Center for Disease Control and Prevention (CDC). How to Protect Yourself & Others | CDC [Internet]. CDC;2020 [cited 2020 Sep.3]. Available from:
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html
8. World Health Organization (WHO). Shortage of personal protective equipment endangering health workers worldwide [Internet]. WHO;2020 [cited 2020 Sep.7]. Available from:
https://www.who.int/news-room/detail/03-03-2020-shortage-of-personal-protective-equipment-endangering-health-workers-worldwide
9. Kirby T. Australian Government releases face masks to protect against coronavirus [Internet]. Vol. 8, The Lancet. Respiratory medicine. NLM (Medline); 2020 [cited 2020 Sep.7]. p. 239. Available from:
www.thelancet.com/respiratory
10. Offeddu V, Yung CF, Low MSF, Tam CC. Effectiveness of Masks and Respirators Against Respiratory Infections in Healthcare Workers: A Systematic Review and Meta-Analysis. Clin Infect Dis [Internet]. 2017 Dec.1 [cited 2020 Sep.7];65(11):1934-42. Available from:
https://pubmed.ncbi.nlm.nih.gov/29140516/
11. Long Y, Hu T, Liu L, Chen R, Guo Q, Yang L, et al. Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis. J Evid Based Med [Internet]. 2020 May 1 [cited 2020 Sep.7];13(2):93–101. Available from:
https://pubmed.ncbi.nlm.nih.gov/32167245/
12. MacIntyre CR, Chughtai AA, Rahman B, Peng Y, Zhang Y, Seale H, et al. The efficacy of medical masks and respirators against respiratory infection in healthcare workers. Influenza Other Respi Viruses [Internet]. 2017 Nov.1 [cited 2020 Sep.7];11(6):511–7. Available from:
https://pubmed.ncbi.nlm.nih.gov/28799710/
13. Gupta D, Simalti A, Gupta N, Sachdev A, Bansal A, Sood A, et al. Personal protective equipment during COVID-19 epidemic. J Pediatr Crit Care [Internet]. 2020 [cited 2020 Sep.7];7(7):22. Available from:
http://www.jpcc.org.in/article.asp?issn=2349-6592;year=2020;volume=7;issue=7;spage=22;epage=30;aulast=Gupta
14. Shaikh F. Prevention and disinfection in COVID-19. J Pediatr Crit Care [Internet]. 2020 [cited 2020 Sep.7];7(7):56. Available from:
http://www.jpcc.org.in/article.asp?issn=2349-6592;year=2020;volume=7;issue=7;spage=56;epage=64;aulast=Shaikh
15. National Institue of Communicable Diseases. COVID-19 Prevention | NICD [Internet]. 2020 [cited 2020 Sep.7]. Available from:
https://www.nicd.ac.za/diseases-a-z-index/covid-19/covid-19-prevention/
16. European Center for Disease Prevention and Control. Using face masks in the community - Reducing COVID-19 transmission from potentially asymptomatic or pre-symptomatic people through the use of face masks [Internet]. 2020 [cited 2020 Sep.7]. Available from:
https://www.ecdc.europa.eu/en/publications-data/using-face-masks-community-reducing-covid-19-transmission
17. Chughtai A, Seale H, MacIntyre C. Use of cloth masks in the practice of infection control - evidence and policy gaps. Int J Infect Control [Internet]. 2013 [cited 2020 Sep.7];9. Available from:
https://www.ijic.info/article/view/11366/8308
18. Shakya KM, Noyes A, Kallin R, Peltier RE. Evaluating the efficacy of cloth facemasks in reducing particulate matter exposure. J Expo Sci Environ Epidemiol [Internet]. 2017 May 1 [cited 2020 Sep.7];27(3):352–7. Available from: https://pubmed.ncbi.nlm.nih.gov/27531371/
19. TIC. Fabric Face Masks Manufactured by South Africa’s. Clothing and Textile Manufacturing Industry for General Public Use. Recommended Guidelines – updated [Internet]. Republic of South Africa; 2020 [cited 2020 Sep.7]. Available from:
https://www.nicd.ac.za/diseases-a-z-index/covid-19/frequently-asked-questions/
20. Esposito S, Principi N, Leung CC, Migliori GB. Universal use of face masks for success against COVID-19: Evidence and implications for prevention policies. European Respiratory Journal. European Respiratory Society [Internet]. 2020 [cited 2020 Sep.7]; Vol. 55 Available from:
https://doi.org/10.1183/13993003.01260-2020
21.NOISH. Use of Respirators and Surgical Masks for Protection against healthcare hazards | NIOSH | CDC [Internet]. National Institute for Occupational Safety and Health l CDC. 2018 [cited 2020 Sep.7]. Available from:
https://www.cdc.gov/niosh/topics/healthcarehsps/respiratory.html
22. Institue of Medicine(IOF). Reusability of facemasks during an influenza pandemic: Facing the flu. Reusability of Facemasks During an Influenza Pandemic: Facing the Flu. National Academies Press; 2006. 1–92 p.
23. Lipp A, Edwards P. Disposable surgical face masks for preventing surgical wound infection in clean surgery. Cochrane Database of Systematic Reviews. John Wiley and Sons Ltd. [Internet].Pubmed; 2014 [cited 2020 Sep 7]; Vol. 2014 Available from:
https://pubmed.ncbi.nlm.nih.gov/24532167/
24. Garg M, Garg S. Novel coronavirus (COVID-19): N95 mask hysteria. Int J Crit Illn Inj Sci [Internet]. 2020 Apr. 1 [cited 2020 Sep.7];10(2):53. Available from:
http://www.ijciis.org/text.asp?2020/10/2/53/286201
25. Cook TM. Personal protective equipment during the coronavirus disease (COVID) 2019 pandemic – a narrative review [Internet]. Vol. 75, Anaesthesia. Blackwell Publishing Ltd; 2020 [cited 2020 Sep 7]. p. 920–7. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/anae.15071
26. International Union Against Tuberculosis and Lung Disease. COVID-19 and TB: Frequently Asked Questions | The Union [Internet]. 2020 [cited 2020 Sep.7]. Available from:
https://www.theunion.org/news-centre/covid-19/covid-tb-faqs-version-2
27. Adhikari SP, Meng S, Wu YJ, Mao YP, Ye RX, Wang QZ, et al. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: A scoping review. Infectious Diseases of Poverty. BioMed Central Ltd. [Internet].2020 [cited 2020 Sep.7];9:29. Available from: https://idpjournal.biomedcentral.com/articles/10.1186/s40249-020-00646-x
28. Fischer WA, Weber DJ, Wohl DA. Personal Protective Equipment: Protecting Health Care Providers in an Ebola Outbreak. Clin Ther [Internet]. 2015 Nov.1 [cited 2020 Sep.7];37(11):2402–10. Available from:
https://pubmed.ncbi.nlm.nih.gov/26452427/
29. Occupational Safety and Health Administration(OSA). Guidance on Preparing Workplaces for an Influenza Pandemic l OSHA 3327-02N 2007 [Internet].OSHA;2007 [cited 2020 Sep.]. Available from:
https://www.osha.gov/Publications/influenza_pandemic.html
30. Center for Disease Control and Prevention (CDC). Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings [Internet]. CDC;2020 [cited 2020 Sep.7]. Available from:
https://www.cdc.gov/hai/pdfs/ppe/PPEslides6-29-04.pdf
31. World Health Organization (WHO). Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection Interim guidance l WHO/MERS/ IPC/15.1 Rev 1;2019.
32. World Health Organization (WHO). Advice on the use of masks in the community, during home care and in healthcare settings in the context of the novel coronavirus (COVID-19) outbreak [Internet]. WHO;2020 [cited 2020 Sep.7]. Available from:
https://www.who.int/publications/i/item/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak
33. Sharma S, Kant R. Who should use a face mask during COVID-19 pandemic? An evidence-based review. Indian J Respir Care [Internet]. 2020 [cited 2020 Sep.7];0(0):0. Available from:
http://www.ijrconline.org/preprintarticle.asp?id=286098;type=0
34. Salunke G, Biswas S, Bhat V. Mask Etiquette amidst COVID-19 Crisis and Personal Protection Equipment Shortage. Indian J Med Paediatr Oncol. 2020;41:458–60.
35. Miguel R. Unite coronavirus guide Unite Health and Safety Guide Coronavirus COVID-19 Officers and Representatives [Internet]. Publichealth;2020 [cited 2020 Sep.7]. Available from:
https://www.publichealth.hscni.net/news/covid-19-coronavirus
36. Kellerman SE, Saiman L, Gabriel PS, Besser R, Jarvis WR. Observational study of the use of infection control interventions for Mycobacterium tuberculosis in pediatric facilities. Pediatr Infect Dis J [Internet]. 2001 [cited 2020 Sep 7];20(6):566–70. Available from:
https://pubmed.ncbi.nlm.nih.gov/11419496/
37. Loeb M, McGeer A, Henry B, Ofner M, Rose D, Hlywka T, et al. SARS among Critical Care Nurses, Toronto. Emerg Infect Dis [Internet]. 2004 [cited 2020 Sep 7];10(2):251–5. Available from:
/pmc/articles/PMC3322898/?report=abstract
38. Gandhi M, Beyrer C, Goosby E. Masks Do More Than Protect Others During COVID-19: Reducing the Inoculum of SARS-CoV-2 to Protect the Wearer. J Gen Intern Med [Internet]. 2020 Jul.31 [cited 2020 Sep.7];1–4. Available from:
https://pubmed.ncbi.nlm.nih.gov/32737790/
39. Howard J, Huang A, Li Z, Tufekci Z, Zdimal V, Westhuizen H-M van der, et al. Face Mask Against COVID-19: An Evidence Review. Br Med J [Internet]. 2020 Apr.12 [cited 2020 Sep.7];(April):1–8. Available from:
www.preprints.org
40. Střížová Z, Bartůňková J, Smrž D. Can wearing face masks in public affect transmission route and viral load in COVID-19? Cent Eur J Public Health [Internet]. 2020 Jun.1 [cited 2020 Sep.7];28(2):161-2. Available from:
http://cejph.szu.cz/doi/10.21101/cejph.a6290.html
41. Kelkar US, Gogate B, Kurpad S, Gogate P, Deshpande M. How effective are face masks in operation theatre? A time frame analysis and recommendations. Int J Infect Control [Internet]. 2013 [cited 2020 Sep.7];9(1). Available from:
https://www.ijic.info/article/view/10788
42. Smith JD, MacDougall CC, Johnstone J, Copes RA, Schwartz B, Garber GE. Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: A systematic review and meta-analysis. CMAJ [Internet]. 2016 May 17 [cited 2020 Sep.9];188(8):567–74. Available from:
https://pubmed.ncbi.nlm.nih.gov/26952529/
43. Liang M, Gao L, Cheng C, Zhou Q, Uy JP, Heiner K, et al. Efficacy of face mask in preventing respiratory virus transmission: A systematic review and meta-analysis. Travel Med Infect Dis. 2020 May 1;36:101751.
44. Xiao J, Shiu EYC, Gao H, Wong JY, Fong MW, Ryu S, et al. Nonpharmaceutical measures for pandemic influenza in nonhealthcare settings-personal protective and environmental measures. Emerg Infect Dis [Internet]. 2020 May 1 [cited 2020 Sep.9];26(5):967–75. Available from:
https://doi.org/10.3201/eid2605.190994
45. Wu H liang, Huang J, Zhang CJP, He Z, Ming WK. Facemask shortage and the novel coronavirus disease (COVID-19) outbreak: Reflections on public health measures. EClinicalMedicine [Internet]. 2020 Apr.1 [cited 2020 Sep.9];21. Available from:
https://doi.org/10.1016/j.eclinm.2020.100329
46. Saunders-Hastings P, Crispo JAG, Sikora L, Krewski D. Effectiveness of personal protective measures in reducing pandemic influenza transmission: A systematic review and meta-analysis. Vol. 20, Epidemics. Elsevier B.V; 2017. p. 1–20.
47. Ontario Agency for Health Protection and Promotion. What We Know So Far About Coronavirus Disease 2019 (COVID-19) | Public Health Ontario [Internet]. 2020 [cited 2020 Sep.9]. Available from:
https://www.publichealthontario.ca/en/diseases-and-conditions/infectious-diseases/respiratory-diseases/novel-coronavirus/what-we-know
48. Aggarwal N, Dwarakanathan V, Gautam N, Ray A. Facemasks for prevention of viral respiratory infections in community settings: A systematic review and meta-analysis. Indian J Public Health [Internet]. 2020 Jun.1 [cited 2020 Sep.9];64(Supplement):S192–200. Available from:
https://pubmed.ncbi.nlm.nih.gov/32496254/
49. Cowling BJ, Zhou Y, Ip DKM, Leung GM, Aiello AE. Face masks to prevent transmission of influenza virus: a systematic review. Epidemiology and Infection. Epidemiol Infect [Internet] 2010 [cited 2020 Sep 9]; 138:449–56. Available from:
https://pubmed.ncbi.nlm.nih.gov/20092668/
50. Maclntyre CR, Cauchemez S, Dwyer DE, Seale H, Cheung P, Browne G, et al. Face mask use and control of respiratory virus transmission in households. Emerg Infect Dis [Internet]. 2009 Feb [cited 2020 Sep.9];15(2):233–41. Available from:
https://pubmed.ncbi.nlm.nih.gov/19193267/
51. Eikenberry SE, Mancuso M, Iboi E, Phan T, Eikenberry K, Kuang Y, et al. To mask or not to mask: Modeling the potential for face mask use by the general public to curtail the COVID-19 pandemic. Infect Dis Model. 2020 Jan 1;5:293–308.
52. Brainard JS, Jones N, Lake I, Hooper L, Hunter P. Facemasks and similar barriers to prevent respiratory illness such as COVID-19: A rapid systematic review. medRxiv [Internet]. 2020 Apr. [cited 2020 Sep.9];2020.04.01.20049528. Available from:
https://doi.org/10.1101/2020.04.01.20049528
53. van der Sande M, Teunis P, Sabel R. Professional and home-made face masks reduce exposure to respiratory infections among the general population. PLoS One [Internet]. 2008 Jul.9 [cited 2020 Sep.9];3(7). Available from:
/pmc/articles/PMC2440799/?report=abstract
54. Sunjaya AP, Jenkins C. Rationale for universal face masks in public against COVID ‐19. Respirology [Internet]. 2020 Jul.30 [cited 2020 Sep.9];25(7):678–9. Available from:
https://onlinelibrary.wiley.com/doi/abs/10.1111/resp.13834
55. Konda A, Prakash A, Moss GA, Schmoldt M, Grant GD, Guha S. Aerosol Filtration Efficiency of Common Fabrics Used in Respiratory Cloth Masks. ACS Nano [Internet]. 2020 May 26 [cited 2020 Sep.9];14(5):6339–47. Available from:
https://dx.doi.org/10.1021/acsnano.0c03252
56. National Academies of Sciences, Engineering and M. Rapid Expert Consultations on the COVID-19 Pandemic [Internet]. National Academies of Sciences, Engineering, and Medicine. National Academies Press; 2020 [cited 2020 Sep.9]. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK556962/
57. Mantzari E, Rubin GJ, Marteau TM. Is risk compensation threatening public health in the covid-19 pandemic? BMJ [Internet]. 2020 Jul.26 [cited 2020 Sep.9];370:m2913. Available from:
http://dx.doi.org/10.1136/bmj.m2913
58. MacIntyre CR, Seale H, Dung TC, Hien NT, Nga PT, Chughtai AA, et al. A cluster randomised trial of cloth masks compared with medical masks in healthcare workers. BMJ Open [Internet]. 2015 [cited 2020 Sep.9];5(4). Available from:
/pmc/articles/PMC4420971/?report=abstract
59. Desai AN, Aronoff DM. Masks and Coronavirus Disease 2019 (COVID-19). Journal of the American Medical Association. American Medical Association [Internet]. JAMA; 2020 [cited 2020 Sep.9]; 323:2103. Available from:
www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-
60. Kyung SY, Kim Y, Hwang H, Park JW, Jeong SH. Risks of N95 Face Mask Use in Subjects With COPD. Respir Care [Internet]. 2020 May 1 [cited 2020 Sep.9];65(5):658–64. Available from:
https://pubmed.ncbi.nlm.nih.gov/31992666/
61. Zhu JH, Lee SJ, Wang DY. Effects of Long-Duration Wearing of N95 Respirator and Surgical Facemask: A Pilot Study. J Lung, Pulm Respir Res. 2014 Nov 22;1(4).
62. Rebmann T, Carrico R, Wang J. Physiologic and other effects and compliance with long-term respirator use among medical intensive care unit nurses. Am J Infect Control [Internet]. 2013 Dec. [cited 2020 Sep.9];41(12):1218–23. Available from:
https://pubmed.ncbi.nlm.nih.gov/23768438/
63. Wang MW, Zhou MY, Ji GH, Ye L, Cheng YR, Feng ZH, et al. Mask crisis during the COVID-19 outbreak. Eur Rev Med Pharmacol Sci [Internet]. 2020 [cited 2020 Sep.9];24(6):3397–9. Available from:
https://pubmed.ncbi.nlm.nih.gov/32271457/
64. Foo CCI, Goon ATJ, Leow YH, Goh CL. Adverse skin reactions to personal protective equipment against severe acute respiratory syndrome - A descriptive study in Singapore. Contact Dermatitis [Internet]. 2006 Nov. [cited 2020 Sep.9];55(5):291–4. Available from:
https://pubmed.ncbi.nlm.nih.gov/17026695/
65. Tan KT, Greaves MW. N95 acne. Int J Dermatol [Internet]. 2004 Jul. [cited 2020 Sep.9];43(7):522–3. Available from:
https://pubmed.ncbi.nlm.nih.gov/15230894/
66. Donovan J, Kudla I, Holness LD, Skotnicki-Grant S, Nethercott JR. Skin Reactions Following Use of N95 Facial Masks. Dermatitis [Internet]. 2007[cited 2020 Sep.9];18(2). Available from:
https://journals.lww.com/dermatitis/Fulltext/2007/06000/Skin_Reactions_Following_Use_of_N95_Facial_Masks.13.aspx
67. Li Y, Tokura H, Guo YP, Wong ASW, Wong T, Chung J, et al. Effects of wearing N95 and surgical facemasks on heart rate, thermal stress and subjective sensations. Int Arch Occup Environ Health [Internet]. 2005 Jul. [cited 2020 Sep.9];78(6):501–9. Available from:
https://pubmed.ncbi.nlm.nih.gov/15918037/
68. Lee DW, Li DW. N-95 respirator: Gain in protection, pain in the face?. Vol. 77. [Internet]. Occupational and Environmental Medicine. BMJ Publishing Group; 2020 [cited 2020 Sep 9]. p. 583. Available from:
https://oem.bmj.com/content/77/8/583
69. NYC Health. COVID-19 Face Coverings: Frequently Asked Questions;2020.
70. Kumar S. COVID-19 pandemic: Only views, counter views, and reviews, no clear-cut answers yet. MGM J Med Sci [Internet]. 2020 [cited 2020 Sep.9];7(1):1. Available from:
http://www.mgmjms.com/article.asp?issn=2347-7946;year=2020;volume=7;issue=1;spage=1;epage=4;aulast=Kumar
71. Ghosh M, Bhattacharyya A, Ghosh K, Bhattacharya K, Halder AK. Saving the savior in COVID19 pandemic: Face masks. Int J Heal Allied Sci. 2020;9:58–61.
72. Chamsi-Pasha H, Chamsi-Pasha M, Albar M. Ethical dilemmas in the era of COVID-19. Avicenna J Med [Internet]. 2020 [cited 2020 Sep.9];0(0):0. Available from:
/pmc/articles/PMC7414603/?report=abstract
73. Shrivastava S, Shrivastava P. COVID-19 pandemic: Responding to the challenge of global shortage of personal protective equipment. Soc Heal Behav [Internet]. 2020 [cited 2020 Sep.9];3(2):70. Available from:
http://www.shbonweb.com/article.asp?issn=2589-9767;year=2020;volume=3;issue=2;spage=70;epage=71;aulast=Shrivastava
74. Ontario Waste Management Association. How to Safely Dispose of Household Sharps [Internet]. 2020 [cited 2020 Sep.22]. Available from:
https://www.owma.org/articles/how-to-safely-dispose-of-facemasks-and-gloves
75. Biswal S, Chandra A. Role of mask in COVID-19 pandemic. Int J Drug Reg Affairs [Internet]. 2020Sep.16 [cited 2020 Sep.23];8(3):22-8. Available from:
http://ijdra.com/index.php/journal/article/view/404
76. Badjatya JK, Pooja Chaudhari, Bheda A. Prevention, treatment and cure for COVID-19. Int J Drug Reg Affairs [Internet]. 2020Sep.17 [cited 2020 Sep.23];8(3):36-5. Available from:
http://ijdra.com/index.php/journal/article/view/406
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El-Gilany, A.-H., and N. S. Farrag. “Facemasks and COVID-19 Prevention: To Use or Not to Use”. International Journal of Drug Regulatory Affairs, Vol. 8, no. 4, Dec. 2020, pp. 37-44, doi:10.22270/ijdra.v8i4.432.