Coronavirus
Technology Solutions
UK Mask Production Cleanroom Built on
Accelerated Schedule
Comfort and Appearance Important for Child Masks
Mask Cleaning and Disposal should be as Frequent
as Stepping on a Foot Sanitizer
Mask Choices for the Pandemic
Media Starting to Analyze Mask Fit and Its
Importance
Efforts Needed to Reduce Risk of COVID Evolving
to Resist Vaccines
Similar to bacteria evolving resistance to
antibiotics, viruses can evolve resistance to
vaccines, and the evolution of SARS-CoV-2 could
undermine the effectiveness of vaccines that are
currently under development, according to a
paper published in the open-access journal PLOS
Biology by
David Kennedy and Andrew Read from Penn State
University. The authors also offer
recommendations to vaccine developers for
minimizing the likelihood of this outcome.
"A COVID-19 vaccine is urgently needed to save
lives and help society return to its
pre-pandemic normal," said Kennedy, assistant
professor of biology. "As we have seen with
other diseases, such as pneumonia, the evolution
of resistance can quickly render vaccines
ineffective. By learning from these previous
challenges and by implementing this knowledge
during vaccine design, we may be able to
maximize the long-term impact of COVID-19
vaccines."
The researchers specifically suggest that the
standard blood and nasal-swab samples taken
during clinical trials to quantify individuals'
responses to vaccination may also be used to
assess the likelihood that the vaccines being
tested will drive resistance evolution. For
example, the team proposes that blood samples
can be used to assess the redundancy of immune
protection generated by candidate vaccines by
measuring the types and amounts of antibodies
and T-cells that are present.
"Much like how combination antibiotic therapy
delays the evolution of antibiotic resistance,
vaccines that are designed to induce a redundant
immune response—or one in which the immune
system is encouraged to target multiple sites,
called epitopes—on the virus's surface, can
delay the evolution of vaccine resistance," said
Andrew Read, Evan Pugh Professor of Biology and
Entomology and director of the Huck Institutes
of the Life Sciences. "That's because the virus
would have to acquire several mutations, as
opposed to just one, in order to survive the
host immune system's attack."
The researchers also recommend that nasal swabs
typically collected during clinical trials may
be used to determine the viral titer, or amount
of virus present, which can be considered a
proxy for transmission potential. They noted
that strongly suppressing virus transmission
through vaccinated hosts is key to slowing the
evolution of resistance, since it minimizes
opportunities for mutations to arise and reduces
opportunities for natural selection to act on
those mutations that do arise.
In addition, the team suggests that the genetic
data acquired through nasal swabs can be used to
examine whether vaccine-driven selection has
occurred. For example, differences in alleles,
or forms of genes that arise from mutations,
between the viral genomes collected from
vaccinated versus unvaccinated individuals would
indicate that selection has taken place.
"According to the World Health Organization, at
least 198 COVID-19 vaccines are in the
development pipeline, with 44 currently
undergoing clinical evaluation," said Kennedy.
"We suggest that the risk of resistance be used
to prioritize investment among otherwise
similarly promising vaccine candidates."
UK Mask Production Cleanroom Built on
Accelerated Schedule
The COVID-19 pandemic and the new government
advice/rules on mandatory face coverings has
seen a huge rise in demand for face masks. But
how can the UK government satisfy such a large
and sustained increase in demand without
impacting on the supply of face masks for the
countries front-line National Health Service
(NHS) staff? The answer: build new state of the
art facilities in accelerated time frames.
One such facility is located at British
Rototherm, in Port Talbot, Wales. Cleanroom
Solutions was tasked with the design and build
of the brand new, 425 sqm cleanroom.
The facility was designed in a matter of days,
built in four weeks, with production equipment
installed at the end of week four. This proved
to be an immense challenge and an even greater
achievement, testament to the national effort we
have seen throughout this pandemic.
The facility is an ISO Class 8 cleanroom to ISO
14644-1, which is required for production of
high grade face coverings and masks for front
line NHS workers. The cleanroom included
changing room and goods in/out airlock for
production materials. The facility was fully
air-conditioned for comfort conditions.
Due to the extreme urgency of the build and
difficulties getting construction materials at
short notice the build programme had to be
modified. The walls were erected before the
steelwork and temporally supported until the
steelwork was delivered and constructed.
From planning to completion, the project was
closely followed by national UK news outlets,
such as The BBC and ITV news. Labour MP Stephen
Kinnock visited the site as the project was
nearing its end and was immensely impressed by
the effort and workmanship involved with the
facility, especially in keeping within such
challenging time frames.
Upon completion, the Secretary of state for
Wales The Rt Hon. Simon Hart visited the site to
meet the team and highlighted how great it was
to see British companies successfully working
under extreme time pressures to manufacture
high-quality PPE to protect our front line
workers and the wider community against
COVID-19.
Cleanroom Solutions Site Director, Sean Gaylard,
said: "This has to be one of the most
challenging cleanroom installations that I can
recall us taking on and completing. In light of
the current world pandemic with many
manufacturers and suppliers still on furlough,
we managed to have the cleanroom ready for the
production equipment within four weeks. A great
team effort."
British Rototherm Managing Director, Oliver
Conger, added: "The commitment to meeting and
achieving a very tight project schedule was
tremendous and the quality of the build was
first class. The team worked very well with our
own operations team and this made it a real
pleasure and we built up a very good working
relationship with them and a high level of
trust. We would highly recommend Cleanroom
Solutions to anyone looking to build a cleanroom,
particularly if you are under any time pressures
such as ourselves."
Comfort and Appearance Important for Child Masks
In this pilot study, British researchers
assessed the perceived wear ability of three
facemasks (Vogmask, TuHao and ReSpimask)
marketed in the UK as being designed to protect
children against exposure to air pollution.
Twenty-four primary school children wore each
facemask during a standardized walking and
running activity. After each activity, the
children were asked to rate facemask wear
ability in terms of parameters, such as
perceived comfort, hotness, breathability and
fit. At the end of the trial, the children
compared and identified their preferred
facemask. The main complaint about the facemasks
was the children’s faces being too hot. The
ReSpimask was most frequently reported as being
perceived to be the hardest to breathe through.
The TuHao facemask was the only adjustable strap
mask assessed but was reported to be difficult
to adjust. Facemasks with a nose clip were
frequently rated highest for fit (TuHao and
Vogmask). The patterned, cloth fabric Vogmask
had significantly higher ratings for appearance
and perceived fit. The results show children’s
perceptions of facemasks are highly affected by
the facemask’s design, hotness and perceived
breathability. By making children’s facemasks
more appealing, breathable, cooler and improving
their fit, wear ability may be improved.
If masks are uncomfortable, annoying or
embarrassing to wear, the motivation to wear
them, or to keep them on, may be limited and
they will provide inadequate protection. There
is currently limited non-occupational research
into the wear ability of facemasks, irrespective
of whether they are certified (passing
laboratory testing as being capable of filtering
particulate matter, for example, capable of
filtering 95% of small (0.3 µm) particles (i.e.,
the US N95 standard, equivalent to Filtering
Face Piece 2 (FFP2) in Europe)) or not.
There was a significant difference in the level
of comfort of the masks whilst walking (p =
0.013) and running (p = 0.003), with
the children finding it more comfortable when
walking. The Vogmask was given the highest mean
score for comfort whilst walking (1.3) and
running (0.8), and was ranked most comfortable
of the three masks tested, by 67% of the
children (χ2 = 18.9, p <
0.001), ReSpimask was consistently the lowest
rated and was ranked the least comfortable by
67% (χ2 = 19.5, p < 0.001)
of the children.
There was a highly significant difference
between perceptions of the different facemasks’
appearance (p < 0.001). Vogmask had the
highest facemask appearance mean rating (1.6)
and ReSpimask had the lowest (−0.4). Vogmask had
a higher rating than TuHao and ReSpimask
(difference = 0.83, p = 0.005 and
difference = 2.00, p < 0.001,
respectively); TuHao had a higher rating than
ReSpimask (difference = 1.17, p <
0.001).
After being asked to rate the facemasks’
appearance, the children were invited to explain
their answer. Vogmask had the highest proportion
of positive comments (85%), and the lowest
proportion of negative comments about its
appearance (11%). Fifteen children (63%), said
they liked the design of Vogmask. ReSpimask had
the lowest proportion of positive comments
(15%), and the highest proportion of negative
comments (77%) about its appearance; for
example, many children said the ReSpimask looked
like a nappy/diaper.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7312046/
Mask Cleaning and Disposal should be as Frequent
as Stepping on a Foot Sanitizer
A nurse attending to an influenza patient one
minute and entering the isolation room with a
COVID patient the next should change not only
her mask but all outer clothing exposed to the
air.
She should also step on a foot sanitizer
as discussed in our interviews with PathO3Gen
In actual practice people are changing masks
frequently but not other garments.
There is a mask shortage and concern that
there will not be enough CATE masks to meet
demand.
So we need to take a fresh look at mask
cleaning and disposal. Here is a comment from a
South East Asia mask supply website.
To put things into perspective, a mask is not a
special "germ magnet". It is not the only part
that gets exposed to viral particles and germs -
your hands, bags, shoes, outerwear, metro/mrt
cards and mobile phone are probably more
biologically contaminated. These are constantly
in contact with foreign objects or your hands,
whereas no one consciously brushing his masked
faced against any foreign objects.
It is true that the mask is filtering the
incoming air. Since most of the transmission is
airborne, it stands to reason that the mask
exterior will have more virus retention than
other clothing.
However an alcohol wipe can be applied to
the mask surface at any time. But in the low
virus load environment which is typically where
the non-isolation ward personnel are found the
likelihood of virus accumulation and
transmission from the mask outer surface is very
low.
Mask rejection due to appearance is legitimate.
Using our foot sanitizer analogy properly shined
shoes are also important to many. But people
below the poverty line welcome
shoes which are functional despite
appearance.
Used garments account for over 50% of the
clothing sector by volume in many sub-Saharan
African countries.
The conclusion is that mask appearance and
surface contamination if properly prioritized
are no longer dominant determinators of mask
life..
Mask Choices for the Pandemic
The pandemic is spinning out of control.
Everyone agrees that masks are the most
effective weapon. But as shown in the last few
Alerts CATE masks are seven times more effective
than alternatives. The $64,000 question or maybe
$64 billion question is how do we supply masks
for at least half of the 8 billion people on
earth.
Most CATE Masks are reusable. They can be worn
many times. The captured particulate builds up
in the filter media and over time will make the
mask more uncomfortable. With many uses it will
look less attractive. But as one of the British
children participating in research comparing a
CATE mask to a white disposable mask said, “ It
doesn’t look like a nappy”.
If CATE masks are used many times and the supply
is quickly expanded it should be possible within
a matter of months to supply the world with
sufficient masks. So the
overall
value of old CATE masks needs to be compared to
alternatives.
An earlier chart prepared by McIlvaine shows the
perceived value of masks at various viral loads.
For the next year we can assume that there will
be high viral load.
At this high viral load here is a comparison of
old CATE masks versus alternatives.
The perfect score would be 180. The old CATE
mask is slightly less valuable than the new CATE
mask but considerably more valuable than the
alternatives.
The conclusion is that CATE masks are more
valuable even at greatly extend use. Since
sufficient quantities can be produced and worn,
it is time to create a crash program to
manufacture CATE masks.
Media Starting to Analyze Mask Fit and Its
Importance
Here is a recent news article with coverage of
recent studies comparing masks. It is heartening
that the differences between masks are now being
analyzed.
Cleveland.com reviewed
12 studies on the efficacy of masks, based on
published research in recognized scientific
journals. When choosing to buy or make a mask,
recent research cites three factors as key:
fabric, fit and ties.
The gold standard for medical professionals is
still a properly-fitted N95.
Experts told cleveland.com, however, that N95s
are impractical for the entire population to
wear. There are many consumer choices that can
improve how well masks work. N95s are commonly
used in hospitals, and need to be properly
fitted, which is why the general public normally
uses surgical or fabric masks.
Keep in mind that wearing even a simple mask can
help stem the spread of disease, though a mask
does not substitute for appropriate social
distancing and hygiene measures.
Fit
Fit is a theme throughout the literature
published on the efficacy of masks, though
research experiments with fabric more than fit.
One study published
in Nature on
the efficacy of masks and face coverings notes
the potential importance of fit in the context
of the study’s results. Both surgical masks and
unvented N95s reduced emission rates by 90% and
74%, respectively, without taking fit into
account. Researchers noted that N95s, in this
study, didn’t perform as well as a surgical
mask.
“It may be that imperfect fitting of KN95
respirators allows for greater escape of
particles from the mask-covered environment
compared to the more flexible surgical masks,”
the authors wrote. “Regardless, all surgical
masks, KN95 and N95 respirators tested here
provided substantial reduction of particle
emission compared to no mask.”
So simply wearing the mask is helpful, though
there are enough ways that people are wearing
them incorrectly that there are internet memes
poking fun at them. Covering the nose with a
mask is crucial, so
leaving it hanging on the chin or bunched up
under the nose won’t work.
The way a normal cloth mask is structured can
leave gaps between the cheek and the mask, which
could allow for some issues with leaking virus.
Essentially, the jet of air that comes out of
the mouth when breathing or talking is going to
look for a path where it isn’t blocked. If
there’s a gap where material does not cover it,
the air will redirect
through those holes instead of being filtered
through the mask.
A study published in “Physics
of Fluids" tested how effective cloth and
off-the-shelf masks are
in obstructing air flow that contains
respiratory droplets, which researchers
recognize is a main transmission method of the
coronavirus. In a demonstration for “Good
Morning America," researchers showed the
difference in their modeling in a common, blue,
surgical mask. When the researchers did not
press down on the wire nose clip for the mask,
there was more leakage out of the top of the
mask.
"The main thing to keep in mind is make sure it
fits snugly on the face and any metallic wires
or strips that are present, you should always
try to press it down so it contours well to your
face,” Dr.
Sid Verma told GMA.
A study published in Extreme Mechanics Letters showed
that surgical masks or cloth masks that aren’t
fitted could allow for significant leaks. Trying
to find a cloth mask with a wire that form fits
it to your nose and face can help reduce any
gaps. Researchers at the University of Illinois
also suggested in the Extreme Mechanics Letters
study that a more breathable fabric can help
spread out airflow, reducing leaks through
un-filtered areas. Adding another layer of
fabric over the mask is also showing promise,
though published research on that is limited.
Ties
The most common type of mask hinges on ear
loops, rather than ties. Aside from some users
complaining of discomfort around the ears, some
studies show that ties that go behind the head
can be more secure and work better for fit.
Researchers reviewed 29 types of respirators and
face masks, and found that in all of the tests, the
masks with ties outperformed the ones with ear
loops. For
example, in the tests for surgical masks, the
filtration efficiency -- how well the mask
blocks -- proved almost double that in the masks
with ties as it did with the ones with ear
loops.
Because the researchers tested effectiveness
while subjects were moving around, they
concluded that the ear loops might not provide
enough tension to keep the mask snugly fitted.
Ear loops that are adjustable could help with
fit. A review on best practices for cloth masks
found that users should hold their mask to their
nose and mouth while tying ties or ear loops.
When tying a mask with behind-the-head ties, tie
the top tie around the back of the head, and
then at the base of the neck.
Fabric
There are many considerations when picking a
fabric for a mask. Take a look at a regular,
surgical mask. Behind the pleated front, the
layers of fabric can pull apart. Multiple layers
play different roles in stopping the coronavirus
from spreading. One layer could absorb large
droplets, stopping them from carrying out the
coronavirus (but prompting you to need to
dispose of or wash a mask). Then another would
filter out smaller, aerosolized particles.
Having multiple layers made of different fabrics
can also be helpful with moisture. Fabrics are
grouped into hydrophilic and hydrophobic,
meaning the fabric retains moisture or repels
moisture. Having both of those types of fabrics
in a mask design can be helpful in blocking
droplets.
The number of layers is important in selecting a
mask. Researchers from the University of
Cambridge and Northwestern University tested a
wide range of fabrics that could be used in
homemade masks. The multiple-layer fabrics performed
better than the single-layer fabrics across the
board. Cotton
and thick cotton performed well in filtering out
fine particles. Other fabrics, like windbreaker
material and denim showed a higher rate of
filtration but aren’t as breathable.
"A mask which blocks particles really well but
restricts your breathing isn’t an effective
mask,” author Eugenia O’Kelly from Cambridge’s
Department of Engineering said in an article on
the university’s website.
“Denim, for example, was quite effective at
blocking particles, but it’s difficult to
breathe through, so it’s probably not a good
idea to make a mask out of an old pair of jeans.
N95 masks are much easier to breathe through
than any fabric combinations with similar levels
of filtration.”
A review of 25 articles referencing cloth masks, published
by the Mayo Clinic, found
fabrics with higher thread counts performed
better than those with lower ones, and better
still when layered. Researchers recommend a
cotton with thread count of at least 100
threads-per-inch. Pleated masks are also
recommended, which allow the user to pull the
mask to the chin easily.
The “Physics of Fluids” study showed that
wearing a bandana-style mask is significantly
less effective than other masking methods. If
you choose to wear a gaiter, make sure there are
multiple layers to the gaiter, the
Centers for Disease Control and Prevention
recommends.
The most important aspect of masking is to wear
one, and to wear it correctly, as well as
following social distancing guidelines and
avoiding crowds.
When picking a mask or making your own, consider
first whether there are at least two layers.
Then, assess the fit on your face and whether
there are gaps that could be corrected with a
nose wire along the top of the mask, or
pleating. Those basics can help pick the right
mask for you. When in doubt, a surgical mask
with a wire to help fit fulfills many of these
considerations, though the price could stack up
and experts
worry about the impact on the environment.
Also, be sure to wash reusable masks frequently,
especially after being in areas with higher
coronavirus risk.
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