Community Use of Face Masks against the Spread of COVID-19

Abstract

The role of face masks to prevent and control COVID-19 is critical, especially since asymptomatic or pre-symptomatic infected individuals can shed high loads of SARS-CoV-2 in the surrounding environment. In addition to being a two-way barrier to protect against virions droplets both in terms of "source control" (for the benefits of the community) and "physical protection" (for wearer), face masks also allow maintaining physiological temperatures and humidity of the nasal cavity and mouth, independently from the external environmental conditions. Beyond compromising the viral transmission speed, exposure to cold environments could have a detrimental effect on the host's susceptibility to SARS-CoV-2. The innate human immune system becomes in fact weaker with cooler nose temperatures and thus more vulnerable to viral replication. Furthermore, there is evidence that warm, humid climates are associated with reduced spread of SARS-CoV-2, while cold dry conditions favor its stability and transmissibility. In the early stage of a viral infection, a physiological body temperature in the upper airways supports the innate immune system, endorsing the muco-ciliary clearance, inhibiting, or deactivating any first settlement of viruses. Face masks are therefore strongly recommended also outdoors, especially under cold weather conditions, not only as a physical barrier against the transmission of SARS-CoV-2, but also to prevent the rapid cooling of the nasal mucosa and the inhibition of the human innate defense of the upper airways.

Keywords: COVID-19; SARS-CoV-2; face masks; health protection; nasal cavity; transmissibility.

Figure 1

(A) From Cherrie et al. 2019 [29]. Exhaled Breath Temperature (EBT) inside the mask, measured by a sensor, when the disposable respirator (3M 9211) was worn (“Mask on”) or not (“Mask off”). Median EBT (in Celsius degrees) with interquartile range. (B) From Cherrie et al. 2019 [29]. Relative humidity (RH) inside the mask, measured by a sensor, when the disposable respirator (3M 9211) was worn (“Mask on”) or not (“Mask off”). Median RH (%) with interquartile range.

Figure 2

Anatomy of the nasal cavity.

Figure 3

From Liener et al. 2020 [19]. Median mucosal temperatures (Celsius degrees) of four different anatomical nasal districts (vestibule, valve area, anterior turbinate, choanae) at end of inspiration (a) and expiration (b), after exposures to three different combinations of air temperature and relative humidity (RH), during three consecutive days. Continuous measurements made during a 2 min interval in which subjects inhaled ambient air (24 C; 35% RH)—Day 1: 10 min exposure to cold dry air (12 C; 13% RH); Day 2: 10 min exposure to ambient air (24 C; 35% RH); Day 3: 10 min exposure to hot humid air (40 C; 80% RH).