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Covid-19: How the Virus Gets in and How to Block It: Aerosols, Droplets, Masks, Face Shields, & More

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Covid-19: How the Virus Gets in and How to Block It: Aerosols, Droplets, Masks, Face Shields, & More

In this Covid-19 Medical Grand Rounds (July 16, 2020), three world experts discuss a variety of issues surrounding how the coronavirus moves from person to person, how best to block viral spread, and the potential that mask-wearing may not only prevent infection but also lead to a milder clinical course. The questions regarding aerosol vs. droplet transmission and the value of wearing masks and/or face shields are central to formulating public health strategies as well as to informing the personal decisions that each of us makes every day. The session is hosted by UCSF Department of Medicine chair Bob Wachter.

Program
Bob Wachter: Introduction
00:04:45 – Aerosol vs. Droplets:
Don Milton, Professor, Environmental & Occupational Health, University of Maryland School of Public Health
00:25:35 – Q&A
00:29:03 – Masks:
Monica Gandhi, UCSF Professor of Medicine; Associate Chief of Division of HIV, Infectious Diseases, and Global Medicine at ZSFG; Director of the UCSF Center for AIDS Research; and Medical Director of the HIV Clinic, Ward 86, ZSFG
00:45:46 – Q&A
00:48:25 – Face Shields:
Michael Edmond, Chief Quality Officer and Associate Chief Medical Officer, University of Iowa Health Care; Professor of Medicine, Division of Infectious Diseases, University of Iowa Carver College of Medicine
01:06:14 – Q&A
01:08:10 – Panel Discussion
01:28:57 – Bob Wachter: Closing

See previous Covid-19 Medical Grand Rounds:
• July 9: The State of the Pandemic, Opening the Schools, and the Outbreak at San Quentin State Prison

• June 25: Special Presentation: An Interview with John Barry, Author of the Bestselling Book, The Great Influenza: The Story of the Deadliest Pandemic in History

• June 18: Covid-19: Update in Therapies (including Steroids), and Covid Patients with Persistent Symptoms: What’s Going On?

• June 11: Covid-19: Update in Epidemiology, and, Are the Publication and FDA Approval Processes Moving Too Fast for Safety?


See all UCSF Covid-19 grand rounds, which have been viewed more than 300,000 times, here:
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Are Face Shields Better Than Masks For Coronavirus? - Cheddar Explains

Now that we’ve all gotten used to face masks, are we ready to make the switch to shields? A recently published article in The Journal of the American Medical Association, argued that a face shield could better help reduce the transmission of the coronavirus. So what's the final world?

Sources:
JAMA

New York Times
Business Insider
WebMD
Dr. Amesh Adalja

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How Effective Against Coronavirus Are Face Shields Compared To Masks? | TODAY

As summer temperatures soar, face shields present a tempting alternative to masks to prevent the spread of coronavirus, and they cover your eyes as well as your mouth and nose. NBC investigative and consumer correspondent Vicky Nguyen reports as TODAY’s Search for Solutions series continues.
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#FaceShields #Coronavirus #TodayShow

How Effective Against Coronavirus Are Face Shields Compared To Masks? | TODAY
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High speed camera captures how different types of face masks work

Which mask works best? To visualise droplets and aerosols, UNSW researchers used LED lighting system & a high-speed camera, filming people coughing and sneezing in different scenarios — using no mask, 2 different types of cloth masks, and a surgical mask.

We confirmed that even speaking generates substantial droplets. Coughing and sneezing (in that order) generate even more.

A three-ply surgical mask was significantly better than a one-layered cloth mask at reducing droplet emissions caused by speaking, coughing and sneezing, followed by a double-layer cloth face covering.

A single-layer cloth face covering also reduced the droplet spread caused by speaking, coughing and sneezing but was not as good as a two-layered cloth mask or surgical mask.

We do not know how this translates to infection risk, which will depend on how many asymptomatic or mildly symptomatic infected people are around. However, it shows a single layer is not as good a barrier as a double layer.

Here's more on what we found:

VIDEO: UNSW/ Thorax
AUTHORS:
- C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW;
- Abrar Ahmad Chughtai, Epidemiologist, UNSW;
- Charitha de Silva, Lecturer, UNSW;
- Con Doolan, Professor, School of Mechanical and Manufacturing Engineering, UNSW;
- Prateek Bahl, PhD Candidate, School of Mechanical and Manufacturing Engineering, UNSW, and;
- Shovon Bhattacharjee, PhD Candidate, The Kirby Institute, UNSW

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COVID 10: Is COVID-19 an airborne disease? Will we all need to wear face-masks against SARS-CoV-2?

There seems to be a lot of confusion in the droplet versus aerosol discussion and how these relate to the spread of COVID-19. Is it airborne and inhaled or droplet based via fomites and hands? The uncomfortable truth is that we have evidence for both modes.

In this video we first define what a droplet and an aerosol is based on their behaviour in the environment. We then examine both through the findings from two published studies. We will also discuss how long viral particles survive and stay viable and able to infect after they fall on a surface or get suspended in the air.

For COVID-19, we agree that the various transmission routes may predominate in different settings. The airborne route is relevant for hospitals and hospital staff as well as crowded and badly ventilated public spaces. Everyone else is more likely to get the virus through touching surfaces, bad hand hygiene and then touching their face.

#medmastery #coronavirus #COVID19 #sarscov2 #coronaviruschina #coronavirustruth #coronavirusdeaths #WHO #wuhan #infection #pandemic #publichealth
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Links for reference:




-----------------------------------------------------------
More updates by Dr. Wiesbauer:
COVID-19 Update 1: How to tell if a pandemic is likely to occur or not–R0 and the serial interval:
COVID-19 Update 2: How to stop an epidemic - Herd immunity:
COVID-19 Update 3: Symptoms of COVID-19:
COVID-19 Update 4: Clinical characteristics of COVID-19:
COVID-19 Update 5: Estimating case fatality rates for COVID-19:
COVID-19 Update 6: Seasonality: will COVID-19 go away in the summer?:
COVID-19 Update 7: This is probably the most important picture of the whole Coronavirus-epidemic:
COVID-19 Update 8: Zinc and chloroquine for the treatment of COVID-19?:
COVID-19 Update 9: Hydroxychloroquine and azithromycin for the treatment of COVID-19–Review of study by Didier Raoult:
-----------------------------------------------------------
Useful resources:
For checking daily developments of cases, deaths and more:



Other useful resources:
Journal Watch:

New England Journal of Medicine:

Github collaboration:

CDC:

WHO:

Nucleuswealth:

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Speaker: Franz Wiesbauer, MD MPH
Internist & Founder at Medmastery
LinkedIn:
PubMed:

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Please Note: Medmastery's videos, medical lectures, medical illustrations, and medical animations are for medical education and exam preparation purposes, and not intended to replace recommendations by your doctor or health care provider.

Best Masks to Keep COVID-19 to Yourself

Researchers at Florida Atlantic University's College of Engineering and Computer Science made visualizations to show exactly how face masks stop COVID-19 transmission. Without a mask, droplets produced during coughing can travel up to 12 feet. With a mask, this distance is reduced to just a few inches. But some cloth masks appear to work better than others at stopping the spread of potentially infectious droplets. Read the full #facemask article here:

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The TRUTH of How Coronavirus Spreads and Coronavirus Prevention | Airborne Transmission

The TRUTH of How Coronavirus Spreads and Coronavirus Prevention | Airborne Transmission
#coronavirus #covid19

Coronavirus | COVID-19 YouTube Video Playlist:


Coronavirus Update : Coronavirus Transmission Through Air
It’s becoming clearer and clearer now, that this coronavirus spreads not just through contact and respiratory droplets that fly through the air like ballistics, but also it's being transmitted through the airborne route, meaning through aerosol, meaning the virus lingers in the air, and then someone inhales the virus. This is known as airborne transmission.

Let’s face it, there is a reason why hospitals with designated COVID-19 areas require everyone to wear an N95 respirator mask, as well as eye goggles. That’s because we know that this virus has the potential for airborne transmission. During normal breathing and speech, tiny particles are emitted mainly from the mouth. These particles can range in size, with the smallest being less than a micron (1 um), and the biggest being over 500 um in diameter.

To put some perspective on that, the average diameter of human hair is about 80 microns). Typically droplets that are less than 5 um are considered small, and its these small droplets that can be suspended in the air. Droplets that are over 100 um are considered large, and between 5 and 100 microns is intermediate. But the reality is, it’s a range of sizes, it’s a continuum, from less than 1 um to over 500 um. And more and more particles are emitted when someone is breathing heavier, such as with exercise, …..or if someone is coughing or sneezing, or if someone is shouting or singing.

Due to gravitational forces, particles that are bigger than 5 microns tend to settle, meaning fall down on surfaces such as the floor, and they fall fairly close to the source, typically within 6 feet. This is why the CDC recommends 6 feet for social distancing. But here’s the thing, sometimes these larger particles travel further than that, especially if someone is breathing heavy, or shouting, or singing, or coughing, or sneezing. Typically they fly no further than 12 feet in these situations. But we’re also spraying particles that are smaller than 5 microns, and its tiny particles that don’t act like ballistics, they act more like a gas cloud, where they float in the air, and travel up to 27 feet. The ones that are less than 1 um evaporate within milliseconds of hitting the air, while the particles that are more than 100 um can take up to a minute to evaporate.

What happens when the droplets that are less than 5 microns, what if they are spewed from someone who is infected with the virus, and all of a sudden in midair, they evaporate? Well, they dry out, and you’re left with a virus that is floating in the air. These are called droplet nuclei, aka aerosols. There are lots of factors that determine how long aerosols remain in the air. It depends on the person who emitted the particles, how they emitted them, the temperature, and humidity of the environment. Lack of airflow means this cloud will persist longer. And when this moist cloud finally does dissipate, you’re still going to have droplet nuclei that stay airborne….for about 3 hours, based on that NIH study.
At this point, we might not have 100% conclusive evidence that proves airborne transmission, but there are now several studies that strongly suggest that to be the case. Now just because we know that this virus spreads through the airborne route, that’s not to say that it doesn’t spread through contact and respiratory droplets, meaning the bigger droplets that act like ballistics. It spreads by all 3 of these mechanisms.

So handwashing is still important. As is not touching your face or mask with dirty hands. And maintaining 6 feet apart is a good thing, but its not good enough for certain situations. Remember earlier how I said when someone sneezes, that moist cloud containing aerosols can travel up to 27 feet?, And the virus can linger in the air for 3 hours. Some rooms have adequate ventilation that supplies clean outdoor air and minimizes recirculated air. The better the ventilation, the less likely the spread of aerosols. And even cracking open a window can make a huge difference, and having a fan blowing is good too. Other measures can help too, like having an air purifier with high-efficiency air filtration, and germicidal UV lights.

Dr. Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine
Website:
Instagram Account:

#coronavirus #covid19

Everything you need to know about face masks | COVID-19 Special

How useful are face masks during the coronavirus crisis? Experts can’t really agree on this: Should we wear them? And if so: who should wear them? Do they protect me, or the other person? And which types of masks make sense at all?
In many Asian countries, face masks are regarded as one of the main weapons in the fight against the coronavirus. And in China it’s even forbidden to be on the streets without a mask.
Here in Europe, we have mixed feelings about wearing masks. In times of scarcity many believe masks should be reserved for healthcare workers who depend on protection. But that view seems to have changed recently. Now more and more local authorities do recommend to wear masks in public.
So let's talk about face masks - and what they can do for us during a pandemic.Subscribe:

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#Coronavirus #Covid19 #FaceMasks

The Best Way to Prevent Getting COVID - *NEW* Respokare® N95 Respirator Mask

The Best Way to Prevent Getting COVID - *NEW* Respokare® N95 Respirator Mask
(Personal Protective Equipment)

There is a brand new N95 respirator mask that is NOW available to the public. It’s also a lot more comfortable compared to other N95 masks, and also has the added benefit of inactivating viral and bacterial proteins.

Here is the link: (N95 Respirator Mask)


The TRUTH of How Coronavirus Spreads and How to Prevent Coronavirus:
Watch Now:

How can you prevent inhaling the virus? The best thing you can do to prevent inhaling the virus into your lungs…Is to wear an N95 mask or an elastomeric mask. N95 respirators are tight-fitting and filter out at least 95% of airborne particles as small as 0.3 microns. But, the CDC recommends the public not to purchase these, and not to wear these.

And there are multiple reasons for that. These n95 masks (respiratory protection) are being reserved for health care workers. And Amazon will not sell them right now. They’re also uncomfortable, and your voice gets muffled, or make you feel smothered. It partially obstructs airflow in and out of your mouth and nostrils, so if you have an underlying lung condition, like COPD emphysema, probably not something you can tolerate for very long. Also, these have to fit properly on your face to be effective, and in order to do so, you can’t have most types of facial hair, because that can disrupt a good seal of the mask. An elastomeric respirator is a reusable device with exchangeable cartridge filters. Like an N95 respirator, it also filters out at least 95% of airborne particles as small as 0.3 microns. It fits tight against the user's face but is more comfortable than an N95. Before reusing the mask, all its surfaces need to be wiped down with a disinfectant.

So although both of these are not perfect, they are very effective at preventing inhalation of the virus. So these are the best way to prevent inhaling coronavirus, as well as other viruses like influenza and measles, but wearing these is not necessarily a practical thing to do. But, then, just last week, another doctor saw my video on airborne transmission, and messaged me on Instagram, asking me if I heard about this new Respokare® NIOSH N95 mask. And so I looked it up online and did a bunch of research on it. The company that makes the mask is Innonix. At first, I thought this would be some sort of gimmicky mask, but I was wrong.

I was impressed enough to reach out to them and ask if I could review the mask and possibly make a video about it, and they sent me a few samples, and here we are. Just like a regular N95, such as this one that we use in the hospital, made by the company 3M (3M n95 mask), this mask will filter out particles as small as 0.3 microns. It’s also listed on the CDC’s website of NIOSH-Approved N95 Respirators. It’s also FDA approved. So what sets this mask apart from a regular N95 mask? Several things, actually. For one, it's much more comfortable to wear. You’ve probably seen pictures of health care workers with marks and lines and even bruising on their faces as a result of wearing N95s. And from my personal experience, they’re just not comfortable, especially for more than an hour or two of use. The company also claims that it can “inactivate up to 99.9% of particles within minutes,” So not only trapping viruses and bacteria but destroying them too.
This new KN95 Respokare mask has 4 layers, and the innermost layer is built of soft materials to ensure comfort during periods of long-wear, and is also water-resistant, which is also nice.

On top of that are 3 more layers, that serve to not only trap fine particles, but one of the layers contains copper and zinc ions which serve to destruct viruses and bacteria. Also, the outermost layer has an acidic coating, creating a low pH environment, which helps to destroy viral and bacterial proteins. Unfortunately, I was not able to find any published evidence of this in a medical journal. They also show tables of which viruses and bacteria become activated with a few minutes. So this includes not only coronavirus, but also other viruses and bacteria that can become airborne, like influenza, measles, and some bacteria like tuberculosis, and also helps to prevent inhaling allergens, and pollution. So this is something I am going to buy more of, not only for myself, my friends and family. Also, if you are around other people, don’t forget to protect your eyes with goggles, or glasses that don’t let air in. And try not to touch your face or mask without having clean hands.

Coronavirus | COVID-19 YouTube Video Playlist:


Dr. Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine
Website:
Instagram Account:

#coronavirus #covid19

DOCTOR REVEALS TRUTH ABOUT MASKS: Why Healthcare Workers Are Catching COVID-19

Why are 10% of COVID-19 (coronavirus) cases health care workers? Are we not protecting ourselves well enough? We’re going to tackle this question head on and I've asked Dr. Rishi Desai, the former epidemic intelligence officer for the CDC, pediatric infectious disease doctor and current medical director at Osmosis, to give us his opinion.

What the difference between a surgical mask and N95?
Is coronavirus spread by droplet or aerosols?

For those of you who are new here, I'm Siobhan, a 3rd year internal medicine resident working on the front lines of the coronavirus pandemic in Canada.

HUGE thank you to Dr. Desai for sharing his thoughts with us!
Check out this link to see a the Osmosis COVID page to see more videos by Dr. Desai and a free trial of Osmosis:

SUBSCRIBE so you never miss a video
COMMENT with any questions or just to say hi
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See you in the next video!
~ Siobhan (Violin MD) ~
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New findings warn of higher risk in airborne coronavirus transmissions | COVID-19 Special

What does the latest research tell us about the spread of coronavirus? Do masks help prevent new infections?
A study by Berlin's Charite Hospital has found the risk of catching the coronavirus from contaminated surfaces is lower than thought. The bad news is the risk from droplets and aerosols is greater than previously thought. Aerosols are tiny particles, like fine dust. Virus particles can attach themselves to the aeorsols and spread infection. While larger droplets can't travel far because they fall to the ground, smaller aerosols are lighter and float in the air for several hours indoors, spreading all over. Scientists are now certain that these are the main infection route indoors. That means talking, singing, coughing or sneezing can spread the virus when inside.
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#Coronavirus #Aerosols #Droplets

COVID-19 Update 16: Effectiveness of surgical masks for prevention

In this video, we further touch on the distinction between droplets and aerosols. The WHO and others claim that COVID-19 is primarily spread by the inhalation of aerosols and near range droplets. There are others who disagree with this statement, and so there is confusion on if masks are helpful or not. To support this claim, we review a study in which viral load in the air was measured in various public locations. Finally, we take a look at a recent trial demonstrating that simple surgical masks worn by individuals with upper respiratory tract infections could significantly reduce viral concentration in the exhaled air.

#medmastery #coronavirus #COVID19 #sarscov2 #coronaviruschina #coronavirustruth #coronavirusdeaths #WHO #wuhan #infection #pandemic #publichealth
-------------------------------------------------
Links for reference:









-----------------------------------------------------------
More updates by Dr. Wiesbauer:
COVID-19 Update 1: How to tell if a pandemic is likely to occur or not–R0 and the serial interval:
COVID-19 Update 2: How to stop an epidemic - Herd immunity:
COVID-19 Update 3: Symptoms of COVID-19:
COVID-19 Update 4: Clinical characteristics of COVID-19:
COVID-19 Update 5: Estimating case fatality rates for COVID-19:
COVID-19 Update 6: Seasonality: will COVID-19 go away in the summer?:
COVID-19 Update 7: This is probably the most important picture of the whole Coronavirus-epidemic:
COVID-19 Update 8: Zinc and chloroquine for the treatment of COVID-19?:
COVID-19 Update 9: Hydroxychloroquine and azithromycin for the treatment of COVID-19–Review of study by Didier Raoult:
COVID-19 Update 10: Is COVID-19 an airborne disease? Will we all need to wear face-masks against SARS-CoV-2?
COVID-19 Update 11: How exactly the coronavirus becomes airborne.
COVID-19 Update 12: Attack rates of COVID-19 depend on face-to-face time spent with infected persons:

COVID-19 Update 13: Randomized Controlled Trial of Hydroxychloroquine in Patients with COVID-19:

COVID-19 Update 14: Are children contributing to the spread of COVID-19?

COVID-19 Update 15: Can we disinfect and reuse N95 masks?:
-----------------------------------------------------------
Useful resources:
For checking daily developments of cases, deaths and more:



Other useful resources:
Journal Watch:

New England Journal of Medicine:

Github collaboration:

CDC:

WHO:

Nucleuswealth:

-------
Speaker: Franz Wiesbauer, MD MPH
Internist & Founder at Medmastery
LinkedIn:
PubMed:

Check out our course library and register for a free trial account:

Facebook:
Twitter:

Please Note: Medmastery's videos, medical lectures, medical illustrations, and medical animations are for medical education and exam preparation purposes, and not intended to replace recommendations by your doctor or health care provider.

How Scientists Test Face Mask Effectiveness Against Coronavirus | NBC Nightly News

Scientists around the world have conducted research that finds wearing face masks can significantly decrease the spread of the coronavirus by blocking droplets created when a person coughs, sneezes, or talks that would carry the virus.» Subscribe to NBC News:
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How Scientists Test Face Mask Effectiveness Against Coronavirus | NBC Nightly News

How Much Do Cloth Masks Protect You From Getting the Coronavirus?

The CDC is recommending that the general public wear cloth face masks to help decrease everyone’s chances of getting COVID-19. So how does the virus that causes COVID-19—SARS-CoV-2—spread? And how much could cloth face masks help stop it? We contacted some experts to find out, and to learn what materials work best if you’re making your own.

#stayhome #coronavirus #covid-19 #covid19 #SARS-CoV-2 #facemask

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Credits:
Executive Producers:
George Zaidan
Hilary Hudson

Producers:
Andrew Sobey
Elaine Seward

Writer/Host:
Samantha Jones, PhD

Scientific consultants:
Raina MacIntyre, PhD
Donald Milton, MD, DrPH
Shan Soe-Lin, PhD, MPH
Brianne Raccor, PhD
Michelle Boucher, PhD

SOURCES:

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What face masks actually do against coronavirus

Face masks don't make you invincible.

Support Vox by joining the Video Lab at or making a one-time contribution:

The fight against coronavirus is global. But the guidelines on whether you should wear a face mask as part of that fight are often completely different from place to place. That means that, for a lot of people, whether you wear a face mask when you leave the house is basically up to you.

Here’s where almost every expert agrees: If you have Covid-19, and you leave the house, you should wear a mask. Masks help keep sick people from spreading their germs. Most of the uncertainty around mask use is related to a totally separate question: Whether masks can protect healthy people from getting Covid-19.

The truth is that no mask can actually guarantee that you won’t get sick; experts say one of the most dangerous assumptions about face masks is that they basically make you invincible. Masks have to be used correctly to offer any protection at all, and they’re most effective if used alongside other preventative measures like hand-washing and social distancing.

But experts also say that the question of whether healthy people should wear masks is a lot easier to answer when you consider one of Covid-19’s most dangerous characteristics: Because of the disease’s long incubation period, and the high occurrence of infected people who never feel symptoms at all, it’s almost impossible to be completely sure that you don’t already have it. And that means the safest course of action is ultimately for everyone to behave like a sick person; in other words, to wear a mask.

More of Vox.com's coverage of face masks:

An in-depth explainer on viral respiratory particle behavior and covid-19 transmission:

The US Center for Disease Control's current guidance on face masks:

An MIT disease transmission researcher's study on respiratory droplets and aerosols:

Ed Yong's great explainer on the confusion around face masks:

For the full Schlieren mirror video from Bauhaus University, Weimar:

The World Health Organization's updated recommendations on face mask use:

Our source for pre-symptomatic and asymptomatic cases:

The headline on this piece has been updated. Previous headline: Why you should wear a face mask to fight coronavirus

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Why aerosol vs. droplet transmission of covid-19 matters

What are the differences between the two types of transmission, how do scientists believe covid-19 spreads, and how does this affect the coronavirus pandemic? Read more: Subscribe to The Washington Post on YouTube:

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Universal Face Shields: A Better Option for COVID-19 Containment?

Contagion Editorial Director Allie Ward speaks with Michael B. Edmond, MD, MPH, MPA, MBA, associate chief medical officer, University of Iowa Health Care, about a viewpoint published in JAMA, which hypothesized that universally adopting face shields could help cut the transmissibility of COVID-19.

Face shields alone won’t stop COVID-19 spread: Study l GMA

Researchers at Florida Atlantic University found relying only on face shields or face masks with valves won't stop the spread of COVID-19.
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#GMA #COVID19 #FaceShields #FaceMasks #PPE #FAU

Can Face Shields Better Protect Against COVID Than Masks?

From surgical-style disposable masks to washable cotton face coverings to coveted N95 masks, there has been a run on face masks of all kinds since news of the pandemic spread. But one piece of personal protective equipment that has been largely overlooked by the public is the face shield. A simulation shows that exposure can be reduced by 96% when wearing a face shield that covers your eyes, nose and mouth. Plus, they can be easily wiped down and sanitized.

COVID-19: What Kind of Mask Is Best?

► Dr. Jason Bowling explains the pros and cons of the most commonly used masks, and how they are one of the best tools for preventing the spread of COVID-19, along with good hand hygiene and physical distancing.

We’ll look at:
• The N95
• The Surgical Mask
• The Cloth Mask
• Masks with Valves
• The Bandana
• The Neck Gaiter

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