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      Face Masks and Containment of Coronavirus Disease 2019 (COVID-19): Experience from South Korea

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          Abstract

          Sir, A novel coronavirus (SARS-CoV-2) emerged in the city of Wuhan, China in December 2019 and has now spread worldwide. Since the end of February 2020, the COVID-19 spread to South Korea and there was a rapid increase in COVID-19 cases from the end of February to mid-March. Fortunately, due to the efforts from both government and private sectors, the spread of the disease has been declining rapidly and only a few cases were reported in May. There are several reasons why COVID-19 has been relatively well controlled in South Korea. Wearing a face mask in public seems to have been one of the major contributing factors. During the COVID-19 pandemic, the use of face masks has been discouraged in several countries, particularly in Europe. However, our government has strongly advised wearing a mask (11, 12) from the beginning. Hence, we felt it would be highly informative to share the experience of South Korea from a public health perspective. In South Korea, an aggressive “trace, test, and treat” program was put in place. The general public was advised to avoid large gatherings and crowded places, and to keep quarantine protocols, such as wearing a mask, washing hands, and social distancing. Among these, wearing a mask is counted as one of the most effective preventive measures among general protocols. According to a recently published article, 63.2% of Koreans reported wearing a facial mask when they were outside (1). In another international survey, the reported rate of wearing face masks among Koreans was even higher (94%) and the highest among 28 countries (2). There are several reasons why wearing a mask has been well accepted by public in South Korea. In 2015, there was an outbreak of 186 patients with MERS-CoV infection, including 38 fatalities in South Korea. The epidemic has lasted for 2 months and the government quarantined 16,993 individuals(3). The MERS outbreak strengthened the behavior of wearing a mask in the face of unexpected threat of respiratory viral infections. The increased awareness of particulate matter (PM) also needs to be mentioned. South Korea has had the highest PM level among OECD countries (4). Over the last few years, people in Korea became more and more aware of the problem after government started to issue alerts. Yellow dust (also called yellow sand or Asian dust), a natural source of particulate matter(PM), originates from the deserts of Mongolia and northern China, particularly in springtime, and has long been a public health issue after a formal warning in February, 2014 (5). The professional medical societies in South Korea have warned about health hazards from impaired infant health to increased adult mortality rate, and people are advised to wear a facial mask when PM level is very high([6], [7], [8], [9], [10]). This increasing public concern regarding PM has made wearing a face mask a matter of everyday life during epidemics of respiratory diseases in South Korea. The acceptance of wearing face masks might be influenced by cultural differences. In European countries, wearing a face mask traditionally has been taken to indicate illness or bad intention. By contrast, it seems to be generally regarded as a sign of thoughtfulness and modesty in South Korea. Interestingly, young Korean pop (Kpop) singers made mask-wearing a fashion trend. So, wearing a mask is considered as a fashion item by young persons in many Asian countries. Although N95 respirators showed several advantages over medical masks in experimental conditions, several meta-analyses have concluded that there are insufficient data to support the superiority of N95 respirators over medical masks in protecting against transmissible respiratory pathogens including SARS-CoV-2 in clinical settings ([14], [15], [16]). A recently published article clearly showed the effectiveness of surgical face masks in reducing respiratory viral shedding(17). To conclude, considering the relatively low incidences of severe cases or mortality and good control of COVID-19 in several countries where self-quarantine principles are well established, wearing protective masks is an important strategy to stop the spread of respiratory viruses such as SARS-CoV-2. Among several ways that were helpful for South Korea to combat this pandemic effectively, adhering to quarantine protocols such as wearing an appropriate mask in the proper way seems to have been vital. Maintaining social distance at all times and washing hands thoroughly also must have played a critical role for controlling COVID-19. Uncited References [13]. Declaration of Competing Interest The authors have nothing to declare.

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          Most cited references 14

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          N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel

          Clinical studies have been inconclusive about the effectiveness of N95 respirators and medical masks in preventing health care personnel (HCP) from acquiring workplace viral respiratory infections.
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            Is Open Access

            Middle East respiratory syndrome: what we learned from the 2015 outbreak in the Republic of Korea

            Middle East Respiratory Syndrome coronavirus (MERS-CoV) was first isolated from a patient with severe pneumonia in 2012. The 2015 Korea outbreak of MERSCoV involved 186 cases, including 38 fatalities. A total of 83% of transmission events were due to five superspreaders, and 44% of the 186 MERS cases were the patients who had been exposed in nosocomial transmission at 16 hospitals. The epidemic lasted for 2 months and the government quarantined 16,993 individuals for 14 days to control the outbreak. This outbreak provides a unique opportunity to fill the gap in our knowledge of MERS-CoV infection. Therefore, in this paper, we review the literature on epidemiology, virology, clinical features, and prevention of MERS-CoV, which were acquired from the 2015 Korea outbreak of MERSCoV.
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              Particulate-Matter Related Respiratory Diseases

              Particulate matter (PM) is suspended dust that has a diameter of <10 µm and can be inhaled by humans and deposited in the lungs, particularly the alveoli. Recent studies have shown that PM has an adverse effect on respiratory diseases. The aim of this article is to review respiratory diseases associated with PM. According to existing studies, PM is associated with chronic obstructive pulmonary disease, bronchial asthma, and several other respiratory diseases and increases the mortality rates of these diseases. Moreover, increased exposure in the high concentration of atmospheric PM is associated with the development of lung cancer. The most simple and common way to protect an individual from airborne PM is to wear a face mask that filters out PM. In areas of high concentration PM, it is recommended to wear a face mask to minimize the exposure to PM. However, the use of N95 or KF94 masks can interfere with respiration in patients with chronic respiratory diseases who exhibit low pulmonary function, leading to an increased risk of respiratory failure. Conclusionally, reduction of the total amount of PM is considered to be important factor and strengthening the national warning notification system to vulnerable patients and proper early management of exacerbated patients will be needed in the future.
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                Author and article information

                Journal
                J Hosp Infect
                J. Hosp. Infect
                The Journal of Hospital Infection
                The Healthcare Infection Society. Published by Elsevier Ltd.
                0195-6701
                1532-2939
                12 June 2020
                12 June 2020
                Affiliations
                Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, South Korea
                Author notes
                []Corresponding author. Hong Bin Kim, MD, FIDSA, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, South Korea.
                [1]

                These first two authors contributed equally to this article.

                Article
                S0195-6701(20)30302-9
                10.1016/j.jhin.2020.06.017
                7291980
                © 2020 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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                Infectious disease & Microbiology

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